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Noninvasive assessment of cutaneous vascular function in vivo using capillaroscopy, plethysmography and laser-Doppler instruments: its strengths and weaknesses

Yvonne-Tee GB, Rasool AH, Halim AS, Rahman AR

Clin. Hemorheol. Microcirc., 2006;34(4):457-73.
PMID: 16687786

Given that functional abnormalities of the microcirculation are one of the primary abnormalities in cardiovascular disease pathogenesis, various noninvasive clinical tools have been developed recently to assess the microvascular function, particularly at the skin. The common techniques used to assess cutaneous microvascular function in vivo include capillaroscopy, venous occlusion plethysmography, and laser-Doppler instruments (laser-Doppler fluximetry and laser-Doppler imaging). These noninvasive techniques can be used as an early measure of functional abnormalities within the microvascular tree, predominantly in population at high risk for cardiovascular events. This review discusses some underlying application principle of these techniques, including its clinical significance, method reproducibility and limitations.

Matched MeSH terms: Cardiovascular Diseases/physiopathology
Re: Giorgio Gandaglia, Alberto Briganti, Graham Jackson, et Al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur urol 2014;65:968-78

Ho CC, Ho SE, Das S

Eur Urol, 2014 Nov;66(5):e87.
PMID: 24951360 DOI: 10.1016/j.eururo.2014.06.003
Matched MeSH terms: Cardiovascular Diseases/physiopathology*
Atherosclerotic cardiovascular disease: a review of initiators and protective factors

Ellulu MS, Patimah I, Khaza'ai H, Rahmat A, Abed Y, Ali F

Inflammopharmacology, 2016 Feb;24(1):1-10.
PMID: 26750181 DOI: 10.1007/s10787-015-0255-y

Atherosclerotic cardiovascular disease (CVD) is a collective term comprising of a group of disorders of the heart and blood vessels. These diseases are the largest cause of morbidity and premature death worldwide. Coronary heart disease and cerebrovascular disease (stroke) are the most frequently occurring diseases. The two major initiators involved in the development of atherosclerotic CVD are vascular production of reactive oxygen species (ROS) and lipid oxidation. In atherosclerosis development, ROS is associated with rapid loss of anti-inflammatory and anti-atherogenic activities of the endothelium-derived nitric oxide (NO(·)) resulting in endothelial dysfunction. In part involving activation of the transcription factor NF-κB, ROS have been involved in signaling cascades leading to vascular pro-inflammatory and pro-thrombotic gene expression. ROS is also a potent activator of matrix metalloproteinases (MMPs), which indicate plaque destabilization and rupture. The second initiator involved in atherosclerotic CVD is the oxidation of low-density lipoproteins (LDL). Oxidation of LDL in vessel wall leads to an inflammatory cascade that activates atherogenic pathway leading to foam cell formation. The accumulation of foam cells leads to fatty streak formation, which is the earliest visible atherosclerotic lesion. In contrast, the cardiac sarco/endoplasmic reticulum Ca(2+)-ATPase (SERCA2a) and hepatic apolipoprotein E (apoE) expression can improve cardiovascular function. SERCA2a regulates the cardiac contractile function by lowering cytoplasmic calcium levels during relaxation, and affecting NO(·) action in vascular cells, while apoE is a critical ligand in the plasma clearance of triglyceride- and cholesterol-rich lipoproteins.

Matched MeSH terms: Cardiovascular Diseases/physiopathology*
Fulltext Nutritional aspects of changes in disease patterns in the Western Pacific region

Cavalli-Sforza LT, Rosman A, de Boer AS, Darnton-Hill I

Bull World Health Organ, 1996;74(3):307-18.
PMID: 8789929

One impact of socioeconomic progress on populations has been to reduce the number of cases due to diseases of undernutrition and microbial contamination of food, which affected mostly infants and young children, and to increase those due to diseases of excessive food consumption, which are affecting adults and a growing number of children. This article reviews the main dietary factors which have an influence on cardiovascular disease and cancer, and discusses the link between economic development and increased rates of chronic diseases. There is evidence that the noncommunicable diseases and their risk factors have risen rapidly in countries of the WHO Western Pacific Region. Data from 29 countries and areas in the region indicate that 70% of them show lifestyle diseases in three or more of the top five causes of death. While public health measures have been implemented by some countries to prevent and control nutrition-related chronic diseases, further action is needed.

Matched MeSH terms: Cardiovascular Diseases/physiopathology
Fulltext Cardiovascular disease risk factors among older people: Data from the National Health and Morbidity Survey 2015

Sazlina SG, Sooryanarayana R, Ho BK, Omar MA, Krishnapillai AD, Mohd Tohit N, et al.

PLoS One, 2020;15(10):e0240826.
PMID: 33085718 DOI: 10.1371/journal.pone.0240826

Study on cardiovascular disease (CVD) risk factors and their prevalence among the older people in Malaysia is limited. We aimed to determine the prevalence and factors associated with CVD risk factors using the non-laboratory Framingham Generalized 10-Year CVD risk score among older people in Malaysia. This was a population-based cross-sectional study using data of 3,375 participants aged ≥60 years from the National Health and Morbidity Survey 2015. Sociodemographic, health factors and clinical assessments (anthropometry and blood pressure) were included. Complex survey analysis was used to obtain prevalence with 95% confidence intervals (CI). We applied ordinal regression to determine the factors associated with CVD risk. The prevalence for the high 10-year CVD risk was 72.1%. Body mass index was higher among those aged 60-69 years in men (25.4kg/m2, 95%CI 25.1-25.8) and women (26.7kg/m2, 95%CI 26.3-27.1) than the other age groups. The factors associated with moderate and high 10-year CVD risk were Malay ethnicity (Odds Ratio(OR) 0.76, 95%CI 0.63-0.92, p = 0.004), unmarried status (OR 1.55, 95%CI 1.22-1.97, p<0.001) and physically inactive (OR 0.72, 95%CI 0.55-0.95, p = 0.020). There is a need for future study to evaluate preventive strategies to improve the health of older people in order to promote healthy ageing.

Matched MeSH terms: Cardiovascular Diseases/physiopathology*
Obesity, cardiovascular disease, and role of vitamin C on inflammation: a review of facts and underlying mechanisms

Ellulu MS

Inflammopharmacology, 2017 Jun;25(3):313-328.
PMID: 28168552 DOI: 10.1007/s10787-017-0314-7

Obesity means the accumulation of excessive fat that may interfere with the maintenance of optimal state of health. Obesity causes cardiac and vascular disease through well-known mediators such as hypertension, type-2 diabetes mellitus, and dyslipidemia, but there are evidences for other mediators such as chronic inflammation, oxidative stress, and thrombosis. The decreased levels of antioxidants factors and nitric oxide predispose to further cardiovascular adverse events. To reduce the risks, antioxidants can help by neutralizing the free radicals and protecting from damage by donating electrons. Having the capacity, vitamin C protects from oxidative stress, prevention of non-enzymatic glycosylation of proteins, and enhances arterial dilation through its effect on nitric oxide release. It also decreases lipid peroxidation, and alleviates inflammation. The anti-inflammatory property of vitamin C could be attributed to ability to modulate the NF-kB DNA binding activity and down-regulation in the hepatic mRNA expression for the interleukins and tumor factors.

Matched MeSH terms: Cardiovascular Diseases/physiopathology*
Fulltext COVID-19 as a viral functional ACE2 deficiency disorder with ACE2 related multi-organ disease

Gan R, Rosoman NP, Henshaw DJE, Noble EP, Georgius P, Sommerfeld N

Med Hypotheses, 2020 Nov;144:110024.
PMID: 32758871 DOI: 10.1016/j.mehy.2020.110024

SARS-CoV-2, the agent of COVID-19, shares a lineage with SARS-CoV-1, and a common fatal pulmonary profile but with striking differences in presentation, clinical course, and response to treatment. In contrast to SARS-CoV-1 (SARS), COVID-19 has presented as an often bi-phasic, multi-organ pathology, with a proclivity for severe disease in the elderly and those with hypertension, diabetes and cardiovascular disease. Whilst death is usually related to respiratory collapse, autopsy reveals multi-organ pathology. Chronic pulmonary disease is underrepresented in the group with severe COVID-19. A commonality of aberrant renin angiotensin system (RAS) is suggested in the at-risk group. The identification of angiotensin-converting-enzyme 2 (ACE2) as the receptor allowing viral entry to cells precipitated our interest in the role of ACE2 in COVID-19 pathogenesis. We propose that COVID-19 is a viral multisystem disease, with dominant vascular pathology, mediated by global reduction in ACE2 function, pronounced in disease conditions with RAS bias toward angiotensin-converting-enzyme (ACE) over ACE2. It is further complicated by organ specific pathology related to loss of ACE2 expressing cells particularly affecting the endothelium, alveolus, glomerulus and cardiac microvasculature. The possible upregulation in ACE2 receptor expression may predispose individuals with aberrant RAS status to higher viral load on infection and relatively more cell loss. Relative ACE2 deficiency leads to enhanced and protracted tissue, and vessel exposure to angiotensin II, characterised by vasoconstriction, enhanced thrombosis, cell proliferation and recruitment, increased tissue permeability, and cytokine production (including IL-6) resulting in inflammation. Additionally, there is a profound loss of the "protective" angiotensin (1-7), a vasodilator with anti-inflammatory, anti-thrombotic, antiproliferative, antifibrotic, anti-arrhythmic, and antioxidant activity. Our model predicts global vascular insult related to direct endothelial cell damage, vasoconstriction and thrombosis with a disease specific cytokine profile related to angiotensin II rather than "cytokine storm". Our proposed mechanism of lung injury provides an explanation for early hypoxia without reduction in lung compliance and suggests a need for revision of treatment protocols to address vasoconstriction, thromboprophylaxis, and to minimize additional small airways and alveolar trauma via ventilation choice. Our model predicts long term sequelae of scarring/fibrosis in vessels, lungs, renal and cardiac tissue with protracted illness in at-risk individuals. It is hoped that our model stimulates review of current diagnostic and therapeutic intervention protocols, particularly with respect to early anticoagulation, vasodilatation and revision of ventilatory support choices.

Matched MeSH terms: Cardiovascular Diseases/physiopathology
Association between different methods of assessing blood pressure variability and incident cardiovascular disease, cardiovascular mortality and all-cause mortality: a systematic review

Smith TO, Sillito JA, Goh CH, Abdel-Fattah AR, Einarsson A, Soiza RL, et al.

Age Ageing, 2020 02 27;49(2):184-192.
PMID: 31985773 DOI: 10.1093/ageing/afz178

BACKGROUND: Blood pressure variability (BPV) is a possible risk factor for adverse cardiovascular outcomes and mortality. There is uncertainty as to whether BPV is related to differences in populations studied, measurement methods or both. We systematically reviewed the evidence for different methods to assess blood pressure variability (BPV) and their association with future cardiovascular events, cardiovascular mortality and all-cause mortality.
METHODS: Literature databases were searched to June 2019. Observational studies were eligible if they measured short-term BPV, defined as variability in blood pressure measurements acquired either over a 24-hour period or several days. Data were extracted on method of BPV and reported association (or not) on future cardiovascular events, cardiovascular mortality and all-cause mortality. Methodological quality was assessed using the CASP observational study tool and data narratively synthesised.
RESULTS: Sixty-one studies including 3,333,801 individuals were eligible. BPV has been assessed by various methods including ambulatory and home-based BP monitors assessing 24-hour, "day-by-day" and "week-to-week" variability. There was moderate quality evidence of an association between BPV and cardiovascular events (43 studies analysed) or all-cause mortality (26 studies analysed) irrespective of the measurement method in the short- to longer-term. There was moderate quality evidence reporting inconsistent findings on the potential association between cardiovascular mortality, irrespective of methods of BPV assessment (17 studies analysed).
CONCLUSION: An association between BPV, cardiovascular mortality and cardiovascular events and/or all-cause mortality were reported by the majority of studies irrespective of method of measurement. Direct comparisons between studies and reporting of pooled effect sizes were not possible.

Matched MeSH terms: Cardiovascular Diseases/physiopathology
Fulltext Two Sides of the Same Coin: The Roles of KLF6 in Physiology and Pathophysiology

Syafruddin SE, Mohtar MA, Wan Mohamad Nazarie WF, Low TY

Biomolecules, 2020 09 28;10(10).
PMID: 32998281 DOI: 10.3390/biom10101378

The Krüppel-like factors (KLFs) family of proteins control several key biological processes that include proliferation, differentiation, metabolism, apoptosis and inflammation. Dysregulation of KLF functions have been shown to disrupt cellular homeostasis and contribute to disease development. KLF6 is a relevant example; a range of functional and expression assays suggested that the dysregulation of KLF6 contributes to the onset of cancer, inflammation-associated diseases as well as cardiovascular diseases. KLF6 expression is either suppressed or elevated depending on the disease, and this is largely due to alternative splicing events producing KLF6 isoforms with specialised functions. Hence, the aim of this review is to discuss the known aspects of KLF6 biology that covers the gene and protein architecture, gene regulation, post-translational modifications and functions of KLF6 in health and diseases. We put special emphasis on the equivocal roles of its full-length and spliced variants. We also deliberate on the therapeutic strategies of KLF6 and its associated signalling pathways. Finally, we provide compelling basic and clinical questions to enhance the knowledge and research on elucidating the roles of KLF6 in physiological and pathophysiological processes.

Matched MeSH terms: Cardiovascular Diseases/physiopathology*
Comments on Point:Counterpoint: Sympathetic activity does/does not influence cerebral blood flow. When noradrenergic restraint of cerebral blood flow makes homeostatic sense

Prakash ES

J Appl Physiol (1985), 2008 10;105(4):1373.
PMID: 18938648 DOI: 10.1152/japplphysiol.zdg-8199.pcpcomm.2008
Matched MeSH terms: Cardiovascular Diseases/physiopathology*
The Physiological/Pathophysiological Significance of Vitamin D in Cancer, Cardiovascular Disorders and Beyond

AlMatar M, AlMandeal H, Makky EA, Kayar B, Yarar E, Var I, et al.

Curr Drug Metab, 2017;18(3):207-224.
PMID: 27928943 DOI: 10.2174/1389200217666161207161212

BACKGROUND: Vitamin D, a molecular precursor of the potent steroid hormone calcitriol, has crucial functions and roles in physiology and pathophysiology. Tellingly, calcitriol has been shown to regulate various cellular signalling networks and cascades that have crucial role in cancer biology and diagnostics. Mounting lines of evidences from previous clinical and preclinical investigations indicate that the deficiency of vitamin D may contribute to the carcinogenesis risk. Concomitantly, recent reports suggested that significant reduction in the cancer occurrence and progression is more likely to appear after vitamin D supplementation. Furthermore, a pivotal role functioned by vitamin D in cardiovascular physiology indicates that the deficiency of vitamin D is significantly correlated with enhanced prevalence of stroke, hypertension and myocardial infarction. Notably, vitamin D status is more likely to be used as a lifestyle biomarker, since poor and unhealthy lifestyles are correlated with the deficiency of vitamin D, a feature which may result in cardiovascular complications. Moreover, recent reports revealed that the effect of vitamin D is to cover not only cardiovascular system but also skeletal system.
OBJECTIVE: Herein, we are highlighting the recent knowledge of vitamin D roles and functions with respect to pathophysiological disorders such as cancer, cardiovascular diseases, rheumatoid arthritis (RA) and debate the potential avails of vitamin D on slowing cancer, cardiovascular disease and RA progression.
CONCLUSION: The findings of this review confirm that the importance of vitamin D metabolites or analogues which can provide a helpful platform to target some kinds of cancer, particularly when used in combination with existing therapies. Moreover, the correlation between vitamin D deficiencies with cardiovascular diseases and rheumatoid arthritis (RA) progression might suggest a pivotal role of vitamin D in either initiation or progression of these diseases.

Matched MeSH terms: Cardiovascular Diseases/physiopathology
Management of Patient Care in Hemodialysis While Focusing on Cardiovascular Disease Events and the Atypical Role of Hyper- and/or Hypotension: A Systematic Review

Khan A, Khan AH, Adnan AS, Syed Sulaiman SA, Gan SH, Khan I

Biomed Res Int, 2016;2016:9710965.
PMID: 27833921

Background. Hemodialysis related hemodynamic instability is a major but an underestimated issue. Moreover, cardiovascular events are the leading cause of morbidity and mortality associated with blood pressure in hemodialysis patients. However, there have been many controversies regarding the role and management of hyper- and/or hypotension during hemodialysis that needs to be addressed. Objective. To critically review the available published data on the atypical role of hyper- and/or hypotension in cardiovascular associated morbidity and mortality in patients on hemodialysis and to understand the discrepancies in this context. Methods. A comprehensive search of literature employing electronic as well as manual sources and screening 2783 papers published between Jan 1980 and Oct 2015 was conducted to collect, identify, and analyze relevant information through peer-reviewed research articles, systematic reviews, and other published works. The cardiovascular events, including accelerated atherosclerotic cardiovascular disease (ASCVD), stroke, heart failure, myocardial infarction, myocardial ischemia, and stress induced myocardial dysfunction, leading to death were considered relevant. Results. A total of 23 published articles met the inclusion criteria and were included for in-depth review and analysis to finalize a comprehensive systematic review article. All the studies showed a significant association between the blood pressure and cardiovascular disease events in hemodialysis patients. Conclusions. Both intradialytic hypertension/hypotension episodes are major risk factors for cardiovascular mortality with a high percentage of probable causality; however, clinicians are faced with a dilemma on how to evaluate blood pressure and treat this condition.

Matched MeSH terms: Cardiovascular Diseases/physiopathology*
Fulltext Mechanisms underpinning sympathetic nervous activity and its modulation using transcutaneous vagus nerve stimulation

Deuchars SA, Lall VK, Clancy J, Mahadi M, Murray A, Peers L, et al.

Exp Physiol, 2018 Mar 01;103(3):326-331.
PMID: 29205954 DOI: 10.1113/EP086433

What is the topic of this review? This review briefly considers what modulates sympathetic nerve activity and how it may change as we age or in pathological conditions. It then focuses on transcutaneous vagus nerve stimulation, a method of neuromodulation in autonomic cardiovascular control. What advances does it highlight? The review considers the pathways involved in eliciting the changes in autonomic balance seen with transcutaneous vagus nerve stimulation in relationship to other neuromodulatory techniques. The autonomic nervous system, consisting of the sympathetic and parasympathetic branches, is a major contributor to the maintenance of cardiovascular variables within homeostatic limits. As we age or in certain pathological conditions, the balance between the two branches changes such that sympathetic activity is more dominant, and this change in dominance is negatively correlated with prognosis in conditions such as heart failure. We have shown that non-invasive stimulation of the tragus of the ear increases parasympathetic activity and reduces sympathetic activity and that the extent of this effect is correlated with the baseline cardiovascular parameters of different subjects. The effects could be attributable to activation of the afferent branch of the vagus and, potentially, other sensory nerves in that region. This indicates that tragus stimulation may be a viable treatment in disorders where autonomic activity to the heart is compromised.

Matched MeSH terms: Cardiovascular Diseases/physiopathology*
Fulltext Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia

Otgontuya D, Oum S, Buckley BS, Bonita R

BMC Public Health, 2013 Jun 05;13:539.
PMID: 23734670 DOI: 10.1186/1471-2458-13-539

BACKGROUND: Recent research has used cardiovascular risk scores intended to estimate "total cardiovascular disease (CVD) risk" in individuals to assess the distribution of risk within populations. The research suggested that the adoption of the total risk approach, in comparison to treatment decisions being based on the level of a single risk factor, could lead to reductions in expenditure on preventive cardiovascular drug treatment in low- and middle-income countries. So that the patient benefit associated with savings is highlighted.
METHODS: This study used data from national STEPS surveys (STEPwise Approach to Surveillance) conducted between 2005 and 2010 in Cambodia, Malaysia and Mongolia of men and women aged 40-64 years. The study compared the differences and implications of various approaches to risk estimation at a population level using the World Health Organization/International Society of Hypertension (WHO/ISH) risk score charts. To aid interpretation and adjustment of scores and inform treatment in individuals, the charts are accompanied by practice notes about risk factors not included in the risk score calculations. Total risk was calculated amongst the populations using the charts alone and also adjusted according to these notes. Prevalence of traditional single risk factors was also calculated.
RESULTS: The prevalence of WHO/ISH "high CVD risk" (≥20% chance of developing a cardiovascular event over 10 years) of 6%, 2.3% and 1.3% in Mongolia, Malaysia and Cambodia, respectively, is in line with recent research when charts alone are used. However, these proportions rise to 33.3%, 20.8% and 10.4%, respectively when individuals with blood pressure > = 160/100 mm/Hg and/or hypertension medication are attributed to "high risk". Of those at "moderate risk" (10- < 20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor. Of all individuals, 44.6%, 29.0% and 15.0% are affected by hypertension as a single risk factor (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg or medication).
CONCLUSIONS: Used on a population level, cardiovascular risk scores may offer useful insights that can assist health service delivery planning. An approach based on overall risk without adjustment of specific risk factors however, may underestimate treatment needs.At the individual level, the total risk approach offers important clinical benefits. However, countries need to develop appropriate clinical guidelines and operational guidance for detection and management of CVD risk using total CVD-risk approach at different levels of health system. Operational research is needed to assess implementation issues.

Matched MeSH terms: Cardiovascular Diseases/physiopathology
Fulltext Prevalence of cardiovascular disease risk factors among attendees of the Batu 9, Cheras Health Centre, Selangor, Malaysia

Amplavanar NT, Gurpreet K, Salmiah MS, Odhayakumar N

Med J Malaysia, 2010 Sep;65(3):173-9.
PMID: 21939163 MyJurnal

This study describes the prevalence of selected cardiovascular disease (CVD) risk factors screened in patients 30 years and above attending a health centre in Cheras, Selangor. The study involved 3772 patients screened from March 2002 to June 2008. Risk factors screened included blood pressure, height, weight, serum total cholesterol, random blood sugar levels and smoking status. Majority of respondents were between 40 and 49 years of age (58.1%), males (64.7%) and ethnic Malays (74.4%). About two thirds (62.6%) were found to be overweight or obese, two fifths (40.2%) had hypercholesterolemia, a third (34.2%) had hypertension and 31.6% were smokers at some time. Overall 87% and 60% had at least one and two CVD risk factors respectively. Prevalence of four of the five risk factors screened was highest among the Malay middle aged men and lowest among the Chinese. Thus a substantial proportion of middle aged men were at high risk of CVD. Our findings show the need for ongoing monitoring of CVD risk factors and implementation of effective preventive strategies.

Matched MeSH terms: Cardiovascular Diseases/physiopathology
A century old renin-angiotensin system still grows with endless possibilities: AT1 receptor signaling cascades in cardiovascular physiopathology

Balakumar P, Jagadeesh G

Cell Signal, 2014 Oct;26(10):2147-60.
PMID: 25007996 DOI: 10.1016/j.cellsig.2014.06.011

Ang II, the primary effector pleiotropic hormone of the renin-angiotensin system (RAS) cascade, mediates physiological control of blood pressure and electrolyte balance through its action on vascular tone, aldosterone secretion, renal sodium absorption, water intake, sympathetic activity and vasopressin release. It affects the function of most of the organs far beyond blood pressure control including heart, blood vessels, kidney and brain, thus, causing both beneficial and deleterious effects. However, the protective axis of the RAS composed of ACE2, Ang (1-7), alamandine, and Mas and MargD receptors might oppose some harmful effects of Ang II and might promote beneficial cardiovascular effects. Newly identified RAS family peptides, Ang A and angioprotectin, further extend the complexities in understanding the cardiovascular physiopathology of RAS. Most of the diverse actions of Ang II are mediated by AT1 receptors, which couple to classical Gq/11 protein and activate multiple downstream signals, including PKC, ERK1/2, Raf, tyrosine kinases, receptor tyrosine kinases (EGFR, PDGF, insulin receptor), nuclear factor κB and reactive oxygen species (ROS). Receptor activation via G12/13 stimulates Rho-kinase, which causes vascular contraction and hypertrophy. The AT1 receptor activation also stimulates G protein-independent signaling pathways such as β-arrestin-mediated MAPK activation and Src-JAK/STAT. AT1 receptor-mediated activation of NADPH oxidase releases ROS, resulting in the activation of pro-inflammatory transcription factors and stimulation of small G proteins such as Ras, Rac and RhoA. The components of the RAS and the major Ang II-induced signaling cascades of AT1 receptors are reviewed.

Matched MeSH terms: Cardiovascular Diseases/physiopathology*
Psychological Factors and Cardiovascular Disease Risk Factors as Mediators of the Relationship between Overweight/Obesity and Cognitive Function among School Children in Kuala Lumpur, Malaysia

Tung SEH, Mohd Nasir MT, Chin YS, Zalilah MS, Zubaidah JO, Yim HS

Child Obes, 2019 01;15(1):56-62.
PMID: 30339034 DOI: 10.1089/chi.2018.0066

BACKGROUND: Recent research suggests that a negative relationship exists between adiposity and cognitive function in children. However, limited information is known on how they are related. This study aimed to examine the mediators of the relationship between overweight/obesity and cognitive function among school children in Kuala Lumpur, Malaysia.
METHODS: This is a cross-sectional comparison study whereby 225 overweight/obese children matched for age, sex, and ethnicity with 225 normal weight children participated in this study. Body image dissatisfaction, disordered eating, and depressive symptoms were assessed through a self-administered questionnaire. Blood pressure was measured, whereas blood was drawn to determine insulin, high-sensitivity C-reactive protein (hs-CRP), glucose, and lipid profiles. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) was calculated using glucose and insulin levels. Wechsler's Intelligence Scale for Children-Fourth Edition (WISC-IV) was used to assess cognitive function in children. Ordinary least square regression analysis was conducted to determine the direct and indirect relationships between weight status and cognitive function.
RESULTS: A negative relationship was found between overweight/obesity with cognitive function. Overweight/obese children were on average 4.075 units lower in cognitive function scores compared to normal weight children. Such difference was found through mediators, such as body image dissatisfaction, disordered eating, depression, systolic blood pressure, triglycerides, HOMA-IR, and hs-CRP, contributing 22.2% of the variances in cognitive function in children.
CONCLUSION: Results highlight the important mediators of the relationship between overweight/obesity and cognitive function. Consequently, future interventions should target to improve psychological well-being and reduce cardiovascular disease risk for the prevention of poorer cognitive performance in overweight/obese children.

Matched MeSH terms: Cardiovascular Diseases/physiopathology*
Molecular understanding of Epigallocatechin gallate (EGCG) in cardiovascular and metabolic diseases

Eng QY, Thanikachalam PV, Ramamurthy S

J Ethnopharmacol, 2018 Jan 10;210:296-310.
PMID: 28864169 DOI: 10.1016/j.jep.2017.08.035

ETHNOPHARMACOLOGICAL RELEVANCE: The compound epigallocatechin-3-gallate (EGCG), the major polyphenolic compound present in green tea [Camellia sinensis (Theaceae], has shown numerous cardiovascular health promoting activity through modulating various pathways. However, molecular understanding of the cardiovascular protective role of EGCG has not been reported.
AIM OF THE REVIEW: This review aims to compile the preclinical and clinical studies that had been done on EGCG to investigate its protective effect on cardiovascular and metabolic diseases in order to provide a systematic guidance for future research.
MATERIALS AND METHODS: Research papers related to EGCG were obtained from the major scientific databases, for example, Science direct, PubMed, NCBI, Springer and Google scholar, from 1995 to 2017.
RESULTS: EGCG was found to exhibit a wide range of therapeutic properties including anti-atherosclerosis, anti-cardiac hypertrophy, anti-myocardial infarction, anti-diabetes, anti-inflammatory and antioxidant. These therapeutic effects are mainly associated with the inhibition of LDL cholesterol (anti-atherosclerosis), inhibition of NF-κB (anti-cardiac hypertrophy), inhibition of MPO activity (anti-myocardial infarction), reduction in plasma glucose and glycated haemoglobin level (anti-diabetes), reduction of inflammatory markers (anti-inflammatory) and the inhibition of ROS generation (antioxidant).
CONCLUSION: EGCG shows different biological activities and in this review, a compilation of how this bioactive molecule plays its role in treating cardiovascular and metabolic diseases was discussed.

Matched MeSH terms: Cardiovascular Diseases/physiopathology
Fulltext The effects of exercise on vascular markers and C-reactive protein among obese children and adolescents: An evidence-based review

Salamt N, Muhajir M, Aminuddin A, Ugusman A

Bosn J Basic Med Sci, 2020 May 01;20(2):149-156.
PMID: 31509733 DOI: 10.17305/bjbms.2019.4345

Numerous studies have evaluated the effects of exercise training on obese children and adolescents. However, the impact of aerobic and/or resistance exercise alone, without any other interventions, on vascular markers and C-reactive protein (CRP) in obese children and adolescents is still not clear. We performed a literature search in Ovid Medline, PubMed, and SCOPUS databases to identify articles on the effects of exercise on vascular markers and CRP among obese children and adolescents, published between January 2009 and May 2019. Only full-text articles in English that reported on the effect of aerobic and/or resistance exercise on the vascular markers pulse wave velocity (PWV), carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), augmentation index (AIx), or CRP in obese children and adolescents (5-19 years old) were included. The literature search identified 36 relevant articles; 9 articles that fulfilled all the inclusion criteria were selected by two independent reviewers. Aerobic exercise or a combination of aerobic and resistance exercise training significantly improved CIMT and PWV in obese children and adolescents in all studies in which they were measured (2 studies for PWV and 4 studies for CIMT). However, the effects of exercise on FMD and CRP levels were inconclusive, as only half of the studies demonstrated significant improvements (1/2 studies for FMD and 4/8 studies for CRP). The results of our review support the ability of exercise to improve vascular markers such as PWV and CIMT in obese children and adolescents. This finding is important as obesity is a modifiable risk factor of cardiovascular disease (CVD), and exercise may help in reducing the future occurrence of CVD in this population.

Matched MeSH terms: Cardiovascular Diseases/physiopathology*
Fulltext Implication of dietary phenolic acids on inflammation in cardiovascular disease

Ali SS, Ahmad WANW, Budin SB, Zainalabidin S

Rev Cardiovasc Med, 2020 Jun 30;21(2):225-240.
PMID: 32706211 DOI: 10.31083/j.rcm.2020.02.49

In spite of medical advances, cardiovascular disease remains a significant concern, imposing a great burden upon the economy and public health of nations by causing the highest morbidity and mortality cases globally. Moreover, it is well established that inflammation is closely linked to the pathogenesis of cardiovascular diseases. Hence, targeting inflammation seems to be a promising strategy in reducing cardiovascular risks. Currently, the importance of natural products in modern medicine is well recognised and continues to be of interest to the pharmaceutical industry. Phenolic acids are a class of phytochemical compounds that are well-known for their health benefits. They consists of various phytochemical constituents and have been widely studied in various disease models. Research involving both animals and humans has proven that phenolic acids possess cardioprotective properties such as anti-hypertensive, anti-hyperlipidemia, anti-fibrotic and anti-hypertrophy activity. Furthermore, numerous studies have proven that phenolic acids in phytochemical constituents such as gallic acid, caffeic acid and chlorogenic acid are promising anti-inflammatory agents. Hence, in this review, we outline and review recent evidence on the role of phenolic acids and their anti-inflammatory significance in studies published during the last 5 years. We also discuss their possible mechanisms of action in modulating inflammation related to cardiovascular disease.

Matched MeSH terms: Cardiovascular Diseases/physiopathology

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