Cardiovascular Outcomes

Pathophysiology of Cardiovascular Disease has been divided into four sections that focus on heart dysfunction and its associated characteristics (hypertrophy, cardiomyopathy and failure); vascular dysfunction and disease; ischemic heart disease; and novel therapeutic interventions. This volume is a compendium of different approaches to understanding cardiovascular disease and identifying the proteins, pathways and processes that impact it.

This issue of Endocrinology and Metabolism Clinics, edited by Dr. Guillermo E. Umpierrez, will focus on Cardiovascular Outcomes of Treatments available for Patients with Type 1 and 2 Diabetes. Topics include--but are not limited to--Diabetes and CAD and PVD; Prediabetes and CVD- DM prevention; Pathogenesis of atherosclerosis/CVD in diabetes Intensive Diabetes Treatment and CV Outcomes in T1D; Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes, Diabetes and Stroke; Cardiovascular outcome trials of glucose-lowering drugs or strategies in type 2 diabetes; Heart Failure in Diabetes Mellitus; Individualizing Glucose Lowering Therapy in the Patient with Diabetes and Heart Disease; Managing Dyslipidemia in Type 2 Diabetes; Blood pressure control and cardiovascular and renal outcomes; Hyperglycemia in acute coronary syndromes; Hospital Glucose Control; Managing Diabetes and cardiovascular risk in chronic kidney disease; and more.

Cardiovascular disease (CVD), once thought to be confined primarily to industrialized nations, has emerged as a major health threat in developing countries. Cardiovascular disease now accounts for nearly 30 percent of deaths in low and middle income countries each year, and is accompanied by significant economic repercussions. Yet most governments, global health institutions, and development agencies have largely overlooked CVD as they have invested in health in developing countries. Recognizing the gap between the compelling evidence of the global CVD burden and the investment needed to prevent and control CVD, the National Heart, Lung, and Blood Institute (NHLBI) turned to the IOM for advice on how to catalyze change. In this report, the IOM recommends that the NHLBI, development agencies, nongovernmental organizations, and governments work toward two essential goals: creating environments that promote heart healthy lifestyle choices and help reduce the risk of chronic diseases, and building public health infrastructure and health systems with the capacity to implement programs that will effectively detect and reduce risk and manage CVD. To meet these goals, the IOM recommends several steps, including improving cooperation and collaboration; implementing effective and feasible strategies; and informing efforts through research and health surveillance. Without better efforts to promote cardiovascular health, global health as a whole will be undermined.

A collection of the most current and innovative presentations in path-based collaborative practices, this second of two volumes focuses on the design, implementation and analysis of outcomes in cardiovascular care. As in Health Care Outcomes, the authors present two to three standard clinical pathways for each DRG, and then show how those pathways can be manipulated to alter outcomes. Cardiovascular Outcomes covers a full range of medical and surgical cardiovascular outcomes. A comprehensive collection of critical pathways and outcomes maps being used by leading hospitals and health care agencies around the country, this is an important reference for developing path-based care models or revising critical paths and outcomes maps.

Caffeine in Food and Dietary Supplements is the summary of a workshop convened by the Institute of Medicine in August 2013 to review the available science on safe levels of caffeine consumption in foods, beverages, and dietary supplements and to identify data gaps. Scientists with expertise in food safety, nutrition, pharmacology, psychology, toxicology, and related disciplines; medical professionals with pediatric and adult patient experience in cardiology, neurology, and psychiatry; public health professionals; food industry representatives; regulatory experts; and consumer advocates discussed the safety of caffeine in food and dietary supplements, including, but not limited to, caffeinated beverage products, and identified data gaps. Caffeine, a central nervous stimulant, is arguably the most frequently ingested pharmacologically active substance in the world. Occurring naturally in more than 60 plants, including coffee beans, tea leaves, cola nuts and cocoa pods, caffeine has been part of innumerable cultures for centuries. But the caffeine-in-food landscape is changing. There are an array of new caffeine-containing energy products, from waffles to sunflower seeds, jelly beans to syrup, even bottled water, entering the marketplace. Years of scientific research have shown that moderate consumption by healthy adults of products containing naturally-occurring caffeine is not associated with adverse health effects. The changing caffeine landscape raises concerns about safety and whether any of these new products might be targeting populations not normally associated with caffeine consumption, namely children and adolescents, and whether caffeine poses a greater health risk to those populations than it does for healthy adults. This report delineates vulnerable populations who may be at risk from caffeine exposure; describes caffeine exposure and risk of cardiovascular and other health effects on vulnerable populations, including additive effects with other ingredients and effects related to pre-existing conditions; explores safe caffeine exposure levels for general and vulnerable populations; and identifies data gaps on caffeine stimulant effects.

The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus immediately qualify for benefits. In this report, the IOM makes several recommendations for improving SSA's capacity to determine disability benefits more quickly and efficiently using the Listings.

Renin-angiotensin-aldosterone system (RAAS) dependent hypertension, diabetes featured by hyperglycemia, hyperlipidemia, hyperuricemia, hyperhomocysteinemia, overweight or obesity etc., represent the major types of endocrine and metabolic disorders which contribute most to the development of atherosclerosis-based cardiovascular diseases. In clinical studies, these diseases comprise nonfatal myocardial infarction, nonfatal cerebral infarction, or even cardiovascular death, termed 3 major adverse cardiovascular events (3p MACE). On one side, these endocrine or metabolic dysfunctions are the upstream risk factors of cardiovascular diseases. Meanwhile, more and more antidiabetic drugs, e.g., glucagon-like peptide-1 (GLP-1) receptor agonists, sodium-glucose transporter-2 inhibitors (SGLT2i) etc., are reported to have not only blood glucose lowering effects, but also have direct cardiovascular protective effects independent of the glucose lowering effects. Regarding the close relationship between endocrine or metabolic disorders and downstream cardiovascular outcomes, a call for a new subspeciality in internal medicine, cardiometabolic medicine, was proposed in Am J Med, 2019. Recently, many basic or clinical studies focused on endocrine and metabolic cardiovascular outcomes. The goal of this Research Topic is to compile recent advances concentrating in this area, both in terms of basic and clinical aspects, to further value the cardiovascular outcomes in treating endocrine and metabolic diseases.