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.

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.

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.

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.

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.

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.

The Impact of Nutrition and Statins on Cardiovascular Diseases presents a summary of the background information and published research on the role of food in inhibiting the development of cardiovascular diseases. Written from a food science, food chemistry, and food biochemistry perspective, the book provides insights on the origin of cardiovascular diseases, an analysis of statin therapy, their side effects, and the role of dietary intervention as an alternative solution to preventing cardiovascular diseases. It focuses on the efficacy of nutrition and statins to address inflammation and inhibit the onset of disease, while also providing nutrition information and suggested dietary interventions. Includes a bioscience approach that focuses on inflammation and revisits the lipid hypothesis Presents the view that nutritional interventions have considerable value, not only for reducing cardiovascular risk for CVDs patients, but also acting as the best precaution for otherwise healthy people Advocates that nutritional habits that are formed at a young age are the best way to tackle the global epidemic that is CVDs

In State of the Heart, Dr. Haider Warraich takes readers inside the ER, inside patients' rooms, and inside the history and science of cardiac disease. State of the Heart traces the entire arc of the heart, from the very first time it was depicted on stone tablets, to a future in which it may very well become redundant. While heart disease has been around for a while, the type of heart disease people have, why they have it, and how it’s treated is changing. Yet, the golden age of heart science is only just beginning. And with treatments of heart disease altering the very definitions of human life and death, there is no better time to look at the present and future of heart disease, the doctors and nurses who treat it, the patients and caregivers who live with it, and the stories they hold close to their chests. More people die of heart disease than any other disease in the world and when any form of heart disease progresses, it can result in the development of heart failure. Heart failure affects millions and can affect anyone at anytime, a child recovering from a viral infection, a woman who has just given birth or a cancer patient receiving chemotherapy. Yet new technology to treat heart failure is fundamentally changing just what it means to be human. Mechanical pumps can be surgically sown into patients’ hearts and when patients with these pumps get really sick, sometimes they don’t need a doctor or a surgeon—they need a mechanic. In State of the Heart, the journey to rid the world of heart disease is shown to be reflective of the journey of medical science at large. We are learning not only that women have as much heart disease as men, but that the type of heart disease women experience is diametrically different from that in men. We are learning that heart disease and cancer may have more in common than we could have imagined. And we are learning how human evolution itself may have led to the epidemic of heart disease. In understanding how our knowledge of the heart evolved, State of the Heart traces the twisting and turning road that science has taken—filled with potholes and blind turns—all the way back to its very origin.