Journal of Preventive Medicine

Description

In hypertensive patients, Left Ventricular Hypertrophy (LVH) is a predictor of cardiovascular risk. In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, 26,376 participants were randomly assigned to Chlorthalidone (C), Amlodipine (A), or lisinopril (L) Resveratrol (RSV), a naturally occurring phenolic compound, has been found to have insulinsensitizing and cardiovascular protection properties. Streptozotocin (STZ)-induced diabetic rats with or without acute myocardial ischemia/reperfusion (I/R) injury was used to compare the effects of RSV and its combination with insulin on mortality, hemodynamics, insulin signaling, and nitrosative stress. In STZ-diabetic rats, insulin-mediated Akt/GLUT4 (glucose transporter 4) activation and cardiac systolic and diastolic functions were impaired under normoxic conditions. The aforementioned diabetes-related abnormalities were significantly prevented by the combination of RSV and insulin. Despite this, the diabetic state increased the animals' susceptibility to myocardial I/R injury, as did the mortality rate, expression of inducible nitric oxide synthase (iNOS)/ nitrotyrosine protein, and production of superoxide anion in diabetic hearts with I/R injuries. RSV treatment on its own, on the other hand, had a better cardiac systolic function and a lower mortality rate (from 62.5 to 18%) than insulin treatment. In diabetic myocardium damaged by I/R, RSV also prevented the overproduction of superoxide anion and iNOS/nitrotyrosine protein. The combination treatment significantly reduced hyperglycemia, impaired insulin signaling, overexpression of iNOS/nitrotyrosine, and production of superoxide anion, but it did not reduce mortality (30%) or cardiac performance in comparison to RSV treatment alone.

Cardiac Dysfunction

Based on these findings, insulin and RSV may have simultaneously activated the insulin-mediated Akt/GLUT4 signaling pathway, preventing diabetes-related cardiac dysfunction. Even though insulin and RSV combination treatment resulted in simultaneous activation of the protective signal (Akt/GLUT4) and suppression of the adverse markers (iNOS, nitrotyrosine, and superoxide anion), insulin negated the advantage of RSV in diabetics who suffered an acute heart attack. The epidemic of heart failure is spreading, and one of the most pressing issues in contemporary cardiovascular medicine is how to prevent it in order to cut down on hospital readmission rates and the associated clinical and financial burden. The purpose of this position paper is to support the implementation of efficient preventive measures by providing practical, evidence-based information. An overview of the populationattributable risks on various continents is presented following a review of the most common risk factors to identify potential effective prevention opportunities and inform preventive strategies. Last but not least, a list of potential treatments that have been suggested and have been shown to prevent heart failure is provided. The most common causes of death worldwide are stroke and Coronary Heart Disease (CHD).

The polypill, a multi-component tablet or capsule that is intended to simultaneously reduce several cardiovascular causal risk factors, has the potential to reduce the incidence of heart attacks and strokes by approximately 80 percent. The exact reduction will depend on the formulation of the polypill and the patient's adherence to preventive treatment. Because the majority of heart attacks and strokes are first events, the polypill's full impact on public health can only be realized if it is used to prevent first cardiovascular disease events. It is necessary to have a straightforward and efficient method for determining who should receive the polypill. Although lowering serum cholesterol and blood pressure has a significant preventive effect (a 1.8 mmol/L reduction in LDL cholesterol reduces the likelihood of Coronary Heart Disease (CHD) events by approximately 60% and a 10 mmHg reduction in diastolic blood pressure also reduces the likelihood of stroke by approximately 60%), they are not good screening tests. When determining who will experience a CHD event or stroke and who will not, they significantly outperform age. They add unnecessary complexity to the screening process and tend to medicalize the preventive strategy by being included in a risk assessment algorithm. Preventive treatment with the polypill can be selected more easily and effectively by age alone. As a life-threatening condition, heart failure must be addressed as a global health priority.

Heart Failure

Heart failure affects approximately 26 million people worldwide at this time. Patients with these types of cancer have worse survival rates than those with bowel, breast, or prostate cancer. Patients, caregivers, and healthcare systems all face significant strain as a result of heart failure. As patient numbers rise as a result of aging populations, negative lifestyle changes, and improved survival rates for those who develop heart failure as the final stage of another disease, it is anticipated that demands on healthcare services will rise significantly in particular over the course of the next ten years. Clear policy initiatives that prioritize heart failure prevention and champion equity of care for all are needed to alleviate strain on healthcare systems. Awareness of heart failure is low, despite the burdens it places on society. Numerous premature deaths occur as a result. Despite the fact that a healthy lifestyle can lower risk and the majority of forms of heart failure can be avoided, this is the case. If people were taught to recognize the symptoms and seek immediate medical attention, it would be possible to prevent premature deaths even after the development of heart failure. These messages are the focus of public awareness campaigns that have the potential to save lives and improve outcomes for heart failure patients. Patients with heart failure who adhere to clinical practice guidelines also have better outcomes. However, the degree to which physicians adhere to guidelines' recommendations varies greatly from country to country. Utilizing localized hospital performance measures and incentives should be used to encourage improvement in order to increase care equity. To this end, policies should encourage the research needed to build a solid foundation for performance measures that reflect better patient outcomes. If we are to address unmet needs in heart failure care, we must conduct ongoing research. Patients who have types of heart failure for which current treatments only alleviate symptoms but do not treat the disease need new treatments. In the developing world, therapies that are more accessible at a lower cost are desperately needed. Tens of millions of people worldwide stand to gain from international collaborative research on the causes and treatment of heart failure. Improvements in both health care and prevention can lead to life-saving changes at the policy level. It is time to confront heart failure and make a difference all over the world.