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<p>  </p> <p>Mushrooms, unique edible fungi, contain several essential nutrients and bioactive compounds including L-ergothioneine, beta-glucans, and lovastatin, which may improve cardiometabolic health through their anti-inflammatory, cholesterol-lowering, and antioxidant properties, respectively. Despite a long history of consumption, the chemical composition and health benefits of mushrooms are not well documented. Research included in this dissertation aims to document the unique properties of dietary mushrooms and their effects on cardiometabolic disease risk factors in middle-aged and older adults. Thematically, this research describes mushrooms from a nutrient, food, and dietary pattern perspective. Using untargeted liquid chromatography mass spectrometry (LC/MS)-based metabolomics, we detected over 10,000 compounds in seven mushroom varieties, each sourced from two farms (3 replicates/farm). Over 1,300 compounds were detected in all seven mushroom varieties, supporting some level of similarity. In contrast, each variety had tens-to-hundreds of unique-to-mushroom variety compounds, ranging from 29 for crimini to 854 for lion’s mane. Amino acid analysis revealed <em>Agaricus bisporus</em> varieties (white button, crimini, portabella) had similar amino acid profiles, including detection of all nine essential amino acids, while other varieties (lion’s mane, maitake, oyster, shiitake) had less methionine and tryptophan. Collectively, these findings highlight not all mushrooms are chemically comparable. From a food/dietary pattern perspective, experimental evidence from a systematically searched literature review indicate greater mushroom consumption reduces blood triglycerides and hs-CRP. Evidence from observational research indicate mixed, albeit neutral to positive, associations between mushroom consumption and most cardiometabolic health outcomes. Results from our randomized controlled trial indicate adoption of a healthy dietary pattern with mushrooms improves fasting blood glucose and dense LDL III. Adoption of a healthy dietary pattern, independent of mushroom consumption, improves total cholesterol and non-LDL cholesterol. Results from the research presented in this dissertation confirm mushrooms are nutritionally unique and may improve several risk factors for cardiometabolic diseases with regular consumption.</p>

Cardiovascular disease (CVD) has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus (HIV) (PLWH) on antiretroviral therapy (ART). Nearly 50% of PLWH are likely to have an increased risk of developing CVD, including coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerosis. Aside from the common risk factors, HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity. Potential non-pharmacological therapies are currently being tested worldwide for this purpose, including eating patterns such as Intermittent fasting (IF). IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins, blood pressure (BP), platelet-derived growth factor AB, systemic inflammation, and carotid artery intima-media thickness among others cardiovascular benefits. This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction, lipid peroxidation and aging. Intermittent fasting regimens need to be tested in clinical trials as an important, cost-effective, and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH. / Revisión por pares

Introduction: This study aimed to examine the association of smoking status with homocysteine levels and to determine whether the association is modified by oestradiol or cholesterol. Methods: Data (N = 4580) were obtained from National Health and Nutrition Examination Survey 2003–2004 with analysis done in 2018 on adults aged ≥20 years. The outcome was homocysteine; smoking status was the exposure variable and categorized as current, former or never smoker. Generalized linear models were used to examine the associations between smoking status and homocysteine levels, while assessing the impact of oestradiol and cholesterol. Results: After adjusting for age, sex, ethnicity, education and income level, homocysteine levels did differ by smoking status ((current smokers versus never smokers: β: 0.18 CI: 0.00, 0.36), (former smokers: β: 0.10 CI: –0.09, 0.28)). The addition of oestradiol as an interaction term in adjusted models was associated with a 16.6% increase in homocysteine levels when compared to models without the interaction term. Oestradiol but not cholesterol did moderate the association between smoking status and homocysteine levels. Discussion and conclusions: Homocysteine levels did differ across smoking status after adjusting for confounders. Oestradiol did moderate the relationship between homocysteine and smoking status.

(English) Smoking is the leading cause of premature mortality and morbidity globally (WHO, 2018). Within the Czech Republic (CR) tobacco consumption ranks among the highest in the world, and tobacco control measures rank among the poorest globally (Joossens and Raw, 2014; American Cancer Society, 2018). Smoking related chronic diseases and the loss of active part of life are an enormous and growing burden on the Czech system. There is urgency to invest in efforts that will control and decrease the demand for tobacco products (OECD, 2017). Experiences and lessons learned in tobacco control (TC) by other countries, such as Canada, may provide valuable insight to help guide Czech decision makers in identifying policy best buys moving forward. The basic research carried out as part of this PhD project focuses specifically on a comparison of TC in Canada and the CR. It also includes: 1) a national cross-sectional survey of all organizations involved in TC to describe capacity and involvement in TC measures outlined by the WHO Framework Convention on Tobacco Control (FCTC) (Fraser et al. 2019); 2) a prospective cohort study which describes the results of intensive smoking cessation treatment offered by Centers for Tobacco Dependent (CTD) (Králiková et al. 2014); 3) a cross sectional survey of patients...

Introduction: Peripartum Cardiomyopathy (PPCM) affects 1 in 3,000 pregnancies and accounts for 5% of heart transplants in US women. Preeclampsia is one of the Hypertensive Disorders of Pregnancy (HDOP) that has been epidemiologically associated with PPCM which is a form of dilated cardiomyopathy. This concurrent clinical presentation of PPCM with associated Preeclampsia appears to be increasing in rural Northeast Tennessee. The diagnosis of Peripartum Cardiomyopathy is made by echocardiographic criteria of left ventricular dysfunction with LVEF Case Presentation: A 22 year old G2P0010 @ 33 weeks and 1 day gestation was accepted as a transfer of care from an outside hospital. Patient had no prenatal care, was homeless, had a history of depression and polysubstance abuse. She presented with abdominal pain, shortness of breath, coughing, and unknown due date. Vitals on presentation were BP 175/99 mmHg, HR 113, respiratory rate 32, and temperature 99.2. Lab results showed elevated AST/ALT 234/102, LDH 903, Uric Acid 7.0, WBC 26.2, and BNP 1935. The 24 hour urine total protein resulted 4455 mg. Transthoracic echocardiogram revealed LV ejection fraction of 30 to 35% with global hypokinesis of the LV wall. The CXR was consistent with bilateral infiltrates and pulmonary edema. She was admitted to L & D and given a dose of Betamethasone for fetal lung maturity. Fetal heart tracing showed a baseline of 145 bpm with minimal variability and no accelerations or decelerations. The tocodynamometer showed contractions q 3-5 minutes and the ultrasound evaluation showed cephalic presentation. Social work and Cardiology consults were obtained. The clinical diagnoses of Peripartum Cardiomyopathy, Preeclampsia with severe features, and Bilateral Pneumonia were made and treatment included Lasix, Metoprolol, Magnesium Sulfate, Ceftriaxone, and Azithromycin. A primary low transverse cesarean delivery was performed with a live female infant weighing 1920 grams, 4 pounds 4 ounces, and Apgars: 6, 8. The patient was discharged home on Metoprolol XL 25 mg bid, Lisinopril 10 mg daily, Procardia 30 mg daily, Lovenox 40 mg daily, and Depo-Provera for contraception. Patient was informed that she would need a repeat echocardiogram in 3 months to assess left ventricular function. Discussion: In this Appalachian region, there is an increased occurrence of Peripartum Cardiomyopathy presenting concurrently with Preeclampsia. These two combined clinical entities increase maternal morbidity and mortality. From a public health perspective, this clinical case highlights the psychosocial factors such as poverty, homelessness, polysubstance abuse, and depression that may have contributed to the clinical disease. The distinct features of this preterm antepartum case of PPCM are a younger, Caucasian primigravida with singleton gestation. Healthcare providers should have heightened awareness of this clinical presentation, especially in the postpartum period.

Bakgrund: Hjärt- och kärlsjukdom är ett folkhälsoproblem som leder till försämrad livskvalitet. Antalet människor som insjuknar ökar och det leder till hög belastning på sjukvården och stora kostnader för samhället. I det hälsofrämjande omvårdnadsarbetet fokuserar sjuksköterskor på hälsa och välbefinnande genom livsstilsförändringar. Syfte: Syftet med litteraturöversikten var att belysa sjuksköterskors omvårdnadsåtgärder för att förebygga hjärt- och kärlsjukdom hos patienter. Metod: En litteraturöversikt som utförts strukturerat med inslag av den metodologi som används vid systematisk litteraturöversikt baserad på resultatet från 14 vetenskapliga artiklar som är inhämtade från PubMed och CINAHL. Resultat: I resultatet presenteras huvudkategorierna Fysisk aktivitet, Kost och Patientutbildning som belyser sjuksköterskors omvårdnadsåtgärder för att förebygga hjärt- och kärlsjukdom. Underkategorierna beskriver metoder och verktyg för att främja förebyggande omvårdnadsåtgärder och effekterna av dessa. Underkategorierna beskriver även sjuksköterskors roll och insatser i det förebyggande arbetet av hjärt- och kärlsjukdom. Slutsats: Det finns olika typer av omvårdnadsåtgärder som sjuksköterskor kan utföra för att förebygga hjärt- och kärlsjukdom. Sjuksköterskor har en central roll i det hälsofrämjande arbetet vilket innebär att motivera, informera och följa upp livsstilsförändringar. Sjuksköterskors kompetens, kommunikation, respekt och relation med patienter ökar patienters följsamhet till en hälsosammare livsstil. Därmed främjas förutsättningarna för sjuksköterskor att utföra omvårdnadsåtgärder för att förebygga hjärt- och kärlsjukdom. / Background: Cardiovascular disease is a public health problem that leads to a reduced quality of life. The number of people who fall ill is increasing, and this leads to a high burden on the healthcare system and large costs for society. In health-promoting nursing work, nurses focus on health and well-being through lifestyle changes. Aim: The purpose of the literature review was to illuminate nurses nursing measures to prevent cardiovascular disease in patients. Method: A literature review carried out structured with elements of the methodology used in systematic literature reviews based on the results from 14 scientific articles obtained from PubMed and CINAHL. Results: The results present the main categories Physical activity, Diet and Patient education, which highlight nurses nursing measures to prevent cardiovascular disease. The subcategories describe methods and tools to promote preventive nursing measures and their effects. The subcategories also describe the role and efforts of nurses in the preventive work of cardiovascular disease. Conclusions: There are different types of nursing measures that nurses can perform to prevent cardiovascular disease. Nurses have a central role in the health promotion work, which means motivating, informing and following up on lifestyle changes. Nurses competence, communication, respect and relationship with patients increase patients adherence to a healthier lifestyle. This promotes the conditions for nurses to carry out nursing measures to prevent cardiovascular disease.

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The Central Appalachian region of the United States disproportionately experiences higher rates of cardiovascular diseases (CVD) and associated risk factors. Primary risk factors for CVD include hypertension, hypercholesterolemia, and tobacco use, all of which have the potential to be mitigated through lifestyle behavior changes. Dietary and physical activity practices are the two main driving forces for the development of hypertension and hypercholesterolemia, while tobacco use is a behavioral choice on its own. Subsequentially, shifting lifestyle choices to emphasize healthier living has the potential to reduce CVDs within the Central Appalachian region. Considering behavioral choices are not made in isolation and are the result of internal and external influences, it is necessary to contemplate the multitude of factors driving these rates. Additionally, healthcare systems within this region ability to provide patient-centered care (PCC) is another consideration, as effective point of care also can address these rates from a disease treatment and management level. The purpose of this study was to explore the knowledge, perceptions, and influences among patients with cardiovascular diseases and non-licensed caregivers within these communities, at the behavioral and community levels, in addition to the perceptions of essential components of PCC among professional stakeholders. Seven focus group discussions with CVD patients and non-licensed caregivers were conducted, with a total of 78 participants; additionally, 20 interviews were held with professional stakeholders within the healthcare field. At the behavioral level participants identified internal and external barriers to sustaining healthy diets, the impact of interpersonal relationships on diet and stress, and influential role of cardiac rehabilitation in physical activity following a major cardiac event. At the community level participants discussed the economic characteristics of communities, a need for community infrastructure expansion, and the role of community organizations. Professional stakeholders addressed PCC in the current healthcare system, constructs of effective patient-provider interactions and the role of community outreach. This research serves as a look into the challenges and opportunities within this region and provides insight to inform future research and interventions.

Methamphetamine abuse is a growing global health concern. Cardiovascular disease is the leading cause of death in methamphetamine users because of its significant effects on vasoconstriction, pulmonary hypertension, atherosclerotic plaque formation, cardiac arrhythmias, and cardiomyopathy. Stimulants like methamphetamine and cocaine are known to induce severe coronary vasospasm resulting in angina and myocardial infarction (MI), but MI secondary to methamphetamine-induced coronary thrombosis is rarely reported. A 40-year-old female with medical history of immune thrombocytopenia s/p splenectomy, NSTEMI, tobacco and substance abuse presented to the hospital via EMS in an unresponsive state. Patient was admitted to the hospital 20 days before the current episode with complaints of chest pain and was diagnosed with NSTEMI due to troponin elevation without EKG changes; Echocardiogram at that time showed a left ventricular ejection fraction (LVEF) of 55-60% without any other abnormalities. Coronary angiography at that time was unremarkable except for mild luminal irregularities of the left anterior descending (LAD) artery. The patient’s symptoms resolved and was discharged home with a diagnosis of COVID-induced MI with nonobstructive coronaries. During the current episode, the patient started having crushing substernal chest pain radiating to left shoulder and associated with dizziness. She suffered cardiac arrest on the way to the hospital but was successfully resuscitated. EKG revealed anterior STEMI and the patient was loaded with aspirin. Emergent coronary angiography showed 100% occlusion of proximal LAD, while other coronaries were completely patent without any atherosclerotic plaque. A successful mechanical thrombectomy followed by a 4 x 28 mm drug-eluting stent was placed in the ostial-proximal LAD. TIMI-3 flow was restored and post-intervention troponin peaked at 70. Urine drug screen was positive for amphetamines and benzodiazepines. The echocardiogram showed a reduced LVEF of 30%. Patient was started on dual antiplatelet therapy with aspirin and ticagrelor, rosuvastatin, and low-dose metoprolol tartrate; further guideline-directed medical therapy could not be initiated due to patient’s low blood pressure. Hypercoagulability workup was negative for any abnormalities. As other usual causes were ruled out, the patient was deemed to have methamphetamine-induced coronary thrombosis resulting in myocardial infarction, and cardiomyopathy. Discussion Amphetamines are potent sympathomimetic agents that increase the risk of MI through various cardiovascular effects. Elevated serum catecholamines lead to increased heart rate, and blood pressure resulting in increased myocardial oxygen demand, while also inducing coronary vasospasm which can limit myocardial oxygen supply. Furthermore, in-vitro studies have shown amphetamines are prothrombotic as they can induce tissue factor (TF) expression, activate endothelial cells, and inhibit the activity of tissue factor pathway inhibitor (TFPI). They also increase the expression of plasminogen activator inhibitor-1 (PAI-1), a key fibrinolysis suppressant. In contrast to cocaine, amphetamines can induce thrombosis even in a non-inflamed endothelium, affecting even young individuals without atherosclerotic risk factors. These cumulative procoagulant effects may result in coronary artery thrombi as seen in our patient, which combined with other adrenergic effects, poses a significant risk for acute coronary events.