Devinder S. Dhindsa

Comprehensive Cardiovascular Risk Reduction and Cardiac Rehabilitation in Diabetes and the Metabolic Syndrome.

The epidemic of obesity has contributed to a growing burden of metabolic syndrome (MetS) and diabetes mellitus (DM) worldwide. MetS is defined as central obesity along with associated factors such as hypertriglyceridemia, low high-density lipoprotein cholesterol, hyperglycemia, and hypertension. MetS and DM are associated with significant cardiovascular morbidity and mortality. Healthy behavioural modification is the cornerstone for reducing the atherosclerotic cardiovascular disease burden in this population. Comprehensive, multidisciplinary cardiac rehabilitation (CR) programs reduce mortality and hospitalizations in patients with MetS and DM. Despite this benefit, patients with MetS and DM are less likely to attend and complete CR because of numerous barriers. Implementation of innovative CR delivery models might improve utilization of CR and cardiovascular outcomes in this high-risk population.

Natural Approaches in Diabetes Management: A Review of Diet, Exercise, and Natural Products.

Diabetes mellitus (DM) is a highly prevalent condition that causes significant morbidity and mortality in the United States and worldwide. Conventional therapies include lifestyle modification, oral pharmacological agents, and subcutaneous insulin. Emerging data suggest that natural approaches to the treatment of DM may help supplement current therapies for further glycemic control. Herein, we review the evidence of several natural modalities for DM treatment. We describe the pathophysiology of diabetes and its complications, provide an overview of current pharmacologic treatments, and finally, discuss natural approaches to diabetes management. Specifically, we will describe on the utility of diet, physical activity, and common natural products in the treatment of DM and focus on recent, high-quality studies. Adverse effects and potential interactions of each therapy will be highlighted where applicable.

Biomarkers to Predict Cardiovascular Death

This article reviews biomarkers that have been shown to identify subjects at increased risk for cardiovascular death within the general population, in those with established coronary artery disease, and in those with heart failure. Use of biomarkers for risk stratification for sudden cardiac death continues to evolve. It seems that a multimarker strategy for risk stratification using simple measures of circulating proteins and usual clinical risk factors, particularly in patients with known coronary artery disease, can be used to identify patients at near-term risk of death. Whether similar strategies in the general population will prove to be cost-effective needs to be investigated.

The art of cardiovascular risk assessment

Cardiovascular disease (CVD) remains the leading cause of death in the United States. Healthcare expenditures have been principally allocated toward treatment of CVD at the end of the health/disease continuum, rather than toward health promotion and disease prevention. A focused effort on both primordial and primary prevention can promote cardiovascular health and reduce the burden of CVD. Risk‐factor assessment for predicting atherosclerotic CVD events serves as the foundation of preventive cardiology and has been driven by population‐based scoring algorithms based on traditional risk factors. Incorporating individual nontraditional risk factors, biomarkers, and selective use of noninvasive measures may help identify more at‐risk patients as well as truly low‐risk individuals, allowing for better targeting of treatment intensity. Using a combination of validated population‐based atherosclerotic CVD risk‐assessment tools, nontraditional risk factors, social health determinants, and novel markers of atherosclerotic disease, we should be able to improve our ability to assess CVD risk. Through scientific evidence, clinical judgment, and discussion between the patient and clinician, we can implement an effective evidence‐based strategy to assess and reduce CVD risk.

Endothelial Dysfunction and Essential Hypertension

Systemic hypertension is a chronic disorder of cardiovascular system characterized by an increase in systemic vascular resistance (SVR). Although the level of blood pressure is a product of SVR and cardiac output, it is the former which is responsible for chronic blood pressure elevation. A number of biochemical, biophysical, and neuro-humoral factors participate in the maintenance of SVR. Whatever the underlying molecular mechanism may be for elevated SVR, the end consequence is endothelial dysfunction. Normal endothelium promotes vasodilation and prevention of local thrombotic phenomena whereas abnormal endothelium promotes vasoconstriction and thrombotic processes. One of the basic pathophysiological aberrations in hypertension is abnormal endothelial function. A number of blood pressure lowering strategies (life-style modification and or anti-hypertensive drugs) result in reversing endothelial dysfunction in hypertension. Thus, endothelial function is considered both as a mechanism and a therapeutic target in hypertension. This review summarizes the physiology and pathophysiology of endothelium in hypertension.

Cardiovascular disease risk reduction in diabetes through conventional and natural approaches

Type 2 diabetes mellitus (DM) is a significant cause of premature complications and mortality in patients with cardiovascular disease (CVD). In addition to lifestyle modifications, conventional treatment of DM consists of oral hypoglycemic agents, insulin sensitizers, and subcutaneous insulin. In diabetic individuals with or at risk for CVD, aspirin and statin therapy reduce CVD morbidity and mortality. Several natural or herbal supplements have shown potential benefit in patients with CVD and DM. We provide an overview of the current guidelines for treatment of DM and CVD. We then review the literature to describe the efficacy of natural approaches to CVD risk reduction in diabetic patients, with a focus on physical activity, dietary modification, and natural/herbal supplements. Activity and diet improve cardiovascular outcomes in patients with CVD and DM. Natural and herbal supplements have potential for benefit but require further research to determine their efficacy and safety.