Editor’s presentation

Anti-hypertensive therapy reduces cardiovascular events and total mortality, but current hypertension guidelines do not make specific recommendations on what should be the first line anti-hypertensive therapy.1 The results of a new meta-analysis evaluating the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on cardiovascular outcomes, in comparison with a control group, show that both classes of drugs have similar benefits on the reduction of acute myocardial infarction, stroke and heart failure (HF) hospitalisation, but only ACEIs significantly reduced cardiovascular death and total mortality.2 These results were consistent with several previous meta-analyses that also demonstrated an added cardiovascular protection with ACEIs. It is speculated that this difference may be a result of the higher concentration of bradykinin with the use of ACEIs, by virtue of their cardiovascular protective properties and not on the reduction of blood pressure only. P-wave axis abnormalities have been found to predict mortality in the general population.3 Here, the prognostic impact of an abnormal P-wave axis on both overall and cardiovascular mortality is confirmed in 810 patients following coronary revascularisation and/or valve surgery, measured at the time of discharge from a 2-week cardiac rehabilitation programme.4 This conclusion should be taken with caution, because these findings were not adjusted for important prognostic variables such as the type of operation, prior surgery, functional class and important comorbidities such as diabetes mellitus, renal failure and lung disease. Patients who suffer a severe bacterial infection are more likely to experience cardiovascular events not only acutely, but also in the years to follow.5 The magnitude of association is highest in the year following infection, but remained at a relatively high magnitude for up to 3 years and is not eliminated after 5 years. Inflammation and coagulative pathways are linked, and inflammation in acute infections is frequently followed by a procoagulant state, which is characterised by activation of procoagulant pathways and inhibition of anticoagulant pathways, and probably represents one of the most important mechanisms underlying infection-associated cardiovascular disease (CVD).6 This suggests another reason to protect against infection and identifies a post-infection window of increased CVD risk which both healthcare professionals and patients should be aware of, when additional monitoring or preventive interventions may be of particular value in reducing disease burden.1 Controversy exists regarding the effect of alcohol consumption on metabolic health.7 Moreover, few investigators have examined the association between alcohol consumption and the overall profile of cardiometabolic risk factors in young adults. Here, evidence for a lower burden of cardiometabolic risk factors among moderate drinkers compared to light drinkers in young adults is presented. Results are still significant after adjusting for potential confounders, including physical activity (PA), cardiorespiratory fitness and mental health.8 However higher levels of alcohol consumption are associated with higher blood pressure, confirming the detrimental effect. Therefore, health promotion messages should convey both the positive and negative effects of alcohol on the cardiometabolic and general health of young people. Acculturation has been shown to be associated with the increased prevalence of cardiovascular risk factors among immigrants in western countries.9,10 Acculturation refers to the change in behaviours, beliefs and attitudes that occurs when people from different cultures come into constant contact with each other. Also among Chinese immigrants in Australia, higher levels of acculturation (defined as age at migration, length of residence in Australia and other language spoken at home) are positively associated with cardiovascular risk factors.11 Patients with symptomatic peripheral artery disease (PAD) in real-life clinical practice have a higher baseline cardiovascular and comorbid risk profile, and a higher risk of CVD-related outcomes and death, than do similar patients without PAD.12 This is not a novel finding, because an increased risk of cardiovascular events and death in individuals with PAD was also described recently in a Dutch cohort study of patients with vascular disease13 and a post-hoc analysis of the PLATO trial.14 However, this is the largest study to date of cardiovascular outcomes and risk factors in primary care patients with symptomatic PAD. Data are from electronic medical records in THIN, a database of patients from a representative UK general population in terms of age, sex and geographical location. This emphasises the importance of individualised treatment based on each patient’s risk factor profile. The role of prognostic parameters derived from cardiopulmonary exercise testing (CPET) has been extensively investigated in heart failure with reduced ejection fraction (HFrEF),15 but little is known concerning their role in the recently defined group of heart failure with middle range ejection fraction (HFmrEF).16 Here it is presented that independent predictors of adverse cardiac events in the HFmrEF group are peak oxygen consumption (VO2) and oxygen uptake efficiency slope, but of cardiac death and all-cause death it is only peak VO2. CPET parameters in HFmrEF patients were intermediate between heart failure with preserved ejection fraction (HFpEF) and HFrEF, probably because the pathophysiology of HFmrEF overlaps with that of both HFpEF and HFrEF.17 Several studies show that upon returning home after a cardiac rehabilitation programme, cardiovascular patients reduce PA time and increase the time spent in sedentary activities, which may increase the risk of recurrence.18 The arrival on the market of PA sensors (pedometers, accelerometers, global positioning system) has facilitated the continuous out-of-hospital measurement of the amount of PA of both healthy subjects and patients.19 However, it is here demonstrated that wearable sensors are not accurate enough and underestimate the actual energy expenditure values in post-stroke patients in the subacute phase.20 However, they may still play a role in stimulating adherence to prescribed PA. North walking (NW) has its origins in Finland, where it was introduced in the late 1980s as a summer training for Nordic skiing. After 2000, it spread out worldwide and, increasingly investigated, soon became an exercise component of cardiovascular rehabilitation programmes.21 In a systematic review and meta-analysis, NW training is shown to be of significant benefit in terms of exercise capacity in patients with coronary artery disease, PAD and stroke than conventional cardiac rehabilitation alone.22 Taken as a whole, these results reinforce the practical benefits of NW, but future prospective studies using standardised and structured training protocols are necessary to quantify the benefits of NW training objectively. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) received no financial support for the research, authorship, and/or publication of this article.