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 Table of Contents  
Year : 2022  |  Volume : 6  |  Issue : 1  |  Page : 1-2

Lifestyle, social environment, physiological environment and cardiovascular disease

Department of Cardiology, Clinical Research Centre, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China

Date of Submission17-Jan-2022
Date of Acceptance22-Jan-2022
Date of Web Publication31-Jan-2022

Correspondence Address:
Prof. Xuerui Tan
Department of Cardiology, Clinical Research Centre, The First Affiliated Hospital of Shantou University Medical College, No. 22, Xinling Road, Shantou, Guangdong 515041
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/hm.hm_1_22

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How to cite this article:
Tan X. Lifestyle, social environment, physiological environment and cardiovascular disease. Heart Mind 2022;6:1-2

How to cite this URL:
Tan X. Lifestyle, social environment, physiological environment and cardiovascular disease. Heart Mind [serial online] 2022 [cited 2023 Mar 27];6:1-2. Available from: http://www.heartmindjournal.org/text.asp?2022/6/1/1/336888

Unhealthy diet, smoking and lack of physical activity are well-known lifestyle risk factors for human health. The current studies have revealed that lifestyle factors including diet, smoking, exercise, alcohol, sleep patterns and body mass index can be associated with the prevention, development, outcomes and rehabilitation of cardiovascular diseases (CVDs). These studies have given us much inspiration and have helped us better explore the prevention and treatment of CVDs. This issue aims to provide a more in-depth understanding of current knowledge regarding the association between lifestyle factors and CVDs, focus on the influence and interaction of lifestyle factors in CVDs and highlight the latest significant studies in the field.

A refreshing review entitled “Relationship between red meat metabolite trimethylamine N-oxide and cardiovascular disease” by Shu Ye et al. overviews the relationship between trimethylamine N-oxide (TMAO) and CVDs. It discusses the possible role underlying the mechanisms. This review indicates that TMAO is a dietary metabolite associated with CVDs, including heart failure and stroke. The gut microbiota is a major source of TMAO. Dietary choline, phospholipid phosphatidylcholine and betaine are converted to trimethylamine, transformed to TMAO by hepatic flavin monooxygenase-3. Evidence indicates that TMAO, a metabolite of red meat and animal-derived foods, produces and promotes CVDs and their consequences. The effects of TMAO on CVDs are several and varied, with effects seen in both the liver and the vascular walls, resulting in changes in lipid metabolism and vascular cell behaviours linked to the onset and progression of atherosclerosis. To determine both the cell behaviour changes induced by TMAO and the molecular mechanism driving atherosclerotic initiation and progression, and whether TMAO influences plaque stability and the late-stage outcomes of CVDs, more research into the effects of TMAO on hepatic and vascular cells is needed. In addition, it is essential to explore further the processes underlying TMAO's link to the other CVDs, such as heart failure. This could lead to the discovery of new targets for pharmaceutical interventions that counteract the effects of TMAO on CVDs.

Qing Wang provided a review entitled “The role of dietary potassium and sodium in hypertension and cardiovascular damage and protection: A narrative review”, First, he describes the global burden of hypertension and CVDs and discusses sodium and potassium imbalance's pathophysiological mechanisms and significance in inducing hypertension. Next, he cites experimental evidence and explains how a high-sodium and low-potassium diet causes target organ damage independent of blood pressure. Finally, he addresses the role that a low-sodium and high-potassium diet may play in reducing the incidence of hypertension, CVDs and the subsequent events. Instead of achieving a very low-sodium intake, he suggests reducing sodium and increasing potassium in the diet. Such a diet may be more acceptable to the general population, and its implementation would lead to a significant reduction of CVDs and subsequent events and deaths.

Depression and preeclampsia (PE) are severe pregnancy complications, increasing the maternal and foetal mortality risk. Dong Lin et al. have submitted an interesting review entitled “Maternal depression and PE: Effects on the maternal and offspring's mental and physical health”. It suggests that pregnant women with depression are at increased risk of developing pregnancy-induced hypertension than those without depression. Correspondingly, hypertensive gravidae are more susceptible to experiencing symptoms of depression than normotensive mothers during pregnancy and the postpartum period. Although the mechanism proposed may be complicated, some evidence from experimental and clinical studies indicates ways these two conditions can affect each other and their roles in the neurodevelopment of affected offspring. Factors proposed include inflammation, oxidative stress and maternal immune activation. However, the precise mechanism of depression and PE in pregnancy remains to be elucidated, emphasising the need for further study.

Mina Karki et al. have contributed a review entitled “Heart diseases, anxiety disorders, and negative thoughts”. This study describes how negative thoughts, feelings or emotions influence lifestyle patterns and increase the risk of heart disease. It also explains how people being chronically stressed, nervous, sad or angry are more likely to consume excessive amounts of alcohol, smoke, overeat and exercise insufficiently – all harmful habits that are detrimental to their heart health.

In Kiriaki Mavromoustakou et al.'s study, entitled “Impact of atrial fibrillation on the severity, progress and disability of the ischemic stroke patients”, possible correlations between the severity, progress and outcomes of ischemic stroke and the presence of AF were investigated. They enrolled a total of 344 patients diagnosed with ischemic stroke and assessed patients. The assessment was based on neurological status on diagnosis, the National Institutes of Health Stroke Scale, the neurological symptoms during hospitalisation and the outcomes at discharge using the optimised modified Rankin scale. Strikingly, they conclude that AF, a previously unrecognised risk factor, is associated with higher severity, poorer progress and more adverse clinical outcomes of ischemic stroke in patients, which may lead to a higher degree of disability along with higher medical costs. Their work extends previous associations between AF and extended hospitalisation and worse outcomes for ischemic stroke.

Furthermore, a lower frequency of transient ischemic attacks was observed in patients with AF. Finally, patients with AF presented higher middle cerebral artery occlusion incidence and were more frequently found with a lesion on the left cerebral hemisphere. They recommend that AF is predictive of higher severity and poorer prognosis in ischemic stroke, independently from other cardiovascular risk factors, making it a valuable tool to monitor this condition in determining treatment and prognosis.

Idean A. Pourshams et al. contributed their work on “Decision making experiences and decisional regret in patients receiving implanted cardioverter defibrillators”. Their research provides a valuable insight into patients' perception of education received before implantation of an implantable cardioverter-defibrillator (ICD). Education is strongly recommended to prevent or mitigate feelings of regret and frustration in ICD recipients. In addition, Medicare guidelines for ICDs require a shared decision-making approach that focuses on patients' health goals, values and preferences before implantation. Still, many patients are not fully informed when recovering from ICD implantation or living with an ICD long term. With the objective of understanding decision-making processes and decisional regret in patients requiring ICDs using in-depth interviews, they recruited 19 patients at Stanford University Medical Centre in individual interviews using closed-ended and open-ended questions to engage dialogue. Notes taken during interviews were assessed and used to identify major themes. They found that the patients described a lack of adequate education about ICD post-operative recovery and long-term, post-implantation considerations such as avoiding electromagnetic fields, false-positive ICD shocks and the aesthetic effect of ICD implantation. In addition, feelings of fear and anxiety were prevalent in participants' recollections of accepting an ICD. They suggest that further education among patients before ICD placement is needed. Despite the study's limitations, they enlighten that the decision-making process can be simplified and patient regret and frustration minimised by providing more consistent access to reliable information that is accessible and interactive. Further recognition may lead to even more significant health benefits when being considered in the light of other work on the psychocardiological axis.

In Jessica B. Loures et al.'s research, entitled “Socioeconomic and clinical factors associated with disease related knowledge of cardiac rehabilitation patients in Brazil”, they aim to identify socioeconomic and clinical factors associated with disease-related knowledge of cardiac rehabilitation (CR) patients. This study recruited 39 patients under the CR Phase 1 and completed questionnaires on the 1st day of Phase 2. The results showed that low-income and unemployed participants were more likely to have inadequate disease-related knowledge; however, the entire sample presented a low understanding of their condition. Therefore, the authors suggest that public health strategies and educational interventions must focus on these vulnerable groups.

Interaction and interdependency of CVDs and lifestyle factors are naturally a theme running through this issue, highlighting the relationship of “heart and mind”. The chosen papers strengthen our knowledge and recognition of comorbidity mechanisms and further illuminate new areas for the investigation that should attract extensive attention in academic and clinical circles. These published articles in this issue offer us cutting-edge scientific arguments and significant achievements in identifying new research hotspots and leading to recommendations that benefit patients. On behalf of the editorial team, I would like to express my heartfelt thanks to all the authors.


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