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Can Vitamin C Prevent COVID-19?

The outbreak of COVID-19 has created a global public health crisis. Our knowledge continues to be limited about the protective factors of this infection. Therefore, preventive health measures that can reduce the risk of infection, and halt the progression and severity of symptoms and complications related to COVID-19 are desperately needed. In the midst of the COVID-19 pandemic, health promotion measures, such as proper nutrition, physical activity, rest, and stress reduction measures have been advocated.  More recently, attention has been shifted to vitamin supplementation as a means to keep American’s health and immune system in optimal status.

Source: https://www.heart.org/en/healthy-living/healthy-eating/add-color

Adequate intake of micronutrients is critical for optimal health, growth and development, and healthy aging. However,  the Dietary Guidelines for Americans 2015–2020 highlight low-consumption of important nutrients including vitamins A, C, D and E, calcium, magnesium, iron, potassium, choline and fiber, with variations by age groups.1   Vitamin C has recently gained attention as a potential micronutrient in the prevention of COVID-19.  Vitamin C has been known for promoting the oxidant scavenging activity of the skin, potentially protecting against environmental oxidative stress, enhancing chemotaxis, phagocytosis, and microbial killing.2

Based on previous evidence, oral vitamin C (2-8 g/day) may reduce the incidence and duration of respiratory infections and intravenous vitamin C (6-24 g/day) has been shown to reduce mortality, hospital length of stay, and time on mechanical ventilation for severe respiratory infections3-4

Given the favorable safety profile and low cost of vitamin C, and the frequency of vitamin C deficiency in respiratory infections, trials are currently underway to determine its effect in hospitalized patients with COVID-19.4-5  Although there are currently no published results of these clinical trials due to the novelty of SARS-CoV-2 infection, there is pathophysiologic rationale for exploring the use of vitamins such as Vitamin C in this global pandemic.6

Source: https://www.heart.org/en/news/2019/07/01/low-vitamin-d-in-babies-predicts-blood-pressure-problems-for-older-kids

While we await for results from these trials, we need to continue being vigilant, and adhere to a varied and balanced diet with an abundance of fruits and vegetables and the essential nutrients known to contribute to the normal immune system functioning.  Vitamin C supplementation could present a safe and inexpensive approach to prevention of respiratory diseases, and perhaps aid in COVID-19.7

Avoidance of deficiencies and identification of suboptimal intakes of these micronutrients in targeted groups of patients and in distinct and highly sensitive populations could help to strengthen the resilience of people to the COVID-19 pandemic. It will be also important to highlight evidence-based public health messages, to prevent false and misleading claims about the benefits of vitamin supplements. It will also be important to communicate the exploratory state of research on micronutrients and COVID-19 infection and that no diet will prevent or cure COVID-19 infection. Frequent handwashing and social distancing will continue to be critical to reduce transmission during this pandemic.8

 

References:

  1. Blumberg JB, Frei B, Fulgoni VL, Weaver CM, Zeisel SH. Contribution of Dietary Supplements to Nutritional Adequacy in Various Adult Age Groups. Nutrients. 2017;9(12):1325. Published 2017 Dec 6. doi:10.3390/nu9121325
  2. U.S. Department of Health and Human Services. U.S. Department of Agriculture [(accessed on 15 March 2017)];2015–2020 Dietary Guidelines for Americans. (8th ed.). 2015 Available online: http://health.gov/dietaryguidelines/2015/guidelines/
  3. Holford P, Carr AC, Jovic TH, et al. Vitamin C-An Adjunctive Therapy for Respiratory Infection, Sepsis and COVID-19. Nutrients. 2020;12(12):3760. Published 2020 Dec 7. doi:10.3390/nu12123760
  4. Carr AC. A new clinical trial to test high-dose vitamin C in patients with COVID-19. Crit Care. 2020;24(1):133. Published 2020 Apr 7. doi:10.1186/s13054-020-02851-4
  5. Zhang J, Rao X, Li Y, et al. Pilot trial of high-dose vitamin C in critically ill COVID-19 patients. Ann Intensive Care. 2021;11(1):5. Published 2021 Jan 9. doi:10.1186/s13613-020-00792-3
  6. Jovic TH, Ali SR, Ibrahim N, et al. Could Vitamins Help in the Fight Against COVID-19?. Nutrients. 2020;12(9):2550. Published 2020 Aug 23. doi:10.3390/nu12092550
  7. Allegra A, Tonacci A, Pioggia G, Musolino C, Gangemi S. Vitamin deficiency as risk factor for SARS-CoV-2 infection: correlation with susceptibility and prognosis. Eur Rev Med Pharmacol Sci. 2020;24(18):9721-9738. doi:10.26355/eurrev_202009_23064
  8. Richardson DP, Lovegrove JA. Nutritional status of micronutrients as a possible and modifiable risk factor for COVID-19: a UK perspective [published online ahead of print, 2020 Aug 20]. Br J Nutr. 2020;1-7. doi:10.1017/S000711452000330X

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

 

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Exercise: New Year Resolutions in the Midst of the COVID Pandemic

New Year. New Resolutions. With the start of the New Year, many of us make commitments to improve our health. Some of us take on a new routine or hobby, give up or change old habits.  As the holidays go, many of us take on the resolution to engage in more exercise and lose the extra pounds gained through the indulgence during the holidays.  As we embark on the new journey to better health at the start of a new year, it is important to know that we are not alone. There are many around us that are also trying to engage in a healthy resolution to be fit. And there are many resources available to increase our physical activity and remain fit throughout the year.

It has been well established that physical activity contributes to many health benefits. Those who engage in regular exercise benefit from better sleep, growth, development, mood, and overall health.1 On the contrary, the lack of exercise and an increase in sedentary behaviors may contribute to overweight and obesity. Overweight and obesity have deleterious effects in adults, including increased risk of cardiovascular disease, cancer, metabolic syndrome, depression, poor quality of life, and decreased life span.

As the global COVID‐19 pandemic unfolded in year 2020, over 90% of U.S. adult residents found themselves confined to their homes, with restaurants, shops, schools, and workplaces shut down to prevent the disease from spread.2 For some, it meant additional changes, including working remotely, homeschooling children, and personal changes in lifestyle behaviors. Some of these, unfortunately, have led to increased sedentary activity and decreased physical activity, known risk factors associated with overweight and obesity.

For some groups, the transition to lockdown and social distancing has resulted in increased physical activity, especially for bodyweight training, and higher adherence to a healthier diet. Some individuals have engaged in higher consumption of farmers’ produce or purchasing of organic fruits and vegetables, resulting in lower body mass index.3   However, this has not been the norm. More studies report adults experiencing five-to-ten pound increases in weight as a result of increased eating in the home environment. The increased levels of stress, combined with the lack of dietary restraint, snacking after meals, reduced physical activity, and inadequate sleep has further aggravated the risk of overweight and obesity in our population.4   Some groups report less frequent consumption of vegetables, fruit, and legumes during the quarantine, and higher adherence to meat, dairy, and fast-foods.5   Anxiety, depression, self-reported boredom, and solitude have worsened the consumption of snacks, unhealthy foods, cereals, and sweets. These have correlated with higher weight gain for many.6

Being overweight not only increases the risk of infection and complications for those categorized as obese. Recent studies also suggest that the large prevalence of obese individuals within the population might increase the chance of appearance of the more virulent viral strain, and prolong the virus shedding throughout the total population. This may further increase the overall mortality rate as a result of COVID-19. A study on previous influenza pandemics suggests losing weight with a mild caloric restriction, including AMPK activators and PPAR gamma activators in the drug treatment for obesity-associated diabetes. Practicing mild-to-moderate physical exercise may further improve our immune response. Regular physical exercise enhances levels of cytokine production mediated via TLR (toll-like receptor) signaling pathways during microbial infection, improving host resistance to pathogen invasion.7 Regular physical activity may then serve as a cornerstone measure to improve our defenses against influenza viral infection, cardiometabolic diseases, and COVID-19.

Physical activity remains one of the seven modifiable health behaviors and an important metric of The American Heart Association (AHA) Life’s Simple 7 (LS7), associated with improved cardiovascular disease survival and reduced healthcare costs.8   As we battle the restrictions imposed by the pandemic, we have to also think that these circumstances present opportunities to engage our communities in healthy lifestyle practices. Practice aimed to increase our physical activity, may contribute to improving overall health status in the midst of the COVID pandemic.

Here are some ideas on how to meet the New Year resolution to exercise and increase our levels of physical activity:

  • Move More
    • Set up a timer or alarm to move at least once every hour.
    • A good starting goal is to engage in physical activity at least 150 minutes a week. This represents three 50-minute sessions or five 30-minute sessions a week.
    • Start slowly. Gradually build up to at least 30 minutes of activity on most or all days of the week.
    • Check with your healthcare provider before beginning a physical activity program and follow their recommendations.
  • Establish a routine
    • Start with small changes.
    • Make the time.
    • Try to engage in exercising consistently at the same time every day and every week.
    • Stick to the new routine for at least a month.
    • Find a convenient time and place to do activities.
    • Be flexible. If you miss an exercise opportunity, get back on track.
    • Work physical activity or exercise session into your day in another way.
    • Keep reasonable expectations of yourself and your physical activity or exercise routines.
    • Reward or praise yourself for sticking to the changes.
    • Use non-food items to reward yourself.
  • Get support
    • Find buddies or friends who are also making the same commitment to be fit and engage in physical activity.
    • Invite others to join you on your journey.
    • It becomes more fun when you exercise or move in a company.

Start the New Year with a commitment to better health by increasing activity and engaging in regular exercise. Engage others in exercise while keeping social distancing guidelines. Celebrate the small changes. Make a commitment to a Better You!

References:

  1. Centers for Disease Control (CDC). Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Physical Activity Basics. Reviewed 2020 Nov 18. Accessed 2021 Jan 13. https://www.cdc.gov/physicalactivity/basics/index.htm
  2. Bhutani S, Cooper JA. COVID-19-Related Home Confinement in Adults: Weight Gain Risks and Opportunities. Obesity (Silver Spring). 2020;28(9):1576-1577. doi:10.1002/oby.22904
  3. Di Renzo L, Gualtieri P, Pivari F, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):229. Published 2020 Jun 8. doi:10.1186/s12967-020-02399-5
  4. Zachary Z, Brianna F, Brianna L, et al. Self-quarantine and weight gain related risk factors during the COVID-19 pandemic. Obes Res Clin Pract. 2020;14(3):210-216. doi:10.1016/j.orcp.2020.05.004
  5. Sidor A, Rzymski P. Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland. Nutrients. 2020;12(6):1657. Published 2020 Jun 3. doi:10.3390/nu12061657
  6. Pellegrini M, Ponzo V, Rosato R, et al. Changes in Weight and Nutritional Habits in Adults with Obesity during the “Lockdown” Period Caused by the COVID-19 Virus Emergency. Nutrients. 2020;12(7):2016. Published 2020 Jul 7. doi:10.3390/nu12072016
  7. Luzi L, Radaelli MG. Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic. Acta Diabetol. 2020;57(6):759-764. doi:10.1007/s00592-020-01522-8
  8. Garg PK, O’Neal WT, Mok Y, Heiss G, Coresh J, Matsushita K. Life’s Simple 7 and Peripheral Artery Disease Risk: The Atherosclerosis Risk in Communities Study. Am J Prev Med. 2018;55(5):642-649. doi:10.1016/j.amepre.2018.06.021

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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#AHA20: Reflections from 2020 AHA Scientific Sessions

As an American Heart Association Early Career Professional, attending the #2020 AHA Scientific Sessions will be an unforgettable experience. The virtual modality of the conference provided an alternative to the social distancing challenges presented by COVID-19. There was creativity in the programming to allow opportunity to engage through the various forums and live chats for those interested in live participation; and this added to the unique experience of online networking and learning. Participants also had the opportunity to join the on-demand sessions, learning at their own pace, within the comfort of their home or work setting.

From the early morning health and wellness sessions to late-breaking science, technology application to support better patient outcomes in the treatment of cardiovascular disease, and COVID-19 topics, the conference programming was comprehensive, diverse, and appealing to the interest of the participants. It was also in tune with the current state of global health and social issues, addressing ongoing debates in cardiovascular disease management.

The wide range of topics presented at the sessions truly reminds us of the AHA’s mission to be a relentless force for a world of longer, healthier lives.

Highlights of the #AHA 2020 Scientific Sessions included the following:

  1. Focus on Fitness and Health. Participants had the opportunity to join the morning fitness and dance breaks, as well as and on-demand exercise sessions. Attendees who could not join the early scheduled meetings had the opportunity to join the on-demand model.
  2. Discussion on racism in Medicine. The opening session featured a fireside chat with two legends in the education and treatment of cardiovascular disease, Dr. Eugene Braunwald and Dr. Nanette Wenger. This was followed by a robust discussion of racism as a public health crisis at various sessions delivered over the course of the five days. They also presented a call to support and embrace diversity, equity, and inclusion in the delivery of care to our growing racial and ethnically diverse population.
  3. Late-Breaking Science. Recent findings from clinical trials were presented during the sessions on precision or polypill with TIPS and TIPS+ASA, the STRENGTH and OMEMI trials, the GALACTIC-HF and VITAL Rhythm trial.
  4. Women Professional Development. Session topics ranged from discussions on leadership, self-care during COVID-19, and management of cardiovascular disease risk among women across the lifespan.
  5. Latest Insight on COVID-19 and Cardiovascular Disease. The session addressed a wide range of topics from diagnostics and treatment, to the management of complications as a result of COVID-19. Discussion on complications such as thrombosis and myocardial involvement was presented and provided a fresh view of the latest treatment guidelines and the need for monitoring for cardiovascular complications.

These sessions will be available on-demand until January 4th, 2020, and AHA Partners have FREE access to Scientific Sessions 2020 OnDemand Extended Access through 2021. Please check these out to learn about the latest evidence.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Fish Oils versus Statins?

Hypercholesterolemia remains a significant risk factor for cardiovascular disease. Management of hypercholesterolemia has entailed the use of statins and non-statins, such as omega-3 fatty acid supplements. Common side effects related to fish oil supplements have included reports of gastrointestinal upset and difficulty in swallowing the fish capsules. Common side effects of statin therapy have included reports of muscle aches, abdominal pain, dizziness, leading to non-adherence and termination of therapy.

The debate on the use of omega-3 fatty acids over statins in the management of blood cholesterol continues, calling for more studies.1  Day 3 of this year’s AHA Scientific Conference highlighted results from recent trials on the use of non-statins and statins in the reduction of cardiovascular events. Here are some takeaways from three studies: the STRENGTH Trial, the OMENI study, and the SAMSON study.

The STRENGTH (Outcomes Study to Assess STatin Residual Risk Reduction With EpaNova in HiGh CV Risk Patients With Hypertriglyceridemia) trial – This phase III international study evaluated the use of a medication derived from fish oil, containing the omega-3 fatty acids EPA and DHA, more than 13,000 people who had existing heart disease or who were at high risk of heart disease due to other medical conditions.2

  • The medication did not reduce the risk of cardiac events compared to a corn oil-based placebo.
  • Atrial fibrillation, an abnormal heart rhythm, occurred more frequently in participants taking the omega-3 CA medication.

The OMENI (OMega-3 fatty acids in Elderly patients with Myocardial Infarction) trial – a study of more than 1,000 patients in Norway investigated whether adding 1.8 grams of omega-3 fatty acids to standard treatment prevented further cardiovascular events among elderly participants with recent heart attacks.

  • When compared to placebo, omega-3 fatty acids supplement in addition to statin therapy and/or a blood thinner did not reduce the number of cardiac events in the participants.

The SAMSON (The Self-Assessment Method for Statin Side-effects Or Nocebo) Trial – The study, conducted in London, enrolled adults who had previously taken one or more statins but stopped taking them due to side effects. The participants had self-reported symptoms measured throughout a 12-month period of randomly alternating months of statin use, placebo, and no medications.

  • The participants who reported side effects from statins also reported the same side effects when they unknowingly took placebo pills.
  • The side effects appeared to be mostly due to psychological rather than pharmacological effects of statins since the reported symptoms were consistent when taking the placebo.

In the discussion led by Dr. Karol E. Watson, statins remain the mainstay in the reduction of Low-Density Lipoprotein (LDL) and Atherosclerotic cardiovascular disease (ASCVD) risk.  As also recommended in the 2018 AHA/ACC/ AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol, non-statin therapies should be considered in high-risk patients with LDL above thresholds.  Heart-healthy lifestyle changes should be also considered as important measures in the reduction of LDL and triglycerides in patients at risk for ASCVD. The heart-healthy lifestyle should include diet, weight control, and physical activity.4  It will be important to observe the outcome of future studies including the combined effects of heart-healthy lifestyle interventions and non-statin/statin therapy among those considered to be at high risk for ASCVD. Future discussions should also center on intervention studies to address patients’ perceptions of statin/non-statin therapies.

 

 

References

  1. Tummala R, Ghosh RK, Jain V, Devanabanda AR, Bandyopadhyay D, Deedwania P, Aronow WS. Fish Oil and Cardiometabolic Diseases: Recent Updates and Controversies. Am J Med. 2019 Oct;132(10):1153-1159. doi: 10.1016/j.amjmed.2019.04.027. Epub 2019 May 8. PMID: 31077653.
  2. Nicholls SJ, Lincoff AM, Bash D, Ballantyne CM, Barter PJ, Davidson MH, Kastelein JJP, Koenig W, McGuire DK, Mozaffarian D, Pedersen TR, Ridker PM, Ray K, Karlson BW, Lundström T, Wolski K, Nissen SE. Assessment of omega-3 carboxylic acids in statin-treated patients with high levels of triglycerides and low levels of high-density lipoprotein cholesterol: Rationale and design of the STRENGTH trial. Clin Cardiol. 2018 Oct;41(10):1281-1288. doi: 10.1002/clc.23055. Epub 2018 Sep 28. PMID: 30125052; PMCID: PMC6489732.
  3. Kalstad AA, Myhre PL, Laake K, Tveit SH, Schmidt EB, Smith P, Trygve Nilsen DW, Tveit A, … Effects of n-3 Fatty Acid Supplements in Elderly Patients after Myocardial Infarction: A Randomized Controlled Trial. Circulation. 2020 Nov. https://doi.org/10.1161/CIRCULATION AHA.120.052209Circulation.
  4. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/ AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019 Jun 25;73(24):e285-e350. doi: 10.1016/j.jacc.2018.11.003. Epub 2018 Nov 10. Erratum in: J Am Coll Cardiol. 2019 Jun 25;73(24):3237-3241. PMID: 30423393.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Reducing Disparities in Access to Cardiovascular Disease Prevention with the Polypill

This year’s AHA 2020 Scientific Session is taking place using combined modalities, including live, simulive, and on-demand sessions. Despite the change from the traditional in-person modality to the virtual approach, listening to the opening session and findings from emerging science reminded me of the mission of the American Heart Association to be a relentless force for a world of longer, healthier lives. This year’s scientific sessions also align with a wide range of events we all have experienced this year, ranging from the COVID-19 pandemic, to racial/ethnic, gender, and income disparities leading to health inequity in our society. These further present a call to action in order to address these very same societal issues that are likely to impact on health equity for the most vulnerable groups.

The cardiovascular polypill, or combined aspirin, cholesterol, and blood-pressure-lowering agents into a single pill has been proposed for nearly a decade as a complementary option in the prevention of cardiovascular diseases in intermediate- and high-risk patient populations.1 Yet there have been previous limitations in understanding its efficacy and relative safety in developing countries.2  The findings of the International Polycap Study (TIPS)-3 presented by Dr. Salim Yusuf during the late-breaking science session bring a ray of hope to the global disparities in cardiovascular disease prevention.3 The study resulted in a 30% reduction in cardiovascular risk with a combined regimen composed of Aspirin and a polypill (atenolol, ramipril, hydrochlorothiazide, and a statin).3  Based on the TIPS-3 study, the polypill approach presents a safe and cost-effective strategy with the potential for satisfactory medication adherence.

While these findings are promising for developing countries, the polypill may present a viable solution to underserved, low-income minority groups in developed countries.4  Another important takeaway from this study was the inclusion of women, who represented 53% of the sample.  Their inclusion in global studies such as this one also highlights the move into health equity and awareness of women’s health globally at a time when cardiovascular disease continue to present women’s greatest health threat. Traditionally, the enrollment of women in clinical trials has been limited. This has resulted in a limited understanding of risk factors and benefits from treatment regimens for cardiovascular disease-specific to women.5

As we observe the benefits related to polypill, it is also important to keep in mind that it may not align with the medical trend in developed countries for precision medicine, leading to individualized, targeted therapy.6  With cardiovascular disease remaining the leading cause of mortality and morbidity in developed and developing countries, and low-income, ethnic minorities affected by it, the question remains on long-term, best preventive strategies in the reduction of cardiovascular risk factors for all. It will also be important to measure long-term outcomes related to polypill strategies in future studies.

 

References:

  1. Lafeber M, Spiering W, Singh K, Guggilla RK, Patil V, Webster R; SPACE collaboration. The cardiovascular polypill in high-risk patients. Eur J Prev Cardiol. 2012 Dec;19(6):1234-42. doi: 10.1177/1741826711428066. Epub 2011 Oct 21. PMID: 22019908.
  2. Nguyen C, Cheng-Lai A. The polypill: a potential global solution to cardiovascular disease. Cardiol Rev. 2013 Jan-Feb;21(1):49-54. doi: 10.1097/CRD.0b013e3182755429. PMID: 23018668.
  3. Joseph P, Pais P, Dans AL, Bosch J, Xavier D, Lopez-Jaramillo P, Yusoff K, Santoso A, Talukder S, Gamra H, Yeates K, Lopez PC, Tyrwhitt J, Gao P, Teo K, Yusuf S; TIPS-3 Investigators. The International Polycap Study-3 (TIPS-3): Design, baseline characteristics and challenges in conduct. Am Heart J. 2018 Dec;206:72-79. doi: 10.1016/j.ahj.2018.07.012. Epub 2018 Aug 2. PMID: 30342297; PMCID: PMC6299262.
  4. Muñoz D, Uzoije P, Reynolds C, Miller R, Walkley D, Pappalardo S, Tousey P, Munro H, Gonzales H, Song W, White C, Blot WJ, Wang TJ. Polypill for Cardiovascular Disease Prevention in an Underserved Population. N Engl J Med. 2019 Sep 19;381(12):1114-1123. doi: 10.1056/NEJMoa1815359. PMID: 31532959; PMCID: PMC6938029.
  5. Saeed A, Kampangkaew J, Nambi V. Prevention of Cardiovascular Disease in Women. Methodist Debakey Cardiovasc J. 2017 Oct-Dec;13(4):185-192. doi: 10.14797/mdcj-13-4-185. PMID: 29744010; PMCID: PMC5935277.
  6. Psaty BM, Dekkers OM, Cooper RS. Comparison of 2 Treatment Models: Precision Medicine and Preventive Medicine. JAMA. 2018 Aug 28;320(8):751-752. doi: 10.1001/jama.2018.8377. PMID: 30054607.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”