Heart Disease and Stroke

Dear Readers, I'm pleased to introduce a special issue on “Heart disease and stroke,” from a group of distinguished editors and productive authors from around the globe. It is well known that ischemic heart disease (IHD) is a leading cause of death, claims 8.9 million people worldwide a year. Stroke is also a leading cause of death, claiming at 6.1 million. The two conditions often coexist and are associated with a high mortality. Importantly, cardiac disease can lead to stroke. This special issue includes excellent articles discussing the connection of the heart and brain, in less commonly considered but still critically important areas such as stroke in noncompaction cardiomyopathy and after the cardiac procedure of transcatheter aortic valve replacement (TAVR). Two key issues that impact on the development of the heart–stroke interaction are discussed, specifically the impact of mental stress and disparities in health-related quality of life among adults with IHD, stroke, and both conditions. Physical exercise as a preventive strategy is touched upon, as well in this issue. Heart and Mind is fortunate to have Barry A. Franklin as the spotlight guest. During the interview, Prof. Franklin shared his perspectives on physical activity, cardiorespiratory fitness, and cardiovascular health. He discussed that exercise benefits cardiac patients, yet too much exercise might be risky. He highlights the importance of patients' motivation in cardiac rehabitation programs, provided novel viewpoints on psychosocial stressors, etc. In addition, he revealed the potential power of soft skills for being superachievers. The spotlight article is entitled “Perspectives of Barry A. Franklin, PhD: A World-Renowned Professor, Author, and Speaker.” In the article entitled “Noncompaction Cardiomyopathy and Embolic Events: A Mini-Review,” George Bazoukis et al. discussed that patients with left ventricular noncompaction cardiomyopathy (LVNC) have an increased risk of embolic events. They conclude that LVNC patients with prior embolic events, atrial fibrillation, left ventricular (LV) thrombus, and LV dysfunction should have anticoagulation. For individuals without a clear indication according to the current guidelines, anticoagulation could be considered when their CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus and stroke or transient ischemic attack) score is 2 or greater. Amit Hooda et al. provided a “A Narrative Review on Perprocedural Stroke and Transcatheter Aortic Valve Replacement: Achilles' Heel,” summarizing the currently available strategies for mitigating periprocedural stroke post transcatheter aortic valve replacement (TAVR) and providing insights into future directions. The authors advocate for large, prospective, randomized controlled trials that are required to predict the patient profile where cerebral embolic protection devices would be useful. Furthermore, additional strategies with newer valve technologies are recommended to improve the neurological safety of TAVR. An article entitled “Mental Stress Contributes to the Pathogenesis of Atherosclerotic Heart and Brain Diseases: A Mini-Review” is contributed by Yongjian Geng. This study highlighted that mental stress serves as an independent risk factor that plays a key role in changing the function and metabolism of cardiovascular tissues during the development of atherosclerotic vascular disease. The author summarized the benefits of increases in positive stress resilience, lower psychological susceptibility while increasing the resilience to cardiovascular insults, and improving dietary supply, lifestyle, and physical fitness. Moreover, preventive and therapeutic approaches are developing in multiple fronts aimed at mitigating the stress-associated vascular responses and development of atherosclerotic vascular disorders. Molly M. Jacobs et al. contributed an article entitled “Disparities in Health-Related Quality of Life among Adults with Ischemic Heart Disease, Stroke, and Both Conditions: A Cross-Sectional Study.” They estimated differences in Health-Related Quality of Life (HRQOL) between racial and ethnic groups, as well as racial/ethnic differences in the HRQOL of IHD, stroke, or both conditions. They calculated the Health and Activity Limitation Index – a generic HRQOL measure comprising perceived health and activity limitations – for 29,482 adults, using data from the 2021 US National Health Interview Survey. They found that while IHD and stroke are independently associated with significantly low HRQOL, their co-occurrence has a substantially negative impact on HRQOL, particularly among minority racial groups. In the article “What is Bad for the Heart is Bad for the Brain?,” Eduard Guasch appraised the idea that regular moderate and vigorous exercises positively impinge the cardiovascular–cognition connection. The animal models and human trials suggest that the cognitive benefits promoted by regular exercise may be highly dependent on exercise intensity and duration, yet strenuous and long-term forms of exercise may paradoxically be deleterious. The author claimed that the related data need to be confirmed in large and well-designed studies. With the aim of inspiring physicians and researchers to find better strategies for cardiac patients, this issue explores aspects of prevention, diagnosis, treatment, and outcome of heart disease and stroke, especially their connections. The publication of the issue received high-quality contributions from authors from various countries. I remain grateful to them for their incredible support.

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