The TRAIN Health Awareness Clinical Trial: Baseline Findings and Cardiovascular Risk Management in Aortic Dissection Patients

Nora Bacour; Simran Grewal; Aytug U. Tirpan; Rutger Theijse; Olivia Van Erp; Robert J.M. Klautz; Natzi Sakalihasan; Rebecka Hultgren; Nimrat Grewal

doi:10.1055/a-2524-4772

AORTA, Table of Contents

CC BY 4.0 · Aorta (Stamford) 2024; 12(04): 086-093
DOI: 10.1055/a-2524-4772

Original Research Article

The TRAIN Health Awareness Clinical Trial: Baseline Findings and Cardiovascular Risk Management in Aortic Dissection Patients

Authors

Nora Bacour‡^*

¹Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
Simran Grewal‡^*

²Department of Orthopaedic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
Aytug U. Tirpan‡

¹Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
Rutger Theijse

¹Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
Olivia Van Erp

¹Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
Robert J.M. Klautz

¹Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands

³Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
Natzi Sakalihasan

⁴Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Liège, Belgium.
Rebecka Hultgren

⁵Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden

⁶Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
Nimrat Grewal

¹Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands

³Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

Abstract

Background/Objective

Acute Type A aortic dissection (ATAAD) is a life-threatening condition requiring timely surgical intervention. Despite successful surgery, postoperative outcomes are frequently suboptimal due to the high frequency of cardiovascular risk factors. This study examines baseline cardiovascular risk factors in a population of ATAAD patients in the Netherlands. Additionally, this study outlines the protocol for a randomized controlled trial, designed to improve postoperative management.

Methods

Baseline data were collected from patients with ATAAD. Data were gained through the Stichting Aorta Dissectie Nederland, a Dutch association for aortic dissection patients. The data included information on cardiovascular risk factors and health-related quality of life. A survey was further conducted, to gain more insights into the ATAAD postoperative care experiences of cardiac and vascular surgeons.

Results

Among the 50 ATAAD patients in our study, we found significant cardiovascular risk factors, including smoking (36.7%), obesity (34.2%), and hypertension (51.3%). In the surgeon survey (N = 48), 84% of respondents highlighted the significance of lifestyle changes for patients, underscoring the need for individualized risk management. These findings underscore the need for tailored postoperative management programs aimed at improving patient outcomes.

Conclusion

The results of our study highlight that ATAAD patients require comprehensive postoperative care management strategies. The ultimate goal is to enhance long-term patient outcomes and improve health-related quality of life. To address this need, the TRAIN (Targeted caRdiovAscular rIsk reductioN) Health Awareness platform seeks to implement personalized eHealth-based lifestyle interventions.

Keywords

Type A aortic dissection - cardiovascular risk management - eHealth Interventions - lifestyle modifications - postoperative outcomes

Full Text

References

References
1 Bossone E, Eagle KA. Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol 2021; 18 (05) 331-348
2 Dolmaci OB, Ayyildiz T, Poelmann RE. et al. Risk for acquired coronary artery disease in genetic vs. congenital thoracic aortopathy. Front Cardiovasc Med 2023; 9: 1036522
3 Isselbacher EM, Preventza O, Hamilton Black Iii J. et al; Writing Committee Members. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines. J Am Coll Cardiol 2022; 80 (24) e223-e393
4 Breel JS, de Klerk ES, Strypet M. et al. What really matters to survivors of acute type A aortic dissection-a survey of patient-reported outcomes in the Dutch National Aortic Dissection Advocacy Group. J Clin Med 2023; 12 (20) 6584
5 Koba A, Yamagishi K, Sairenchi T. et al. Risk factors for mortality from aortic aneurysm and dissection: results from a 26-year follow-up of a community-based population. J Am Heart Assoc 2023; 12 (08) e027045
6 Grewal N, Idhrees M, Velayudhan B, Klautz RJM, Grewal S. Practical considerations of remote care in thoracic aortopathy in India. J Clin Med 2024; 13 (11) 3327
7 International Meeting on Aortic Diseases. New insight into an old problem; 2024 . Accessed at: https://www.imad-meeting.com
8 Hibino M, Otaki Y, Kobeissi E. et al. Blood pressure, hypertension, and the risk of aortic dissection incidence and mortality: results from the J-SCH study, the UK biobank study, and a meta-analysis of cohort studies. Circulation 2022; 145 (09) 633-644
9 Bundy JD, Li C, Stuchlik P. et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol 2017; 2 (07) 775-781
10 Powell-Wiley TM, Poirier P, Burke LE. et al; American Heart Association Council on Lifestyle and Cardiometabolic Health, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Stroke Council. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2021; 143 (21) e984-e1010
11 Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009; 9: 88
12 Posadzki P, Pieper D, Bajpai R. et al. Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews. BMC Public Health 2020; 20 (01) 1724
13 Marquez DX, Aguiñaga S, Vásquez PM. et al. A systematic review of physical activity and quality of life and well-being. Transl Behav Med 2020; 10 (05) 1098-1109
14 Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med 2017; 32: 246-256
15 Lee S, Kim JH, Chung JH. The association between sleep quality and quality of life: a population-based study. Sleep Med 2021; 84: 121-126
16 Gallucci G, Tartarone A, Lerose R, Lalinga AV, Capobianco AM. Cardiovascular risk of smoking and benefits of smoking cessation. J Thorac Dis 2020; 12 (07) 3866-3876
17 Jung E, Kong SY, Ro YS, Ryu HH, Shin SD. Serum cholesterol levels and risk of cardiovascular death: a systematic review and a dose-response meta-analysis of prospective cohort studies. Int J Environ Res Public Health 2022; 19 (14) 8272
18 Aune D, Giovannucci E, Boffetta P. et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol 2017; 46 (03) 1029-1056
19 Sayed A, Munir M, Bahbah EI. Aortic dissection: a review of the pathophysiology, management and prospective advances. Curr Cardiol Rev 2021; 17 (04) e230421186875
20 Lavie CJ, Ozemek C, Carbone S, Katzmarzyk PT, Blair SN. Sedentary behavior, exercise, and cardiovascular health. Circ Res 2019; 124 (05) 799-815
21 Tanimura T, Teramoto M, Tamakoshi A, Iso H. Association of physical activity with aortic disease in japanese men and women: the Japan Collaborative cohort study. J Atheroscler Thromb 2023; 30 (04) 408-414
22 Higashi Y. Smoking cessation and vascular endothelial function. Hypertens Res 2023; 46 (12) 2670-2678
23 Doonan RJ, Hausvater A, Scallan C, Mikhailidis DP, Pilote L, Daskalopoulou SS. The effect of smoking on arterial stiffness. Hypertens Res 2010; 33 (05) 398-410
24 Messner B, Bernhard D. Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol 2014; 34 (03) 509-515
25 Libby P, Buring JE, Badimon L. et al. Atherosclerosis. Nat Rev Dis Primers 2019; 5 (01) 56
26 Li N. Platelets as an inter-player between hyperlipidaemia and atherosclerosis. J Intern Med 2024; 296 (01) 39-52
27 Staef M, Ott C, Kannenkeril D. et al. Determinants of arterial stiffness in patients with type 2 diabetes mellitus: a cross sectional analysis. Sci Rep 2023; 13 (01) 8944
28 da Silva FR, Guerreiro RC, Barreto AT, Brant VM, Silva A, De-Mello MT. Can improving postoperative sleep speed up surgical recovery?. Sleep Sci 2024; 17 (03) e335-e338
29 Mitra AK, Bhuiyan AR, Jones EA. Association and risk factors for obstructive sleep apnea and cardiovascular diseases: a systematic review. Diseases 2021; 9 (04) 88
30 Zhou Z, Cecchi AC, Prakash SK, Milewicz DM. Risk factors for thoracic aortic dissection. Genes (Basel) 2022; 13 (10) 1814
31 Rueda-Ochoa OL, Bons LR, Zhu F. et al. Thoracic aortic diameter and cardiovascular events and mortality among women and men. Radiology 2022; 304 (01) 208-215
32 Dolmaci OB, El Mathari S, Driessen AHG. et al. Are thoracic aortic aneurysm patients at increased risk for cardiovascular diseases?. J Clin Med 2022; 12 (01) 272
33 Chen H, Chen Y, Wu W. et al. Total cholesterol, arterial stiffness, and systolic blood pressure: a mediation analysis. Sci Rep 2021; 11 (01) 1330