Introducing the work of the International #ZeroWaste City Network, launched at the 2022 #BRSCOPs & currently counting 61 members from 21 countries, representatives of #BCRC Asia Pacific & BCRC #Argentina highlight success stories in various public sector initiatives.
V8 Supercars kick us of for Season 14 tomorrow!!
Make sure to join up so you can join us on track!
discord.gg/phoenixsimsport
#PHX #phoenixsimsport #BCRC #racing #v8supercars
Diet and micro biome, derived metabolites
Another image of diet and Microbiome, derived of metabolites
As you and I age, let's make efforts to celebrate the journeys of our older adults and develop care interventions that are proactive rather than reactive...
Planned to post so much more from #ACR24; my favorite slides from today will have to suffice.
From the #BCRC Dr Monica Guma’s talk about diet and microbiome.
From Dr Namrata Singh — a reminder that we are all aging.
From Dr Connie Weyand’s - metabolic checkpoints in RA T cells and macrophage.
📲Additional considerations:
-cost of wearables
-older adults & tech setup/use
-difficulty of clipping on wearables for some adults with arthritis
👉Limitations: wearables don't measure sedentary behavior, which is also important for CV health
#ACR24 #BCRC
👉Opportunities for wearables:
-more accuracy than traditional measures of physical activity; location of wear matters
-smaller studies show high adherence & acceptability
#ACR24 #BCRC
Evidence:
📲Smart phone apps: small ⬆️ in step count for adults🚶♀️
⌚️Wearables: ⬆️1500-1800 steps/day & ⬆️6-15 min MVPA/day
#ACR24 #BCRC
#ACR24 #BCRC on CVD/RMD
⭐️Christine Pellegrini - wearables & physical activity
🚶♀️Physical activity is low in adults with arthritis
📲Wearables & smart phones are widely owned
Evidence for behavior change techniques with wearables?
💓MIS-C:
-overlapping features with Kawasaki, MAS/HLH
+GI, +cytopenias
💉COVID vax reduces risk by >90% ("RFK Jr, please listen...🙏)
💉RECOVERY trial: MP alone may be acceptable (vs IVIG)
#ACR24 #BCRC
💓rheumatic heart disease: ⬆️incidence (2019 GBD); work on improved screening with TTE
💓Kawasaki dz: see 2021 ACR, 2017 AHA guidelines for mgmt
-IVIG (first 10 days) to prevent coronary artery aneurysms
-IL-17 as biomarker?
#ACR24 #BCRC
#ACR24 #BCRC on CVD/RMD
⭐️Bryce Binstadt - pediatric rheum disease & CV manifestations
👉In peds rheum disease, pts face a lifetime of elevated CV risk
💊Juvenile SLE: APPLE trial negative for atorva vs pbo on CIMT progression
👩⚕️🧑⚕️Last benefit is that collaboration helps specialists learn from each other
🦸Now, with immunomodulators being increasingly studied for CVD: rheum to the rescue?
#ACR24 #BCRC
-treatment of CV risk factors with T2T approach, with understanding of lipid paradox iso b/tsDMARD use
-pt focused with coordination of care, attention to lifestyle & behavioral factors, tailored support
#ACR24 #BCRC
💓How does UofT cardiorheum program improve CVD care?
-improved screening & CVD detection w std screening & contextualization by cards & rheum together; also using biomarkers & CVD imaging beyond TTE
#ACR24 #BCRC
👉Move towards shared care:
-interdisciplinary: traditional referrals
-multidisciplinary
-transdisciplinary
Dr Kuriya makes a plug for tomorrow's panel with @ashimamakol.bsky.social @kristenyoung.bsky.social & Kerry Spichiger, with @nartherheumie.bsky.social & I moderating
#ACR24 #BCRC
💓Inflammation doesn't act alone; high prevalence of cardiometabolic RFs
🛑Barriers to good CV prevention in RMD:
-awareness
-time, resources
-silos of care
-focus on acute care > prevention
#ACR24 #BCRC
#ACR24 #BCRC on CVD/RMD
⭐️Bindee Kuriya - Cardio-Rheum clinical care models
👉Driving rationale: 50% of RA death is d/t CVD & there is still excess death in those <50 yrs (the mortality gap) despite improvement in RA mgmt
🔍Inflammatory phenotype (time in high dz activity)
👉However, excess risk reductions of CV mortality & CVE in RA vs gen pop have not been consistently shown in studies
🧐Current Q: do we really need RMD specific CV risk calculators? Should we focus on CV prevention strategy instead?
#ACR24 #BCRC
Disease activity over time hard to capture in these scores. Would a surrogate work better?
📉CV mortality & CVE trends over time have improved
-Olmsted County (US)
-BC, Canada
-Sweden
#ACR24 #BCRC
🫀CVD risk in SLE:
-SLECRE didn't perform better than gen pop calculators
-SLECRISK: newer & needs external validation
#ACR24 #BCRC
🫀CVD risk in RA:
-F'ham risk score has poor calibration & poor discrimination (C statistic of ~0.5)
-AHA PREVENT, C statistic ~0.7 (similar performance to Pooled Cohort Equation)
#ACR24 #BCRC
Performance of risk scores:
1. Calibration - is absolute risk prediction accurate?
2. Discrimination - do we get correct rank of low to high risk? Assessed with ROC
#ACR24 #BCRC
#ACR24 #BCRC on CVD/RMD
⭐️Cynthia Crowson - CV risk models
Purpose: individualized preventive strategies
In gen pop, many CV risk scores with AHA PREVENT as newest
-includes HF
-removes race
-includes CKM: CV/kidney/metabolic
Part of the perfect storm of maladaptive metabolism within the RA joint: 🌊
-synovium is nutrient-stressed (limited glucose)
-poor mitochondria DNA repair mechanisms
-T cells: caspase activation
-lysosomal failure; poor waste mgmt
#ACR24 #BCRC
#ACR24 #BCRC on CVD/RMD
⭐️Cornelia Weyand with a more molecular take on metabolism & inflammation
🧐Central Q: in RA is pathogenic immunity a result of maladaptive metabolism?
Since this was conducted during the pandemic, the intervention was shifted to be delivered remotely
pubmed.ncbi.nlm.nih.gov/38126260/
👉SWET improved RA dz activity & cardiometabolic risk factors & PROs
#ACR24 #BCRC
🚴SWET-RA: older, overweight/obese, seropositive RA
-supervised exercise included aerobic & resistance training; caloric restriction diet
-CHAT comparator: counseling sessions + nutrition meeting
#ACR24 #BCRC
#ACR24 #BCRC on CVD/RMD
⭐️Brian Andonian - exercise, weight loss, inflammation
pubmed.ncbi.nlm.nih.gov/30587230/
🚴HIIT for RA: 10 wks treadmill walking; improved RA dz activity as well as cardiopulm fitness
-impact on innate immune function?
