Come from Venezuela to contribute to leading an international team in Czechia has been an amazing and challenging experience. I have the luck to work with a wonderful team that is pushing their boundaries and producing each day great results. Here is the Kardiovize Team in numbers since September 2019, when I arrived in the team:   

Kardiovize in Numbers

#

Number of publications

·        Kardiovize data – 8

·        International Collaboration – 12

·        Poster in Conferences – 4

24

Number of grants submitted

7

Number of subjects evaluated in the Kardiovize Follow up survey

600

Number of subjects evaluated in the Mental Health and COVID-19 survey

330

Number of Conferences organized

1

Number of papers currently submitted

13

Number of interventions that started

1

Number of participants in the pilot study of the Czech Diabetes Prevention Program

30

Here the list of our main partners in this journey

Intra – Institutional Collaboration FNUSA – ICRC 

Translational Neuroscience and Aging Program Research Group – ICRC-FNUSA, Brno, Czechia. Led by Dr. Stokin

Epigenetics, Metabolism and Aging (EMA) – ICRC-FNUSA, Brno, Czechia. Led by Dr. Vinciguerra

Acute Coronary Syndromes (ACS) – – ICRC-FNUSA, Brno, Czechia. Led by Dr. Hlinomaz

Biostatistics (BST) Department – ICRC-FNUSA, Brno, Czechia.

Czech National Collaboration

Masaryk University, Brno, Czech Republic

Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic

Department of Social Geography and Regional Development, Faculty of Science, Charles University Prague, Czech Republic

Internal Medicine, Second Faculty of Medicine, Charles University Prague, Czech Republic

International Collaboration

Mayo Clinic, Rochester, MN, US.

Harvard T.H. Chan School of Public Health, Boston, US.

LifeDoc Health, Memphis, TN, USA

Icahn School of Medicine at Mount Sinai New York USA

University College London, London, UK

List of Publications since September 2019 to August 2021:

Kardiovize Data

  1. Anna Polcrova, Iuliia Pavlovska, Geraldo A. Maranhao Neto, Sarka Kunzova, Maria M. Infante-Garcia, Jose R. Medina-Inojosa, Francisco Lopez-Jimenez, Jeffrey I. Mechanick, Ramfis Nieto-Martinez, Gorazd B. Stokin, Juan P. Gonzalez-Rivas. Visceral Fat Area and Cardiometabolic Risk: The Kardiovize Study. Obesity Research & Clinical Practice. 18 March 2021. https://doi.org/10.1016/j.orcp.2021.03.005
  2. Iuliia Pavlovska, Jeffrey I. Mechanick, Geraldo A. Maranhao Neto, Maria M. Infante-Garcia, Ramfis Nieto-Martinez, Sarka Kunzova, Anna Polcrova, Robert Vysoky, Jose R. Medina-Inojosa, Francisco Lopez-Jimenez, Gorazd B. Stokin, Juan P. González-Rivas. Arterial Stiffness and Cardiometabolic-Based Chronic Disease: The Kardiovize Study. Endocrine Practice. March 2021 DOI:1016/j.eprac.2021.03.004
  3. Juan P. Gonzalez‐Rivas, Jeffrey I. Mechanick José Pantaleón Hernandez María M Infante‐Garcia Iuliia Pavlovska José R. Medina‐Inojosa Sarka Kunzova Ramfis Nieto‐Martinez Jan Brož Luca Busetto  Geraldo A Maranhao Neto  Francisco Lopez‐Jimenez. Jana Urbanová Gorazd B Stokin. Prevalence of Adiposity‐Based Chronic Disease in middle‐aged adults from Czech Republic. The Kardiovize Study. Obesity Science and Practice. 25 February 2021 https://doi.org/10.1002/osp4.496
  4. Juan P. Gonzalez-Rivas, Jeffrey I. Mechanick, Maria M. Infante-Garcia, Jose R. Medina-Inojosa, Iuliia Pavlovka, Ota Hlinomaz, Petr Zak, Sarka Kunzova, Ramfis Nieto-Martinez, Mária Skladaná, Jan Brož, Jose Pantaleon Hernandez, Francisco Lopez-Jimenez, Gorazd B Stokin. Prevalence of Dysglycemia-Based Chronic Disease (DBCD) in a European Population: A New Paradigm to Address Diabetes Burden. The Kardiovize Study. Endocr Pract 2020 https://doi.org/10.1016/j.eprac.2020.10.003 
  5. Jan Sebastian Novotný, Juan Pablo Gonzalez-Rivas, Šárka Kunzová, Mária Skladaná, Anna Pospíšilová, Anna Polcrová, Jose Ramon Medina-Inojosa, Francisco Lopez-Jimenez, Yonas Endale Geda, and Gorazd Bernard Stokin Frontiers in Psychiatry. Risk Factors Underlying COVID-19 Lockdown-Induced Mental Distress. Front. Psychiatry 11:603014. doi: 10.3389/fpsyt.2020.603014
  6. Andrea Maugeri, Ota Hlinomaz, Antonella Agodi, Martina Barchitta, Sarka Kunzova, Hana Bauerova 1, Ondrej Sochor 1, Jose R. Medina-Inojosa 3, Francisco Lopez-Jimenez, Manlio Vinciguerra, Gorazd Bernard Stokin, and Juan Pablo González-Rivas. Is Drinking Alcohol Really Linked to Cardiovascular Health? Evidence from the Kardiovize 2030 Project. Nutrients 2020, 12, 2848; doi:10.3390/nu12092848
  7. Iuliia Pavlovska, Sarka Kunzova, Juraj Jakubik, Jana Hruskova, Maria Skladana, Irma Magaly Rivas-Serna, Jose R. Medina-Inojosa, Francisco Lopez-Jimenez, Robert Vysoky, Yonas E. Geda, Gorazd B. Stokin, Juan P. González-Rivas. Associations between high triglycerides and arterial stiffness in a population-based sample: Kardiovize Brno 2030 study. Lipids in Health and Disease (2020) 19:170. https://doi.org/10.1186/s12944-020-01345-0
  8. Iuliia Pavlovska, Anna Polcrova, Jeffrey I. Mechanick, Jan Brož, Maria M. Infante-Garcia, Ramfis Nieto-Martínez, Geraldo A. Maranhao Neto, Sarka Kunzova, Maria Skladana, Jan S. Novotny, Hynek Pikhart, Jana Urbanová, Gorazd B. Stokin, Jose R. Medina-Inojosa, Robert Vysoky, Juan P. González-Rivas. Dysglycemia and Abnormal Adiposity Drivers of Cardiometabolic-Based Chronic Disease in the Czech Population: Biological, Behavioral, and Cultural/Social Determinants of Health. Nutrients 2021, 13, 2338. https://doi.org/10.3390/nu13072338

 International Collaboration

  1. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. March 2021. eLife Sciences. DOI: 7554/eLife.60060.
  2. Ramfis Nieto-Martínez, Juan P. González-Rivas, Eunice Ugel, Maritza Duran, Eric Dávila, Ramez Constantino, Alberto García, Jeffrey I. Mechanick, María Inés Marulanda. Cardiometabolic risk factors in Venezuela. The EVESCAM study: a national cross-sectional survey in adults. Prim Care Diabetes. 2021 Feb;15(1):106-114. doi: 10.1016/j.pcd.2020.07.006. Epub 2020 Aug 5. https://www.primary-care-diabetes.com/article/S1751-9918(20)30228-X/fulltext
  3. Juan P. González-Rivas, Jeffrey I. Mechanick, Rocio Iglesias-Fortes, Diana De Oliveira-Gomes3, Jesús Silva, José Valencia, Estherbany Figueroa, Maritza Duran, Eunice Ugel, María M. Infante-García, María Inés Marulanda, Ramfis Nieto-Martínez. Optimal waist circumference cutoff values to predict cardiometabolic alterations in a Venezuela national representative sample. The EVESCAM study. Arch Cardiol Mex 2020 Dec 23. doi: 10.24875/ACM.20000165.
  4. NCD Risk Factor Collaboration (NCD-RisC) Juan P Gonzalez-Rivas. Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants. Lancet 2020; 396: 1511–24.
  5. Dina Goodman, Juan P. González-Rivas, Lindsay M. Jaacks, Maritza Duran, María Inés Marulanda, Eunice Ugel, Josiemer Mattei, Jorge E. Chavarro & Ramfis Nieto-Martinez. Dietary intake and cardiometabolic risk factors among Venezuelan adults: a nationally representative analysis. BMC Nutr 6, 61 (2020). https://doi.org/10.1186/s40795-020-00362-7
  6. NCD Risk Factor Collaboration (NCD-RisC). Repositioning of the global epicentre of nonoptimal cholesterol. Nature. In press. https://doi.org/10.1038/s41586-020-2338-1
  7. NCD Risk Factor Collaboration (NCD-RisC). Trends in cardiometabolic risk factors in the Americas between 1980 and 2014: a pooled analysis of population-based surveys. January 2020 The Lancet Global Health 8(1):e123-e133. DOI: 10.1016/S2214-109X(19)30484-X
  8. Diana De Oliveira-Gomes, Juan P. González-Rivas, Katherine A. Rosales-Pereira, Leidy De Jesus Henrriques, Rocío Iglesias-Fortes, Eunice Ugel, Maritza Duran, Erik L Dávila Alcalá, María Inés Marulanda, Ramfis Nieto-Martínez. Prevalencia De  Obesidad  En  La  Región  Capital  De Venezuela. Resultados Del Evescam. Rev Venez Endocrinol Metab 2020;18(2): 57-63
  9. Juan P. González-Rivas, Jeffrey I. Mechanick, Carlos Ponte, Diana de Oliveira-Gomes, Rocio Iglesias-Fortes, Livia Machado, Maritza Duran, Maria Inés Marulanda, Ramfis Nieto-Martínez. Impact of the complex humanitarian crisis on the epidemiology of the cardiometabolic risk factors in Venezuela. Clínica e Investigación en Arteriosclerosis. Available online 24 July 2021. https://doi.org/10.1016/j.arteri.2021.04.002
  10. Nieto-Martínez R., González-Rivas J.P., Mechanick J.I. (2020) Survey of International Centers that Incorporate Lifestyle Medicine. In: Mechanick J., Kushner R. (eds) Creating a Lifestyle Medicine Center. Springer, Cham. https://doi.org/10.1007/978-3-030-48088-2_30
  11. Nieto-Martínez R., González-Rivas J.P. (2020) Transcultural Lifestyle Medicine. In: Mechanick J., Kushner R. (eds) Creating a Lifestyle Medicine Center. Springer, Cham. https://doi.org/10.1007/978-3-030-48088-2_19
  12. Juan Pablo Gonzalez-Rivas. Remisión De Diabetes Mellitus Tipo 2 ¿Cirugía Bariátrica Vs Estilo De Vida? Rev Venez Endocrinol Metab 2020;18(2): 43-45.

Posters

  1. Neto, G. A.; Pavlovska, I; Polcrova, A.; Mechanick, J. I.; Infante-Garcia, M. M., Medina Inojosa, J. R., Kunzova, S.; Nieto-Martinez, R.; Lopez Jimenez, F., Stokin, G. B.; Gonzalez-Rivas, J. P. Importance of Time Watching Television on the association of Physical Activity Level with Cardiometabolic Risk Factors. The Kardiovize Study. European Congress on Obesity (ECO Online 2021). 28th Congress, 10-13 May, 2021. Poster: EP3-17. Obes Facts 2021;15 (suppl 1): 99. Doi:10.1159/000515911
  1. Pavlovska, I; Mechanick, J. I.; Neto, G. A.; Infante-Garcia, M. M., Nieto-Martinez, R.; Kunzova, S., Polcrova, A.; Vysoky, R; Medina Inojosa, J. R., Lopez Jimenez, F., Stokin, G. B.; Gonzalez-Rivas, J. P. Arterial stiffness and cardiometabolic-based chronic disease: the Kardiovize study. European Congress on Obesity (ECO Online 2021). 28th Congress, 10-13 May, 2021. Poster: AD15.01. Obes Facts 2021;15 (suppl 1): 61. Doi:10.1159/000515911
  1. Polcrova, A., Pavlovska, I.; Neto, G. A.; Kunzova, S., Infante-Garcia, M. M., Medina Inojosa, J. R., Lopez Jimenez, F., Mechanick, J. I.; Nieto-Martinez, R.; Stokin, G. B.; Pikhart, H.; Gonzalez-Rivas, J. P. Visceral Fat Area and Cardiometabolic Risk: The Kardiovize Study. European Congress on Obesity (ECO Online 2021). 28th Congress, 10-13 May, 2021. Poster: AD02.04. Obes Facts 2021;15 (suppl 1):24. Doi:10.1159/000515911
  1. Juan P. Gonzalez-Rivas, Jeffrey I. Mechanick,Maria M. Infante-Garcia, Jose R. Medina-Inojosa, Iuliia Pavlovka, Ota Hlinomaz1 Petr Zak, Sarka Kunzova, Ramfis Nieto-Martinez, Mária Skladaná, Jan Brož, Jose Pantaleon Hernandez, Francisco Lopez-Jimenez,4 Gorazd B Stokin. Prevalence of dysglycemia-based chronic disease DBCD in Brno, Czech Republic: a new paradigm to address diabetes burden. The Kardiovize study. 56th EASD Annual Meeting 21 – 25 September 2020. Diabetologia, Vol 63; Supplement 1, poster #345.

List of Grants Submitted

  1. Effect of epicardial adipose tissue on the extent of atherosclerotic changes in coronary arteries as a basis for coronary artery disease

Applicants: Ing. Jana Hrušková & Juraj Jakubik

Aims: To determine if the severity of atherosclerotic changes in a specific section of the coronary artery is directly related to the thickness of EAT located immediately in the area of this atherosclerotic lesion.

Funding Agency: AZV

Total requested funding:  4,521,000.00- Czech koruna

  1. Prevalence of novel tobacco products use in young adults of the Czech Republic – Cross-sectional mix survey in the population of high schools and university students in Brno

Applicants: Sarka Kunzova & Maria Skladana & Juan Pablo Gonzalez Rivas

Aims:

  1. To determine the prevalence of consumption of the novel tobacco products (HTPs, e-cigarettes and others), regular cigarettes, and other traditional tobacco products in young adults (age 18-22) – students of high schools and universities in Brno city, Czech Republic.
  2. To determine the patterns of tobacco use and changes in smoking status related to the use of novel tobacco products.
  3. To investigate perceptions and beliefs associated with novel tobacco products marketing and use in this specific population group, using qualitative evaluation methods.

Funding Agency: AZV

Total requested funding: 4,726,250 Czech koruna.

  1. Children’s Afterschool Intervention Program for The Promotion of Desirable Health and Nutrition Behavior.

Applicants: Anna Polcrova & Iuliia Pavlovska & Juan Pablo Gonzalez Rivas

Aims:

  1. To adapt the content of Food and Fun afterschool program for the Czech population
  2. To implement a pilot evaluation of the program in afterschool centers, during school year 2022-2023
  3. To evaluate the implementation process of the program
  4. To evaluate the change in the diet composition and physical activity habits and anthropometric measurements

Funding Agency: AZV

Total requested funding: 6,619,625 – Czech koruna.

  1. Hybridized Three Steps (HITS) Intervention for Diabetes Prevention and Remission. The HITS DIABETES program (Multi-country intervention including Czechia, Spain, and France)

Applicants: Juan Pablo Gonzalez Rivas & Didac Mauricio & Patrick Ritz & Jan Broz & Josep Franch-Nadal

Aims:

  1. Transcultural adaptation to three European populations an LSI program focused on an intensive weight reduction of patients with overweight/obesity with or without prediabetes/T2D named HITS DIABETES. This transcultural adaptation will be done using the transcultural Diabetes Nutrition Algorithm process and will produce an adapted algorithm of diagnoses, a path of management, and a culturally tailored core/curriculum program.
  2. To evaluate the implementation process of the HITS DIABETES program using the Framework for Implementation, in a multi-center pilot study with six months of intervention.

Funding Agency: JPI ERA-Net HDHL-INTIMIC

Total requested funding (in euro’s): 536.385

  1. Use of the Simple app and the Hearts package to improve the cascade of care for hypertension in Uganda. (International Project in Collaboration among Czechia, Kenya, and Uganda)

Applicants: Juan Pablo Gonzalez Rivas & Bruce Twinamasiko & Charles Mondo & Shukri Mohamed.

Aims:

  1. To coordinate workshops to adapt the HEARTS package to Uganda and incorporate the use of mobile technology, the Simple app, to improve the registry and management of hypertension.
  2. To coordinate and support the implementation of a pilot intervention assessing the integration of the Simple app with the HEARTS package. This includes:
  3. Its evaluation in a demonstration site, Kisiizi Community, Uganda.
  4. Design a implementation plan, this will include strategies to improve health literacy and shortage of drugs
  5. Build capacity: training of medical doctors, nurses, and CHWs to use the HEARTS package and the Simple app.
  6. Evaluation of the implementation process and the effectiveness to control hypertension.
  7. To coordinate dissemination activities.

Funding Agency: Horizon 2020. Call: H2020-SC1-DTH-2018-2020

Total requested funding (in Euro’s): 1,723,587.50

  1. The assessment of nutrition literacy with a focus on dietary patterns and cardiometabolic risk in Czechia

Applicants: RNDr. Michala Lustigová, Ph.D. & Mgr. Anna Polcrová

Aims: 

  1. In the first and second years, to validate a questionnaire to measure nutrition literacy in the Czech adult population.
  2. In the third year, to implement a population-based survey, including health examination, to collect data on nutrition literacy, dietary patterns, cardiometabolic risk factors, and social determinants.
  3. In the last year, to determine the prevalence of low nutrition literacy and its association with dietary patterns, cardiometabolic risk factors, and social determinants in the Czech adult population.

Funding Agency: AZV

Total requested funding: 6 934 000 CZK

  1. Health Outcomes in Post-Stroke Patients Monitored by Objective Measurement of Physical Activity: Effects of Mobile Technology

Applicants: Geraldo A. Maranhao Neto, Ph.D.

Aims: 

  1. To implement an intervention to post-stroke patients in order to achieve the recommendations of ≥ 5000 steps/day during 1- year;
  2. To compare the effectiveness of two different strategies of intervention: the use of physical activity tracker Fitbit to objectively measure the steps and the use of the same tracker with the addition of motivational text messages;
  3. To analyse the association between the number of steps/day and health outcomes

Funding Agency: AZV

Total requested funding: 8 513 000 CZK

Events

In October 16, 2020, we organized the Kardiovize Conference Day –.

Intervention Programs

We started a transculturalization process addressing dysglycemia and abnormal adiposity drivers. Summary of the process:

Currently, an evidence-based transculturalization process for lifestyle interventions is being developed to address the increasing burden of dysglycemia and abnormal adiposity in Czechia. Transculturalization describes the process of adapting clinical recommendations from one culture to another, using source and target culture experts in an interactive setting. Optimally, this process is evidence-based and incorporates multiple validated components to significantly improve the prevention of Cardiometabolic-Based Chronic Disease (CMBCD) progression.  By extension, transculturalization positively impacts chronic disease risk factor incidence and prevalence, as well as quality of life and healthcare costs.

The current process started with analyses of prevalences rates of ABCD and DBCD [Kardiovize Data Publications #3 and #4, see above] in Czechia, and impact of these metabolic drivers in cardiovascular health [Kardiovize Data Publications #2]. Subsequently, healthy versus unhealthy cut-off values of visceral adiposity in adults were determined [Kardiovize Data Publications #1]. Various biological, behavioral, environmental, and cultural factors relevant to dysglycemia and abnormal adiposity were then compiled and presented as a narrative review [Kardiovize Data Publications #8]. This document presents the resultant comprehensive transcultural adaption of the CMBCD model for the Czech population (tCMBCD-CZ). Furthermore, implementation of the tCMBCD-Cz is facilitated through the development of two pragmatic instruments: a tCMBCD-CZ algorithm to assist with decision-making for healthcare professionals (HCPs), and a tCMBCD-CZ toolkit to assist with education, engagement, and adherence for patients.

With this project we are creating several outputs:

The tCMBCD-CZ algorithm

Figure: Transcultural Cardiometabolic-Based Chronic Disease (CMBCD) Algorithm using locally adapted tools and recommendations. See also Toolkit in Annex. Abbreviations: ABCD – Adiposity-based Chronic Disease, BMI – body mass index, BP- blood pressure, CMBCD – Cardiometabolic-based Chronic Disease, DBCD – Dysglycemia-based Chronic Disease, T2D – type 2 diabetes

The Transcultural Adaptation of the Diabetes Prevention Program Core Curriculum

We adapted the content of the Diabetes Prevention Program (DPP) to the Czech culture. This included the process of

  1. Translation to the Czech language
  2. Review and transcultural adaptation using the Ecological Validity Framework in different layers of specialization
  • Two nutritionists, then
  • Two physicians, an internist and a specialist in lifestyle intervention, then
  • Two diabetologist, then
  • Two lay collaborators

Examples of the adapted core curriculum

The tCMBCD-CZ Toolkit

The aim of the toolkit is to assist with education, engagement, and adherence for patients.

Examples of the content:

Recommendations

Risk Factors Management: General recommendations 

  1. Czech Version’s Mediterranean diet meal plan
  2. Physical activity recommendations template.

Action Plan for Physical Activity: It is recommended at least 150 min or more of moderate-to-vigorous intensity aerobic activity per week or minimum 75 min/week of vigorous-intensity, at least 3 days/week. Resistance training is recommended two or more times per week for muscle mass maintenance and growth. Stretching exercises – are recommended after every exercise routine for maintaining a full range of movement.

Provide the recommendations using an action plan, this should be realistic, doable (small changes improving progressively), specific (in detail), flexible (adapt – improve), focus on behaviors, and enjoyable.

Implementation

With these materials, a physician, nutritionist, and coach were trained and a pilot evaluation started in July 2021, with 30 participants. 

Here is an example of the delivery of the online sessions with the lifestyle Coach

We hope to continue maintaining our productivity contributing with high-quality papers and addressing research challenges in innovative ways.

Juan Pablo Gonzalez Rivas

Juan Pablo González Rivas

PI – Kardiovize Study