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Mok Y, Ballew SH, Schrack JA, Howard CM, Butler KR, Wagenknecht L, Coresh J, Budoff M, Tanaka H, Blaha MJ, Matsushita K. Mid-life physical activity and calcification of coronary arteries, aorta, and cardiac valves in late life: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2025; 402:119115. [PMID: 39922082 PMCID: PMC11890941 DOI: 10.1016/j.atherosclerosis.2025.119115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 12/20/2024] [Accepted: 01/26/2025] [Indexed: 02/10/2025]
Abstract
BACKGROUND AND AIMS The association of physical activity (PA) with coronary artery calcification (CAC), one of the strongest predictors of cardiovascular disease, is unclear. Moreover, different domains of PA (e.g., exercise/sports vs. work) and extra-coronary calcification (ECC) have not been extensively studied. We comprehensively evaluated the association of PA with CAC and ECC. METHODS We investigated 2025 ARIC participants (age 73-95 years) without coronary heart disease at visit 7 (2018-19). Mid-life total and domain-specific (sport, leisure, and work) PA scores were estimated using a modified Baecke questionnaire. We modeled the averaged PA scores at visit 1 (1987-89; age 44-65 years) and visit 3 (1993-95; age 49-70 years). We explored continuous CAC and ECC (log-transformed [Agatston score+1]) or the presence of any CAC and ECC (Agatston score >0 vs. 0) as dependent variables using multivariable linear regression and logistic regression models, as appropriate. RESULTS Total PA scores showed a U-shaped association with both continuous and any vs. no CAC. Higher total PA scores were associated inversely with ECC and most pronounced for the descending aorta calcification. The associations were generally consistent across demographic subgroups. When specific PA domains were examined, higher sport and work PA scores were significantly associated with lower descending aorta calcification. CONCLUSIONS Mid-life PA showed a U-shaped association with late-life CAC. Among ECC, the association of higher PA with lower calcification of the descending aorta was the most consistent. Our results further corroborate a complex interplay between PA and vascular health and unique pathological processes across different vascular beds.
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Affiliation(s)
- Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shoshana H Ballew
- Optimal Aging Institute, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Lynne Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Josef Coresh
- Optimal Aging Institute, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Matthew Budoff
- Endowed Chair of Preventive Cardiology, Lundquist Institute, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Sung DE, Sung KC. The Paradox of Physical Activity and Coronary Artery Calcification: Implications for Cardiovascular Risk. J Clin Med 2024; 13:6523. [PMID: 39518662 PMCID: PMC11547064 DOI: 10.3390/jcm13216523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 10/27/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024] Open
Abstract
The introduction of CT scans and the subsequent Agatston score in the 1990s drastically improved our ability to detect coronary artery calcification (CAC). This led to its incorporation into cardiovascular risk assessment guidelines set forth by organizations such as the American Heart Association (AHA) and the American College of Cardiology (ACC). Over time, these guidelines have evolved significantly, reflecting an increasing understanding of CAC. Physical activity has become a key factor in the management of cardiovascular disease. However, the relationship between physical activity and CAC remains complex. Although physical activity is generally beneficial for cardiovascular health, paradoxically, high levels of physical activity have been associated with elevated CAC scores. However, these higher CAC levels may indicate the presence of more stable, calcified plaques that provide protection against plaque rupture. These contradictory findings call for balanced interpretations that acknowledge the cardiovascular benefits of physical activity. This review examines the historical development of clinical guidelines for CAC, the paradoxical relationship between physical activity and CAC, and potential underlying mechanisms. It emphasizes the need for future research to utilize objective measures and consistent methodologies to better understand the relationship between physical activity and CAC.
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Affiliation(s)
- Da-Eun Sung
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea
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Narendrula A, Brinza E, Horvat Davey C, Longenecker CT, Webel AR. Relationship between objectively measured physical activity and subclinical cardiovascular disease: a systematic review. BMJ Open Sport Exerc Med 2024; 10:e001596. [PMID: 38292295 PMCID: PMC10826575 DOI: 10.1136/bmjsem-2023-001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
Introduction The association of physical activity (PA) with subclinical cardiovascular disease (CVD) is unclear. Clarifying this relationship may inform cardiovascular prevention strategies. Methods We performed a systematic review (CRD42021226089) using Medline, Embase, CINAHL and Cochrane (1 January 2000 to 1 September 2023). Studies published with adult populations exploring the relationship between objectively measured PA and subclinical CVD were included. Subclinical CVD was assessed using: ankle-brachial index (ABI); arterial stiffness; carotid artery disease; coronary artery atherosclerosis; endothelial function; and measures of cardiac structure and function. The Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and Cochrane Risk of Bias tools were used for quality review. Results Of 68 included studies, most supported an inverse relationship between PA and subclinical CVD. Arterial stiffness was the most common outcome (n=40), and 33 studies suggested that less sedentary behaviour (SB), increased PA and/or higher intensity PA was associated with less arterial stiffness. Ten studies of carotid artery disease (total n=18), six of endothelial function (n=10), two of coronary artery disease (n=3) and all of ABI (n=6) suggested that PA or less SB is associated with less subclinical disease. Five studies assessing cardiac structure/function (n=6) suggested alterations in structure/function with PA. Conclusions PA reduces the risk of CVD events, and this systematic review demonstrates that some of the benefits may be mediated by an inverse association between PA and subclinical CVD. Interventions to increase PA are important for CVD prevention, so we provide a comprehensive overview of which surrogate outcome measures may be most useful to assess future CVD prevention interventions. PROSPERO registration number CRD42021226089.
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Affiliation(s)
- Aparna Narendrula
- Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Ellen Brinza
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine Horvat Davey
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Chris T Longenecker
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Allison R Webel
- University of Washington School of Nursing, Seattle, Washington, USA
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Ekblom-Bak E, Börjesson M, Ekblom Ö, Angerås O, Bergman F, Berntsson C, Carlhäll CJ, Engström G, Engvall J, Fagman E, Flinck A, Johansson P, Jujic A, Kero T, Lind L, Mannila M, Ostenfeld E, Persson A, Persson J, Persson M, Redfors B, Sandberg C, Wennberg P, Öhlin J, Östgren CJ, Jernberg T. Accelerometer derived physical activity and subclinical coronary and carotid atherosclerosis: cross-sectional analyses in 22 703 middle-aged men and women in the SCAPIS study. BMJ Open 2023; 13:e073380. [PMID: 37996228 PMCID: PMC10668326 DOI: 10.1136/bmjopen-2023-073380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES The aim included investigation of the associations between sedentary (SED), low-intensity physical activity (LIPA), moderate-to-vigorous intensity PA (MVPA) and the prevalence of subclinical atherosclerosis in both coronaries and carotids and the estimated difference in prevalence by theoretical reallocation of time in different PA behaviours. DESIGN Cross-sectional. SETTING Multisite study at university hospitals. PARTICIPANTS A total of 22 670 participants without cardiovascular disease (51% women, 57.4 years, SD 4.3) from the population-based Swedish CArdioPulmonary bioImage study were included. SED, LIPA and MVPA were assessed by hip-worn accelerometer. PRIMARY AND SECONDARY OUTCOMES Any and significant subclinical coronary atherosclerosis (CA), Coronary Artery Calcium Score (CACS) and carotid atherosclerosis (CarA) were derived from imaging data from coronary CT angiography and carotid ultrasound. RESULTS High daily SED (>70% ≈10.5 hours/day) associated with a higher OR 1.44 (95% CI 1.09 to 1.91), for significant CA, and with lower OR 0.77 (95% CI 0.63 to 0.95), for significant CarA. High LIPA (>55% ≈8 hours/day) associated with lower OR for significant CA 0.70 (95% CI 0.51 to 0.96), and CACS, 0.71 (95% CI 0.51 to 0.97), but with higher OR for CarA 1.41 (95% CI 1.12 to 1.76). MVPA above reference level, >2% ≈20 min/day, associated with lower OR for significant CA (OR range 0.61-0.67), CACS (OR range 0.71-0.75) and CarA (OR range 0.72-0.79). Theoretical replacement of 30 min of SED into an equal amount of MVPA associated with lower OR for significant CA, especially in participants with high SED 0.84 (95% CI 0.76 to 0.96) or low MVPA 0.51 (0.36 to 0.73). CONCLUSIONS MVPA was associated with a lower risk for significant atherosclerosis in both coronaries and carotids, while the association varied in strength and direction for SED and LIPA, respectively. If causal, clinical implications include avoiding high levels of daily SED and low levels of MVPA to reduce the risk of developing significant subclinical atherosclerosis.
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Affiliation(s)
- Elin Ekblom-Bak
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
| | - Mats Börjesson
- Center for Health and Performance, University of Gothenburg, Goteborg, Sweden
- Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - Örjan Ekblom
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
| | - Oskar Angerås
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
| | - Frida Bergman
- Department of Public Health and Clinical Medicine, Umeå Universitet, Umeå, Sweden
| | - Caroline Berntsson
- Department of Radiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Goteborg, Sweden
| | - Carl-Johan Carlhäll
- Department of Health, Medicine and Caring Sciences and Department of Clinical Physiology, Linköping University, Linkoping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences and Department of Clinical Physiology, Linköping University, Linkoping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
| | - Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Goteborg, Sweden
| | - Agneta Flinck
- Department of Radiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Goteborg, Sweden
| | - Peter Johansson
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Amra Jujic
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital Malmö, Malmo, Sweden
| | - Tanja Kero
- Medical Image Centre, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences and Radiology, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Maria Mannila
- Department of Cardiology and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Anders Persson
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Jonas Persson
- Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine, University Hospital, Malmö, Sweden
| | - Björn Redfors
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Camilla Sandberg
- Department of Public Health and Clinical Medicine, Umeå Universitet, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umea, Sweden
| | - Patrik Wennberg
- Public Health and Clinical Medicine, Family Medicine, Umeå University, Umea, Sweden
| | - Jerry Öhlin
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization, Linköping University, Linkoping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
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Shahraki MN, Jouabadi SM, Bos D, Stricker BH, Ahmadizar F. Statin Use and Coronary Artery Calcification: a Systematic Review and Meta-analysis of Observational Studies and Randomized Controlled Trials. Curr Atheroscler Rep 2023; 25:769-784. [PMID: 37796384 PMCID: PMC10618336 DOI: 10.1007/s11883-023-01151-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE OF REVIEW This review aimed to determine the association between statin use and coronary artery calcification (CAC), as detected by computed tomography in the general population, in previously published observational studies (OSs) and randomized controlled trials (RCTs). RECENT FINDINGS A systematic search until February 2022 identified 41 relevant studies, comprising 29 OSs and 12 RCTs. We employed six meta-analysis models, stratifying studies based on design and effect metrics. For cohort studies, the pooled β of the association with CAC quantified by the Agatston score was 0.11 (95% CI = 0.05; 0.16), with an average follow-up time per person (AFTP) of 3.68 years. Cross-sectional studies indicated a pooled odds ratio of 2.11 (95% CI = 1.61; 2.78) for the presence of CAC. In RCTs, the pooled standardized mean differences (SMDs) for CAC, quantified by Agatston score or volume, over and AFTP of 1.25 years were not statistically significant (SMD = - 0.06, 95% CI = - 0.19; 0.06 and SMD = 0.26, 95% CI = - 0.66; 1.19), but significantly different (p-value = 0.04). Meta-regression and subgroup analyses did not show any significant differences in pooled estimates across covariates. The effect of statins on CAC differs across study designs. OSs demonstrate associations between statin use and higher CAC scores and presence while being prone to confounding by indication. Effects from RCTs do not reach statistical significance and vary depending on the quantification method, hampering drawing conclusions. Further investigations are required to address the limitations inherent in each approach.
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Affiliation(s)
- Mitra Nekouei Shahraki
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Soroush Mohammadi Jouabadi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Department of Data Science and Biostatistics, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands.
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Masson W, Barbagelata L, Falconi M, Arenaza DPD. Association between physical activity and coronary artery calcification estimated by computed tomography: A systematic review. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2023; 35:129-141. [PMID: 36371286 DOI: 10.1016/j.arteri.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The relationship between physical activity and coronary artery calcification (CAC) was evaluated in different studies during the last years, although the results were conflicting. OBJECTIVE The main objective of the present systematic review was to assess the association between different levels of physical activity and CAC score estimated by computed tomography (CT). METHODS This systematic review was performed according to PRISMA guidelines. A literature search was performed to detect studies that evaluated the association between physical activity and CAC score. The levels of physical activity evaluated were those reported by the original publications. The CAC score was estimated by CT and was reported in Agatston units. RESULTS Twenty six studies including 89,405 subjects were considered eligible for this research. The studies developed in the general population showed different results regarding the association between physical activity and CAC score: no association (7 studies), a positive association (4 studies), an inverse relationship (6 studies), a U-shaped relationship (2 studies), or different results depending on the subgroup evaluated (2 studies). In the largest studies, a positive association was observed. When we analyzed the studies that evaluated athletes, four studies showed a positive association between exercise intensity and CAC. CONCLUSION This systematic review showed disparate results regarding the association between physical activity and CAC score. The largest studies and most studies developed in athletes suggest that intense physical activity could be associated with high CAC score, although this hypothesis should be confirmed in future research.
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Affiliation(s)
- Walter Masson
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Leandro Barbagelata
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariano Falconi
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Gao JW, Hao QY, Lu LY, Han JJ, Huang FF, Vuitton DA, Wang JF, Zhang SL, Liu PM. Associations of long-term physical activity trajectories with coronary artery calcium progression and cardiovascular disease events: results from the CARDIA study. Br J Sports Med 2022; 56:854-861. [PMID: 35288374 DOI: 10.1136/bjsports-2021-105092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The study aimed to assess the associations of physical activity (PA) trajectories across a 25-year span with coronary artery calcium (CAC) progression, and subsequent risk of cardiovascular disease (CVD) events. METHODS We included 2497 participants from the Coronary Artery Disease Risk Development in Young Adults study who had computed tomography-assessment of CAC at baseline (year 15: 2000-2001) and follow-up (year 20 or 25) and at least three measures of PA from year 0 to year 25. Long-term PA trajectories were determined by latent class modelling using a validated questionnaire. RESULTS Among the included participants, 1120 (44.9%) were men, 1418 (56.8%) were white, and the mean (SD) age was 40.4 (3.6) years. We identified three distinct PA trajectories based on PA average levels and change patterns: low (below PA guidelines, n=1332; 53.3%); moderate (meeting and slightly over PA guidelines, n=919; 36.8%) and high (about three times PA guidelines or more, n=246; 9.9%). During a mean (SD) follow-up of 8.9 (2.1) years, 640 (25.6%) participants had CAC progression. Participants in the high PA trajectory group had a higher risk of CAC progression than those in the low PA trajectory group after adjustment for traditional cardiovascular risk factors (HR 1.51; 95% CI 1.18 to 1.94). However, high PA trajectory was not associated with an increased risk of incident CVD events (HR 1.01; 95% CI 0.44 to 2.31) and the incidence of CVD events in participants with CAC progression was similar across all three PA trajectory groups (p=0.736). CONCLUSION Long-term PA about three times the guidelines or more is independently associated with CAC progression; however, no additional risk of incident CVD events could be detected.
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Affiliation(s)
- Jing-Wei Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qing-Yun Hao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liu-Yi Lu
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia-Jin Han
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fei-Fei Huang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dominique A Vuitton
- Research Unit EA 3181, Université Bourgogne Franche-Comté, 25030 Besançon, France
| | - Jing-Feng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shao-Ling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pin-Ming Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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The association between prolonged sedentary time and coronary artery calcification in young healthy men in Korea: a cohort study. Sci Rep 2022; 12:2724. [PMID: 35177731 PMCID: PMC8854407 DOI: 10.1038/s41598-022-06739-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/31/2022] [Indexed: 12/03/2022] Open
Abstract
Coronary artery calcium score (CACS) is a useful method for predicting coronary artery disease in asymptomatic adults. In this study, we investigated the association between prolonged sedentary time and CACS. A cohort study was conducted in 14949 men with negative CACS (CACS = 0) at baseline who were followed up at least once. Sedentary time was categorized into < 7, 7–8, and ≥ 9 h/day. CACS was calculated by cardiac tomography. During 60,112.1 person-years of follow-up, 569 participants developed positive CACS. The multivariable adjusted hazard ratios (95% confidence intervals) for incident positive CACS comparing sedentary times of 7–8 h/day and ≥ 9 h/day to sedentary time of < 7 h/day were 1.25 (0.97–1.62) and 1.28 (1.03–1.59), respectively. This association was more strongly observed in the non-obese group (BMI < 25 kg/m2). In contrast, in the obese group (BMI ≥ 25 kg/m2), there was no significant association between sedentary time and incidence of positive CACS. Prolonged sedentary time was significantly associated with incidence of positive CACS in the study. CACS is also an effective screening tool for predicting future cardiovascular events in asymptomatic patients. Therefore, CACS can be an effective screening method for predicting coronary artery diseases in people with prolonged sedentary time, especially in metabolically healthy people.
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Sung KC, Hong YS, Lee JY, Lee SJ, Chang Y, Ryu S, Zhao D, Cho J, Guallar E, Lima JAC. Physical activity and the progression of coronary artery calcification. Heart 2021; 107:1710-1716. [PMID: 34544807 DOI: 10.1136/heartjnl-2021-319346] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The association of physical activity with the development and progression of coronary artery calcium (CAC) scores has not been studied. This study aimed to evaluate the prospective association between physical activity and CAC scores in apparently healthy adults. METHODS Prospective cohort study of men and women free of overt cardiovascular disease who underwent comprehensive health screening examinations between 1 March 2011 and 31 December 2017. Baseline physical activity was measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and categorised into three groups (inactive, moderately active and health-enhancing physically active (HEPA)). The primary outcome was the difference in the 5-year change in CAC scores by physical activity category at baseline. RESULTS We analysed 25 485 participants with at least two CAC score measurements. The proportions of participants who were inactive, moderately active and HEPA were 46.8%, 38.0% and 15.2%, respectively. The estimated adjusted average baseline CAC scores (95% confidence intervals) in participants who were inactive, moderately active and HEPA were 9.45 (8.76, 10.14), 10.20 (9.40, 11.00) and 12.04 (10.81, 13.26). Compared with participants who were inactive, the estimated adjusted 5-year average increases in CAC in moderately active and HEPA participants were 3.20 (0.72, 5.69) and 8.16 (4.80, 11.53). Higher physical activity was association with faster progression of CAC scores both in participants with CAC=0 at baseline and in those with prevalent CAC. CONCLUSION We found a positive, graded association between physical activity and the prevalence and the progression of CAC, regardless of baseline CAC scores.
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Affiliation(s)
- Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Yun Soo Hong
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Seung-Jae Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Yoosoo Chang
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea (the Republic of)
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea (the Republic of)
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea (the Republic of)
| | - Seungho Ryu
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea (the Republic of)
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea (the Republic of)
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea (the Republic of)
| | - Di Zhao
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Juhee Cho
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea (the Republic of)
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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10
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Matsushita S, Shimada A, Yamamoto T, Minematsu K, Inaba H, Kuwaki K, Amano A. Nutritional supplement drink reduces inflammation and postoperative depression in patients after off-pump coronary artery bypass surgery. World J Cardiol 2021; 13:348-360. [PMID: 34589170 PMCID: PMC8436681 DOI: 10.4330/wjc.v13.i8.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/13/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronary artery bypass grafting is a surgical treatment for ischemic heart disease. Although development in surgical technique and improvement of perioperative management reduced the postoperative complications, some patients still delayed in progress of postoperative rehabilitation. In this study, we aimed to investigate the effect of daily intake of an herbal medicine-containing drink for rehabilitation after surgery in patients with ischemic heart disease.
AIM To investigate the effect of taking an herbal medicine-containing, commercially available drink for postoperative rehabilitation in those patients.
METHODS Patients who underwent isolated off-pump coronary artery bypass (OPCAB) surgery were divided into two groups depend on the timing of the admission to the hospital: the Yunker (YKR) group, that consumed one bottle of a caffeine-free nutritional supplement drink on a daily basis and the control group (CTL) that underwent regular rehabilitation.
RESULTS A total of 229 patients (CTL = 130, YKR = 99) were enrolled. No significant differences were observed in the baseline characteristics between the two groups. The YKR group had a significantly increased number of daily steps postoperatively (P < 0.05) and had significantly lower postoperative serum tumor necrosis factor-alpha levels (P < 0.01), while no significant differences were observed in the levels of other inflammatory or stress-related cytokines (interleukin-6, adiponectin, superoxide dismutase, and urine 8-hydroxy-2′-deoxyguanosine) between the two groups. Also, the YKR group showed a significant improvement in the Hospital Anxiety and Depression Score (P < 0.05). Moreover, there were no differences in postoperative complications and the duration of postoperative hospital stay between the two groups.
CONCLUSION Our results demonstrated that the daily intake of an herbal medicine-containing drink after OPCAB surgery may have beneficial effects on cardiac rehabilitation by reducing inflammation markers and depression.
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Affiliation(s)
- Satoshi Matsushita
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Kazuo Minematsu
- Department of School Health, Graduate School of Education, Nagasaki University, Nagasaki 852-8521, Japan
| | - Hirotaka Inaba
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
- Department of Cardiovascular Surgery, Juntendo University Urayasu Hospital, Chiba 279-0021, Japan
| | - Kenji Kuwaki
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
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11
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Nutritional supplement drink reduces inflammation and postoperative depression in patients after off-pump coronary artery bypass surgery. World J Cardiol 2021. [DOI: 10.4330/wjc.v13.i8.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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12
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Kamimura D, Cain-Shields LR, Clark D, Oshunbade AA, Ashley KE, Guild CS, Loprinzi PD, Newton R, Blaha MJ, Suzuki T, Butler J, Hall JE, Correa A, Hall ME. Physical Activity, Inflammation, Coronary Artery Calcification, and Incident Coronary Heart Disease in African Americans: Insights From the Jackson Heart Study. Mayo Clin Proc 2021; 96:901-911. [PMID: 33714604 PMCID: PMC8026689 DOI: 10.1016/j.mayocp.2020.09.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine associations between physical activity (PA), inflammation, coronary artery calcification (CAC), and incident coronary heart disease (CHD) in African Americans. METHODS Among Jackson Heart Study participants without prevalent CHD at baseline (n=4295), we examined the relationships between PA and high-sensitivity C-reactive protein, the presence of CAC (Agatston score ≥100), and incident CHD. Based on the American Heart Association's Life's Simple 7 metrics, participants were classified as having poor, intermediate, or ideal PA. RESULTS After adjustment for possible confounding factors, ideal PA was associated with lower high-sensitivity C-reactive protein levels (β, -0.15; 95% CI, -0.15 to -0.002) and a lower prevalence of CAC (odds ratio, 0.70; 95% CI, 0.51-0.96) compared with poor PA. During a median of 12.8 years of follow-up, there were 164 incident CHD events (3.3/1000 person-years). Ideal PA was associated with a lower rate of incident CHD compared with poor PA (hazard ratio, 0.55; 95% CI, 0.31-0.98). CONCLUSION In a large community-based African American cohort, ideal PA was associated with lower inflammation levels, a lower prevalence of CAC, and a lower rate of incident CHD. These findings suggest that promotion of ideal PA may be an important way to reduce the risk of subclinical and future clinical CHD in African Americans.
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Affiliation(s)
- Daisuke Kamimura
- Department of Medicine, University of Mississippi Medical Center, Jackson; Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | | | - Donald Clark
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | | | - Kellan E Ashley
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Cameron S Guild
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Paul D Loprinzi
- Center for Health Behavior Research, University of Mississippi, University
| | - Robert Newton
- PA & Ethnic Minority Health Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD
| | - Takeki Suzuki
- Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - John E Hall
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, University of Mississippi Medical Center, Jackson
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson; Department of Physiology and Biophysics, Mississippi Center for Obesity Research, University of Mississippi Medical Center, Jackson
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13
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Optical Coherence Tomography for the Diagnosis of Exercise-Related Acute Cardiovascular Events and Inconclusive Coronary Angiography. J Interv Cardiol 2020; 2020:8263923. [PMID: 32774188 PMCID: PMC7395998 DOI: 10.1155/2020/8263923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 02/08/2023] Open
Abstract
Objectives The aim of this study is to assess the utility of optical coherence tomography (OCT) in patients with exercise-related acute coronary syndrome (ACS) presenting with inconclusive angiographic findings. Background Regular physical activity reduces the incidence of cardiovascular events. Nevertheless, the risk of ACS or sudden cardiac death (SCD) increases during sport. In adults older than 35 years, exercise-related ACS or SCD is associated with plaque rupture, but not infrequently patients present ambiguous angiographic findings. Methods Between September 2015 and January 2020, patients admitted for ACS or SCD triggered by physical exertion and with coronary stenosis ≤50% were included in this prospective observational study. OCT was performed on the artery deemed to be responsible of the event. Results Ten patients were enrolled, predominantly men (80%) of middle age (51 years old, IQR 41–63) with low cardiovascular risk burden. Cycling was the most frequent (50%) exercise-related trigger, 8 patients were regular sport practitioners, and 7 had the clinical event during strenuous exertion. Five patients presented with non-ST-elevation ACS, two with ST-elevation ACS, and three with SCD. Angiographic analysis showed nonsignificant stenosis in all patients (42% stenosis, IQR 36–46). OCT identified the etiology of the event in 9 patients (4 plaque erosion, 3 plaque rupture, 1 eruptive calcific nodule, and 1 coronary dissection). Treatment was adjusted according to OCT findings. Conclusions OCT is a valuable technique to identify the etiology of exercise-related ACS or SCD in patients with nonobstructive coronary arteries and, as a result, may lead to a more specific treatment.
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14
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Aengevaeren VL, Mosterd A, Sharma S, Prakken NHJ, Möhlenkamp S, Thompson PD, Velthuis BK, Eijsvogels TMH. Exercise and Coronary Atherosclerosis: Observations, Explanations, Relevance, and Clinical Management. Circulation 2020; 141:1338-1350. [PMID: 32310695 PMCID: PMC7176353 DOI: 10.1161/circulationaha.119.044467] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Physical activity and exercise training are effective strategies for reducing the risk of cardiovascular events, but multiple studies have reported an increased prevalence of coronary atherosclerosis, usually measured as coronary artery calcification, among athletes who are middle-aged and older. Our review of the medical literature demonstrates that the prevalence of coronary artery calcification and atherosclerotic plaques, which are strong predictors for future cardiovascular morbidity and mortality, was higher in athletes compared with controls, and was higher in the most active athletes compared with less active athletes. However, analysis of plaque morphology revealed fewer mixed plaques and more often only calcified plaques among athletes, suggesting a more benign composition of atherosclerotic plaques. This review describes the effects of physical activity and exercise training on coronary atherosclerosis in athletes who are middle-aged and older and aims to contribute to the understanding of the potential adverse effects of the highest doses of exercise training on the coronary arteries. For this purpose, we will review the association between exercise and coronary atherosclerosis measured using computed tomography, discuss the potential underlying mechanisms for exercise-induced coronary atherosclerosis, determine the clinical relevance of coronary atherosclerosis in middle-aged athletes and describe strategies for the clinical management of athletes with coronary atherosclerosis to guide physicians in clinical decision making and treatment of athletes with elevated coronary artery calcification scores.
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Affiliation(s)
- Vincent L Aengevaeren
- Department of Physiology (V.L.A., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands (A.M.)
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's University of London, United Kingdom (S.S.)
| | - Niek H J Prakken
- Department of Radiology, University Medical Center Groningen, The Netherlands (N.H.J.P.)
| | - Stefan Möhlenkamp
- Clinic of Cardiology and Intensive Care Medicine, Bethanien Hospital Moers, Germany (S.M.)
| | | | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, The Netherlands (B.K.V.)
| | - Thijs M H Eijsvogels
- Department of Physiology (V.L.A., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Powell C, Herring MP, Dowd KP, Donnelly AE, Carson BP. The cross-sectional associations between objectively measured sedentary time and cardiometabolic health markers in adults - a systematic review with meta-analysis component. Obes Rev 2018; 19:381-395. [PMID: 29178252 DOI: 10.1111/obr.12642] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 12/26/2022]
Abstract
Sedentary time is viewed as an independent risk factor for adverse cardiometabolic health (CMH). No systematic review and meta-analysis on the cross-sectional associations between objectively measured sedentary time and CMH markers has been conducted. PubMed, Scopus and Web of Science Core Collection were searched for papers that examined the cross-sectional association between objectively measured sedentary time and CMH markers in adults. Forty-six papers met the inclusion criteria. The included papers had a combined sample size of 70,576 and an age range of 18-87 years. To examine the effect of increased levels of sedentary time on CMH markers, data on effect sizes and moderators were extracted, where possible. By pooling the unadjusted data from the included papers, increased sedentary time was shown to have a significant detrimental association with fasting glucose (Δ = 0.12, 95% confidence interval [CI]: 0.02, 0.23), fasting insulin (Δ = 0.19, 95% CI: 0.06, 0.32), triglycerides (Δ = 0.25, 95% CI: 0.14, 0.37), high-density lipoprotein cholesterol (Δ = -0.20, 95% CI: -0.28, -0.13) and waist circumference (Δ = 0.25, 95% CI: 0.15, 0.35). How sedentary time was quantified and the device used to measure sedentary time significantly influence the size of the effect reported. Future interventions focused on both decreasing sedentary time and increasing physical activity may be the most effective strategy to improve CMH.
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Affiliation(s)
- C Powell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - M P Herring
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - K P Dowd
- Department of Sport and Health Sciences, Athlone Institute of Technology, Athlone, Ireland
| | - A E Donnelly
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - B P Carson
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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16
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Perry B, Herrington W, Goldsack JC, Grandinetti CA, Vasisht KP, Landray MJ, Bataille L, DiCicco RA, Bradley C, Narayan A, Papadopoulos EJ, Sheth N, Skodacek K, Stem K, Strong TV, Walton MK, Corneli A. Use of Mobile Devices to Measure Outcomes in Clinical Research, 2010-2016: A Systematic Literature Review. Digit Biomark 2018; 2:11-30. [PMID: 29938250 PMCID: PMC6008882 DOI: 10.1159/000486347] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/13/2017] [Indexed: 01/08/2023] Open
Abstract
Background The use of mobile devices in clinical research has advanced substantially in recent years due to the rapid pace of technology development. With an overall aim of informing the future use of mobile devices in interventional clinical research to measure primary outcomes, we conducted a systematic review of the use of and clinical outcomes measured by mobile devices (mobile outcomes) in observational and interventional clinical research. Method We conducted a PubMed search using a range of search terms to retrieve peer-reviewed articles on clinical research published between January 2010 and May 2016 in which mobile devices were used to measure study outcomes. We screened each publication for specific inclusion and exclusion criteria. We then identified and qualitatively summarized the use of mobile outcome assessments in clinical research, including the type and design of the study, therapeutic focus, type of mobile device(s) used, and specific mobile outcomes reported. Results The search retrieved 2,530 potential articles of interest. After screening, 88 publications remained. Twenty-five percent of the publications (n = 22) described mobile outcomes used in interventional research, and the rest (n = 66) described observational clinical research. Thirteen therapeutic areas were represented. Five categories of mobile devices were identified: (1) inertial sensors, (2) biosensors, (3) pressure sensors and walkways, (4) medication adherence monitors, and (5) location monitors; inertial sensors/accelerometers were most common (reported in 86% of the publications). Among the variety of mobile outcomes, various assessments of physical activity were most common (reported in 74% of the publications). Other mobile outcomes included assessments of sleep, mobility, and pill adherence, as well as biomarkers assessed using a mobile device, including cardiac measures, glucose, gastric reflux, respiratory measures, and intensity of head-related injury. Conclusion Mobile devices are being widely used in clinical research to assess outcomes, although their use in interventional research to assess therapeutic effectiveness is limited. For mobile devices to be used more frequently in pivotal interventional research – such as trials informing regulatory decision-making – more focus should be placed on: (1) consolidating the evidence supporting the clinical meaningfulness of specific mobile outcomes, and (2) standardizing the use of mobile devices in clinical research to measure specific mobile outcomes (e.g., data capture frequencies, placement of device). To that aim, this manuscript offers a broad overview of the various mobile outcome assessments currently used in observational and interventional research, and categorizes and consolidates this information for researchers interested in using mobile devices to assess outcomes in interventional research.
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Affiliation(s)
- Brian Perry
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Clinical Trials Transformation Initiative, Durham, North Carolina, USA
| | - Will Herrington
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer C Goldsack
- Clinical Trials Transformation Initiative, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Cheryl A Grandinetti
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kaveeta P Vasisht
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Martin J Landray
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lauren Bataille
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | | | - Corey Bradley
- Duke University Hospital, Durham, North Carolina, USA
| | | | - Elektra J Papadopoulos
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nirav Sheth
- MicroMedicine, Watertown, Massachusetts, USA
| | - Ken Skodacek
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Marc K Walton
- Janssen Research and Development, Titusville, New Jersey, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Clinical Trials Transformation Initiative, Durham, North Carolina, USA
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17
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Ekblom-Bak E, Ekblom Ö, Fagman E, Angerås O, Schmidt C, Rosengren A, Börjesson M, Bergström G. Fitness attenuates the prevalence of increased coronary artery calcium in individuals with metabolic syndrome. Eur J Prev Cardiol 2017; 25:309-316. [DOI: 10.1177/2047487317745177] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The association between cardiorespiratory fitness, physical activity and coronary artery calcium (CAC) is unclear, and whether higher levels of fitness attenuate CAC prevalence in subjects with metabolic syndrome is not fully elucidated. The present study aims to: a) investigate the independent association of fitness on the prevalence of CAC, after adjustment for moderate-to-vigorous physical activity and sedentary time, and b) study the possible attenuation of increased CAC by higher fitness, in participants with metabolic syndrome. Design Cross-sectional. Methods In total 678 participants (52% women), 50–65 years old, from the SCAPIS pilot study were included. Fitness (VO2max) was estimated by submaximal cycle ergometer test and moderate-to-vigorous physical activity and sedentary time were assessed using hip-worn accelerometers. CAC score (CACS) was quantified using the Agatston score. Results The odds of having a significant CACS (≥100) was half in participants with moderate/high fitness compared with their low fitness counterparts. Further consideration of moderate-to-vigorous physical activity, sedentary time and number of components of the metabolic syndrome did only slightly alter the effect size. Those with metabolic syndrome had 47% higher odds for significant CAC compared with those without metabolic syndrome. However, moderate/high fitness seems to partially attenuate this risk, as further joint analysis indicated an increased odds for having significant CAC only in the unfit metabolic syndrome participants. Conclusions Being fit is associated with a reduced risk of having significant CAC in individuals with metabolic syndrome. While still very much underutilized, fitness should be taken into consideration in everyday clinical risk prediction in addition to the traditional risk factors of the metabolic syndrome.
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Affiliation(s)
- Elin Ekblom-Bak
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Örjan Ekblom
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Erika Fagman
- Department of Radiology, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caroline Schmidt
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Börjesson
- Institute of Neuroscience and Physiology, Department of Food and Nutrition, and Sport Science, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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18
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Aengevaeren VL, Mosterd A, Braber TL, Prakken NHJ, Doevendans PA, Grobbee DE, Thompson PD, Eijsvogels TMH, Velthuis BK. Relationship Between Lifelong Exercise Volume and Coronary Atherosclerosis in Athletes. Circulation 2017; 136:138-148. [PMID: 28450347 DOI: 10.1161/circulationaha.117.027834] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/14/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Higher levels of physical activity are associated with a lower risk of cardiovascular events. Nevertheless, there is debate on the dose-response relationship of exercise and cardiovascular disease outcomes and whether high volumes of exercise may accelerate coronary atherosclerosis. We aimed to determine the relationship between lifelong exercise volumes and coronary atherosclerosis. METHODS Middle-aged men engaged in competitive or recreational leisure sports underwent a noncontrast and contrast-enhanced computed tomography scan to assess coronary artery calcification (CAC) and plaque characteristics. Participants reported lifelong exercise history patterns. Exercise volumes were multiplied by metabolic equivalent of task (MET) scores to calculate MET-minutes per week. Participants' activity was categorized as <1000, 1000 to 2000, or >2000 MET-min/wk. RESULTS A total of 284 men (age, 55±7 years) were included. CAC was present in 150 of 284 participants (53%) with a median CAC score of 35.8 (interquartile range, 9.3-145.8). Athletes with a lifelong exercise volume >2000 MET-min/wk (n=75) had a significantly higher CAC score (9.4 [interquartile range, 0-60.9] versus 0 [interquartile range, 0-43.5]; P=0.02) and prevalence of CAC (68%; adjusted odds ratio [ORadjusted]=3.2; 95% confidence interval [CI], 1.6-6.6) and plaque (77%; ORadjusted=3.3; 95% CI, 1.6-7.1) compared with <1000 MET-min/wk (n=88; 43% and 56%, respectively). Very vigorous intensity exercise (≥9 MET) was associated with CAC (ORadjusted=1.47; 95% CI, 1.14-1.91) and plaque (ORadjusted=1.56; 95% CI, 1.17-2.08). Among participants with CAC>0, there was no difference in CAC score (P=0.20), area (P=0.21), density (P=0.25), and regions of interest (P=0.20) across exercise volume groups. Among participants with plaque, the most active group (>2000 MET-min/wk) had a lower prevalence of mixed plaques (48% versus 69%; ORadjusted=0.35; 95% CI, 0.15-0.85) and more often had only calcified plaques (38% versus 16%; ORadjusted=3.57; 95% CI, 1.28-9.97) compared with the least active group (<1000 MET-min/wk). CONCLUSIONS Participants in the >2000 MET-min/wk group had a higher prevalence of CAC and atherosclerotic plaques. The most active group, however, had a more benign composition of plaques, with fewer mixed plaques and more often only calcified plaques. These observations may explain the increased longevity typical of endurance athletes despite the presence of more coronary atherosclerotic plaque in the most active participants.
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Affiliation(s)
- Vincent L Aengevaeren
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.).
| | - Arend Mosterd
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Thijs L Braber
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Niek H J Prakken
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Pieter A Doevendans
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Diederick E Grobbee
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Paul D Thompson
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Thijs M H Eijsvogels
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.).
| | - Birgitta K Velthuis
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
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Koolhaas CM, Dhana K, van Rooij FJA, Kocevska D, Hofman A, Franco OH, Tiemeier H. Sedentary time assessed by actigraphy and mortality: The Rotterdam Study. Prev Med 2017; 95:59-65. [PMID: 27939262 DOI: 10.1016/j.ypmed.2016.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 01/09/2023]
Abstract
Research suggests that sedentary behavior is a risk factor for mortality. However, most studies rely on questionnaires, which are prone to reporting error. We examined the association between sedentary time assessed by actigraphy and mortality among 1839 participants, aged 45-98years, from the prospective population-based Rotterdam Study, enrolled between 2004 and 2007. Participants wore an actigraph around the wrist for seven days. Sedentary time was evaluated continuously, per 1h/day increase, and categorically in three groups (<8, 8-11, ≥11h/day). The lowest category was used as reference. Mortality risks were examined using Cox proportional hazard models, adjusted for confounders and biological risk factors. We examined the association between sedentary behavior and mortality over and beyond other activity measures (including physical activity (PA) and activities of daily living (ADL)) in a final model. During 11years of follow-up (median: 7.5years, interquartile range: 6.6-8.3years), 212 participants (11.5%) died. In the multivariable model, the hazard ratio (HR) and 95% confidence interval (95% CI) per 1 more hour/day sedentary time was 1.09 (1.00, 1.18). The HR (95% CI) after adjustment for PA and ADL was 1.04 (0.96, 1.13). Participants sedentary for ≥11h/day had a higher mortality risk (HR: 1.80, 95% CI: 1.14, 2.84) than those sedentary <8h/day, in the multivariable model. After adjusting for PA and ADL, this association was clearly attenuated (HR: 1.50, 95% CI: 0.93, 2.41). In conclusion, our study suggests that sedentary behavior is a risk factor for mortality. Further investigation is needed to examine whether this association is distinct from the effect of other measures of activity.
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Affiliation(s)
- Chantal M Koolhaas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Klodian Dhana
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Nutrition, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Frank J A van Rooij
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Desana Kocevska
- Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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20
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Imran TF, Patel Y, Ellison RC, Carr JJ, Arnett DK, Pankow JS, Heiss G, Hunt SC, Gaziano JM, Djoussé L. Walking and Calcified Atherosclerotic Plaque in the Coronary Arteries: The National Heart, Lung, and Blood Institute Family Heart Study. Arterioscler Thromb Vasc Biol 2016; 36:1272-7. [PMID: 27102966 DOI: 10.1161/atvbaha.116.307284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/31/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification. APPROACH AND RESULTS In a cross-sectional design, we studied 2971 participants of the National Heart, Lung, and Blood Institute Family Heart Study without a history of myocardial infarction, coronary artery bypass grafting, or percutaneous transluminal angioplasty. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute walking metabolic equivalent hours. CAC was measured by cardiac computed tomography. We defined prevalent CAC and aortic calcification using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios. Mean age was 55 years, and 60% of participants were women. Compared with the ≤3.75-Met-h/wk group, prevalence ratios for CAC after adjusting for age, sex, race, smoking, alcohol use, total physical activity (excluding walking), and familial clustering were 0.53 (95% confidence interval, 0.35-0.79) for >3.75 to 7.5 Met-h/wk, 0.72 (95% confidence interval, 0.52-0.99) for >7.5 to 15 Met-h/wk, and 0.54 (95% confidence interval, 0.36-0.81) for >15 to 22.5 Met-h/wk, (P trend=0.01). The walking-CAC relationship remained significant for those with body mass index ≥25 (P trend=0.02) and persisted with CAC cutoffs of 300, 200, 150, and 50 but not 0. When examined as a continuous variable, a J-shaped association between walking and CAC was found. The walking-aortic calcification association was not significant. CONCLUSIONS Our findings suggest that walking is associated with lower prevalent CAC (but not aortic calcification) in adults without known heart disease.
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Affiliation(s)
- Tasnim F Imran
- From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.).
| | - Yash Patel
- From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - R Curtis Ellison
- From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - J Jeffrey Carr
- From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Donna K Arnett
- From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - James S Pankow
- From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Gerardo Heiss
- From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Steven C Hunt
- From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - J Michael Gaziano
- From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
| | - Luc Djoussé
- From the Department of Medicine, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Harvard Medical School, Boston, MA (T.F.I., Y.P., J.M.G., L.D.); Preventive Medicine and Epidemiology, Boston University School of Medicine, MA (R.C.E.); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN (J.J.C.); Department of Epidemiology, University of Alabama at Birmingham (D.K.A.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (J.S.P.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Cardiovascular Genetics, Department of Medicine, University of Utah, Salt Lake City (S.C.H.)
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Association between a healthy cardiovascular risk factor profile and coronary artery calcium score: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Am Heart J 2016; 174:51-9. [PMID: 26995370 DOI: 10.1016/j.ahj.2015.12.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Our goal was to evaluate cross-sectionally the association between ideal risk factor (IRF) profile and the presence and severity of subclinical atherosclerosis measured as coronary artery calcium (CAC) in the Brazilian Longitudinal Study of Adult Health. METHODS We included 4,077 participants with no prior history of cardiovascular disease aged 35 to 74 years who underwent CAC measurement. The 2010 Task Force of the American Heart Association cutoffs were used to define the ideal level of smoking, physical activity, diet, blood pressure, glucose/cholesterol levels, and body mass index. RESULTS Participants were categorized according the number of IRF: 0 to 1 (n = 1,025, 25.1%), 2 (n = 1,200, 29.4%), 3 to 4 (n = 1,551, 38.1%), or 5 to 7 (n = 301, 7.4%). Compared to individuals with 0 to 1 IRF, the odds ratio of participants with 2 IRFs presenting with CAC >0 (compared to 0), ≥100 (compared to <100), and ≥400 (compared to <400) was 0.75 (95% CI 0.62-0.91), 0.64 (0.49-0.84), and 0.75 (0.49-1.15), respectively. Similarly, the odds ratios of CACs >0, ≥100, and ≥400 in individuals with 3 to 4 IRFs were 0.59 (95% CI 0.48-0.71), 0.46 (0.34-0.62), and 0.50 (0.30-0.83), respectively, and, for individuals with 5 to 7 IRFs, were 0.36 (95% CI 0.24-0.56), 0.22 (0.09-0.55), and 0.20 (0.03-1.45), respectively. CONCLUSIONS Subjects with an IRF profile have lower CAC when compared to subjects with fewer controlled risk factors. However, even among individuals with 5 to 7 IRFs, it is possible to find a CAC higher than zero reflecting that measures of IRF do not fully account for all factors that resulted in coronary artery disease.
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Eijsvogels TMH, Fernandez AB, Thompson PD. Are There Deleterious Cardiac Effects of Acute and Chronic Endurance Exercise? Physiol Rev 2016; 96:99-125. [PMID: 26607287 PMCID: PMC4698394 DOI: 10.1152/physrev.00029.2014] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Multiple epidemiological studies document that habitual physical activity reduces the risk of atherosclerotic cardiovascular disease (ASCVD), and most demonstrate progressively lower rates of ASCVD with progressively more physical activity. Few studies have included individuals performing high-intensity, lifelong endurance exercise, however, and recent reports suggest that prodigious amounts of exercise may increase markers for, and even the incidence of, cardiovascular disease. This review examines the evidence that extremes of endurance exercise may increase cardiovascular disease risk by reviewing the causes and incidence of exercise-related cardiac events, and the acute effects of exercise on cardiovascular function, the effect of exercise on cardiac biomarkers, including "myocardial" creatine kinase, cardiac troponins, and cardiac natriuretic peptides. This review also examines the effect of exercise on coronary atherosclerosis and calcification, the frequency of atrial fibrillation in aging athletes, and the possibility that exercise may be deleterious in individuals genetically predisposed to such cardiac abnormalities as long QT syndrome, right ventricular cardiomyopathy, and hypertrophic cardiomyopathy. This review is to our knowledge unique because it addresses all known potentially adverse cardiovascular effects of endurance exercise. The best evidence remains that physical activity and exercise training benefit the population, but it is possible that prolonged exercise and exercise training can adversely affect cardiac function in some individuals. This hypothesis warrants further examination.
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Affiliation(s)
- Thijs M H Eijsvogels
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antonio B Fernandez
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul D Thompson
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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Nang EEK, van Dam RM, Tan CS, Mueller-Riemenschneider F, Lim YT, Ong KZ, Ee S, Lee J, Tai ES. Association of Television Viewing Time with Body Composition and Calcified Subclinical Atherosclerosis in Singapore Chinese. PLoS One 2015; 10:e0132161. [PMID: 26132754 PMCID: PMC4488493 DOI: 10.1371/journal.pone.0132161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/10/2015] [Indexed: 01/17/2023] Open
Abstract
Objective Sedentary behavior such as television viewing may be an independent risk factor for coronary heart disease. However, few studies have assessed the impact of television viewing time on coronary artery calcification and it remains unclear how body fat contributes to this relationship. The aim of this study is to evaluate the association between television viewing time and subclinical atherosclerosis and whether effects on visceral or subcutaneous fat may mediate any associations observed. Methods This was a cross-sectional study of 398 Chinese participants (192 men and 206 women) from Singapore prospective study. Participants were free from known cardiovascular diseases and underwent interview, health screening, computed tomography scans of coronary arteries and abdomen. Spearman’s correlation was used to test the correlation between television viewing time, physical activity, body composition and abdominal fat distribution. The association between television viewing time and subclinical atherosclerosis was assessed by multiple logistic regression analysis. Results In men, television viewing time was significantly correlated with higher body fat mass index, percent body fat, subcutaneous and visceral fat. These associations were in the same direction, but weaker and not statistically significant in women. Television viewing time (hours/day) was associated with subclinical atherosclerosis in men (odds ratio: 1.41, 95% CI: 1.03-1.93) but no significant association was observed in women (odds ratio: 0.88, 95% CI: 0.59-1.31) after adjusting for potential socio-demographic and lifestyle confounders. Further adjustments for biological factors did not affect these associations. Conclusions Television viewing time was associated with greater adiposity and higher subcutaneous and visceral fat in men. TV viewing time was also associated with subclinical atherosclerosis in men and the potential mechanisms underlying this association require further investigation.
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Affiliation(s)
- Ei Ei Khaing Nang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
- * E-mail:
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
| | - Falk Mueller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Institute for Social Medicine, Epidemiology and Health Economics, Charite Univeristy Medical Centre, Berlin, Germany
| | - Yi Ting Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Kai Zhi Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Siqing Ee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Jeannette Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
| | - E. Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
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Shikada T, Washio M, Nishizaki A, Kakino T, Ooe K, Ishibashi Y, Sagara S, Morishige K, Tashiro H. Risk factors for coronary artery calcification in Japanese patients. J Cardiol 2015; 66:36-40. [PMID: 25448727 DOI: 10.1016/j.jjcc.2014.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/11/2014] [Accepted: 09/08/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Tomoki Shikada
- Division of Cardiology, St. Mary's Hospital, Kurume, Japan
| | - Masakazu Washio
- Department of Community Health and Clinical Epidemiology, St. Mary's College, Kurume, Japan
| | | | | | - Kensuke Ooe
- Division of Cardiology, St. Mary's Hospital, Kurume, Japan
| | | | | | | | - Hideki Tashiro
- Division of Cardiology, St. Mary's Hospital, Kurume, Japan.
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Idoate F, Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, Marcellán T, de Gordoa AR, Rodriguez-Mañas L, Bastarrika G, Marques MC, Martínez-Velilla N, Vicente-Campos D, Izquierdo M. Adipose tissue compartments, muscle mass, muscle fat infiltration, and coronary calcium in institutionalized frail nonagenarians. Eur Radiol 2014; 25:2163-75. [DOI: 10.1007/s00330-014-3555-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/21/2014] [Accepted: 12/04/2014] [Indexed: 12/25/2022]
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DeFina LF, Haskell WL, Willis BL, Barlow CE, Finley CE, Levine BD, Cooper KH. Physical activity versus cardiorespiratory fitness: two (partly) distinct components of cardiovascular health? Prog Cardiovasc Dis 2014; 57:324-9. [PMID: 25269066 DOI: 10.1016/j.pcad.2014.09.008] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Physical activity (PA) and cardiorespiratory fitness (CRF) both have inverse relationships to cardiovascular (CV) morbidity and mortality. Recent position papers and guidelines have identified the important role of both of these factors in CV health. The benefits of PA and CRF in the prevention of CV disease and risk factors are reviewed. In addition, assessment methodology and utilization in the research and clinical arenas are discussed. Finally, the benefits, methodology, and utilization are compared and contrasted to better understand the two (partly) distinct components and their impact on CV health.
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Affiliation(s)
| | | | | | | | | | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and University of Texas Southwestern Medical Center, Dallas, TX
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Basile C, Lomonte C, Lisi P, Karohl C, Di Iorio B, Bellasi A. Physical activity in chronic kidney disease: a plausible approach to vascular calcification? Kidney Blood Press Res 2014; 39:154-63. [PMID: 25117909 DOI: 10.1159/000355791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/19/2022] Open
Abstract
Vascular calcification (VC) is a prominent feature that affects up to 40 to 80% of Chronic Kidney Disease (CKD) patients depending on the degree of renal impairment. Though etiology and pathogenesis of the different types of VC are far from being elucidated, it is conceivable that an imbalance between promoters and inhibitors represents the condition that triggers VC deposition and progression. In addition to traditional cardiovascular risk factors, several lines of evidence suggest that specific factors may affect the arterial system and prognosis in CKD. Over the last decade, a few pharmacological strategies aimed at controlling different selected risk factors for VC have been investigated yielding conflicting results. In light of the complicated interplay between inhibitors and promoters as well as the fact that VC represents the result of cumulative and prolonged exposure to multiple risk factors, a more comprehensive risk modification approach such as lifestyle modification or physical activity (PA) may represent a valid strategy to attenuate VC deposition and progression.We herein aim at reviewing the rationale and current evidence on the potential for lifestyle modification with a specific focus on PA as a cost-effective strategy for VC treatment.
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Affiliation(s)
- Carlo Basile
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti (BA), Italy
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de Rezende LFM, Rey-López JP, Matsudo VKR, do Carmo Luiz O. Sedentary behavior and health outcomes among older adults: a systematic review. BMC Public Health 2014; 14:333. [PMID: 24712381 PMCID: PMC4021060 DOI: 10.1186/1471-2458-14-333] [Citation(s) in RCA: 433] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/31/2014] [Indexed: 01/08/2023] Open
Abstract
Background In the last decade, sedentary behavior has emerged as a new risk factor for health. The elderly spend most of their awake time in sedentary activities. Despite this high exposure, the impact of this sedentary behavior on the health of this population has not yet been reviewed. We systematically reviewed evidence for associations between sedentary behavior and multiple health outcomes in adults over 60 years of age. Methods We searched the Medline, Embase, Web of Science, SPORTDiscus, PsycINFO, CINAHL, LILLACS, and Sedentary Research Database for observational studies published up to May 2013. Additionally, we contacted members of the Sedentary Behaviour Research Network to identify articles that were potentially eligible. After inclusion, the methodological quality of the evidence was assessed in each study. Results We included 24 eligible articles in our systematic review, of which only 2 (8%) provided high-quality evidence. Greater sedentary time was related to an increased risk of all-cause mortality in the older adults. Some studies with a moderate quality of evidence indicated a relationship between sedentary behavior and metabolic syndrome, waist circumference, and overweightness/obesity. The findings for other outcomes such as mental health, renal cancer cells, and falls remain insufficient to draw conclusions. Conclusion This systematic review supports the relationship between sedentary behavior and mortality in older adults. Additional studies with high methodological quality are still needed to develop informed guidelines for addressing sedentary behavior in older adults.
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DeFina L, Radford N, Leonard D, Gibbons L, Khera A. Cardiorespiratory fitness and coronary artery calcification in women. Atherosclerosis 2014; 233:648-653. [DOI: 10.1016/j.atherosclerosis.2014.01.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/11/2013] [Accepted: 01/05/2014] [Indexed: 11/28/2022]
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Lohne-Seiler H, Hansen BH, Kolle E, Anderssen SA. Accelerometer-determined physical activity and self-reported health in a population of older adults (65-85 years): a cross-sectional study. BMC Public Health 2014; 14:284. [PMID: 24673834 PMCID: PMC3984636 DOI: 10.1186/1471-2458-14-284] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/20/2014] [Indexed: 11/30/2022] Open
Abstract
Background The link between physical activity (PA) and prevention of disease, maintenance of independence, and improved quality of life in older adults is supported by strong evidence. However, there is a lack of data on population levels in this regard, where PA level has been measured objectively. The main aims were therefore to assess the level of accelerometer-determined PA and to examine its associations with self-reported health in a population of Norwegian older adults (65–85 years). Methods This was a part of a national multicenter study. Participants for the initial study were randomly selected from the national population registry, and the current study included those of the initial sample aged 65–85 years. The ActiGraph GT1M accelerometer was used to measure PA for seven consecutive days. A questionnaire was used to register self-reported health. Univariate analysis of variance with Bonferroni adjustments were used for comparisons between multiple groups. Results A total of 560 participants had valid activity registrations. Mean age (SD) was 71.8 (5.6) years for women (n = 282) and 71.7 (5.2) years for men (n = 278). Overall PA level (cpm) differed considerably between the age groups where the oldest (80–85 y) displayed a 50% lower activity level compared to the youngest (65–70 y). No sex differences were observed in overall PA within each age group. Significantly more men spent time being sedentary (65–69 and 70–74 years) and achieved more minutes of moderate to vigorous PA (MVPA) (75–79 years) compared to women. Significantly more women (except for the oldest), spent more minutes of low-intensity PA compared to men. PA differed across levels of self-reported health and a 51% higher overall PA level was registered in those, with “very good health” compared to those with “poor/very poor health”. Conclusion Norwegian older adults PA levels differed by age. Overall, the elderly spent 66% of their time being sedentary and only 3% in MVPA. Twenty one percent of the participants fulfilled the current Norwegian PA recommendations. Overall PA levels were associated with self-reported health.
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Affiliation(s)
- Hilde Lohne-Seiler
- Norwegian School of Sport Sciences, Department of Sport Medicine, P,B, 4014 Ullevaal Stadion, 0806 Oslo, Norway.
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Coronary artery calcium and physical fitness - the two best predictors of long-term survival. Atherosclerosis 2014; 234:93-4. [PMID: 24632043 DOI: 10.1016/j.atherosclerosis.2014.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 11/22/2022]
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García-Ortiz L, Recio-Rodríguez JI, Schmidt-Trucksäss A, Puigdomenech-Puig E, Martínez-Vizcaíno V, Fernández-Alonso C, Rubio-Galan J, Agudo-Conde C, Patino-Alonso MC, Rodríguez-Sánchez E, Gómez-Marcos MA. Relationship between objectively measured physical activity and cardiovascular aging in the general population--the EVIDENT trial. Atherosclerosis 2014; 233:434-440. [PMID: 24530775 DOI: 10.1016/j.atherosclerosis.2014.01.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 01/08/2014] [Accepted: 01/11/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Aging has been associated with an increase in arterial stiffness. We analyzed the relationship between regular physical activity and cardiovascular aging evaluated by the radial augmentation index (rAIx), ambulatory arterial stiffness index (AASI), pulse pressure (PP) and heart age in subjects without atherosclerotic disease. METHODS A cross-sectional study was performed including 1365 subjects from the EVIDENT trial (mean age 54.9±13.7 years; 60.3% women). As a measure of total volume of physical activity we used counts/minute recorded in an accelerometer (Actigraph GT3X) that participants wore for seven days, collecting data in 60-sec epochs, and respondents with ≥4 valid days were retained for the analysis. Arterial stiffness was evaluated using measures of rAIx, AASI, and central and peripheral PP on the B-pro device. rAIx was adjusted to 75 heart rate(rAIx75). Cardiovascular risk and heart age was estimated by the Framingham Risk Score. RESULTS The median (IQR) of counts/min was 236.9 (176.3-307.8), rAIx75 90 (77-100), sleep PP 40 mmHg (33-47), central PP 39 mmHg (32-47) and heart age 57 years (45-73) and the mean±SD of the ASSI was 0.44±0.07. We found an inverse correlation between counts/minute and rAIx75 (r=-0.086; p<0.01), AASI (r=-0.146; p<0.001), heart age (r=-0.163; p<0.001) and peripherals PP. These associations were remained after controlling for potential confounders, except for rAIx75. In the multiple regression analysis, after adjustment, an inverse association persisted between counts/minute and AASI, sleep PP and heart age, but not with rAIx75. Accordingly, for every 100 higher counts/minute of accelerometer measures, both AASI and sleep PP would be lower by one measurement unit (beta=-0.979 and -1.031 respectively, p<0.001) and the estimated heart age by half year (beta=-0.525, p=0.023). CONCLUSIONS Regular physical activity was inversely associated with parameters related to advanced cardiovascular aging after adjustment for potentially influencing variables. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT01083082.
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Affiliation(s)
- Luis García-Ortiz
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | - José I Recio-Rodríguez
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | - Arno Schmidt-Trucksäss
- Division Sports and Exercise Medicine, Institute of Exercise and Health Sciences, University of Basel, Switzerland.
| | - Elisa Puigdomenech-Puig
- Primary Health care Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain.
| | | | | | | | - Cristina Agudo-Conde
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | - Maria C Patino-Alonso
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | | | - Manuel A Gómez-Marcos
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
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Gorman E, Hanson HM, Yang PH, Khan KM, Liu-Ambrose T, Ashe MC. Accelerometry analysis of physical activity and sedentary behavior in older adults: a systematic review and data analysis. Eur Rev Aging Phys Act 2013; 11:35-49. [PMID: 24765212 PMCID: PMC3990855 DOI: 10.1007/s11556-013-0132-x] [Citation(s) in RCA: 241] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 08/23/2013] [Indexed: 12/27/2022] Open
Abstract
Accelerometers objectively monitor physical activity and sedentary patterns and are increasingly used in the research setting. It is important to maintain consistency in data analysis and reporting, therefore, we: (1) systematically identified studies using accelerometry (ActiGraph, Pensacola, FL, USA) to measure moderate-to-vigorous physical activity (MVPA) and sedentary time in older adults, and (2) based on the review findings, we used different cut-points obtained to analyze accelerometry data from a sample of community-dwelling older women. We identified 59 articles with cut-points ranging between 574 and 3,250 counts/min for MVPA and 50 and 500 counts/min for sedentary time. Using these cut-points and data from women (mean age, 70 years), the median MVPA minutes per day ranged between 4 and 80 min while percentage of sedentary time per day ranged between 62 % and 86 %. These data highlight (1) the importance of reporting detailed information on the analysis assumptions and (2) that results can differ greatly depending on analysis parameters.
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Affiliation(s)
- E. Gorman
- Centre for Hip Health and Mobility, 7F - 2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
- Department of Family Practice, University of British Columbia (UBC), 320-5950 University Boulevard, Vancouver, BC V6T1Z3 Canada
| | - H. M. Hanson
- Centre for Hip Health and Mobility, 7F - 2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
- Department of Family Practice, University of British Columbia (UBC), 320-5950 University Boulevard, Vancouver, BC V6T1Z3 Canada
| | - P. H. Yang
- Centre for Hip Health and Mobility, 7F - 2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - K. M. Khan
- Centre for Hip Health and Mobility, 7F - 2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
- Department of Family Practice, University of British Columbia (UBC), 320-5950 University Boulevard, Vancouver, BC V6T1Z3 Canada
- School of Kinesiology, UBC, 210-6081 University Boulevard, Vancouver, BC V6T1Z3 Canada
| | - T. Liu-Ambrose
- Centre for Hip Health and Mobility, 7F - 2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
- Department of Physical Therapy, UBC, 212-2177 Wesbrook Mall, Vancouver, BC V6T1Z3 Canada
| | - M. C. Ashe
- Centre for Hip Health and Mobility, 7F - 2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
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Self-reported and accelerometer-derived physical activity levels and coronary artery calcification progression in older women: results from the Healthy Women Study. Menopause 2013; 20:152-61. [PMID: 22914209 DOI: 10.1097/gme.0b013e31826115af] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the well-supported biological link between physical activity (PA) and atherosclerosis, most previous studies have reported a null association between PA and coronary artery calcification (CAC). The aim of this study was to examine the relationship between PA and CAC progression in 148 Healthy Women Study (HWS) participants over 28 years of observation. METHODS The HWS was designed to examine cardiovascular risk factor changes from premenopause to postmenopause. Based on CAC scores collected on two follow-up visits (electron beam tomography [EBT] 1 and EBT4) scheduled 12 years apart, participants were classified into one of three groups: (1) no-detectable CAC group (n = 37; 0 CAC on both visits); (2) incident CAC group (n = 46; 0 CAC on the first visit and >0 CAC on the last visit); or (3) prevalent CAC group (n = 65; >0 CAC on both visits). PA data were collected regularly throughout the study using self-report questionnaires and accelerometers on EBT4. RESULTS The percentage of HWS participants with no detectable CAC decreased from 56.1% on EBT1 to 25.0% on EBT4. Times spent per day in accumulated moderate- to vigorous-intensity PA (MVPA) and bouts of MVPA were each significantly higher in the no-detectable CAC group when compared with the prevalent CAC group (both P ≤ 0.01). After covariate adjustment, these differences remained statistically significant (both P < 0.05). Although self-reported summary estimates collected throughout the study were significantly associated with accelerometer data on EBT4, there were no significant differences in self-reported PA levels by CAC group after covariate adjustment. CONCLUSIONS Study findings suggest that low levels of accelerometer-derived MVPA may be indicative of subclinical disease in older women.
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Coronary artery calcium and exercise. Menopause 2013; 20:126-7. [DOI: 10.1097/gme.0b013e31827c44d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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