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Farrell SW, Leonard D, Barlow CE, Shuval K, Pavlovic A, Cooper KH, DeFina LF. Associations among cardiorespiratory fitness, C-reactive protein, and all-cause mortality in men and women. J Investig Med 2023; 71:372-379. [PMID: 36692144 DOI: 10.1177/10815589221149190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We examined individual and joint associations among high-sensitivity C-reactive protein (CRP), cardiorespiratory fitness (fitness), and mortality in healthy men and women. Between January 1, 2000 and December 31, 2016, 30,077 adults (31.3% women) received a comprehensive physical examination. Fitness was determined from maximal treadmill exercise test duration. Participants were categorized as unfit (Quintile 1) and fit (Quintiles 2-5), and by normal (<2 mg/L) and elevated (≥2 mg/L) CRP categories. Adjusted hazard ratios (HRs) with 95% confidence interval (CI) for all-cause mortality were computed with Cox regression. During an average of 10.1 years of follow-up, 576 deaths occurred. Following adjustment for age, smoking status, sex, exam year, body mass index, systolic blood pressure, total cholesterol, triglyceride:high-density lipoprotein ratio, and fasting glucose, HR (95% CI) for all-cause mortality were 1.0 (referent) and 1.52 (1.14-2.02) for fit and unfit categories, respectively. Corresponding values for normal and elevated CRP categories were 1.0 and 1.50 (1.20-1.89), respectively. When grouped by fitness and CRP category, there was significantly greater mortality risk in the unfit than the fit category within the elevated CRP category (HR = 1.77 (1.14-2.75)), but not in the normal CRP category (HR = 1.38 (0.96-1.98)). Each 1 metabolic equivalent increment in fitness and 1 mg/L increment in CRP were associated with 10.0% (95% CI: 5.1-14.8%) decreased and 7.3% (95% CI: 2.0%-12.9%) increased mortality hazard, respectively. Compared to the unfit, fit individuals have an attenuated mortality risk within each CRP category. Thus, higher fitness appears to provide some protection against all-cause mortality, particularly among those with elevated levels of inflammation.
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Larsen AI. The pulse; from adagio to prestissimo; the prognostic importance of heart rate increase and its associations with cardiovascular risk factors. Eur J Prev Cardiol 2019; 27:520-525. [PMID: 31480873 DOI: 10.1177/2047487319872690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Alf-Inge Larsen
- Stavanger University Hospital, Norway.,University of Bergen, Norway
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Nemoto S, Kasahara Y, Izawa KP, Watanabe S, Yoshizawa K, Takeichi N, Kamiya K, Suzuki N, Omiya K, Matsunaga A, Akashi YJ. Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2838. [PMID: 31398919 PMCID: PMC6720421 DOI: 10.3390/ijerph16162838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 11/17/2022]
Abstract
A simplified substitute for heart rate (HR) at the anaerobic threshold (AT), i.e., resting HR plus 30 beats per minute or a percentage of predicted maximum HR, is used as a way to determine exercise intensity without cardiopulmonary exercise testing (CPX) data. However, difficulties arise when using this method in subacute myocardial infarction (MI) patients undergoing beta-blocker therapy. This study compared the effects of αβ-blocker and β1-blocker treatment to clarify how different beta blockers affect HR response during incremental exercise. MI patients were divided into αβ-blocker (n = 67), β1-blocker (n = 17), and no-β-blocker (n = 47) groups. All patients underwent CPX one month after MI onset. The metabolic chronotropic relationship (MCR) was calculated as an indicator of HR response from the ratio of estimated HR to measured HR at AT (MCR-AT) and peak exercise (MCR-peak). MCR-AT and MCR-peak were significantly higher in the αβ-blocker group than in the β1-blocker group (p < 0.001, respectively). Multiple regression analysis revealed that β1-blocker but not αβ-blocker treatment significantly predicted lower MCR-AT and MCR-peak (β = -0.432, p < 0.001; β = -0.473, p < 0.001, respectively). Based on these results, when using the simplified method, exercise intensity should be prescribed according to the type of beta blocker used.
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Affiliation(s)
- Shinji Nemoto
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama 241-0811 Japan.
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara 252-0373, Japan.
| | - Yusuke Kasahara
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama 241-0811 Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan
| | - Satoshi Watanabe
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki 216-8511, Japan
| | - Kazuya Yoshizawa
- Department of Rehabilitation Medicine, Kawasaki Municipal Tama Hospital, Kawasaki 214-8525, Japan
| | - Naoya Takeichi
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki 216-8511, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara 252-0373, Japan
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama 241-0811, Japan
| | - Kazuto Omiya
- Department of Internal Medicine, Shimazu Medical Clinic, Yokohama 226-0026, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara 252-0373, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Hospital, Kawasaki 216-8511, Japan
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O'Neal WT, Qureshi WT, Blaha MJ, Dardari ZA, Ehrman JK, Brawner CA, Soliman EZ, Al-Mallah MH. Chronotropic Incompetence and Risk of Atrial Fibrillation: The Henry Ford ExercIse Testing (FIT) Project. JACC Clin Electrophysiol 2016; 2:645-652. [PMID: 28451646 DOI: 10.1016/j.jacep.2016.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine the association between chronotropic incompetence and incident atrial fibrillation (AF). BACKGROUND Patients with inadequate heart rate response during exercise may have abnormalities in sinus node function or autonomic tone that predispose to the development of AF. METHODS We examined the association between heart rate response and incident AF in 57,402 (mean age=54±13 years, 47% female, 64% white) patients free of baseline AF who underwent exercise-treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project. Age-predicted maximum heart rate (pMHR) values <85% and chronotropic index values <80% were used to define chronotropic incompetence. Cox regression, adjusting for demographics, cardiovascular risk factors, medications, coronary heart disease, heart failure, and metabolic equivalent of task achieved, was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between chronotropic incompetence and incident AF. RESULTS Over a median follow-up of 5.0 years (25th-75th percentiles=2.6, 7.8), a total of 3,395 (5.9%) participants developed AF. pMHR values <85% were associated with an increased risk for AF development (HR=1.33, 95%CI=1.22, 1.44). Chronotropic index values <80% also were associated with an increased risk of AF (HR=1.28, 95%CI=1.19, 1.38). The associations of pMHR and chronotropic index with AF remained significant with varying cut-off points to define chronotropic incompetence. CONCLUSIONS Our analysis suggests that patients with inadequate heart rate response during exercise have an increased risk for developing AF.
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Affiliation(s)
- Wesley T O'Neal
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Waqas T Qureshi
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Zeina A Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Elsayed Z Soliman
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mouaz H Al-Mallah
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.,King Saud bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdul Aziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
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Santos MAA, Sousa ACS, Reis FP, Santos TR, Lima SO, Barreto-Filho JA. Does the aging process significantly modify the Mean Heart Rate? Arq Bras Cardiol 2013; 101:388-98. [PMID: 24029962 PMCID: PMC4081162 DOI: 10.5935/abc.20130188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 06/07/2013] [Indexed: 12/03/2022] Open
Abstract
Background The Mean Heart Rate (MHR) tends to decrease with age. When adjusted for gender and
diseases, the magnitude of this effect is unclear. Objective To analyze the MHR in a stratified sample of active and functionally independent
individuals. Methods A total of 1,172 patients aged ≥ 40 years underwent Holter monitoring and were
stratified by age group: 1 = 40-49, 2 = 50-59, 3 = 60-69, 4 = 70-79, 5 = ≥ 80
years. The MHR was evaluated according to age and gender, adjusted for
Hypertension (SAH), dyslipidemia and non-insulin dependent diabetes mellitus
(NIDDM). Several models of ANOVA, correlation and linear regression were employed.
A two-tailed p value <0.05 was considered significant (95% CI). Results The MHR tended to decrease with the age range: 1 = 77.20 ± 7.10; 2 = 76.66 ± 7.07;
3 = 74.02 ± 7.46; 4 = 72.93 ± 7.35; 5 = 73.41 ± 7.98 (p < 0.001). Women showed
a correlation with higher MHR (p <0.001). In the ANOVA and regression models,
age and gender were predictors (p < 0.001). However, R2 and
ETA2 < 0.10, as well as discrete standardized beta coefficients
indicated reduced effect. Dyslipidemia, hypertension and DM did not influence the
findings. Conclusion The MHR decreased with age. Women had higher values of MHR, regardless of the age
group. Correlations between MHR and age or gender, albeit significant, showed the
effect magnitude had little statistical relevance. The prevalence of SAH,
dyslipidemia and diabetes mellitus did not influence the results.
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Affiliation(s)
- Marcos Antonio Almeida Santos
- Universidade Tiradentes, Aracaju, SE – Brazil
- Universidade Federal de Sergipe, Aracaju, SE – Brazil
- Centro de Pesquisas da Clínica e Hospital São Lucas, Aracaju, SE –
Brazil
- Mailing Address: Marcos Antonio Almeida Santos, Avenida Gonçalo Prado
Rollemberg, 211, Sala 210, São José. Postal Code 49010-410 - Aracaju, SE - Brazil.
E-mail: ,
| | - Antonio Carlos Sobral Sousa
- Universidade Federal de Sergipe, Aracaju, SE – Brazil
- Centro de Pesquisas da Clínica e Hospital São Lucas, Aracaju, SE –
Brazil
| | | | | | | | - José Augusto Barreto-Filho
- Universidade Federal de Sergipe, Aracaju, SE – Brazil
- Centro de Pesquisas da Clínica e Hospital São Lucas, Aracaju, SE –
Brazil
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