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Saito M, Miyake Y, Tanaka K, Nagata C, Senba H, Hasebe Y, Miyata T, Higaki T, Kimura E, Matsuura B, Yamaguchi O, Kawamoto R. Smoking and secondhand smoke exposure and carotid intima-media thickness: Baseline data from the Aidai Cohort Study in Japan. Tob Induc Dis 2024; 22:TID-22-17. [PMID: 38250629 PMCID: PMC10798226 DOI: 10.18332/tid/175632] [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: 09/12/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Epidemiological evidence regarding the relationship between smoking and secondhand smoke (SHS) exposure and carotid intima-media thickness (CIMT) has been limited in Asian populations. Employing baseline data from the Aidai Cohort Study, Japan, we evaluated the evidence in this cross-sectional study. METHODS Study subjects were 727 men aged 35-88 years and 1297 women aged 34-85 years. Information on smoking, SHS exposure, and confounders was obtained through a self-administered questionnaire. An automated carotid ultrasonography device was used to measure the right and left CIMT. The greatest CIMT measurement in the left or right common carotid artery was considered the maximum CIMT, and a maximum CIMT >1.0 mm was indicative of carotid wall thickening. Age, alcohol consumption, leisure time physical activity, hypertension, dyslipidemia, diabetes mellitus, body mass index, waist circumference, employment, and education level were adjusted at one time. RESULTS The prevalence of carotid wall thickening was 13.0%. The prevalence of never smoking was 30.5% in men and 90.1% in women. Among those who had never smoked, the prevalence of never SHS exposure at home and work was 74.3% and 48.2% in men and 38.3% and 56.3% in women, respectively. Active smoking and pack-years of smoking were independently positively related to carotid wall thickening regardless of sex, although the association with current smoking in women was not significant. Independent positive relationships were shown between former smoking and pack-years of smoking and maximum CIMT in men but not in women. No significant relationships were found between SHS exposure at home and work and carotid wall thickening or maximum CIMT in either men or women. CONCLUSIONS Active smoking, especially pack-years of smoking, was positively associated with carotid wall thickening in both sexes. Such positive associations with maximum CIMT were found only in men; however, interactions between smoking and sex were not significant.
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Affiliation(s)
- Makoto Saito
- Integrated Medical and Agricultural School of Public Health, Ehime University, Toon, Japan
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Yoshihiro Miyake
- Integrated Medical and Agricultural School of Public Health, Ehime University, Toon, Japan
- Department of Epidemiology and Public Health, Ehime University Graduate School of Medicine, Toon, Japan
- Research Promotion Unit, Translation Research Center, Ehime University Hospital, Toon, Japan
- Center for Data Science, Ehime University, Matsuyama, Japan
| | - Keiko Tanaka
- Integrated Medical and Agricultural School of Public Health, Ehime University, Toon, Japan
- Department of Epidemiology and Public Health, Ehime University Graduate School of Medicine, Toon, Japan
- Research Promotion Unit, Translation Research Center, Ehime University Hospital, Toon, Japan
- Center for Data Science, Ehime University, Matsuyama, Japan
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hidenori Senba
- Department of Epidemiology and Public Health, Ehime University Graduate School of Medicine, Toon, Japan
- Department of Internal Medicine, Matsuyama Shimin Hospital, Matsuyama, Japan
| | | | - Toyohisa Miyata
- Department of Epidemiology and Public Health, Ehime University Graduate School of Medicine, Toon, Japan
- Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takashi Higaki
- Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Eizen Kimura
- Integrated Medical and Agricultural School of Public Health, Ehime University, Toon, Japan
- Center for Data Science, Ehime University, Matsuyama, Japan
- Department of Medical Informatics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Bunzo Matsuura
- Department of Lifestyle-Related Medicine and Endocrinology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Osamu Yamaguchi
- Integrated Medical and Agricultural School of Public Health, Ehime University, Toon, Japan
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Ryuichi Kawamoto
- Integrated Medical and Agricultural School of Public Health, Ehime University, Toon, Japan
- Department of Community Medicine, Ehime University Graduate School of Medicine, Toon, Japan
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Bailey RJ, Sarkar A, Snell-Bergeon JK, Burkhardt BR, Chandrasekaran S, Johnson L, Alman AC. Periodontitis and cardiovascular risk factors in subjects with and without type 1 diabetes: A cross sectional analysis. J Diabetes Complications 2023; 37:108494. [PMID: 37209505 PMCID: PMC10601755 DOI: 10.1016/j.jdiacomp.2023.108494] [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: 01/21/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023]
Abstract
AIMS This cross-sectional analysis explored the relationships between periodontal disease (PD) and subclinical CVD in a cohort of patients with type 1 diabetes and non-diabetic controls. METHODS Data were collected from adults enrolled in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study or enrolled through the Barbara Davis Center for Diabetes Adult Clinic. A clinical periodontal exam measured attachment loss and probing depth. Brachial artery distensibility (brachD), carotid intima-media thickness (cIMT), and pulse wave velocity (PWV) were assessed as measures of subclinical cardiovascular structure and function. RESULTS 144 participants with T1D and 148 non-diabetics were enrolled. Compared to non-diabetic controls, T1D participants had a higher probing depth (2.6 mm vs. 2.5 mm; p = 0.04), higher attachment loss (2.7 mm vs. 2.4 mm; p < 0.01), lower brachD (mean 5.8 vs. 6.4 mmHg; p < 0.01), a higher cIMT (mean 0.68 vs. 0.64 mm; p < 0.01), and a higher PWV (mean 8.3 vs. 7.8 m/s; p < 0.01). There were no significant associations between PD and CVD metrics. CONCLUSIONS Periodontal and cardiovascular health was worse in participants with T1D compared to non-diabetics. No significant associations between PD measures and CVD were identified.
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Affiliation(s)
- Ryan J Bailey
- University of South Florida, College of Public Health, United States of America.
| | - Anujit Sarkar
- University of Tennessee at Knoxville, College of Nursing, United States of America
| | - Janet K Snell-Bergeon
- University of Colorado, Anschutz Medical Campus, School of Medicine, Barbara Davis Center, United States of America
| | - Brant R Burkhardt
- University of South Florida, College of Arts and Sciences, Molecular Biosciences, Microbiology, and Molecular Biology, United States of America
| | - Sangeetha Chandrasekaran
- University of Colorado, Anschutz Medical Campus, School of Dental Medicine, United States of America
| | - Lonnie Johnson
- University of Colorado, Anschutz Medical Campus, School of Dental Medicine, United States of America
| | - Amy C Alman
- University of South Florida, College of Public Health, United States of America
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Diminished Endothelial Function but Normal Vascular Structure in Adults with Tetralogy of Fallot. J Clin Med 2022; 11:jcm11030493. [PMID: 35159945 PMCID: PMC8836741 DOI: 10.3390/jcm11030493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/01/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023] Open
Abstract
The life expectancy of patients with Tetralogy of Fallot (ToF) has increased in recent years. As a result, other risk factors with later onset in life are in the focus of patient care. Endothelial function is an early indicator of cardiovascular risk and was investigated along further structural vessel properties. A total of 17 patients (41.7 ± 7.1 years, 8 women) with Tetralogy of Fallot were 1:2 matched for sex with 34 (38.9 ± 8.1 years, 16 women) healthy volunteers. Participants received an assessment of their endothelial function and a structural assessment of the aorta. Patients with ToF showed a reduced endothelial function determined by reactive hyperaemia index after adjusting for age, weight and height (ToF: 1.55 ± 0.31 vs. controls: 1.84 ± 0.47; p = 0.023). No differences in carotid intima-media thickness (cIMT) between the ToF and healthy controls (ToF: 0.542 ± 0.063 mm vs. controls: 0.521 ± 0.164 mm; p = 0.319) were found. Patients with ToF had reduced vascular function compared to healthy subjects. As the structural component is not affected, endothelial dysfunction seems not to have yet manifested itself as a morphological change. Nevertheless, long-term management of these patients should include vascular parameters.
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Nichols S, Taylor C, Goodman T, Page R, Kallvikbacka-Bennett A, Nation F, Clark A, Birkett S, Carroll S, Ingle L. Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study. Int J Cardiol 2020; 305:25-34. [DOI: 10.1016/j.ijcard.2020.01.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 12/31/2022]
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Gateva A, Assyov Y, Gatev T, Kamenov Z. Endothelial dysfunction and intima media thickness are selectively related to the different carbohydrate disturbances across the glucose continuum. Arch Physiol Biochem 2019; 125:430-434. [PMID: 29882429 DOI: 10.1080/13813455.2018.1479762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Aim: The aim of the present study was to investigate the prevalence of macrovascular complications across different carbohydrate disturbances. Patients and methods: In the study, we included 167 patients, divided them into three age and BMI matched groups - group 1 with obesity without carbohydrate disturbances (n = 66), group 2 with prediabetes (n = 68) and group 3 with newly diagnosed type 2 diabetes (n = 33). Endothelial function was evaluated using EndoPAT, intima media thickness (IMT) was measured on the common carotid artery and ankle-brachial index (ABI) was calculated. Results: The patients with T2D had significantly higher mean IMT than the other two groups. The best predictors of increased IMT were fasting blood glucose followed by age and SBP. ROC-analysis showed that blood glucose on 60 min of OGTT had a very good predictive value for endothelial dysfunction. Conclusions: Patients with newly diagnosed diabetes have increased IMT and a tendency towards higher ABI compared to normoglycemic and prediabetic subjects.
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Affiliation(s)
- Antoaneta Gateva
- Clinic of Endocrinology, University Hospital "Alexandrovska" Medical University-Sofia , Sofia , Bulgaria
| | - Yavor Assyov
- Clinic of Endocrinology, University Hospital "Alexandrovska" Medical University-Sofia , Sofia , Bulgaria
| | - Tsvetan Gatev
- Clinic of Endocrinology, University Hospital "Alexandrovska" Medical University-Sofia , Sofia , Bulgaria
| | - Zdravko Kamenov
- Clinic of Endocrinology, University Hospital "Alexandrovska" Medical University-Sofia , Sofia , Bulgaria
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Santhirakumaran S, Tay J, Lees C. The relationship between maternal characteristics and carotid intima-media thickness using an automated ultrasound technique. Hypertens Pregnancy 2019; 38:252-259. [PMID: 31535936 DOI: 10.1080/10641955.2019.1667382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To investigate CIMT and its relationship with maternal demographic characteristics in healthy pregnancy. Methods: CIMT was measured using an au. Results: CIMT showed no relationship with gestational age (rho=-0.124, p=0.335), parity (Z=-0.055, p=0.960) and MAP (rho=0.110, p=0.393). A relationship was found between CIMT and maternal age (rho=0.277, p=0.028), booking BMI (rho=0.278, p=0.027), and BMI at time of study (rho=0.287, p=0.023). CIMT ranged from 0.30-0.80mm, the 97.5th percentile was 0.63 mm. Conclusion: In healthy pregnancy, we reported CIMT was related to BMI and maternal age but not parity or gestational age.
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Affiliation(s)
| | - Jasmine Tay
- Imperial College School of Medicine, Imperial College London , London , UK.,Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust , London , UK
| | - Christoph Lees
- Imperial College School of Medicine, Imperial College London , London , UK.,Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust , London , UK
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Effect of external compression on femoral retrograde shear and microvascular oxygenation in exercise trained and recreationally active young men. Eur J Appl Physiol 2019; 119:1809-1818. [PMID: 31190212 DOI: 10.1007/s00421-019-04170-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Retrograde shear causes endothelial damage and is pro-atherogenic. The purpose of our study was to examine the impact of vascular remodeling from habitual exercise training on acute changes in retrograde shear and microvascular oxygenation (SMO2) induced via 30 min of external compression. METHODS Participants included 11 exercise trained (ET) men (Division I track athletes; age 20 ± 3 years) and 18 recreationally active (RA) men (age 23 ± 5 years). Near-infrared spectroscopy (NIRS) was used to measure vastus medialis SMO2. Doppler-ultrasound was used to assess SFA intima-media thickness, diameter and flow velocity to derive retrograde shear. Vascular measures were made at baseline (BASELINE), during a sham condition (calf compression to 5 mmHg, SHAM) and during the experimental condition (calf compression to 60 mmHg, EXP). RESULTS Compared to RA, ET had larger SFA diameters (0.66 ± 0.06 vs 0.58 ± 0.06 cm, p < 0.05) and lower SFA IMT (0.33 ± 0.03 vs 0.36 ± 0.07 mm, p < 0.05). Retrograde shear increased similarly in both groups during EXP (p < 0.05) but ET men had lower overall retrograde shear during the conditions (BASELINE 75.8 ± 26.8 vs EXP 88.2 ± 16.9 s-1) compared to RA men (BASELINE 84.4 ± 23.3 vs EXP 106.4 ± 19.6 s-1p < 0.05). There was a similar increase in SMO2 from BASELINE to SHAM (ET + 8.1 ± 4.8 vs RA + 6.4 ± 9.7%) and BASELINE to EXP (ET + 8.7 ± 6.4 vs RA + 7.1 ± 9.0%) in both groups. CONCLUSION Beneficial vascular remodeling in ET men is associated with lower retrograde shear during external compression. Acute increases in retrograde shear with external compression do not detrimentally impact microvascular oxygenation.
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Müller-Scholden L, Kirchhof J, Morbach C, Breunig M, Meijer R, Rücker V, Tiffe T, Yurdadogan T, Wagner M, Gelbrich G, Bots ML, Störk S, Heuschmann PU. Segment-specific association of carotid-intima-media thickness with cardiovascular risk factors - findings from the STAAB cohort study. BMC Cardiovasc Disord 2019; 19:84. [PMID: 30947692 PMCID: PMC6449987 DOI: 10.1186/s12872-019-1044-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background The guideline recommendation to not measure carotid intima-media thickness (CIMT) for cardiovascular risk prediction is based on the assessment of just one single carotid segment. We evaluated whether there is a segment-specific association between different measurement locations of CIMT and cardiovascular risk factors. Methods Subjects from the population-based STAAB cohort study comprising subjects aged 30 to 79 years of the general population from Würzburg, Germany, were investigated. CIMT was measured on the far wall of both sides in three different predefined locations: common carotid artery (CCA), bulb, and internal carotid artery (ICA). Diabetes, dyslipidemia, hypertension, smoking, and obesity were considered as risk factors. In multivariable logistic regression analysis, odds ratios of risk factors per location were estimated for the endpoint of individual age- and sex-adjusted 75th percentile of CIMT. Results 2492 subjects were included in the analysis. Segment-specific CIMT was highest in the bulb, followed by CCA, and lowest in the ICA. Dyslipidemia, hypertension, and smoking were associated with CIMT, but not diabetes and obesity. We observed no relevant segment-specific association between the three different locations and risk factors, except for a possible interaction between smoking and ICA. Conclusions As no segment-specific association between cardiovascular risk factors and CIMT became evident, one simple measurement of one location may suffice to assess the cardiovascular risk of an individual.
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Affiliation(s)
- Lara Müller-Scholden
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 15, 97080, Würzburg, Germany
| | - Jan Kirchhof
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 15, 97080, Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 15, 97080, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Margret Breunig
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 15, 97080, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Rudy Meijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Theresa Tiffe
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 15, 97080, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Tino Yurdadogan
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 15, 97080, Würzburg, Germany
| | - Martin Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 15, 97080, Würzburg, Germany. .,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 15, 97080, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
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Nichols S, Taylor C, Page R, Kallvikbacka-Bennett A, Nation F, Goodman T, Clark AL, Carroll S, Ingle L. Is Cardiorespiratory Fitness Related to Cardiometabolic Health and All-Cause Mortality Risk in Patients with Coronary Heart Disease? A CARE CR Study. SPORTS MEDICINE-OPEN 2018; 4:22. [PMID: 29846834 PMCID: PMC5976559 DOI: 10.1186/s40798-018-0138-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/14/2018] [Indexed: 01/08/2023]
Abstract
Background Higher cardiorespiratory fitness (CRF) is associated with lower morbidity and mortality in patients with coronary heart disease (CHD). The mechanisms for this are not fully understood. A more favourable cardiometabolic risk factor profile may be responsible; however, few studies have comprehensively evaluated cardiometabolic risk factors in relation to CRF amongst patients with CHD. We aimed to explore differences in cardiometabolic risk and 5-year all-cause mortality risk in patients with CHD who have low, moderate, and high levels of CRF. Methods Patients with CHD underwent maximal cardiopulmonary exercise testing, echocardiogram, carotid intima-media thickness measurement, spirometry, and dual X-ray absorptiometry assessment. Full blood count, biochemical lipid profiles, high-sensitivity (hs) C-reactive protein, and NT-proBNP were analysed. Patients were defined as having low, moderate, or high CRF based on established prognostic thresholds. Results Seventy patients with CHD (age 63.1 ± 10.0 years, 86% male) were recruited. Patients with low CRF had a lower ventilatory anaerobic threshold, peak oxygen pulse, post-exercise heart rate recovery, and poor ventilatory efficiency. The low CRF group also had higher NT pro-BNP, hs-CRP, non-fasting glucose concentrations, and lower haemoglobin and haematocrit. Five-year mortality risk (CALIBER risk score) was also greatest in the lowest CRF group (14.9%). Conclusions Practitioners should interpret low CRF as an important clinical risk factor associated with adverse cardiometabolic health and poor prognosis, study registry; www.researchregistry.com.
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Affiliation(s)
- Simon Nichols
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield, S10 2BP, UK.
| | - Claire Taylor
- Carnegie School of Sport, Leeds Beckett University, Fairfax Hall, Headingley Campus, Leeds, LS6 3QS, UK
| | - Richard Page
- Sport Health and Exercise Science, Don Building, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | | | - Fiona Nation
- Sport Health and Exercise Science, Don Building, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Toni Goodman
- City Health Care Partnership CIC, East Riding Community Hospital, Swinemoore Lane, Beverley, HU17 0FA, UK
| | - Andrew L Clark
- Academic Cardiology, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
| | - Sean Carroll
- Sport Health and Exercise Science, Don Building, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Lee Ingle
- Sport Health and Exercise Science, Don Building, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
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Nichols S, Nation F, Goodman T, Clark AL, Carroll S, Ingle L. CARE CR-Cardiovascular and cardiorespiratory Adaptations to Routine Exercise-based Cardiac Rehabilitation: a study protocol for a community-based controlled study with criterion methods. BMJ Open 2018; 8:e019216. [PMID: 29374670 PMCID: PMC5829840 DOI: 10.1136/bmjopen-2017-019216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) reduces all-cause and cardiovascular mortality in patients with coronary heart disease (CHD). Much of this improvement has been attributed to the beneficial effects of structured exercise training. However, UK-based studies have not confirmed this. Improvements in survival and cardiovascular health are associated with concurrent improvements in cardiorespiratory fitness (CRF). It is therefore concerning that estimated CRF improvements resulting from UK-based CR are approximately one-third of those reported in international literature. Modest improvements in CRF suggest that UK CR exercise training programmes may require optimisation if long-term survival is to be improved. However, contemporary UK studies lack control data or use estimates of CRF change. Cardiovascular and cardiorespiratory Adaptations to Routine Exercise-based CR is a longitudinal, observational, controlled study designed to assess the short-term and long-term effect of CR on CRF, as well cardiovascular and cardiometabolic health. METHODS AND ANALYSIS Patients will be recruited following referral to their local CR programme and will either participate in a routine, low-to-moderate intensity, 8-week (16 sessions) exercise-based CR programme or freely abstain from supervised exercise. Initial assessment will be conducted prior to exercise training, or approximately 2 weeks after referral to CR if exercise training is declined. Reassessment will coincide with completion of exercise training or 10 weeks after initial assessment for control participants. Participants will receive a final follow-up 12 months after recruitment. The primary outcome will be peak oxygen consumption determined using maximal cardiopulmonary exercise testing. Secondary outcomes will include changes in subclinical atherosclerosis (carotid intima-media thickness and plaque characteristics), body composition (dual X-ray absorptiometry) and cardiometabolic biomarkers. ETHICS AND DISSEMINATION Ethical approval for this non-randomised controlled study has been obtained from the Humber Bridge NHS Research Ethics Committee-Yorkshire and the Humber on the 27th September 2013, (12/YH/0278). Results will be presented at national conferences and published in peer-reviewed journals.
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Affiliation(s)
- Simon Nichols
- Centre for Sport and Exercise Science, Sheffield Hallam University–Collegiate Crescent Campus, Sheffield, UK
| | - Fiona Nation
- Department of Sport Health and Exercise Science, University of Hull, Hull, UK
| | - Toni Goodman
- Integrated Community Services, City Health Care Partnership CIC, East Riding Community Hospital, Beverley, UK
| | - Andrew L Clark
- Department of Academic Cardiology, Castle Hill Hospital, Cottingham, UK
| | - Sean Carroll
- Department of Sport Health and Exercise Science, University of Hull, Hull, UK
| | - Lee Ingle
- Department of Sport Health and Exercise Science, University of Hull, Hull, UK
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Carotid Intima-Media Thickness Manual Measurements: Intraoperator and Interoperator Agreements Under A Strict Protocol in a Large Sample. Ultrasound Q 2016; 33:28-36. [PMID: 27575841 DOI: 10.1097/ruq.0000000000000243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to assess the intraoperator and interoperator agreement for manual measurements of intima-media thickness (IMT) performed under a strict carotid ultrasound technical protocol. METHODS Two blinded experienced operators independently performed an ultrasound examination at the distal common carotid of 242 subjects in the same patient's position, diastolic phase, probe type, zooming, and depth. Thirty-six subjects were reevaluated in another time point. Three different-angle manual measurements (IMTindiv) were obtained. Interoperator agreements for each IMTindiv, and their mean (IMTmean) and maximum (IMTmax) values, were assessed with the intraclass correlation coefficient and Bland-Altman analysis. Intraoperator agreement was tested taking advantage of the second ultrasound round in 36 subjects. RESULTS IMTmean agreements (intraoperator, 0.665-0.913; interoperator, 0.856-0.897) were higher than IMTmax (intraoperator, 0.435-0.793; interoperator, 0.631-0.718) and any IMTindiv (intraoperator, 0.355-0.676; interoperator, 0.590-0.717). Despite the small systematic error for IMTmean (intraoperator, ≤0.03; interoperator, ≤0.02 mm), at best of times, the sampling error size reached at least 0.28 and 0.25 mm for intraoperator and interoperator agreements, respectively, and was never less than 0.13 mm. CONCLUSIONS Although IMTmean agreement is excellent under a strict protocol, limits of agreement might be too wide to consider carotid ultrasound a robust cardiovascular risk biomarker.
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