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Farrell SW, Leonard D, Li Q, Barlow CE, Shuval K, Berry JD, Pavlovic A, DeFina LF. Association between baseline levels of muscular strength and risk of stroke in later life: The Cooper Center Longitudinal Study. JOURNAL OF SPORT AND HEALTH SCIENCE 2023:S2095-2546(23)00101-1. [PMID: 37839524 DOI: 10.1016/j.jshs.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/22/2023] [Accepted: 09/16/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Muscular strength is an important component of physical fitness. We evaluated the relationship between baseline muscular strength and risk of stroke among adults who were aged ≥65 years during follow-up. METHODS 7627 healthy adults (mean age 43.9 years, 86.0% male) underwent a baseline physical examination between 1980 and 1989. Muscular strength was determined by 1-repetition maximum measures for bench press and leg press and categorized into age and sex-specific tertiles for each measure. Cardiorespiratory fitness (CRF) was assessed via a maximal treadmill exercise test. Those enrolled in fee-for-service Medicare from 1999 to 2019 were included in the analyses. Associations between baseline strength and stroke outcomes were estimated using a modified Cox proportional hazards model. In a secondary analysis, we examined stroke risk by categories of CRF where Quintile 1 = low, Quintiles 2-3 = moderate, and Quintiles 4-5 = high CRF based on age and sex. RESULTS After 70,072 person-years of Medicare follow-up, there were 1211 earliest indications of incident stroke. In multivariable analyses, the hazard ratio (HR) (95% confidence interval (95%CI)) for stroke across bench press categories were 1.0 (referent), 0.96 (0.83-1.11), and 0.89 (0.77-1.04), respectively (p trend = 0.14). The trend across categories of leg press was also non-significant (p trend = 0.79). Adjusted HR (95%CI) for stroke across ordered CRF categories were 1.0 (referent), 0.90 (0.71-1.13), and 0.72 (0.57-0.92) (p trend < 0.01). CONCLUSION While meeting public health guidelines for muscular strengthening activities is likely to improve muscular strength as well as many health outcomes in older adults, performing such activities may not be helpful in preventing stroke. Conversely, meeting guidelines for aerobic activity is likely to improve CRF and lower stroke risk.
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Affiliation(s)
| | - David Leonard
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
| | - Qing Li
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
| | | | - Kerem Shuval
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
| | - Jarett D Berry
- Department of Internal Medicine, University of Texas at Tyler School of Medicine, Tyler, TX 75799, USA
| | | | - Laura F DeFina
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
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Esmaili H, Tajik B, Tuomainen TP, Kurl S, Salonen JT, Virtanen JK. Associations of the serum n-6 PUFA with exercise cardiac power in men. Br J Nutr 2022; 129:1-10. [PMID: 35929337 PMCID: PMC10024979 DOI: 10.1017/s0007114522002501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/09/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022]
Abstract
Low intake or tissue concentrations of the n-6 PUFA, especially to the major n-6 PUFA linoleic acid (LA), and low exercise cardiac power (ECP) are both associated with CVD risk. However, associations of the n-6 PUFA with ECP are unknown. The aim of the present study was to explore cross-sectional associations of the serum total n-6 PUFA, LA, arachidonic acid (AA), γ-linolenic acid (GLA) and dihomo-γ-linolenic acid (DGLA) concentrations with ECP and its components. In total, 1685 men aged 42-60 years from the Kuopio Ischaemic Heart Disease Risk Factor Study and free of CVD were included. ANCOVA was used to examine the mean values of ECP (maximal oxygen uptake (VO2max)/maximal systolic blood pressure (SBP)) and its components in quartiles of the serum total and individual n-6 PUFA concentrations. After multivariable adjustments, higher serum total n-6 PUFA concentration was associated with higher ECP and VO2max (for ECP, the extreme-quartile difference was 0·77 ml/mmHg (95 % CI 0·38, 1·16, Pfor trend across quartiles < 0·001) and for VO2max 157 ml/min (95 % CI 85, 230, Pfor trend < 0·001), but not with maximal SBP. Similar associations were observed with serum LA concentration. Higher serum AA concentration was associated with higher ECP but not with VO2max or maximal SBP. The minor serum n-6 PUFA GLA and DGLA were associated with higher maximal SBP during exercise test and DGLA also with higher VO2max but neither with ECP. In conclusion, especially LA concentration was associated with higher ECP. This may provide one mechanism for the cardioprotective properties of, especially, LA.
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Affiliation(s)
- Haleh Esmaili
- University of Eastern Finland, Kuopio Campus, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Behnam Tajik
- University of Eastern Finland, Kuopio Campus, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- University of Eastern Finland, Kuopio Campus, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Sudhir Kurl
- University of Eastern Finland, Kuopio Campus, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Jukka T. Salonen
- University of Helsinki, the Faculty of Medicine, Department of Public Health, Helsinki, Finland
- Metabolic Analytical Services Oy, Helsinki, Finland
| | - Jyrki K. Virtanen
- University of Eastern Finland, Kuopio Campus, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
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Kurl S, Jae SY, Mäkikallio TH, Voutilainen A, Hagnäs MJ, Kauhanen J, Laukkanen JA. Exercise cardiac power and the risk of heart failure in men: A population-based follow-up study. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:266-271. [PMID: 35367042 PMCID: PMC9068517 DOI: 10.1016/j.jshs.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/29/2019] [Accepted: 11/21/2019] [Indexed: 06/14/2023]
Abstract
BACKGROUND Little is known about exercise cardiac power (ECP), defined as the ratio of directly measured maximal oxygen uptake with peak systolic blood pressure during exercise, on heart failure (HF) risk. We examined the association of ECP and the risk of HF. METHODS This was a population-based cohort study of 2351 men from eastern Finland. The average time to follow-up was 25 years. Participants participated at baseline in an exercise stress test. A total of 313 cases of HF occurred. RESULTS Men with low ECP (<9.84 mL/mmHg, the lowest quartile) had a 2.37-fold (95% confidence interval (95%CI): 1.68-3.35, p < 0.0001) hazards ratio of HF as compared with men with high ECP (>13.92 mL/mmHg, the highest quartile), after adjusting for age. Low ECP was associated with a 1.96-fold risk (95%CI: 1.38-2.78, p < 0.001) of HF after additional adjustment for conventional risk factors. After further adjustment for left ventricular hypertrophy, the results hardly changed (hazards ratio = 1.87, 95%CI: 1.31-2.66, p < 0.001). One SD increase in ECP (3.16 mL/mmHg) was associated with a decreased risk of HF by 28% (95%CI: 17%-37%). CONCLUSION ECP provides a noninvasive and easily available measure from cardiopulmonary exercise tests in predicting HF. However, ECP did not provide additional value over maximal oxygen uptake.
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Affiliation(s)
- Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, Department of Medicine, University of Eastern Finland, Kuopio 70210, Finland.
| | - Sae Young Jae
- Department of Sports Informatics, College of Arts and Physical Education, University of Seoul, Seoul 130-743, Republic of Korea
| | - Timo H Mäkikallio
- Division of Cardiology, Department of Internal Medicine, University Hospital of Oulu, Oulu 90220, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, Department of Medicine, University of Eastern Finland, Kuopio 70210, Finland
| | - Magnus J Hagnäs
- Department of Internal Medicine, Lapland Central Hospital, Rovaniemi 96400, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, Department of Medicine, University of Eastern Finland, Kuopio 70210, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, Department of Medicine, University of Eastern Finland, Kuopio 70210, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä 40620, Finland; Central Finland Health Care District, Jyväskylä 40620, Finland
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Isiozor NM, Kunutsor SK, Voutilainen A, Kauhanen J, Laukkanen JA. Life's Simple 7 and the risk of stroke in Finnish men: A prospective cohort study. Prev Med 2021; 153:106858. [PMID: 34687730 DOI: 10.1016/j.ypmed.2021.106858] [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] [Received: 02/07/2021] [Revised: 09/04/2021] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Population-wide preventive measures constitute important approaches towards reducing stroke risk and its associated burden. We sought to examine the association between American Heart Association's (AHA) Life's Simple7 (LS7) score and the risk of stroke in men. METHODS The study is based on the prospective population-based Kuopio Ischaemic Heart Disease cohort comprising men (42-60 years) without pre-existing history of stroke at baseline (1984-1989). LS7 was computed from AHA's cardiovascular health metrics for 2520 men and includes data on diet, physical activity, body mass index, smoking status, blood pressures, total cholesterol and blood glucose. Participants were classified into three LS7 groups based on the number of ideal metrics: low (0-2), medium (3-4) and high (5-7). Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LS7 scores for total and ischaemic stroke. RESULTS During a median follow-up of 26 years, 428 total and 362 ischaemic incident stroke events were recorded. The risk of both stroke outcomes decreased continuously with increasing LS7 scores across the range 2-6. Men with high LS7 had 48% (HR: 0.52; 95%CI: 0.32-0.86) lower risk of total stroke when compared with those with low LS7. The association was similar for the risk of ischaemic stroke, with 50% (HR: 0.50; 95%CI: 0.29-0.87) lower risk among men with high LS7 compared with those with low LS7. CONCLUSION LS7 was strongly, inversely and linearly associated with risk of total and ischaemic strokes among a middle-aged male Finnish population.
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Affiliation(s)
- Nzechukwu M Isiozor
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, United Kingdom; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Bristol, United Kingdom
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District, Department of Internal Medicine, Jyvaskyla, Finland
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Kurl S, Jae SY, Mäkikallio TH, Hagnäs MJ, Laukkanen JA. Exercise cardiac power and the risk of myocardial infarction and fatal coronary heart disease events in men. Eur J Prev Cardiol 2020; 28:e1-e3. [PMID: 33611364 DOI: 10.1177/2047487320914734] [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: 11/15/2022]
Affiliation(s)
- Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Sae Young Jae
- Department of Sports Informatics, College of Arts and Physical Education, University of Seoul, South Korea
| | - Timo H Mäkikallio
- Division of Cardiology, Department of Internal Medicine, University Hospital of Oulu, Finland
| | - Magnus J Hagnäs
- Department of Internal Medicine, Lapland Central Hospital, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Finland.,Central Finland Health Care District, Jyväskylä, Finland
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Paraoxonase 3: Structure and Its Role in Pathophysiology of Coronary Artery Disease. Biomolecules 2019; 9:biom9120817. [PMID: 31816846 PMCID: PMC6995636 DOI: 10.3390/biom9120817] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 12/21/2022] Open
Abstract
Spanning three decades in research, Paraoxonases (PON1) carried potential of dealing with neurotoxicity of organophosphates entering the circulation and preventing cholinergic crisis. In the past few years, the Paraoxonase multigene family (PON1, PON2, PON3) has been shown to play an important role in pathogenesis of cardiovascular disorders including coronary artery disease (CAD). The PON genes are clustered in tandem on the long arm of human chromosome 7 (q21, 22). All of them have been shown to act as antioxidants. Of them, PON3 is the least studied member as its exact physiological substrate is still not clear. This has further led to limitation in our understanding of its role in pathogenesis of CAD and development of the potential therapeutic agents which might modulate its activity, expression in circulation and tissues. In the present review, we discuss the structure and activity of human PON3 enzyme and its Single nucleotide variants that could potentially lead to new clinical strategies in prevention and treatment of CAD.
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Wang Y, Li F, Cheng Y, Gu L, Xie Z. Cardiorespiratory fitness as a quantitative predictor of the risk of stroke: a dose–response meta-analysis. J Neurol 2019; 267:491-501. [DOI: 10.1007/s00415-019-09612-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022]
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Van Iterson EH, Wheatley CM, Baker SE, Olson TP, Morgan WJ, Snyder EM. The Coupling of Peripheral Blood Pressure and Ventilatory Responses during Exercise in Young Adults with Cystic Fibrosis. PLoS One 2016; 11:e0168490. [PMID: 27997623 PMCID: PMC5172623 DOI: 10.1371/journal.pone.0168490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 11/30/2016] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Cystic fibrosis (CF) is commonly recognized as a pulmonary disease associated with reduced airway function. Another primary symptom of CF is low exercise capacity where ventilation and gas-exchange are exacerbated. However, an independent link between pathophysiology of the pulmonary system and abnormal ventilatory and gas-exchange responses during cardiopulmonary exercise testing (CPET) has not been established in CF. Complicating this understanding, accumulating evidence suggests CF demonstrate abnormal peripheral vascular function; although, the clinical implications are unclear. We hypothesized that compared to controls, relative to total work performed (WorkTOT), CF would demonstrate increased ventilation accompanied by augmented systolic blood pressure (SBP) during CPET. METHODS 16 CF and 23 controls (age: 23±4 vs. 27±4 years, P = 0.11; FEV1%predicted: 73±14 vs. 96±5, P<0.01) participated in CPET. Breath-by-breath oxygen uptake ([Formula: see text]), ventilation ([Formula: see text]), and carbon dioxide output ([Formula: see text]) were measured continuously during incremental 3-min stage step-wise cycle ergometry CPET. SBP was measured via manual sphygmomanometry. Linear regression was used to calculate [Formula: see text] slope from rest to peak-exercise. RESULTS Compared to controls, CF performed less WorkTOT during CPET (90±19 vs. 43±14 kJ, respectively, P<0.01). With WorkTOT as a covariate, peak [Formula: see text] (62±8 vs. 90±4 L/min, P = 0.76), [Formula: see text] (1.8±0.3 vs. 2.7±0.1 L/min, P = 0.40), and SBP (144±13 vs. 152±6 mmHg, P = 0.88) were similar between CF and controls, respectively; whereas CF demonstrated increased [Formula: see text] slope (38±4 vs. 28±2, P = 0.02) but lower peak [Formula: see text] versus controls (22±5 vs. 33±4 mL/kg/min, P<0.01). There were modest-to-moderate correlations between peak SBP with [Formula: see text] (r = 0.30), [Formula: see text] (r = 0.70), and [Formula: see text] (r = 0.62) in CF. CONCLUSIONS These data suggest that relative to WorkTOT, young adults with mild-to-moderate severity CF demonstrate augmented [Formula: see text] slope accompanied by increased SBP during CPET. Although the underlying mechanisms remain unclear, the coupling of ventilatory inefficiency with increased blood pressure suggest important contributions from peripheral pathophysiology to low exercise capacity in CF.
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Affiliation(s)
- Erik H. Van Iterson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Courtney M. Wheatley
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, United States of America
| | - Sarah E. Baker
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, United States of America
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States of America
| | - Thomas P. Olson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Wayne J. Morgan
- Department of Pediatrics, University of Arizona, 1501 N. Campbell Avenue, Room 3301, Tucson, AZ, United States of America
| | - Eric M. Snyder
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, United States of America
- Department of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE. Minneapolis, MN, United States of America
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Kurl S, Mäkikallio T, Jae SY, Ronkainen K, Laukkanen JA. Exercise cardiac power and the risk of coronary heart disease and cardiovascular mortality in men. Ann Med 2016; 48:625-630. [PMID: 27684365 DOI: 10.1080/07853890.2016.1202444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The aim of this study was to examine the relationship of exercise cardiac power (ECP), defined as a ratio of directly measured maximal oxygen uptake with peak systolic blood pressure during exercise, with the risk of mortality from coronary heart diseases (CHD) and cardiovascular diseases (CVD). DESIGN Population-based cohort study with an average follow-up of 25 years from eastern Finland. About 2358 men at baseline participated in exercise stress test and 182 CHD and 302 CVD deaths occurred. RESULTS Men with low ECP (< 8.7 mL/mmHg, lowest quartile) had a 3.5-fold (95% CI 2.1-5.8, p < 0.0001) risk of CHD mortality as compared with men with high ECP (>16.4 mL/mmHg, highest quartile) after adjusting for age and examination year. Low ECP was associated with a 2.8-fold risk of CHD and 2.4-fold for CVD mortality after additional adjustment for conventional risk factors. After further adjustment for leisure time physical activity, the results hardly changed (HR 2.5, 95% CI 1.71-3.67, p < 0.001). CONCLUSION ECP provides non-invasive and easily available measure for the prediction of CHD and CVD mortality. One of the most potential explanation for the association between ECP and the risk of CHD and CVD mortality is an elevated afterload and peripheral resistance indicated by hypertension. Key messages Index of exercise cardiac power defined as the ratio of directly measured maximal oxygen uptake (VO2max) with peak systolic blood pressure gives prognostic information in coronary heart disease (CHD) and CVD mortality risk stratification. ECP provides non-invasive and easily available measure for the prediction of CHD and CVD mortality. One of the most potential explanation for the association between ECP and the risk of CHD and CVD mortality is an elevated afterload and peripheral resistance indicated by hypertension.
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Affiliation(s)
- Sudhir Kurl
- a Institute of Public Health and Clinical Nutrition , University of Eastern Finland , Kuopio , Finland
| | - Timo Mäkikallio
- b Division of Cardiology, Department of Internal Medicine , University Hospital of Oulu , Oulu , Finland
| | - Sae Young Jae
- c Department of Sports Informatics, College of Arts and Physical Education , University of Seoul , South Korea
| | - Kimmo Ronkainen
- a Institute of Public Health and Clinical Nutrition , University of Eastern Finland , Kuopio , Finland
| | - Jari A Laukkanen
- a Institute of Public Health and Clinical Nutrition , University of Eastern Finland , Kuopio , Finland.,d Central Finland Hospital , Jyväskylä , Finland
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The association of serum long-chainn-3 PUFA and hair mercury with exercise cardiac power in men. Br J Nutr 2016; 116:487-95. [DOI: 10.1017/s0007114516002142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractLong-chainn-3 PUFA from fish and exercise capacity are associated with CVD risk. Fish, especially large and old predatory fish, may contain Hg, which may attenuate the inverse association of long-chainn-3 PUFA with CVD. However, the associations of long-chainn-3 PUFA or Hg exposure with exercise capacity are not well known. We aimed to evaluate the associations of serum long-chainn-3 PUFA EPA, docosapentaenoic acid (DPA) and DHA and hair Hg with exercise cardiac power (ECP, a ratio of VO2max:maximal systolic blood pressure (SBP) during an exercise test), a measure for exercise capacity. For this, data from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study were analysed cross-sectionally in order to determine the associations between serum long-chainn-3 PUFA, hair Hg and ECP in 1672 men without CVD, aged 42–60 years. After multivariate adjustments, serum total long-chainn-3 PUFA concentration was associated with higher ECP and VO2max(Ptrendacross quartiles=0·04 andPtrend=0·02, respectively), but not with maximal SBP (Ptrend=0·69). Associations were generally similar when EPA, DPA and DHA were evaluated individually. Hair Hg was not associated with ECP, VO2maxor maximal SBP. However, the associations of total long-chainn-3 PUFA (Pinteraction=0·03) and EPA (Pinteraction=0·02) with higher VO2maxwere stronger among men with lower hair Hg. Higher serum long-chainn-3 PUFA concentration, mainly a marker for fish consumption in this study population, was associated with higher ECP and VO2maxin middle-aged men from eastern Finland.
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Crump C, Sundquist J, Winkleby MA, Sundquist K. Interactive effects of physical fitness and body mass index on risk of stroke: A national cohort study. Int J Stroke 2016; 11:683-94. [PMID: 27016513 DOI: 10.1177/1747493016641961] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND High body mass index (BMI) and low physical fitness are risk factors for stroke, but their interactive effects are unknown. Elucidation of interactions between these modifiable risk factors can help inform preventive interventions in susceptible subgroups. METHODS National cohort study of all 1,547,294 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old males). Standardized aerobic capacity, muscular strength, and body mass index measurements were examined in relation to stroke identified from inpatient and outpatient diagnoses through 2012 (maximum age 62 years). RESULTS Sixteen thousand nine hundred seventy-nine men were diagnosed with stroke in 39.7 million person-years of follow-up. High body mass index, low aerobic fitness, and (less strongly) low muscular fitness were associated with higher risk of any stroke, ischemic stroke, and intracerebral hemorrhage, independently of family history and sociodemographic factors. High body mass index (overweight/obese vs. normal) and low aerobic capacity (lowest vs. highest tertile) had similar effect magnitudes, and their combination was associated with highest stroke risk (incidence rate ratio, 2.36; 95% CI, 2.14-2.60; P < 0.001). Aerobic capacity and muscular strength had a positive additive and multiplicative interaction (P < 0.001), indicating that low aerobic capacity accounted for more strokes among men with low compared with high muscular strength. CONCLUSIONS High body mass index and low aerobic capacity in late adolescence are associated with increased risk of stroke in adulthood. Low aerobic capacity and low muscular strength also have a synergistic effect on stroke risk. These findings suggest that preventive interventions should include weight control and aerobic fitness early in life, and muscular fitness especially among those with low aerobic capacity.
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Affiliation(s)
- Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jan Sundquist
- Clinical Research Centre (CRC), Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Marilyn A Winkleby
- Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | - Kristina Sundquist
- Clinical Research Centre (CRC), Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Li P, Tjen-A-Looi SC, Cheng L, Liu D, Painovich J, Vinjamury S, Longhurst JC. Long-Lasting Reduction of Blood Pressure by Electroacupuncture in Patients with Hypertension: Randomized Controlled Trial. Med Acupunct 2015; 27:253-266. [PMID: 26392838 PMCID: PMC4555646 DOI: 10.1089/acu.2015.1106] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Acupuncture at specific acupoints has experimentally been found to reduce chronically elevated blood pressure. Objective: To examine effectiveness of electroacupuncture (EA) at select acupoints to reduce systolic blood pressure (SBP) and diastolic blood pressures (DBP) in hypertensive patients. Design: Two-arm parallel study. Patients: Sixty-five hypertensive patients not receiving medication were assigned randomly to one of the two acupuncture intervention (33 versus 32 patients). Intervention: Patients were assessed with 24-hour ambulatory blood pressure monitoring. They were treated with 30-minutes of EA at PC 5-6+ST 36-37 or LI 6-7+GB 37-39 once weekly for 8 weeks. Four acupuncturists provided single-blinded treatment. Main outcome measures: Primary outcomes measuring effectiveness of EA were peak and average SBP and DBP. Secondary outcomes examined underlying mechanisms of acupuncture with plasma norepinephrine, renin, and aldosterone before and after 8 weeks of treatment. Outcomes were obtained by double-blinded evaluation. Results: After 8 weeks, 33 patients treated with EA at PC 5-6+ST 36-37 had decreased peak and average SBP and DBP, compared with 32 patients treated with EA at LI 6-7+GB 37-39 control acupoints. Changes in blood pressures significantly differed between the two patient groups. In 14 patients, a long-lasting blood pressure-lowering acupuncture effect was observed for an additional 4 weeks of EA at PC 5-6+ST 36-37. After treatment, the plasma concentration of norepinephrine, which was initially elevated, was decreased by 41%; likewise, renin was decreased by 67% and aldosterone by 22%. Conclusions: EA at select acupoints reduces blood pressure. Sympathetic and renin-aldosterone systems were likely related to the long-lasting EA actions.
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Affiliation(s)
- Peng Li
- Susan-Samueli Center for Integrative Medicine, University of California , Irvine, School of Medicine, Irvine, CA
| | - Stephanie C Tjen-A-Looi
- Susan-Samueli Center for Integrative Medicine, University of California , Irvine, School of Medicine, Irvine, CA
| | | | - Dongmei Liu
- Susan-Samueli Center for Integrative Medicine, University of California , Irvine, School of Medicine, Irvine, CA
| | - Jeannette Painovich
- Susan-Samueli Center for Integrative Medicine, University of California , Irvine, School of Medicine, Irvine, CA
| | | | - John C Longhurst
- Susan-Samueli Center for Integrative Medicine, University of California , Irvine, School of Medicine, Irvine, CA
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Exercise cardiac power and the risk of sudden cardiac death in a long-term prospective study. Int J Cardiol 2015; 181:155-9. [DOI: 10.1016/j.ijcard.2014.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/01/2014] [Indexed: 11/16/2022]
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14
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Hulkkonen J, Aatola H, Pälve K, Lehtimäki T, Hutri-Kähönen N, Viikari JS, Raitakari OT, Kähönen M. Determinants of exercise peak arterial blood pressure, circulatory power, and exercise cardiac power in a population based sample of Finnish male and female aged 30 to 47 years: the Cardiovascular Risk in Young Finns Study. BMC Cardiovasc Disord 2014; 14:35. [PMID: 24621399 PMCID: PMC3995605 DOI: 10.1186/1471-2261-14-35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background Novel parameters derived from peak maximal oxygen uptake (VO2) and exercise arterial blood pressure, such as peak circulatory power (CP) and exercise cardiac power (ECP), can be used in the risk assessment of cardiovascular disease and stroke. However, the determinants of these factors are poorly characterized in the general population. Methods We assessed peak arterial blood pressure, CP and ECP with standardized cardiopulmonary exercise test (CPET) on 281 female and 257 male participants of the Cardiovascular Risk in Young Finns Study. The subjects were aged 30–47 years. Peak VO2 as well as systolic and diastolic arterial blood pressures were measured to calculate peak mean arterial pressure, CP and ECP. These parameters were assessed for correlation with sex, age, height, weight, waist-to-hip ratio, smoking, physical activity index (PAI), fasting insulin and glucose levels as well as the use of antihypertensive treatment. Results Sex, age and weight explained 36% of the variation in peak systolic blood pressure, and these factors in combination with height and the use of antihypertensive treatment explained 13% of the variation in peak diastolic blood pressure. Sex, height, weight, waist-to-hip ratio, PAI and smoking explained 49% − 52% of the variation in peak CP. Sex, age, height, weight, waist-to-hip ratio, PAI, smoking and insulin levels explained 21% − 49% of variation in ECP. Conclusions Subject demographics and lifestyle-related factors should be taken into account when exercise blood pressure response, CP and ECP are used to evaluate patients’ cardiac function in CPET.
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Affiliation(s)
- Janne Hulkkonen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland.
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15
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Abstract
Exercise testing is not limited to observation of ischemic electrocardiographic findings during exercise, but also abnormal findings in blood pressure, heart rate, and exercise capacity are valuable. Individuals with exaggerated exercise blood pressure tend to develop future hypertension. Extensive elevation in systolic blood pressure during exercise has been found to increase the risk of left ventricular hypertrophy, myocardial infarction, cerebrovascular stroke, and cardiovascular death. Previous studies have revealed that blood pressure response to exercise is dependent on underlying heart disease and peripheral resistance. Therefore, subjects with documented cardiovascular disease may not be capable of generating a work-load to allow the manifestation of exercise-induced systolic hypertension. Systolic hypotension during exercise is associated with left ventricular dysfunction and inadequate cardiac output, and it is a marker of severe heart disease. Exercise testing with the definition of blood pressure can be performed in a logical way with test results used to decide on therapies and treatment strategies in addition to blood pressure at rest. A modest increment in blood pressure rise corresponding to work-load achieved during the exercise testing is the best sign from the prognostic point of view. The normal limits of exercise blood pressure response could be very helpful for clinicians.
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Affiliation(s)
- Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
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16
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Kurl S, Sivenius J, Mäkikallio TH, Rauramaa R, Laukkanen JA. Exercise workload, cardiovascular risk factor evaluation and the risk of stroke in middle-aged men. J Intern Med 2009; 265:229-37. [PMID: 18793247 DOI: 10.1111/j.1365-2796.2008.02006.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated the prognostic significance of risk scores and exercise workload with respect to stroke. Background. There are no data on exercise workload combined with European Systematic Coronary Risk Evaluation (SCORE) in the prediction of stroke. METHODS Exercise workload was measured by exercise test with an electrically braked cycle ergometer performed at baseline. The study is based on a random population-based sample of 1639 men (42-60 years) without history of type 2 diabetes or atherosclerotic cardiovascular disease including coronary heart disease, stroke or claudication. RESULTS During an average follow-up of 16 years, a total of 97 strokes occurred, of which 71 were ischaemic strokes. Independent predictors for all strokes were European SCORE [for 1% increment, relative risk (RR): 1.12, 95% CI: 1.02 to 1.22, P=0.017), maximal workload (for 20 W increment, RR: 0.87, 95% CI: 0.80 to 0.95, P=0.003) and body mass index (for 5 kg m(-2) increment, RR: 1.08, 95% CI: 1.03 to 1.14, P=0.004), when adjusted for serum HDL, alcohol consumption, C-reactive protein, family history of coronary heart disease, exercise-induced ST changes and the use of medications for hypertension, dyslipidaemia or aspirin. The risk was 2.54-fold (95% CI: 1.27-5.09, P=0.008) for any strokes and 4.43-fold (95% CI 1.69-11.78, P=0.003) for ischaemic strokes amongst men with exercise capacity less than 162 W when compared with those with high exercise capacity over 230 W, after adjustment for risk factors. CONCLUSIONS Low exercise workload predicts an especially high risk for stroke in the presence of high risk SCORE.
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Affiliation(s)
- S Kurl
- Research Institute of Public Health Unit, School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland.
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17
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Romani R, De Medio GE, di Tullio S, Lapalombella R, Pirisinu I, Margonato V, Veicsteinas A, Marini M, Rosi G. Modulation of paraoxonase 1 and 3 expression after moderate exercise training in the rat. J Lipid Res 2008; 50:2036-45. [PMID: 19091700 DOI: 10.1194/jlr.m800493-jlr200] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Paraoxonases (PONs) are a small family of antioxidant enzymes whose antiatherogenic activity is well known. The aim of the present study was the evaluation of the effects of moderate aerobic training on their expression using a rat model. In order to discriminate between PON1 and PON3 enzymatic activity, we took advantage of some differences in their substrate preferences. PON1 and PON3 enzymatic activities and their protein levels were analyzed in plasma and in liver microsomes, and their mRNA levels in the liver. Exercise training did not affect PON1 expression or enzymatic activity but increased PON3 mRNA, protein levels, and enzymatic activity. Training also induced variations in plasma membrane composition, including an increase in polyunsaturated and a decrease in mono- and di-unsaturated fatty acids. On the other hand, acute exercise inhibited PON activities while increasing PON3 protein content in liver microsomes and reversing the relative composition in mono-, di-, and poly-unsaturated fatty acids, suggesting that physical stress, by altering membrane composition, may impair PON release from liver membranes. In conclusion, we documented, for the first time, the presence of PON3 in rat serum and, notably, found that the upregulation of PON3, rather than PON1, appears to be associated with physical training.
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Affiliation(s)
- Rita Romani
- Department of Experimental Medicine, University of Perugia, Via del Giochetto, Perugia, Italy
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18
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Hooker SP, Sui X, Colabianchi N, Vena J, Laditka J, LaMonte MJ, Blair SN. Cardiorespiratory Fitness as a Predictor of Fatal and Nonfatal Stroke in Asymptomatic Women and Men. Stroke 2008; 39:2950-7. [PMID: 18688008 DOI: 10.1161/strokeaha.107.495275] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Prospective data on the association between cardiorespiratory fitness (CRF) and stroke are largely limited to studies in men or do not separately examine risks for fatal and nonfatal stroke. This study examined the association between CRF and fatal and nonfatal stroke in a large cohort of asymptomatic women and men.
Methods—
A total of 46 405 men and 15 282 women without known myocardial infarction or stroke at baseline completed a maximal treadmill exercise test between 1970 and 2001. CRF was grouped as quartiles of the sex-specific distribution of maximal metabolic equivalents achieved. Mortality follow-up was through December 31, 2003, using the National Death Index. Nonfatal stroke, defined as physician-diagnosed stroke, was ascertained from surveys during 1982 to 2004. Cox regression models quantified the pattern and magnitude of association between CRF and stroke.
Results—
There were 692 strokes during 813 944 man-years of exposure and 171 strokes during 248 902 woman-years of exposure. Significant inverse associations between CRF and age-adjusted fatal, nonfatal, and total stroke rates were observed for women and men (
P
trend
≤0.05 each). After adjusting for several cardiovascular disease risk factors, the inverse association between CRF and each stroke outcome remained significant (
P
trend
<0.05 each) in men. In women, the multivariable-adjusted relationship between CRF and nonfatal and total stroke remained significant (
P
trend
≤0.01 each), but not between CRF and fatal stroke (
P
trend
=0.18). A CRF threshold of 7 to 8 maximal metabolic equivalents was associated with a substantially reduced rate of total stroke in both men and women.
Conclusions—
These findings suggest that CRF is an independent determinant of stroke incidence in initially asymptomatic and cardiovascular disease-free adults, and the strength and pattern of the association is similar for men and women.
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Affiliation(s)
- Steven P. Hooker
- From the Departments of Exercise Science (S.P.H., X.S., S.N.B.), Epidemiology and Biostatistics (N.C., J.V., S.N.B.), and Prevention Research Center (S.P.H., N.C.), Arnold School of Public Health, University of South Carolina, Columbia, SC; the Department of Public Health Sciences (J.L.), University of North Carolina at Charlotte, Charlotte, NC; and the Department of Social and Preventive Medicine (M.J.L.), University at Buffalo, Buffalo, NY
| | - Xuemei Sui
- From the Departments of Exercise Science (S.P.H., X.S., S.N.B.), Epidemiology and Biostatistics (N.C., J.V., S.N.B.), and Prevention Research Center (S.P.H., N.C.), Arnold School of Public Health, University of South Carolina, Columbia, SC; the Department of Public Health Sciences (J.L.), University of North Carolina at Charlotte, Charlotte, NC; and the Department of Social and Preventive Medicine (M.J.L.), University at Buffalo, Buffalo, NY
| | - Natalie Colabianchi
- From the Departments of Exercise Science (S.P.H., X.S., S.N.B.), Epidemiology and Biostatistics (N.C., J.V., S.N.B.), and Prevention Research Center (S.P.H., N.C.), Arnold School of Public Health, University of South Carolina, Columbia, SC; the Department of Public Health Sciences (J.L.), University of North Carolina at Charlotte, Charlotte, NC; and the Department of Social and Preventive Medicine (M.J.L.), University at Buffalo, Buffalo, NY
| | - John Vena
- From the Departments of Exercise Science (S.P.H., X.S., S.N.B.), Epidemiology and Biostatistics (N.C., J.V., S.N.B.), and Prevention Research Center (S.P.H., N.C.), Arnold School of Public Health, University of South Carolina, Columbia, SC; the Department of Public Health Sciences (J.L.), University of North Carolina at Charlotte, Charlotte, NC; and the Department of Social and Preventive Medicine (M.J.L.), University at Buffalo, Buffalo, NY
| | - James Laditka
- From the Departments of Exercise Science (S.P.H., X.S., S.N.B.), Epidemiology and Biostatistics (N.C., J.V., S.N.B.), and Prevention Research Center (S.P.H., N.C.), Arnold School of Public Health, University of South Carolina, Columbia, SC; the Department of Public Health Sciences (J.L.), University of North Carolina at Charlotte, Charlotte, NC; and the Department of Social and Preventive Medicine (M.J.L.), University at Buffalo, Buffalo, NY
| | - Michael J. LaMonte
- From the Departments of Exercise Science (S.P.H., X.S., S.N.B.), Epidemiology and Biostatistics (N.C., J.V., S.N.B.), and Prevention Research Center (S.P.H., N.C.), Arnold School of Public Health, University of South Carolina, Columbia, SC; the Department of Public Health Sciences (J.L.), University of North Carolina at Charlotte, Charlotte, NC; and the Department of Social and Preventive Medicine (M.J.L.), University at Buffalo, Buffalo, NY
| | - Steven N. Blair
- From the Departments of Exercise Science (S.P.H., X.S., S.N.B.), Epidemiology and Biostatistics (N.C., J.V., S.N.B.), and Prevention Research Center (S.P.H., N.C.), Arnold School of Public Health, University of South Carolina, Columbia, SC; the Department of Public Health Sciences (J.L.), University of North Carolina at Charlotte, Charlotte, NC; and the Department of Social and Preventive Medicine (M.J.L.), University at Buffalo, Buffalo, NY
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Exercise workload, coronary risk evaluation and the risk of cardiovascular and all-cause death in middle-aged men. ACTA ACUST UNITED AC 2008; 15:285-92. [DOI: 10.1097/hjr.0b013e3282f37a33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Flavonoid intake and the risk of ischaemic stroke and CVD mortality in middle-aged Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Br J Nutr 2008; 100:890-5. [PMID: 18377681 DOI: 10.1017/s0007114508945694] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The role of flavonoids in CVD, especially in strokes, is unclear. Our aim was to study the role of flavonoids in CVD. We studied the association between the intakes of five subclasses (flavonols, flavones, flavanones, flavan-3-ols and anthocyanidins), a total of twenty-six flavonoids, on the risk of ischaemic stroke and CVD mortality. The study population consisted of 1950 eastern Finnish men aged 42-60 years free of prior CHD or stroke as part of the prospective population-based Kuopio Ischaemic Heart Disease Risk Factor Study. During an average follow-up time of 15.2 years, 102 ischaemic strokes and 153 CVD deaths occurred. In the Cox proportional hazards model adjusted for age and examination years, BMI,systolic blood pressure, hypertension medication, serum HDL- and LDL-cholesterol, serum TAG, maximal oxygen uptake, smoking, family history of CVD, diabetes, alcohol intake, energy-adjusted intake of folate, vitamin E, total fat and saturated fat intake (percentage of energy), men in the highest quartile of flavonol and flavan-3-ol intakes had a relative risk of 0.55 (95% CI 0.31, 0.99) and 0.59 (95% CI 0.30, 1.14) for ischaemic stroke, respectively, as compared with the lowest quartile. After multivariate adjustment, the relative risk for CVD death in the highest quartile of flavanone and flavone intakes were 0.54 (95% CI 0.32, 0.92) and 0.65 (95% CI 0.40, 1.05), respectively. The present results suggest that high intakes of flavonoids may be associated with decreased risk of ischaemic stroke and possibly with reduced CVD mortality.
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Effects of chronic smoking on exercise tolerance and on heart rate-systolic blood pressure product in young healthy adults. ACTA ACUST UNITED AC 2008; 14:646-52. [PMID: 17925623 DOI: 10.1097/hjr.0b013e3280ecfe2c] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Smoking is a major cause of cardiovascular disease and mortality. Smoking-related deaths in Greece account for 23%, whereas 41% of young Greeks are smokers, the highest percentage in Europe. The purpose of this study was to examine the effects of chronic smoking on the rate-pressure product and exercise tolerance in young, healthy male smokers. DESIGN AND METHODS Forty-two smokers and 51 nonsmokers were selected from a population of 543 students based on their age, sex, body mass index, physical fitness, smoking habit and health status. All participants were tested with the standard Bruce treadmill protocol. The rate-pressure product was obtained at rest and during exercise at a given submaximal workload. The evaluation of exercise tolerance was based on peak workload achieved and maximal exercise test duration. RESULTS The smokers had a higher rate-pressure product at rest (P<0.001) due to their higher resting heart rate (P<0.001). Resting values of blood pressure did not differ significantly between the two groups. During exercise, smokers had a greater rate-pressure product (P<0.001), mainly due to their significantly higher systolic blood pressure (P=0.008). The smokers had a higher submaximal heart rate (P=0.005), but the differences in heart rate between groups were reduced for smokers during exercise when compared to rest. The smokers' exercise tolerance was impaired and their maximal exercise test duration time was significantly shorter (P<0.001). CONCLUSIONS Chronic smoking was found to affect young male smokers' cardiovascular fitness, impairing the economy and decreasing the capacity of their circulatory system.
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Laukkanen JA, Rauramaa R, Salonen JT, Kurl S. The predictive value of cardiorespiratory fitness combined with coronary risk evaluation and the risk of cardiovascular and all-cause death. J Intern Med 2007; 262:263-72. [PMID: 17645594 DOI: 10.1111/j.1365-2796.2007.01807.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are no data on directly measured cardiorespiratory fitness combined coronary risk evaluation with respect to death from cardiovascular diseases and all-causes. We investigated the prognostic significance of risk scores and cardiorespiratory fitness with respect to cardiovascular disease and all-cause mortality. METHODS Cardiorespiratory fitness (maximal oxygen uptake, VO2peak) was measured by exercise test with an electrically braked cycle ergometer. The study is based on a random population-based sample of 1639 men (42-60 years) without history of type 2 diabetes or atherosclerotic cardiovascular diseases. RESULTS During an average follow-up of 16 years, a total of 304 deaths occurred. Independent predictors for all-cause death were European Score (for 1% increment, RR 1.15, 95% CI 1.10-1.20), VO2peak (for 1 MET increment, RR 0.84, 95% CI 0.78-0.89), when adjusted for C-reactive protein, alcohol consumption, serum high-density lipoprotein, waist-to-hip ratio, family history of coronary heart disease, exercise-induced ST changes and the use of medications for hypertension, dyslipidaemia or aspirin. Also, Framingham risk score was related to the risk of death (RR 1.05, 95% CI 1.03-1.07, P < 0.001). Subjects with high European or Framingham score and low VO2peak represent the highest risk group. CONCLUSION An important finding is that the risk scores can be used to identify men for whom low cardiorespiratory fitness predicts an especially high risk for death from cardiovascular and any other cause.
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Affiliation(s)
- J A Laukkanen
- Research Institute of Public Health, University of Kuopio, Kuopio, Finland.
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