Associations of Fitness, Physical Activity, Strength, and Genetic Risk With Cardiovascular Disease: Longitudinal Analyses in the UK Biobank Study

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Association between physical activity and sedentary behavior with cardiometabolic multimorbidity in the elderly hypertensive population: an observational and Mendelian randomization study

BACKGROUND

The causal relationships between physical activity (PA), sedentary behavior (SB), and the risk of cardiometabolic disease (CMD) in hypertensive populations remain unclear. We conducted a Mendelian randomization (MR) analysis to investigate these associations.

METHODS

We conducted an observational analysis using a sample of 18,963 hypertensive population. For the two-sample Mendelian Randomization (MR) analysis, we used genome-wide association study (GWAS) summary data from population-wide cohorts obtained from the MRC Integrative Epidemiology Unit (MRC-IEU). The observational study was conducted from July 2023 to September 2023. Genetic tools were selected from GWAS at genome-wide significance (P < 5 × 10-8). The summary statistics for CMD include type 2 diabetes (T2D), stroke, and coronary heart disease (CHD). Logistic regression models were employed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between PA and SB with CMD (T2D, stroke, and CHD) in the hypertensive population.

RESULTS

A total of 17,234 elderly hypertensive population were included, with an average age of 73.0 years. Among them, 9888 (57.4 %) were women, and 9406 (54.5 %) had CMD. Compared to low physical activity (LPA), moderate physical activity (MPA) was associated with a decreased risk of T2D [OR (95 % CI): 0.749 (0.682, 0.823)] and stroke [OR (95 % CI): 0.525 (0.480, 0.575)]. Vigorous physical activity (VPA) was linked to a reduced risk of T2D, stroke, and CHD. In contrast, prolonged SB was associated with an increased risk of T2D, stroke, and CHD. The MR analyses found that genetically predicted MPA was significantly associated with a reduced risk of T2D in the general population, consistent with the observational study results in hypertensive individuals. Similarly, VPA and SB were causally associated with T2D, stroke, and CHD, supporting the inverse relationships observed in the observational study.

CONCLUSIONS

This study suggests that a sedentary lifestyle and moderate to vigorous physical activity may play a significant role in the development of CMD in hypertensive populations.

Aerobic Capacity Beyond Cardiorespiratory Fitness Linking Mitochondrial Function, Disease Resilience and Healthy Aging

Aerobic capacity is conventionally equated with cardiorespiratory fitness (CRF), but its physiological essence extends far beyond cardiopulmonary performance. Aerobic capacity is an integrative physiological indicator reflecting the entire process from oxygen uptake and transport to mitochondrial energy conversion, with mitochondrial function constituting its molecular core. Emerging evidence reveals robust associations between diminished aerobic capacity and increased risks of non-communicable chronic diseases and age-related functional decline. However, its potential as a valuable tool for early disease detection and intervention remains undervalued in clinical practice. By synthesizing recent clinical and experimental studies, we highlight the crucial role of aerobic capacity, particularly its mechanistic links to impaired mitochondrial function, which drives disease progression through impaired energy metabolism and chronic inflammation. Furthermore, exercise interventions designed to enhance aerobic capacity have shown promise in improving mitochondrial efficiency, promoting cardiometabolic adaptation, and boosting overall health, thus offering an effective strategy for chronic disease prevention. We advocate for inclusion of aerobic capacity assessments in routine health evaluations and emphasize the need to integrate aerobic capacity optimization into public health frameworks to advance preventive strategies against chronic diseases and promote healthy aging.

Fitbit-measured physical activity is inversely associated with incident atrial fibrillation among All of Us participants

BACKGROUND

Individuals who report meeting weekly moderate to vigorous physical activity (MVPA) guidelines have lower risk of atrial fibrillation (AF). However existing studies have relied on subjective questionnaires or short-duration (<1 week) objective assessments using accelerometry. The objective of this research was to investigate an association between MVPA levels and the incidence of AF, utilizing long-term, free-living accelerometry data.

METHODS

1-year Fitbit data, in addition to survey and electronic health record (EHR) data, were extracted from the NIH All of Us (AoU) research database. Cox proportional hazards regression was used to model the association of average MVPA and incident AF over a five-year follow-up period.

RESULTS

15570 AoU participants were included (52±16 years, 71% female, 79% White, BMI 28.9±5.0 kg/m2, 41±12 complete weeks of Fitbit wear). 97 individuals (0.6%) experienced incident AF in the five-year follow-up period. Every additional hour of MVPA was associated with 8% lower AF risk (HR = 0.92 [0.86,0.99], p=0.02). In a subset of 10533 participants with genomic data, this association persisted after adjustment for AF genetic risk score.

CONCLUSIONS

Higher amounts of objectively measured MVPA, measured using free-living, long-term accelerometry data, were inversely associated with risk of incident AF, independent of clinical and genetic risk factors.

Physical activity and albuminuria in individuals recently diagnosed with type 2 diabetes

AIMS

We aimed to investigate the association between objectively measured physical activity and the presence and development of albuminuria in individuals recently diagnosed with type 2 diabetes at baseline.

METHODS

This study was based on data from The Danish Centre for Strategic Research in Type 2 diabetes cohort (N = 832). We assessed moderate to vigorous physical activity (MVPA) and sedentary time by 24-hour dual-monitor accelerometry at baseline and 4-years follow-up and investigated the association with albuminuria, defined as urine albumin/creatinine-ratio (UACR) ≥30 mg/g, measured from a urine sample. The odds ratio (OR) for the presence and development of albuminuria were investigated using multiple logistic regressions.

RESULTS

We found an inverse association between baseline MVPA and both presence (OR: 0.82; 95 % CI: 0.69-0.98) and incidence of albuminuria (OR: 0.74; 95 % CI: 0.59-0.94), independent of known confounding factors. However, sedentary time was not significantly associated with increased development of albuminuria. Moreover, neither decrease in MVPA (OR: 0.79; 95 % CI: 0.42-1.49) nor increase in sedentary time (OR: 1.03; 95 % CI: 0.98-1.09) were significantly associated with development of albuminuria from baseline to 4-years follow-up.

CONCLUSIONS

Our findings demonstrate an inverse association between baseline MVPA and development of albuminuria in individuals recently diagnosed with type 2 diabetes. An increase in MVPA from baseline to follow-up inferred 21 % lower incidence of albuminuria after 4-years follow-up, albeit insignificant, likely due to the relatively small sample size at follow-up and the lack of larger changes in physical activity.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02015130.

Physical activity, genetic predisposition, and incident cardiovascular disease: Prospective analyses of the UK Biobank

BACKGROUND

It is unclear whether physical activity can benefit participants with high genetic predisposition to cardiovascular disease. We examined the joint associations of intensity-specific physical activity and genetic predisposition (based on polygenetic risk score) with incident coronary heart disease (CHD), stroke, and atrial fibrillation (AF).

METHODS

This prospective cohort study included 303,950 adults (age = 56.4 ± 8.0 years, mean ± SD; 52.5% females) from the UK Biobank with physical activity and disease-related genotypes. Moderate-to-vigorous physical activity (MVPA) and intensity-specific activity was classified according to volume (e.g., MVPA was classified as none, low, medium, and high). Genetic predisposition for CHD, stroke, and AF were classified as low (Quintile 1), intermediate (Quintiles 2-4), and high (Quintile 5).

RESULTS

During 11.6 ± 2.1 years of follow-up: 19,865 CHD; 7907 stroke; and 16,688 AF events occurred. Compared to the no MVPA and high genetic risk group, we observed lower CHD risk for increasing levels of MVPA over and above genetic risk groupings. These associations were primarily driven by vigorous-intensity activity. For example, in the high genetic risk group, those with low vigorous-intensity activity levels (compared to none) had a hazard ratio (HR) of 0.78 (95% confidence interval (95% CI):0.72-0.86) compared to an HR of 0.90 (95% CI: 0.83-0.98) for low moderate-intensity activity levels. For stroke incidence, we observed a protective association for MVPA across genetic risk groups that was mostly driven by moderate-intensity activity volume. Among the high genetic risk group, low moderate-intensity had an HR of 0.77 (95% CI:0.66-0.90), whereas low vigorous-intensity had no association (HR = 0.95, 95% CI:0.82-1.09). We did not observe a consistent joint association of MVPA and AF genetic predisposition.

CONCLUSIONS

We observed lower CHD and stroke risk for low to high MVPA among participants with high genetic predisposition. The associations of moderate- and vigorous-intensity activity volume differed considerably across cardiovascular disease sub-types. Overall, our findings suggest vigorous intensity activity may mitigate genetic predisposition for CHD while moderate intensity activity may be associated with similar effects for stroke. Joint associations were less consistent across AF genetic predisposition groups. Our results inform precision medicine approaches and future lifestyle modification interventions by quantifying the potential benefits of physical activity among at-risk individuals.

Associations Between Physical Capability Markers and Risk of Coronary Artery Disease: A Prospective Study of 439,295 UK Biobank Participants

Background: The relationship between sarcopenia and the incidence of coronary artery disease (CAD) is not well understood. This study aimed to investigate this relationship and the modifying effect of potential risk factors. Methods: We conducted a prospective study including 439,295 individuals from the UK Biobank. The primary outcome was the incidence of CAD. The main physical capability markers for sarcopenia, grip strength and muscle mass, were investigated as risk factors of interest. Grip strength was measured using a Jamar J00105 (Lafayette, IN, USA) hydraulic hand dynamometer, while muscle mass was estimated through bioelectrical impedance. Cox proportional hazard models were employed to analyze the associations between the exposures and the risk of CAD. Results: A total of 41,564 incident cases of CAD were identified after a median follow-up of 13.15 years (IQR 12.29-13.88 years). Compared with the lowest quintile of grip strength, the adjusted HRs for incidences of CAD from the second to the fifth quintile were 0.81 (95% CI: 0.79-0.83), 0.71 (95% CI: 0.69-0.73), 0.61 (95% CI: 0.60-0.63), and 0.49 (95% CI: 0.48-0.51). The association remained significant in subgroup analysis and interactions were observed between the two exposures and sex, age, smoking status, inflammatory diseases, metabolic syndrome, and genetic predisposition (all p for interactions < 0.05). Conclusions: Physical capability markers of sarcopenia, grip strength and muscle mass, were independently associated with a dose-response decreased risk for CAD incidence, regardless of genetic predisposition and potential modifying risk factors.

Interaction of accelerometer-measured physical activity and genetic risk on cardiovascular diseases: a prospective cohort study from UK Biobank

Objectives

This study aimed to evaluate the interactions of physical activity and polygenic risk score (PRS) on risks of atrial fibrillation, coronary heart disease (CHD), hypertension, and ischaemic stroke.

Methods

This study included 91 629 participants from UK Biobank in this study, all of whom had worn a wrist-worn accelerometer for 7 consecutive days. We computed total volume of physical activity (TPA) and time spent in moderate to vigorous intensity physical activity (MVPA) and light intensity physical activity (LPA). Cox proportional hazard models were used to evaluate associations of physical activity with the four cardiovascular outcomes. Interactions between physical activity and PRS were investigated on multiplicative and additive scales.

Results

During a median follow-up of 7.9 years, 3811 atrial fibrillation, 3994 CHD, 7345 hypertension and 1001 ischaemic stroke cases were recorded. TPA, MVPA and LPA were all negatively associated with risks of the four cardiovascular outcomes, generally independent of genetic risk. Association between LPA and atrial fibrillation was U-shaped among low-PRS stratum (p=0.01), and association between TPA and hypertension was attenuated with genetic risk increasing (p=0.02). Attributable risk (AR) of inactivity was higher in the high-PRS population. For example, increasing MVPA resulted in a twofold greater reduction in CHD cases among individuals with high PRS (AR=2.17%) than among those with low PRS (AR=1.09%).

Conclusions

Increasing physical activity, including LPA, was associated with a reduced risk of cardiovascular diseases. The extent of this benefit may differ among individuals with different genetic risks.

Joint effects of air pollution and diet patterns on the risk of chronic obstructive pulmonary disease

Diet patterns and air pollution have been recognized as factors that affect the onset of chronic obstructive pulmonary disease (COPD). However, the combined effects of these factors on COPD incidence remain unclear. On the basis of a large prospective cohort from UK Biobank, we explored the independent and joint effects of diet patterns and air pollution on the risk of COPD. A total of 314,226 participants from UK Biobank, who were recruited between 2006 and 2010, were included in this study. The participants were randomly divided into the training (70%) and validation (30%) sets, with the air pollution score calculated using the training set. A diet pattern score was constructed in accordance with the intake of fruits, vegetables, fish, processed meat, unprocessed red meat, whole grains, and refined grains. Meanwhile, an air pollution score was calculated by determining the exposure levels to four components: fine particulate matter (PM2.5), PM2.5-10, NO2, and NOx. Cox proportional hazard models with hazard ratios (HRs) and 95% confidence intervals (CIs) were applied to examine the independent effects of diet patterns and air pollution on COPD incidence. Interaction analyses at the multiplicative and additive scales were also applied to assess the joint effects of diet patterns and air pollution on COPD risk. The above analyses were performed on both the training and validation datasets to verify the robustness of the results. In the training set, 6,696 participants were diagnosed with COPD during a median follow-up duration of 13.9 years. In the fully adjusted model, participants with intermediate and low diet pattern scores had higher COPD risk compared with those with high diet pattern score, with HRs being 1.11 (95% CI: 1.05 to 1.17) and 1.31 (95% CI: 1.21 to 1.42), respectively. Moreover, heavier exposure to air pollution was associated with higher COPD risk, with HRs being 1.06 (95% CI: 1.03, 1.14) and 1.13 (95% CI: 1.05, 1.22) for quintiles Q4 and Q5, respectively, compared with that for quintile Q1. Similar results were observed in the validation dataset. Analyses revealed limited evidence of significant joint effects between diet pattern and air pollution scores on either the multiplicative or additive scales, both in the training and validation sets. Targeted intervention on modifiable diet patterns may offset the adverse effect of air pollution exposure on COPD risk.

Muscle Strength, Genetic Risk, and Type 2 Diabetes Among Individuals of South Asian Ancestry: A UK Biobank Study

OBJECTIVE

To examine the independent and combined associations of genetic risk and muscle strength with the risk of incident type 2 diabetes (T2D) and glycated hemoglobin (HbA1c) among individuals of South Asian ancestry.

DESIGN AND METHODS

This study included 5288 South Asian individuals (mean age 52.5 years; 52.3% men) from the UK Biobank study. Baseline assessments were conducted between 2006 and 2010. Muscle strength was assessed through a hand dynamometer and expressed relative to fat-free mass. Sex-and age-specific tertiles were used to classify muscle strength into three categories. Genetic risk of T2D was quantified using a weighted polygenic risk score calculated from 22 distinct South Asian-specific single nucleotide polymorphisms for T2D.

RESULTS

Compared to the bottom tertile of genetic risk for T2D, the highest had increased odds of incident T2D (odds ratio: 1.62; 95% confidence interval [CI]: 1.31-2.00) and HbA1c levels (β: 0.80; 95% CI 0.41-1.19). Compared to high muscle strength, low muscle strength was associated with 89% higher odds of incident T2D (odds ratio: 1.89; 95% CI 1.52-2.35) and higher HbA1c levels (β: 0.95; 95% CI 0.55-1.35), after adjustment for confounders and genetic susceptibility to T2D. Joint analyses revealed lower muscle strength was consistently associated with higher odds of incident T2D and HbA1c levels across all genetic risk strata.

CONCLUSION

Polygenic risk scores for T2D could have great prognostic value in preemptively identifying individuals of South Asian ancestry at high genetic risk of T2D. Regardless of T2D genetic risk, greater muscle strength is linked to lower T2D risk and HbA1c levels.

Vitamin C-Dependent Intergenerational Inheritance of Enhanced Endurance Performance Following Maternal Exercise

Declining levels of physical activity and fitness in children and youth are linked to negative health outcomes. This study investigates whether maternal exercise can enhance offspring's physical fitness. Our results demonstrate that maternal exercise improves offspring's endurance by changing muscle fiber composition and promoting mitochondrial biogenesis, with benefits lasting across generations. This improvement is associated with changes in DNA methylation, specifically the demethylation of the Slc23a2 gene, which codes for SVCT2, crucial for vitamin C (VC) transport, in F1 and F2 generations. Importantly, VC administration during pregnancy mimics the transgenerational benefits of exercise on offspring fitness, but these benefits are absent in genetic VC deficiency mice. VC supplementation increases TET2 expression in murine and human myogenic cells, regulating DNA methylation, promoting the development of oxidative fibers, and enhancing mitochondrial biogenesis. This study highlights the VC-TET2-SVCT2 pathway as a key mechanism for the transgenerational endurance benefits of maternal exercise, suggesting potential strategies to enhance maternal and child health.

Physical Activity, Fitness, and Health-Related Quality of Life in Children and Adolescent Cancer Survivors: A Cross-Sectional Study (iBoneFIT Project)

Background/Objectives: This study aims to evaluate the health-related quality of life (HRQoL) of children and adolescent cancer survivors in relation to previously published normative values for typically developing children and adolescents, as well as to analyze the differences in HRQoL based on their levels of physical activity and fitness. Methods: Cross-sectional study with 116 cancer survivors (12.1 ± 3.3 years, 57.8% boys) from two pediatric oncology units in Andalusia (Spain). HRQoL was assessed using PedsQL 4.0 Generic Core Scales. Physical activity was measured with accelerometers, and fitness was evaluated using self-reported and objective tests for muscular fitness. Independent samples t-tests to compare HRQoL between our sample and the normative values published for typically developing children and adolescents of the same age and analysis of covariance (ANCOVA) were conducted to assess differences in HRQoL according to physical activity and fitness categories in our sample. Results: Children and adolescent cancer survivors had lower HRQoL scores compared to typically developing children's and adolescents' normative values, except for social functioning. Higher levels of moderate-to-vigorous physical activity were associated with better total, physical, and psychosocial HRQoL scores. Children and adolescent cancer survivors with better levels of cardiorespiratory fitness, motor fitness, and flexibility reported better HRQoL scores in total and psychosocial domains. However, muscular fitness (self-reported and objectively measured) did not show a significant difference in HRQoL. Conclusions: Children and adolescent cancer survivors experience lower HRQoL than their typically developing counterparts. Engaging in at least 30 min of moderate-to-vigorous physical activity per day is associated with fewer HRQoL impairments. Improved fitness, particularly cardiorespiratory fitness, motor fitness, and flexibility, are associated with better HRQoL outcomes. These findings highlight the association between physical activity, fitness levels, and HRQoL in children and adolescent cancer survivors, suggesting the potential benefits of promoting physical activity and enhancing fitness levels.

Coronary atherosclerosis in athletes: emerging concepts and preventive strategies

There should be no assumption that an athlete is immune to coronary artery disease (CAD), even when traditional cardiovascular (CV) risk factors appear well-managed. Excelling in certain aspects of health does not equate to total CV protection. Recent data from cardiac imaging studies have raised the possibility that long-term, high-volume, high-intensity endurance exercise is associated with coronary atherosclerosis. Whilst the risk of CV events has not been shown to rise with athletic activity, the potential for CAD should not be overlooked as it is the leading cause of sudden cardiac death in athletes >35 years of age (i.e. 'Masters athletes'). Evaluating both traditional and non-traditional risk factors for CAD is the most important part of pre-participation evaluation in Masters athletes. When managing athletes at risk of CAD it is important to adopt a shared decision-making approach regarding lifestyle adaptation and lipid-lowering treatments. In the great majority of athletes, after excluding the presence of symptoms and inducible ischaemia, this advice should include encouragement to continue exercising as available data indicate that higher levels of fitness are associated with a markedly attenuated incidence of coronary events regardless of the severity of coronary disease. Future research is needed to establish the relationship between clinically relevant CAD outcomes and coronary artery calcification in Masters Athletes, the role of sex, as well as exploration of the mechanisms underpinning these unexpected CV adaptations.

Association of sugar-sweetened beverage consumption and cardiorespiratory fitness with executive function: a cross-sectional survey based on Tajik adolescents at high altitude in China

Background

Executive function has a significant impact on adolescents' academic and future achievement and is strongly associated with multiple factors. However, few studies have examined the association between sugar-sweetened beverage (SSB) consumption, cardiorespiratory fitness, and executive function. Moreover, no research studies have been found on Tajik adolescents at high altitudes in China. The present study aimed to understand the associations between SSB consumption, cardiorespiratory fitness, and executive function among Tajik adolescents in high-altitude areas of China. To accumulate information on the physical and mental health development of Tajik adolescents in high-altitude areas of China.

Methods

In this study, a cross-sectional assessment of SSB consumption, cardiorespiratory fitness, and executive function was conducted on 1,121 Tajik adolescents aged 13-15 years at high altitude in China in 2023. One-way analysis of variance (ANOVA), binary logistic regression analysis, and ordered logistic regression analysis with a generalized linear model were used to analyze the associations that existed between SSB consumption and cardiorespiratory fitness and executive function.

Results

The proportions of Tajik adolescents aged 13-15 years with SSB consumption of ≤1 time/week, 2-5 times/week, and ≥ 6 times/week were 14.6, 51.6, and 33.8%, respectively, in high-altitude areas of China. The VO2max of Tajik adolescents was (37.17 ± 5.52) ml.kg.min-1. The inhibit control function response, refreshing memory function response, and switching flexibility function response of Chinese Tajik adolescents were (19.71 ± 5.86) ms, (1114.39 ± 356.85) ms, (382.2 ± 213.4) ms. Overall, using the SSB consumption ≤1 times/w and VO2max of the Q4 group as the reference group, ordered logistic regression analysis showed that Tajik adolescents with SSB consumption ≥5 times/w and VO2max of the Q1 group experienced inhibit control function dysfunction (OR = 28.80, 95%CI: 10.23 ~ 81.07), refreshing memory function dysfunction (OR = 6.79, 95%CI: 3.19 ~ 14.43), switching flexibility function dysfunction (OR = 13.10, 95%CI: 5.59 ~ 30.70) were at increased risk (p < 0.001).

Conclusion

SSB consumption and cardiorespiratory fitness were associated with executive function in Tajik adolescents at high altitudes in China. Increased frequency of SSB consumption and decreased cardiorespiratory fitness increased the risk of executive function disorders in Tajik adolescents. In the future, SSB consumption and cardiorespiratory fitness should be effectively controlled in Tajik adolescents to improve their executive function and promote the physical and mental health of Tajik adolescents in high-altitude areas.

Using music as a mood regulator in everyday life is associated with unfavourable health and fitness outcomes in overweight adults

Individual traits and habits have shown to be associated with health and health behaviour. One such habit is how individuals use music. This study aimed to examine if using music as a mood regulator is related to risk factors of lifestyle diseases. Participants who joined the present Motivation Makes the Move! lifestyle intervention were overweight and sedentary adults (n = 76, ages 19-40). They answered questionnaires about physical activity and use of music. They also underwent a cardiopulmonary exercise test and their body composition was assessed. Additionally, the analyses' robustness was tested through controlling for physical, sociodemographic and psychological health related factors. We observed that despite the participants' self-reported commitment to regular physical activity, their fitness level was poor. Using music as a mood regulator was associated with lower cardiorespiratory fitness. Use of music was also positively linked to body fat percentage, although this finding did not remain significant after adjusting for age, educational level and experienced health. We urge future research to address the relationship between music use and risk factors of lifestyle diseases in a population sample.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Association of cardiorespiratory fitness with the incidence and progression trajectory of cardiometabolic multimorbidity

OBJECTIVES

This study examined the relationship of cardiorespiratory fitness (CRF) in the transition from healthy status to first cardiometabolic disease, subsequent cardiometabolic multimorbidity and further to death.

METHODS

We used data from the UK Biobank of 47 484 participants without cardiometabolic diseases at baseline. CRF was assessed via a 6 min incremental ramp cycle ergometer test and expressed in metabolic equivalent of tasks (METs, 1 MET=3.5 mL/kg/min). Cardiometabolic multimorbidity was defined as at least two diseases among diabetes, hypertension, coronary heart disease and stroke.

RESULTS

Over 12.5 years median follow-up, 8123 participants developed first cardiometabolic disease, 1958 developed cardiometabolic multimorbidity and 2177 died. CRF was associated with different transition stages in cardiometabolic multimorbidity development. The HRs (95% CIs) per MET increase in CRF were 0.94 (0.93 to 0.95) and 0.97 (0.96 to 0.99) for transitions from healthy baseline to first cardiometabolic disease and subsequent cardiometabolic multimorbidity. Per MET increase in CRF was associated with reduced risk of transition from healthy baseline to death (HR: 0.97, 95% CI 0.95 to 0.99), but not for the transition from first cardiometabolic disease and cardiometabolic multimorbidity to death. When first cardiometabolic disease was divided into specific cardiometabolic diseases, there were comparable trends of CRF on the disease-specific transitions from healthy baseline to first cardiometabolic disease and subsequent cardiometabolic multimorbidity.

CONCLUSION

Higher CRF was associated with a lower risk of progression from a healthy state to first cardiometabolic disease and subsequently to cardiometabolic multimorbidity. These findings suggest that improving CRF is a potential strategy for preventing cardiometabolic multimorbidity development.

Healthy lifestyle practice correlates with decreased obesity prevalence in individuals with high polygenic risk: TMM CommCohort study

Obesity and overweight, fundamental components of the metabolic syndrome, predispose individuals to lifestyle-related diseases. The extent to which adopting healthy lifestyles can reduce obesity risk, even in those with a high genetic risk, remains uncertain. Our aim was to assess the extent to which lifestyle modifications can improve outcomes in individuals with a high polygenic score (PGS) for obesity. We quantified the genetic risk of obesity using PGSs. Four datasets from the Tohoku Medical Megabank Community-Based Cohort (TMM CommCohort) were employed in the study. One dataset (n = 9958) was used to select the best model for calculating PGS. The remaining datasets (total n = 69,341) were used in a meta-analysis to validate the model and to evaluate associated risks. The odds ratio (OR) for obesity risk in the intermediate (11th-90th percentiles in the dataset) and high PGS categories (91st-100th) was 2.27 [95% confidence intervals: 2.12-2.44] and 4.83 [4.45-5.25], respectively, compared to that in the low PGS category (1st-10th). Trend analysis showed that an increase in leisure-time physical activity was significantly associated with reduced obesity risk across all genetic risk categories, representing an OR of 0.9 [0.87-0.94] even among individuals in the high PGS category. Similarly, sodium intake displayed a positive association with obesity across all genetic risk categories, yielding an OR of 1.24 [1.17-1.31] in the high PGS category. The risk of obesity was linked to the adoption of healthy lifestyles, even in individuals with high PGS. Our results may provide perspectives for integrating PGSs into preventive medicine.

Stair climbing and risk of incident atrial fibrillation: Effect modulated by sex, genetic predisposition, and cardiorespiratory fitness

BACKGROUND AND AIMS

Stair climbing, a straightforward and impactful form of physical activity, has shown potential in reducing risks of cardiovascular disease and mortality. However, its association with the development of atrial fibrillation (AF) remains largely unexplored.

METHODS AND RESULTS

451,089 participants (mean age 56.5 years) without cardiovascular disease (year 2006-2010) were included from the UK Biobank study. Stair climbing data was collected through touchscreen questionnaire. AF cases were identified using ICD-10 code: I48 and were followed until February 1, 2022. Models adjusted for traditional cardiovascular risk factors. Over a median follow-up of 12.6 years, 23,660 (5.2 %) participants experienced new-onset AF. In multivariable-adjusted models, climbing 10-50, 60-100, 110-150, and ≥160 steps of stairs per day were associated with significant reductions in the risk of AF, compared to not climbing any stairs. The risk reduction appeared more pronounced in women than in men (P for interaction = 0.09). When compared to participants who climbed no stairs, the HRs for those who climbed 110-150 steps of stairs per day were 0.69 (95 % CI: 0.58-0.82) among those with low cardiorespiratory fitness, 0.71 (95 % CI: 0.57-0.88) among those with intermediate cardiorespiratory fitness, and 0.83 (95 % CI: 0.64-1.07) among those with high cardiorespiratory fitness.

CONCLUSIONS

Climbing stairs was associated with a reduction in AF risks. Significant interaction between cardiorespiratory fitness and stair climbing associated with incident AF was observed. Findings suggest that promoting regular stair climbing could be a potential target for preventing AF onset.

Interplay between lifestyle factors and polygenic risk for incident coronary heart disease in a large multiethnic cohort

Introduction

The objective of this study was to examine the interplay of polygenic risk and individual lifestyle factors (and a composite score of lifestyle) as antecedents of CHD in a large multiethnic cohort.

Methods

We used Genetic Epidemiology Resource in Adult Health and Aging (GERA) cohort participants free of CHD at baseline (n = 60,568; 67 % female; 18 % non-European). The individual and joint associations of smoking, Mediterranean diet pattern, level of physical activity and polygenic risk with incident CHD were assessed using Cox regression adjusting for genetic ancestry and non-mediating risk factors. Hazard ratios (HRs) and number needed to treat (NNT) were estimated according to these lifestyle factors and polygenic risk categories. Strengths included large sample size, long-follow-up, ethnic diversity, a clinically-validated polygenic risk score (PRS), and rich phenotype information.

Results

After 14 years of follow-up, there were 3159 incident CHD events. We observed no statistically significant interactions between individual lifestyle factors and polygenic risk (all p > 0.23). For individuals with a high genetic risk, moving from the worse lifestyle combination (no favorable lifestyle factors) to the best lifestyle combination (all three) is associated with 52 % lower rate of CHD. The NNT was highest in the low polygenic risk group (34), lowest in the high polygenic risk group [19] and in-between (Jin et al., 2011) [24] in the intermediate polygenic risk group.

Conclusions

Lifestyle and polygenic risk together influence the risk of incident CHD. Our results support consideration of polygenic risk in lifestyle interventions because those with high polygenic risk are likely to derive the most benefit.

Observational and genetic associations between cardiorespiratory fitness and age-related diseases: longitudinal analyses in the UK Biobank study

Background

Observational studies have indicated that increased cardiorespiratory fitness is associated with a decreased risk of cardiovascular disease (CVD), Alzheimer's disease (AD), and Parkinson's disease (PD). However, the causal mechanisms remain unclear. The objective of this study was to assess the role of fitness in the early detection and reduction of disease risk within the framework of predictive, preventive, and personalized medicine (PPPM/3PM).

Methods

The associations of fitness with CVD, AD, and PD were explored in a large cohort of up to 502,486 individuals between the ages of 40 and 69 years from the UK Biobank. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of CVD, AD, and PD among participants who completed a submaximal fitness test. Causality relationships were assessed via two-sample Mendelian randomization (MR).

Results

After a median of 11 years of follow-up, each 3.5 ml of O2⋅min-1⋅kg-1 increase in total body mass (equivalent to 1 metabolic equivalent of task (MET), approximately 0.5 standard deviations (SDs)) was associated with decreased risks of CVD (20.0%, 95% CI 17.6-22.3%), AD (31.9%, 95% CI 26.7-33.6%), and PD (21.2%, 95% CI 11.2-31.8%). After adjusting for obesity, the observational associations were attenuated. According to the MR analyses, fitness was associated with PD (OR IVW 0.937, 95% CI 0.897-0.978) and small vessel stroke (OR IVW 0.964, 95% CI 0.933-0.995).

Conclusion

Our results indicate that fitness has an effect on age-related diseases. Protective associations of higher fitness levels with the risk of CVD, AD, and PD were validated in this cohort study. These findings might be valuable for predicting, preventing, and reducing disease morbidity and mortality through primary prevention and healthcare in the context of PPPM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-024-00382-4.

Visceral and subcutaneous adiposity and cardiovascular disease: Unravelling associations and prognostic value

AIM

The distribution pattern of abdominal adiposity may help determine cardiovascular disease (CVD). Waist circumference (WC) is the most common but imprecise method for measuring abdominal adiposity, as it fails to differentiate between visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (ASAT). This study aimed to determine whether elevated VAT or ASAT provides greater prognostic value for CVD events compared to elevated WC in the general population using data from the UK Biobank.

MATERIALS AND METHODS

In this secondary analysis of UK Biobank study, 24 265 participants with available abdominal magnetic resonance imaging data were included. The primary outcome of the study was coronary heart disease (CHD), and secondary outcomes included stroke, heart failure (HF) and atrial fibrillation (AF). Cox regressions for VAT, ASAT and WC were examined in relation to the predefined outcomes on continuous scales using standard deviation (SD) changes and by categories of concordant and discordant values defined by medians.

RESULTS

During a mean follow-up period of 12.9 ± 1.8 years, 2641 participants developed CVD events (1296 CHD, 165 stroke, 286 HF and 894 AF) Each 1 SD increase in VAT yielded a hazard ratio (HR) of 1.15 (95% confidence interval [CI]: 1.09-1.22) for CHD risk, whereas ASAT had a HR of 1.10 (95% CI: 1.04-1.18). Further adjustment for WC eliminated the association between ASAT and CHD risk, in contrast to the association between VAT and CHD risk, which remained almost unaffected. Discordant VAT above the median with WC below presented a HR of 1.43 (95% CI: 1.15-1.78) for CHD, compared with concordant VAT and WC below the median. Similar results were found for discordant WC above the median with VAT below, with a HR of 1.46 (95% CI: 1.18-1.81). In contrast, discordant ASAT above the median with WC below was not associated with an increased risk of CHD. Similarly, discordant ASAT above the median with VAT below was not associated with an increased risk of CHD. Additionally, there was no observed association between VAT or ASAT and the risks of stroke, HF or AF after further adjustment for WC. Additionally, there was no observed association between VAT or ASAT and the risks of stroke, HF or AF after further adjustment for WC.

CONCLUSION

Incorporating VAT measurements alongside WC data improved the ability to identify individuals at high risk for CHD compared to using WC alone. Both VAT and WC proved to be more accurate indicators of CHD risk than ASAT. However, VAT alone did not fully account for the CHD risk associated with elevated WC levels. Neither VAT nor ASAT showed an association with the risk of stroke, HF and AF.

Association between grip strength, walking pace and incident peripheral artery disease: A prospective study of 430,886 UK biobank participants

Background and aims

Patients with peripheral artery disease (PAD) presented overall muscle weakness and reduced physical performance. Previous study focused on the impact of muscle weakness on outcomes of established PAD, however the relationship between compromised muscle function and incident PAD remained unclear.

Methods

A prospective study involving 430,886 participants aged 40-69 y from UK biobank was conducted. The main outcome was incident PAD. Grip strength and walking pace were used as indicators for muscle function. Grip strength was measured using a Jamar J00105 hydraulic hand dynamometer, while walking pace was self-reported by the participants. Cox proportional hazard models were employed to investigate the relationship between grip strength, walking pace, and incident PAD.

Results

A total of 430,886 individuals were included in the final analysis. The mean age of the participants were 56.44 years, and 55.3 % were female. Over a median follow-up period of 13.81 years, 5,661 participants developed PAD. Higher grip strength, whether absolute or relative, exhibited a dose-dependent inverse association with incident PAD. Each 1 kg increment in absolute grip strength and each 0.01 kg/kg increase in relative grip strength were associated with reduced PAD risk by 2 % (HR: 0.98; 95 % CI [0.97-0.98]) and 83 % (HR: 0.17; 95 % CI [0.13-0.23]), respectively. Slow walking pace significantly correlated with increased PAD risk, while brisk walking pace was associated with decreased PAD risk.

Conclusion

Absolute grip strength, relative grip strength and walking pace were inversely associated with the risk of incident PAD.

Combined Effect of Air Pollution and Genetic Risk on Incident Cardiovascular Diseases

BACKGROUND

Whether genetic susceptibility to cardiovascular diseases (CVDs) enhances the vulnerability to adverse cardiovascular outcomes by air pollution is unknown. We assessed the combined effect of air pollution and genetic predispositions on CVD risk.

METHODS AND RESULTS

From the UK Biobank cohort, we selected genetically unrelated White British participants without CVD. Levels of ambient particulate matter with a diameter of <2.5 μm (PM2.5) and <10 μm were estimated using land use regression models. An individual's genetic predisposition to CVDs was determined by polygenic risk scores for coronary artery disease, myocardial infarction, stroke, ischemic stroke, heart failure, and atrial fibrillation. We stratified mortality and CVD risk by PM2.5 exposure across high and low genetic risk groups. A total of 249 082 participants (aged 56.9±8.0 years, 46.8% men) were followed for a median of 10.8 years. The combined effect of PM2.5 exposure and the genetic predisposition of CVD demonstrated the highest risk of cardiovascular death in the high genetic risk group with the greatest PM2.5 exposure (adjusted hazard ratios ranging from 1.73 to 2.12 across the polygenic risk score of each CVD). The combination of higher exposure to ambient PM2.5 and high genetic risk was associated with higher incidence of all CVDs, although no significant interactions were observed between genetic risk and PM2.5 exposure on cardiovascular death or CVD events.

CONCLUSIONS

A combination of greater PM2.5 exposure and higher genetic predisposition to particular CVDs was modestly associated with elevated risks of cardiovascular death and CVDs. Not only alleviating PM2.5 exposure in the general population but also implementing individualized preventive approach for those at high genetic risk might be beneficial.

Fitness-related physical activity intensity explains most of the association between accelerometer data and cardiometabolic health in persons 50-64 years old

OBJECTIVES

To investigate the physical activity (PA) intensity associated with cardiometabolic health when considering the mediating role of cardiorespiratory fitness (CRF).

METHODS

A subsample of males and females aged 50-64 years from the cross-sectional Swedish CArdioPulmonary bioImage Study was investigated. PA was measured by accelerometry and CRF by a submaximal cycle test. Cardiometabolic risk factors, including waist circumference, systolic blood pressure, high-density lipoprotein, triglycerides and glycated haemoglobin, were combined to a composite score. A mediation model by partial least squares structural equation modelling was used to analyse the role of CRF in the association between PA and the composite score.

RESULTS

The cohort included 4185 persons (51.9% female) with a mean age of 57.2 years. CRF mediated 82% of the association between PA and the composite score. The analysis of PA patterns revealed that moderate intensity PA explained most of the variation in the composite score, while vigorous intensity PA explained most of the variation in CRF. When including both PA and CRF as predictors of the composite score, the importance of vigorous intensity increased.

CONCLUSION

The highly interconnected role of CRF in the association between PA and cardiometabolic health suggests limited direct effects of PA on cardiometabolic health beyond its impact on CRF. The findings highlight the importance of sufficient PA intensity for the association with CRF, which in turn is linked to better cardiometabolic health.

Changes in the estimated glucose disposal rate and incident cardiovascular disease: two large prospective cohorts in Europe and Asia

BACKGROUND AND AIMS

Previous study found that estimated glucose disposal rate (eGDR) was significantly associated with cardiovascular disease (CVD). However, little is known about the change in eGDR over time and its association with the development of CVD. The aim of this study was to investigate the association of change in eGDR with CVD risk.

METHODS

This study used data of two prospective cohorts: UK Biobank and China Health and Retirement Longitudinal Study (CHARLS) with two measurements of eGDR. Changes in the eGDR were classified using K‑means clustering analysis, and the cumulative eGDR was also calculated. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders.

RESULTS

A total of 11,682 individuals from the UK Biobank, and 4,974 individuals from the CHARLS were included. The median follow-up periods were 9.7 years in the UK Biobank and 3.0 years in the CHARLS. Compared with persistently high level of eGDR (class 1), individuals with low level increasing (class 3) and persistently low level of eGDR (class 4) showed elevated risks of incident CVD in both UK Biobank (HR = 2.79, 95% 2.15-3.62 for class 3; HR = 3.19, 95% 2.50-4.08 for class 4) and CHARLS (HR = 1.66, 95% 1.29-2.13 for class 3; HR = 1.69, 95% 1.34-2.14 for class 4). In addition, lower level of cumulative eGDR were associated with elevated risks of incident CVD. The dose-response curve between cumulative eGDR and CVD risk showed a negative linear relationship.

CONCLUSION

Different changes in eGDR level are associated with different risks of incident CVD. Dynamic monitoring of eGDR level is of significant importance for the CVD prevention and treatment.

Effects of different exercise methods and intensities on the incidence and prognosis of atrial fibrillation

Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, exhibits a higher risk of cardiovascular adverse events. Exercise plays a crucial role in AF prevention, but the effects of different exercise types and doses are inconclusive. This review aims to comprehensively explore the most recent evidence and possible mechanisms of diverse exercise modalities concerning AF incidence and therapeutic outcomes. Multiple studies underscore the efficacy of moderate-intensity continuous training (MICT) in reducing AF incidence and symptom burden, rendering it the currently favored exercise therapy for AF patients. High-intensity interval training (HIIT) shows promise, potentially surpassing MICT, especially in reducing age-related AF susceptibility and improving symptoms and exercise capacity. Conversely, prolonged high-intensity endurance exercise exacerbates AF risk due to excessive exercise volume, with potential mechanisms encompassing irreversible atrial remodeling, heightened inflammation, and increased vagal tone. In summation, MICT is a secure strategy for populations in mitigating the risk associated with AF incidence and secondary cardiovascular events and should be encouraged. Also, it is recommended to initiate large-scale clinical intervention trials encompassing a variety of exercise types to delineate the optimal exercise prescription for cardiovascular patients, including those afflicted with AF.

Real-world walking behaviors are associated with early-stage heart failure: a Project Baseline Health Study

BACKGROUND

Data collected via wearables may complement in-clinic assessments to monitor subclinical heart failure (HF).

OBJECTIVES

Evaluate the association of sensor-based digital walking measures with HF stage and characterize their correlation with in-clinic measures of physical performance, cardiac function and participant reported outcomes (PROs) in individuals with early HF.

METHODS

The analyzable cohort included participants from the Project Baseline Health Study (PBHS) with HF stage 0, A, or B, or adaptive remodeling phenotype (without risk factors but with mild echocardiographic change, termed RF-/ECHO+) (based on available first-visit in-clinic test and echocardiogram results) and with sufficient sensor data. We computed daily values per participant for 18 digital walking measures, comparing HF subgroups vs stage 0 using multinomial logistic regression and characterizing associations with in-clinic measures and PROs with Spearman's correlation coefficients, adjusting all analyses for confounders.

RESULTS

In the analyzable cohort (N=1265; 50.6% of the PBHS cohort), one standard deviation decreases in 17/18 walking measures were associated with greater likelihood for stage-B HF (multivariable-adjusted odds ratios [ORs] vs stage 0 ranging from 1.18-2.10), or A (ORs vs stage 0, 1.07-1.45), and lower likelihood for RF-/ECHO+ (ORs vs stage 0, 0.80-0.93). Peak 30-minute pace demonstrated the strongest associations with stage B (OR vs stage 0=2.10; 95% CI:1.74-2.53) and A (OR vs stage 0=1.43; 95% CI:1.23-1.66). Decreases in 13/18 measures were associated with greater likelihood for stage-B HF vs stage A. Strength of correlation with physical performance tests, echocardiographic cardiac-remodeling and dysfunction indices and PROs was greatest in stage B, then A, and lowest for 0.

CONCLUSIONS

Digital measures of walking captured by wearable sensors could complement clinic-based testing to identify and monitor pre-symptomatic HF.

Polygenic Risk Score, Cardiorespiratory Fitness, and Cardiometabolic Risk Factors: WASEDA'S Health Study

PURPOSE

This study estimated an individual's genetic liability to cardiometabolic risk factors by polygenic risk score (PRS) construction and examined whether high cardiorespiratory fitness (CRF) modifies the association between PRS and cardiometabolic risk factors.

METHODS

This cross-sectional study enrolled 1296 Japanese adults aged ≥40 yr. The PRS for each cardiometabolic trait (blood lipids, glucose, hypertension, and obesity) was calculated using the LDpred2 and clumping and thresholding methods. Participants were divided into low-, intermediate-, and high-PRS groups according to PRS tertiles for each trait. CRF was quantified as peak oxygen uptake (V̇O 2peak ) per kilogram body weight. Participants were divided into low-, intermediate-, and high-CRF groups according to the tertile V̇O 2peak value.

RESULTS

Linear regression analysis revealed a significant interaction between PRS for triglyceride (PRS TG ) and CRF groups on serum TG levels regardless of the PRS calculation method, and the association between PRS TG and TG levels was attenuated in the high-CRF group. Logistic regression analysis revealed a significant sub-additive interaction between LDpred2 PRS TG and CRF on the prevalence of high TG, indicating that high CRF attenuated the genetic predisposition to high TG. Furthermore, a significant sub-additive interaction between PRS for body mass index and CRF on obesity was detected regardless of the PRS calculation method. These significant interaction effects on high TG and obesity were diminished in the sensitivity analysis using V̇O 2peak per kilogram fat-free mass as the CRF index. Effects of PRSs for other cardiometabolic traits were not significantly attenuated in the high-CRF group regardless of PRS calculation methods.

CONCLUSIONS

The findings of the present study suggest that individuals with high CRF overcome the genetic predisposition to high TG levels and obesity.

A GWAS for grip strength in cohorts of children-Advantages of analysing young participants for this trait

Grip strength (GS) is a proxy measure for muscular strength and a predictor for bone fracture risk among other diseases. Previous genome-wide association studies (GWASs) have been conducted in large cohorts of adults focusing on scores collected for the dominant hand, therefore increasing the likelihood of confounding effects by environmental factors. Here, we perform the first GWAS meta-analyses on maximal GS with the dominant (GSD) and non-dominant (GSND) hand in two cohorts of children (ALSPAC, N = 5450; age range = 10.65-13.61; Raine Study, N = 1162, age range: 9.42-12.38 years). We identified a novel significant association for GSND (rs9546244, LINC02465, p = 3.43e-08) and replicated associations previously reported in adults including with a HOXB3 gene marker that shows an expression quantitative trait locus (eQTL) effect. Despite a much smaller sample (~3%) compared with the UK Biobank we replicated correlation analyses previously reported in this much larger adult cohort, such as a negative correlation with coronary artery disease. Although the results from the polygenic risk score (PRS) analyses did not survive multiple testing correction, we observed nominally significant associations between GS and risk of overall fracture, as previously reported, as well ADHD which will require further investigations. Finally, we observed a higher SNP-heritability (24%-41%) compared with previous studies (4%-24%) in adults. Overall, our results suggest that cohorts of children might be better suited for genetic studies of grip strength, possibly due to the shorter exposure to confounding environmental factors compared with adults.

Genetic Liability to Cardiovascular Disease, Physical Activity, and Mortality: Findings from the Finnish Twin Cohort

PURPOSE

We investigated whether longitudinally assessed physical activity (PA) and adherence specifically to World Health Organization PA guidelines mitigate or moderate mortality risk regardless of genetic liability to cardiovascular disease (CVD). We also estimated the causality of the PA-mortality association.

METHODS

The study used the older Finnish Twin Cohort with 4897 participants aged 33 to 60 yr (54.3% women). Genetic liability to coronary heart disease and systolic and diastolic blood pressure was estimated with polygenic risk scores (PRS) derived from the Pan-UK Biobank ( N ≈ 400,000; >1,000,000 genetic variants). Leisure-time PA was assessed with validated and structured questionnaires three times during 1975 to 1990. The main effects of adherence to PA guidelines and the PRS × PA interactions were evaluated with Cox proportional hazards models against all-cause and CVD mortality. A cotwin control design with 180 monozygotic twin pairs discordant for meeting the guidelines was used for causal inference.

RESULTS

During the 17.4-yr (mean) follow-up (85,136 person-years), 1195 participants died, with 389 CVD deaths. PRS (per 1 SD increase) were associated with a 17% to 24% higher CVD mortality risk but not with all-cause mortality except for the PRS for diastolic blood pressure. Adherence to PA guidelines did not show significant independent main effects or interactions with all-cause or CVD mortality. Twins whose activity levels adhered to PA guidelines over a 15-yr period did not have statistically significantly reduced mortality risk compared with their less active identical twin sibling. The findings were similar among high, intermediate, and low genetic risk levels for CVD.

CONCLUSIONS

The genetically informed Finnish Twin Cohort data could not confirm that adherence to PA guidelines either mitigates or moderates genetic CVD risk or causally reduces mortality risk.

Cardiorespiratory Fitness Benefits of High-Intensity Interval Training After Stroke: A Randomized Controlled Trial

BACKGROUND

Limited evidence supports the effects of short-interval high-intensity interval training (HIIT) for improving cardiorespiratory fitness (V̇O2peak) after stroke. We aimed to compare the effects of 12 weeks of short-interval HIIT versus moderate-intensity continuous training (MICT) on V̇O2peak, cardiovascular risk factors, and mobility outcomes among individuals ≥6 months poststroke.

METHODS

This study was a multi-site, 12-week randomized controlled trial (NCT03614585) with an 8-week follow-up. Participants were randomized into 3 d/wk of HIIT (10×1 minute 80%-100% heart rate reserve interspersed with 1 minute 30% heart rate reserve [19 minutes]) or MICT (20-30 minutes 40%-60% heart rate reserve). Secondary outcomes of the trial, including V̇O2peak, cardiovascular risk factors (carotid-femoral pulse wave velocity, blood pressure, and waist-hip ratio), and mobility (6-minute walk test, 10 m gait speed), were reported. Linear mixed model analyses with a group×study time point interaction evaluated between-group differences.

RESULTS

Of the 305 potential participants, 82 consented (mean [SD] age 64.9 [9.3] years, 32 females [39%], 1.8 [1.2] years poststroke) and were randomized to HIIT (n=42, mean [SD] baseline V̇O2peak 17.3 [5.9] mL/kg·min) or MICT (n=40, mean [SD] baseline V̇O2peak 17.2 [6.0] mL/kg·min). Participants attended 82% of visits (n=2417/2952). No adverse events occurred during the study period. A significant group×study time point interaction was found (χ2=8.46; P=0.015) for V̇O2peak at 12 weeks (mean difference, 1.81 [95% CI, 0.58-3.04]; P=0.004) whereby the HIIT group had greater gains in V̇O2peak (∆3.52 mL/kg·min [95% CI, 2.47-4.57]; P<0.001) compared with the MICT group (∆1.71 mL/kg·min [95% CI, 0.55-2.86]; P=0.001). There was no between-group difference in V̇O2peak (mean difference, 1.08 [95% CI, -0.26 to 2.42]; P=0.11) at 8-week follow-up. No group×study time point interactions were found for cardiovascular risk factors or mobility outcomes.

CONCLUSIONS

Short-interval HIIT may be an effective alternative to MICT for improving V̇O2peak at 12 weeks postintervention.

REGISTRATION

URL: https://clinicaltrials.gov; Unique identifier: NCT03614585.

Cardiorespiratory fitness, atrial fibrillation and stroke: a review of the evidence in 2024

INTRODUCTION

The body of evidence linking cardiorespiratory fitness (CRF) levels with the risk of atrial fibrillation (AF) and stroke - two interconnected cardiovascular conditions - is not entirely consistent. Furthermore, specific CRF thresholds beyond which the risk of AF or stroke might not decrease are not well defined.

AREAS COVERED

This review summarizes research evidence on the role of CRF in the development of AF and stroke including dose-response relationships in general population participants, explores the biological mechanisms through which CRF may exert its effects, assesses the potential implications for clinical care and population health, identifies gaps in the current evidence, and suggest directions for future research. MEDLINE and Embase were searched from inception until July 2024 to identify observational longitudinal and interventional studies as well as systematic reviews and meta-analyses related to these study designs.

EXPERT OPINION

In the general population, increasing levels of CRF, achieved through consistent physical activity, can significantly reduce the likelihood of developing AF and stroke. The findings also advocate for a tailored approach to exercise prescriptions, acknowledging the plateau in benefits for AF risk beyond certain CRF levels, while advocating for higher intensity or prolonged activity to further reduce stroke risk.

Leisure Sedentary Behavior, Physical Activities, and Cardiovascular Disease Among Individuals With Metabolic Dysfunction-Associated Fatty Liver Disease

BACKGROUND

Metabolic dysfunction-associated fatty liver disease is a significant risk factor for cardiovascular disease (CVD). This study assesses the association between leisure-time physical activity, sedentary behavior, and CVD risk among patients with metabolic dysfunction-associated fatty liver disease, considering genetic predisposition to CVD.

METHODS

This cohort study included 157 794 participants with metabolic dysfunction-associated fatty liver disease from the UK Biobank who were free of CVD at baseline. The study measured leisure-time sedentary behaviors (watching TV, using a computer, and driving) and physical activities (walking for pleasure, light and heavy do-it-yourself activities, strenuous sports, and other exercises) in terms of frequency and duration over the 4 weeks before assessment. Both a Cox proportional hazard model and an isotemporal substitution model were utilized in the study to assess the association between leisure sedentary behavior, physical activities, and CVD risk.

RESULTS

During a median 12.5 years of follow-up, 26 355 CVD cases were reported, including 19 746 coronary heart disease, 4836 stroke, and 7398 heart failure cases. High physical activity levels were linked to a significantly lower risk of CVD (21%), coronary heart disease (20%), stroke (15%), and heart failure (31%). In contrast, individuals with >6.5 h/d of sedentary behavior faced a 16% to 21% higher risk of these conditions compared with those with ≤3.5 h/d. Notably, replacing 30 minutes of inactivity with physical activity reduced CVD risks by 3% to 16%, particularly with strenuous sports. A significant interaction was observed between physical activity, sedentary behavior, and genetic predisposition in relation to stroke risk.

CONCLUSIONS

Among patients with metabolic dysfunction-associated fatty liver disease, higher leisure-time physical activity levels correlate with reduced CVD risks, while increased sedentary behavior is linked to higher CVD risks. Replacing sedentary time with physical activity consistently shows benefits in reducing CVD outcomes, irrespective of genetic predisposition.

Relationship between Vitamin D Insufficiency, Lipid Profile and Atherogenic Indices in Healthy Women Aged 18-50 Years

Although vitamin D insufficiency has been correlated with an increased risk of cardiovascular disease (CVD), there are few data on the association between 25-hydroxyvitamin D (25(OH)D) and atherogenic indices predictive of CVD. This study investigated the relationship of vitamin D status with lipid profile and atherogenic indices in adult women in Morocco. Three hundred women aged 18 to 50 years from Meknes were included. Fasting 25(OH)D and lipid concentrations were assayed by a one-step electrochemiluminescence-based immunoassay and an enzymatic method, respectively. Atherogenic indices (atherogenic index of plasma (AIP), atherogenic coefficient (AC), non-HDL cholesterol (non-HDL-C), Castelli risk indices I and II (CRI-I and II), and CHOLIndex (CI)) were calculated using conventional lipid parameters. Logistic regression models and operating characteristic curve (ROC) analysis were used to assess the relationship of the variables and estimate the threshold of 25(OH)D levels associated with high atherogenic indices. 25(OH) D below 20 ng/mL was significantly associated with an enhanced risk of hypertriglyceridemia and elevated values of AIP, AC, non-HDL-C, and CRI-I with an OR (95% CI) of 4.904 (1.856-12.959), 3.637 (2.149-6.158), 3.589 (1.673-7.700), 2.074 (1.215-3.540), and 2.481 (1.481-4.123), respectively. According to the ROC analysis, the likelihood of hypertriglyceridemia and high values of AIP, AC, non-HDL-C, and CRI-I were associated with 25(OH)D thresholds ≤15.15 ng/mL, ≤17.5 ng/mL, ≤19.8 ng/mL, ≤20.1 ng/mL, and ≤19.5 ng/mL, respectively, all p < 0.01. Based on the atherogenic indices, this study indicates that vitamin D below 20 ng/mL may increase the risk of cardiovascular disease in adult women. Additional health measures are essential to raise awareness among women and health professionals of preventing and controlling cardiovascular risk factors, particularly among young individuals.

Handgrip strength, and erectile dysfunction among men with metabolic syndrome attending an institutional primary care clinic in Malaysia: A cross-sectional study

Background

Erectile dysfunction (ED) is an independent predictor for cardiovascular diseases (CVD). The prevalence increases with age, but little is known about the relationship between handgrip strength (HGS) and ED, especially among men with a high risk of CVD. This study aimed to determine the prevalence of ED among men aged ≥40 years with metabolic syndrome (MetS) and its association with HGS.

Materials and Methods

A cross-sectional study at an institutional primary care clinic in Malaysia was conducted between June 2021 and October 2021. HGS and erectile function were assessed using a hand dynamometer and International Index of Erectile Function (IIEF-5) questionnaire, respectively. Multiple logistic regression analyses were performed to determine the association between sociodemographics, clinical characteristics, and HGS with ED.

Results

A total of 334 participants were recruited. The prevalence of ED was 79% (95% confidence interval [CI]: 0.75-0.84). ED was associated with elderly aged ≥60 years (odds ratio [OR] 3.27, 95%CI: 1.60-6.69), low HGS (OR 15.34, 95%CI: 5.64-41.81) and high total cholesterol (OR 0.36, 95%CI: 0.16-0.78).

Conclusion

In conclusion, age above 60 years and those with low HGS are at higher risk of ED. Thus, robust screening of ED among men with MetS and improving muscle strength and physical fitness may be warranted.

Age, Race, Sex and Cardiorespiratory Fitness: Implications for Prevention and Management of Cardiometabolic Disease in Individuals with Diabetes Mellitus

Physical inactivity and poor cardiorespiratory fitness (CRF) are strongly associated with type 2 diabetes (DM2) and all-cause and cardiovascular morbidity and mortality. Incorporating physical activity promotion in the management of DM2 has been a pivotal approach modulating the underlying pathophysiology of DM2 of increased insulin resistance, endothelial dysfunction, and abnormal mitochondrial function. Although CRF is considered a modifiable risk factor, certain immutable aspects such as age, race, and gender impact CRF status and is the focus of this review. Results show that diabetes has often been considered a disease of premature aging manifested by early onset of macro and microvascular deterioration with underlying negative impact on CRF and influencing next generation. Certain races such as Native Americans and African Americans show reduced baseline CRF and decreased gain in CRF in randomized trials. Moreover, multiple biological gender differences translate to lower baseline CRF and muted responsivity to exercise in women with increased morbidity and mortality. Although factors such as age, race, and sex may not have major impacts on CRF their influence should be considered with the aim of optimizing precision medicine.

Racial and Gender Differences in Cardiorespiratory Fitness and Atrial Fibrillation

The expanding field of cardiorespiratory fitness (CRF) in individuals with and without atrial fibrillation (AF) presents a complex landscape, demanding careful interpretation of the existing research. AF, characterized by significant mortality and morbidity, prompts the exploration of strategies to mitigate its impact. Increasing physical activity (PA) levels emerges as a promising avenue to address AF risk factors, such as obesity, hypertension, and diabetes mellitus, through mechanisms of reduced vasoconstriction, endothelin-1 modulation, and improved insulin sensitivity. However, caution is warranted, as recent investigations suggest a heightened incidence of AF, particularly in athletes engaged in high-intensity exercise, due to the formation of ectopic foci and changes in cardiac anatomy. Accordingly, patients should adhere to guideline-recommended amounts of low-to-moderate PA to balance benefits and minimize adverse effects. When looking closer at the current evidence, gender-specific differences have been observed and challenged conventional understanding, with women demonstrating decreased AF risk even at extreme exercise levels. This phenomenon may be rooted in divergent hemodynamic and structural responses to exercise between men and women. Existing research is predominantly observational and limited to racially homogenous populations, which underscores the need for comprehensive studies encompassing diverse, non-White ethnic groups in athlete and non-athlete populations. These individuals exhibit a disproportionately high burden of AF risk factors that could be addressed through improved CRF. Despite the limitations, randomized control trials offer promising evidence for the efficacy of CRF interventions in patients with preexisting AF, showcasing improvements in clinically significant AF outcomes and patient quality of life. The potential of CRF as a countermeasure to the consequences of AF remains an area of great promise, urging future research to delve deeper to explore its role within specific racial and gender contexts. This comprehensive understanding will contribute to the development of tailored strategies for optimizing cardiovascular health and AF prevention in all those who are affected.

Diagnostic value of multimodal cardiovascular imaging technology coupled with biomarker detection in elderly patients with coronary heart disease

Aims/Background Coronary heart disease is a common disease in the elderly and has a complex pathogenesis, which complicates the clinical diagnostic process. Thus, enhancing the diagnostic efficiency for coronary heart disease is imperative to improve the life expectancy of the elderly. This study aimed to explore the diagnostic value of multimodal cardiovascular imaging technology coupled with biomarker detection in elderly patients with coronary heart disease. Methods The medical records of 421 patients with suspected coronary heart disease obtained from the geriatric department of the First Affiliated Hospital of Hebei North University from February 2020 to February 2023 were retrospectively analysed. After excluding 10 patients who did not meet the inclusion criteria, the remaining 411 patients were included in this study. The included subjects had undergone coronary computed tomography angiography and were divided into coronary heart disease group (n=208) and non-coronary heart disease group (n=203) according to the diagnostic results. Multimodal cardiovascular imaging (coronary computed tomography angiography and echocardiography) and detection of serum biomarkers such as small dense low-density lipoprotein, lipoprotein a, and gamma-glutamyl transferase were performed in both groups. The clinical indicators of the two groups were compared, and the combined diagnostic efficacy of multimodal cardiovascular imaging and biomarker detection was evaluated. Results Compared to the non-coronary heart disease group, the coronary heart disease group had significantly higher levels of maximum area stenosis, total plaque volume, total plaque burden and fibrotic plaque volume (p < ..001), and lower left ventricular ejection fraction level (p < ..001). Additionally, the coronary heart disease group exhibited higher levels of left ventricular end-diastolic volume, left ventricular end-systolic volume and stroke volume than the non-coronary heart disease group (p < ..001), and had higher levels of small dense low-density lipoprotein, lipoprotein a and gamma-glutamyl transferase (p < ..001). Our results demonstrated that combined diagnosis had better diagnostic efficacy than individual approaches, marked by higher area under the curve and sensitivity of the former (p < ..001). Conclusion Multimodal cardiovascular imaging technology combined with biomarker detection can distinctly improve the accuracy of coronary heart disease diagnosis in elderly patients.

Relationship between the level of physical activity and body mass index to blood pressure among overweight and obese young adults in the Northern Emirates city: A cross-sectional study

BACKGROUND

Obesity affects both adults and children all over the world and it is a major causative factor for diabetes, cardiovascular disease, different types of cancer, and even death. Therefore, this study aimed to assess the level of PA and BMI to the risk of developing high BP among overweight and obese young adults.

METHODOLOGY

A cross-sectional study was carried out in the Thumbay Medi-city Northern Emirates, Ajman, UAE. Participants enrolled in the study under the convenient sampling method and inclusion criteria: young overweight and obese individuals, male and female, aged between 18 to 30 years. Approval was obtained from the Institutional Review Board (CoHS, GMU (IRB-COHS-STD-110-JUNE-2023). The blood pressure and body mass index were clinically measured using standard tools whereas the GPAQ questionnaire was used to determine the level of physical activity of all participants.

RESULTS

Out of 206 participants, 139 were overweight and 67 were obese. Further, 89 were found to have high normal BP, 93 normal BP, and 24 were found to have optimal blood pressure. The mean GPA scores were 322.8±62.28 in overweight individuals and 301.17±49.05 in obese individuals. Furthermore, among overweight and obese participants there is a weak correlation between PA & BMI (r = 0.06, p = 0.88) and (r = 0.15, p = 0.44) and the BP and BMI (r = 0.18, p = 1.02) and (r = 0.16, p = 0.90) were found.

CONCLUSION

Although PA, BMI, and BP are assumed to be related variables leading to various non-communicable diseases the present study showed a weak correlation between the level of PA and BMI to the risk of developing BP among overweight and obese young adults in the Northern Emirates.

Joint association of genetic risk and accelerometer-measured physical activity with incident coronary artery disease in the UK biobank cohort

Previous research demonstrates the joint association of self-reported physical activity and genotype with coronary artery disease. However, an existing research gap is whether accelerometer-measured overall physical activity or physical activity intensity can offset genetic predisposition to coronary artery disease. This study explores the independent and joint associations of accelerometer-measured physical activity and genetic predisposition with incident coronary artery disease. Incident coronary artery disease based on hospital inpatient records and death register data serves as the outcome of this study. Polygenic risk score and overall physical activity, measured as Euclidean Norm Minus One, and intensity, measured as minutes per day of moderate-to-vigorous intensity physical activity (MVPA), are examined both linearly and by decile. The UK Biobank population-based cohort recruited over 500,000 individuals aged 40 to 69 between 2006 and 2010, with 103,712 volunteers participating in a weeklong wrist-worn accelerometer study from 2013 to 2015. Individuals of White British ancestry (n = 65,079) meeting the genotyping and accelerometer-based inclusion criteria and with no missing covariates were included in the analytic sample. In the sample of 65,079 individuals, the mean (SD) age was 62.51 (7.76) and 61% were female. During a median follow-up of 6.8 years, 1,382 cases of coronary artery disease developed. At the same genetic risk, physical activity intensity had a hazard ratio (HR) of 0.41 (95% CI: 0.29-0.60) at the 90th compared to 10th percentile, equivalent to 31.68 and 120.96 minutes of moderate-to-vigorous physical activity per day, respectively, versus an HR of 0.61 (95% CI: 0.52-0.72) for overall physical activity. The combination of high genetic risk and low physical activity intensity showed the greatest risk, with an individual at the 10th percentile of genetic risk and 90th percentile of intensity facing an HR of 0.14 (95% CI: 0.09-0.21) compared to an individual at the 90th percentile of genetic risk and 10th percentile of intensity. Physical activity, especially physical activity intensity, is associated with an attenuation of some of the risk of coronary artery disease but this pattern does not vary by genetic risk. This accelerometer-based study provides the clearest evidence to date regarding the joint influence of genetics, overall physical activity, and physical activity intensity on coronary artery disease.

Risk/benefit trade-off of habitual physical activity and air pollution on mortality: A large-scale prospective analysis in the UK Biobank

BACKGROUND

Previous observational studies have indicated associations of physical activity (PA) and air pollution with mortality. A few studies have evaluated air pollution and PA interactions for health. Still, the trade-off between the harmful effects of air pollution exposure and the protective effects of PA remains controversial and unclear.

OBJECTIVE

This study aimed to investigate the joint association of air pollution and PA with mortality risks.

METHODS

This prospective cohort study included 322,092 participants from 2006 to 2010 and followed up to 2021 in the UK Biobank study. The concentrations of air pollutants (2006-2010), including particulate matter (PM) with diameters <=2.5 mm (PM2.5), <=10 mm (PM10), and between 2.5 and 10 mm (PM2.5-10), and nitrogen oxides (NO2 and NOx) were obtained. Information on PA measured by the International Physical Activity Questionnaire short form (2006-2010) and wrist-worn accelerometer (2013-2015) were collected. All-cause and cause-specific mortalities were recorded. Cox proportional hazard models were used to investigate the associations of air pollution exposure and PA with mortality risks. The additive and multiplicative interactions were also examined.

RESULTS

During a mean follow-up of 11.83 years, 16629 deaths were recorded. Compared with participants reporting low PA, higher PA was negatively associated with all-cause [hazard ratio (HR), 0.74; 95% CI, 0.71-0.78], cancer (HR, 0.85; 95% CI, 0.80-0.90), CVD (HR, 0.79; 95% CI, 0.71-0.87), and respiratory disease-specific mortality (HR, 0.51; 95% CI, 0.44-0.60). Exposure to PM2.5 (HR, 1.05; 95% CI, 1.00-1.09) and NOx (HR, 1.06; 95% CI, 1.02-1.10) was connected with increased all-cause mortality risk, and significant PM2.5-associated elevated risks for CVD mortality and NOx-associated elevated risks for respiratory disease mortality were observed. No obvious interaction between PA and PM2.5 or NOx exposure was detected.

CONCLUSIONS

Our study provides additional evidence that higher PA and lower air pollutant levels are independently connected with reduced mortality risk. The benefits of PA are not significantly affected by long-term air pollution exposure, indicating PA can be recommended to prevent mortality regardless of air pollution levels. Our findings highlight the importance of public health policies and interventions facilitating PA and reducing air pollution in reducing mortality risks and maximizing health benefits. Future investigation is urgently needed to identify these findings in areas with severe air pollution conditions.

Sweetened Beverages, Genetic Susceptibility, and Incident Atrial Fibrillation: A Prospective Cohort Study

BACKGROUND

An association between sweetened beverages and several cardiometabolic diseases has been reported, but their association with atrial fibrillation (AF) is unclear. We aimed to investigate the associations between consumption of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), and pure fruit juice (PJ) and risk of consumption with AF risk and further evaluate whether genetic susceptibility modifies these associations.

METHODS

A total of 201 856 participants who were free of baseline AF, had genetic data available, and completed a 24-hour diet questionnaire were included. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

During a median follow-up of 9.9 years, 9362 incident AF cases were documented. Compared with nonconsumers, individuals who consumed >2 L/wk of SSB or ASB had an increased risk of AF (HR, 1.10 [95% CI, 1.01-1.20] and HR, 1.20 [95% CI, 1.10-1.31]) in the multivariable-adjusted model. A negative association was observed between the consumption of ≤1 L/wk of PJ and the risk of AF (HR, 0.92 [95% CI, 0.87-0.97]). The highest HRs (95% CIs) of AF were observed for participants at high genetic risk who consumed >2 L/wk of ASB (HR, 3.51 [95% CI, 2.94-4.19]), and the lowest HR were observed for those at low genetic risk who consumed ≤1 L/wk of PJ (HR, 0.77 [95% CI, 0.65-0.92]). No significant interactions were observed between the consumption of SSB, ASB, or PJ and genetic predisposition to AF.

CONCLUSIONS

Consumption of SSB and ASB at >2 L/wk was associated with an increased risk for AF. PJ consumption ≤1 L/wk was associated with a modestly lower risk for AF. The association between sweetened beverages and AF risk persisted after adjustment for genetic susceptibility to AF. This study does not demonstrate that consumption of SSB and ASB alters AF risk but rather that the consumption of SSB and ASB may predict AF risk beyond traditional risk factors.

Lifestyle Medicine: An Antidote to Cardiovascular Diseases

Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Polygenic risk score predicts all-cause death in East Asian patients with prior coronary artery disease

Introduction

Coronary artery disease (CAD) is a highly heritable and multifactorial disease. Numerous genome-wide association studies (GWAS) facilitated the construction of polygenic risk scores (PRS) for predicting future incidence of CAD, however, exclusively in European populations. Furthermore, identifying CAD patients with elevated risks of all-cause death presents a critical challenge in secondary prevention, which will contribute largely to reducing the burden for public healthcare.

Methods

We recruited a cohort of 1,776 Chinese CAD patients and performed medical follow-up for up to 11 years. A pruning and thresholding method was used to calculate PRS of CAD and its 14 risk factors. Their correlations with all-cause death were computed via Cox regression.

Results and discussion

We found that the PRS for CAD and its seven risk factors, namely myocardial infarction, ischemic stroke, angina, heart failure, low-density lipoprotein cholesterol, total cholesterol and C-reaction protein, were significantly associated with death (P ≤ 0.05), whereas the PRS of body mass index displayed moderate association (P < 0.1). Elastic-net Cox regression with 5-fold cross-validation was used to integrate these nine PRS models into a meta score, metaPRS, which performed well in stratifying patients at different risks for death (P < 0.0001). Combining metaPRS with clinical risk factors further increased the discerning power and a 4% increase in sensitivity. The metaPRS generated from the genetic susceptibility to CAD and its risk factors can well stratify CAD patients by their risks of death. Integrating metaPRS and clinical risk factors may contribute to identifying patients at higher risk of poor prognosis.

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

AIM

The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation.

METHODS

A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.

STRUCTURE

Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

AIM

The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation.

METHODS

A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.

STRUCTURE

Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

Interactive effects of physical activity and sarcopenia on incident ischemic heart disease: Results from a nation-wide cohort study

BACKGROUND AND AIMS

Lack of physical activity (PA) and sarcopenia is a known risk factors for ischemic heart disease (IHD). However, considering their coexistence in the middle-aged and elderly population, the interaction of these two factors remains uncertain. Here, we investigated the interactive effects of PA and sarcopenia on IHD.

METHODS

We extracted 344,688 participants free of IHD at baseline from the UK Biobank. PA was classified into low, moderate, and high according to the International Physical Activity Questionnaire. Sarcopenia was identified in accordance with the European Working Group on Sarcopenia in Older People 2. Cox proportional hazard models were applied to estimate the effect of PA and sarcopenia on incident IHD and its subtypes. We also used objective PA data measured by wrist-worn devices to repeat these analyses.

RESULTS

Over a median follow-up of 11.7 years, 24,809 (7.2%) participants developed incident IHD. Lack of PA was associated with a higher risk of IHD after adjusting for potential confounders. The hazard ratio (HR) was 1.09 (95% CI: 1.05-1.13) for individuals without sarcopenia and 1.29 (95% CI: 1.17-1.42) for those with sarcopenia. Regarding the joint effect, the combination of low PA and sarcopenia was associated with the highest risk of IHD, with an HR of 1.54 (95% CI: 1.44-1.66), and both additive and multiplicative interactions were significant (RERI 0.27, 95% CI: 0.14-0.39, p-interaction <0.01). For subtypes of IHD, the interaction was pronounced in acute myocardial infarction and chronic ischemic heart disease.

CONCLUSIONS

These results suggest a synergistic interaction between lack of PA and sarcopenia on the risk of IHD. Findings from this study may help facilitate more effective primary prevention of IHD.