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Norha J, Sjöros T, Garthwaite T, Laine S, Saarenhovi M, Kallio P, Laitinen K, Houttu N, Vähä-Ypyä H, Sievänen H, Löyttyniemi E, Vasankari T, Knuuti J, Kalliokoski KK, Heinonen IHA. Effects of reduced sedentary time on resting, exercise and post-exercise blood pressure in inactive adults with metabolic syndrome - a six-month exploratory RCT. J Hum Hypertens 2024; 38:314-321. [PMID: 38267651 PMCID: PMC11001575 DOI: 10.1038/s41371-024-00894-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
Evidence on the long-term effects of reducing sedentary behaviour (SB) on blood pressure (BP) is scarce. Therefore, we performed a sub-analysis of the BP effects of a six-month intervention that aimed at reducing SB by 1 h/day and replacing it with non-exercise activities. Sixty-four physically inactive and sedentary adults with metabolic syndrome (58% female, 58 [SD 7] years, BP 143/88 [16/9] mmHg, SB 10 [1] h/day) were randomised into intervention (INT, n = 33) and control (CON, n = 31) groups. Resting BP and BP at each stage during and after a graded maximal bicycle ergometer test were measured before and after the intervention. SB, standing, moderate-to-vigorous physical activity (MVPA), and light physical activity (LPA) were measured in six-second intervals at baseline and during the whole six-month intervention using hip-worn accelerometers. The analyses were adjusted for BP medication status. The intervention resulted in a 40 min/day reduction in SB and concomitant 20 min/day increase in MVPA. Resting systolic BP was lower in the CON group before and after the intervention. No group x time interactions were observed in resting BP or BP during exercise at submaximal or maximal intensities, or during recovery. The changes in LPA and MVPA were inversely correlated with the changes in BP during light-to-moderate intensity exercise. An intervention that resulted in a 40 min/day reduction in SB for six months was not sufficient at influencing BP at rest, during or after exercise in adults with metabolic syndrome. However, successfully increasing LPA or MVPA might lower BP during light-to-moderate-intensity activities.
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Affiliation(s)
- Jooa Norha
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
| | - Tanja Sjöros
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Taru Garthwaite
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Saara Laine
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Petri Kallio
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Noora Houttu
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Henri Vähä-Ypyä
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Kari K Kalliokoski
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilkka H A Heinonen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
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Garthwaite T, Sjöros T, Laine S, Koivumäki M, Vähä-Ypyä H, Verho T, Norha J, Kallio P, Saarenhovi M, Löyttyniemi E, Sievänen H, Houttu N, Laitinen K, Kalliokoski KK, Vasankari T, Knuuti J, Heinonen I. Sedentary time associates detrimentally and physical activity beneficially with metabolic flexibility in adults with metabolic syndrome. Am J Physiol Endocrinol Metab 2024; 326:E503-E514. [PMID: 38416072 DOI: 10.1152/ajpendo.00338.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 02/29/2024]
Abstract
Metabolic flexibility (MetFlex) describes the ability to respond and adapt to changes in metabolic demand and substrate availability. The relationship between physical (in)activity and MetFlex is unclear. This study aimed to determine whether sedentary time, physical activity (PA), and cardiorespiratory fitness associate with MetFlex. Sedentary time, standing, and PA were measured with accelerometers for 4 weeks in 64 sedentary adults with metabolic syndrome [37 women, 27 men; 58.3 (SD 6.8) years]. Fitness (V̇o2max; mL·kg-1·min-1) was measured with graded maximal cycle ergometry. MetFlex was assessed with indirect calorimetry as the change in respiratory exchange ratio (ΔRER) from fasting to insulin stimulation with hyperinsulinemic-euglycemic clamp and from low-intensity to maximal exercise. Carbohydrate (CHOox) and fat oxidation (FATox) were calculated from respiratory gases. High sedentary time associated with higher fasting RER [β = 0.35 (95% confidence interval: 0.04, 0.67)], impaired insulin-stimulated MetFlex (ΔRER) [β=-0.41 (-0.72, -0.09)], and lower fasting FATox [β=-0.36 (-0.67, -0.04)]. Standing associated with lower fasting RER [β=-0.32 (-0.62, -0.02)]. Higher standing time and steps/day associated with higher fasting FATox [β = 0.31 (0.01, 0.61), and β = 0.26 (0.00, 0.53)]. Light-intensity and total PA associated with better insulin-stimulated MetFlex [β = 0.33 (0.05, 0.61)], and β = 0.33 (0.05, 0.60)]. Higher V̇o2max associated with higher CHOox during maximal exercise [β = 0.81 (0.62, 1.00)], as well as during insulin stimulation [β = 0.43 (0.13, 0.73)]. P values are less than 0.05 for all associations. Sedentary time and PA associate with MetFlex. Reducing sitting and increasing PA of even light intensity might aid in the prevention of metabolic diseases in risk populations through their potential effects on energy metabolism.NEW & NOTEWORTHY High accelerometer-assessed sedentary time associates with metabolic inflexibility measured during hyperinsulinemic-euglycemic clamp in adults with metabolic syndrome, and more light-intensity and total physical activity associate with more metabolic flexibility. Physical activity behaviors may thus play an important role in the regulation of fuel metabolism. This highlights the potential of reduced sedentary time and increased physical activity of any intensity to induce metabolic health benefits and help in disease prevention in risk populations.
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Affiliation(s)
- Taru Garthwaite
- Turku PET Centre, University of Turku, Åbo Akademi University, and Turku University Hospital, Turku, Finland
| | - Tanja Sjöros
- Turku PET Centre, University of Turku, Åbo Akademi University, and Turku University Hospital, Turku, Finland
| | - Saara Laine
- Turku PET Centre, University of Turku, Åbo Akademi University, and Turku University Hospital, Turku, Finland
| | - Mikko Koivumäki
- Turku PET Centre, University of Turku, Åbo Akademi University, and Turku University Hospital, Turku, Finland
| | - Henri Vähä-Ypyä
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Tiina Verho
- Turku PET Centre, University of Turku, Åbo Akademi University, and Turku University Hospital, Turku, Finland
| | - Jooa Norha
- Turku PET Centre, University of Turku, Åbo Akademi University, and Turku University Hospital, Turku, Finland
| | - Petri Kallio
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Noora Houttu
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kari K Kalliokoski
- Turku PET Centre, University of Turku, Åbo Akademi University, and Turku University Hospital, Turku, Finland
| | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Åbo Akademi University, and Turku University Hospital, Turku, Finland
| | - Ilkka Heinonen
- Turku PET Centre, University of Turku, Åbo Akademi University, and Turku University Hospital, Turku, Finland
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Pietilä-Effati P, Saarinen JT, Löyttyniemi E, Saarenhovi M, Autio R, Kantola I. Long-term effectiveness of enzyme replacement therapy in Fabry disease with the p.Arg227Ter variant: Fabry disease in Ostrobothnia (FAST) study. Am J Med Genet A 2023. [PMID: 37078610 DOI: 10.1002/ajmg.a.63216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 04/21/2023]
Abstract
Fabry disease (FD) is an X chromosome-linked, life-threatening lysosomal disease caused by one of more than 1000 currently known variants in the α-galactosidase A (GLA) gene. The follow-up part of the Fabry Disease in Ostrobothnia (FAST) study reports the long-term effect of enzyme replacement therapy (ERT) on a prospectively collected cohort of 12 patients, 4 males and 8 females, mean age 46 years (SD 16), with the classical variant c.679C > T p.Arg227Ter, which is one of the most common FD variants worldwide. In the natural history period of the FAST study, half of the patients in both sexes had at least one major event, of which 80% were of cardiac origin. During 5 years of ERT, four patients had a total of six major clinical events consisting of one silent ischemic stroke, three ventricular tachycardias and two increased left ventricular mass indexes. In addition, four patients developed minor cardiac events, four patients minor renal events, and one patient a minor neurological event. ERTs may delay but not prevent the progression of the disease in most patients with the variant Arg227Ter. This variant might be suitable for investigating the efficacy of second-generation ERTs compared to the currently used ERTs regardless of sex.
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Affiliation(s)
| | | | | | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Reijo Autio
- Department of Radiology, Vaasa Central Hospital, Vaasa, Finland
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
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Norha J, Sjöros T, Garthwaite T, Laine S, Saarenhovi M, Kallio P, Laitinen K, Houttu N, Vähä-Ypyä H, Sievänen H, Löyttyniemi E, Vasankari T, Knuuti J, Kalliokoski KK, Heinonen IHA. Effects of reducing sedentary behavior on cardiorespiratory fitness in adults with metabolic syndrome: A 6-month RCT. Scand J Med Sci Sports 2023. [PMID: 37073456 DOI: 10.1111/sms.14371] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/07/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Poor cardiorespiratory fitness (CRF) is associated with adverse health outcomes. Previous observational and cross-sectional studies have suggested that reducing sedentary behavior (SB) might improve CRF. Therefore, we investigated the effects of a 6-month intervention of reducing SB on CRF in 64 sedentary inactive adults with metabolic syndrome in a non-blind randomized controlled trial. MATERIALS AND METHODS In the intervention group (INT, n = 33), the aim was to reduce SB by 1 h/day for 6 months without increasing exercise training. Control group (CON, n = 31) was instructed to maintain their habitual SB and physical activity. Maximal oxygen uptake (VO2max ) was measured by maximal graded bicycle ergometer test with respiratory gas measurements. Physical activity and SB were measured during the whole intervention using accelerometers. RESULTS Reduction in SB did not improve VO2max statistically significantly (group × time p > 0.05). Maximal absolute power output (Wmax ) did not improve significantly but increased in INT compared to CON when scaled to fat free mass (FFM) (at 6 months INT 1.54 [95% CI: 1.41, 1.67] vs. CON 1.45 [1.32, 1.59] Wmax /kgFFM , p = 0.036). Finally, the changes in daily step count correlated positively with the changes in VO2max scaled to body mass and FFM (r = 0.31 and 0.30, respectively, p < 0.05). DISCUSSION Reducing SB without adding exercise training does not seem to improve VO2max in adults with metabolic syndrome. However, succeeding in increasing daily step count may increase VO2max .
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Affiliation(s)
- Jooa Norha
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Tanja Sjöros
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Taru Garthwaite
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Saara Laine
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Petri Kallio
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Noora Houttu
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Henri Vähä-Ypyä
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | | | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Kari K Kalliokoski
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilkka H A Heinonen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Rydberg Laboratory of Applied Sciences, University of Halmstad, Halmstad, Sweden
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Garthwaite T, Sjöros T, Laine S, Koivumäki M, Vähä-Ypyä H, Eskola O, Rajander J, Kallio P, Saarenhovi M, Löyttyniemi E, Sievänen H, Houttu N, Laitinen K, Kalliokoski K, Vasankari T, Knuuti J, Heinonen I. Associations of sedentary time, physical activity, and fitness with muscle glucose uptake in adults with metabolic syndrome. Scand J Med Sci Sports 2023; 33:353-358. [PMID: 36517882 DOI: 10.1111/sms.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of the study was to investigate the associations of sedentary time, physical activity, and cardiorespiratory fitness with skeletal muscle glucose uptake (GU). METHODS Sedentary time and physical activity were measured with accelerometers and VO2 max with cycle ergometry in 44 sedentary adults with metabolic syndrome. Thigh muscle GU was determined with [18 F]FDG-PET imaging. RESULTS Sedentary time (β = -0.374), standing (β = 0.376), steps (β = 0.351), and VO2 max (β = 0.598) were associated with muscle GU when adjusted for sex, age, and accelerometer wear time. Adjustment for body fat-% turned all associations non-significant. CONCLUSION Body composition is a more important determinant of muscle GU in this population than sedentary time, physical activity, or fitness.
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Affiliation(s)
- Taru Garthwaite
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Tanja Sjöros
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Saara Laine
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Mikko Koivumäki
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Henri Vähä-Ypyä
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Olli Eskola
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Johan Rajander
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Petri Kallio
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland.,Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Noora Houttu
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kari Kalliokoski
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Ilkka Heinonen
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland.,Rydberg Laboratory of Applied Sciences, University of Halmstad, Halmstad, Sweden
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Garthwaite T, Sjöros T, Koivumäki M, Laine S, Vähä-Ypyä H, Saarenhovi M, Kallio P, Löyttyniemi E, Sievänen H, Houttu N, Laitinen K, Kalliokoski K, Vasankari T, Knuuti J, Heinonen I. Corrigendum to “Standing is associated with insulin sensitivity in adults with metabolic syndrome. Journal of Science and Medicine in Sport 24 (2021) 1255–1260”. J Sci Med Sport 2022; 25:541. [DOI: 10.1016/j.jsams.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Haapala EA, Sjöros T, Laine S, Garthwaite T, Kallio P, Saarenhovi M, Vähä-Ypyä H, Löyttyniemi E, Sievänen H, Houttu N, Laitinen K, Kalliokoski K, Knuuti J, Vasankari T, Heinonen IHA. Association between cardiorespiratory fitness and metabolic health in overweight and obese adults. J Sports Med Phys Fitness 2021; 62:1526-1533. [PMID: 34758008 DOI: 10.23736/s0022-4707.21.13234-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) has been inversely associated with insulin resistance and clustering of cardiometabolic risk factors among overweight and obese individuals. However, most previous studies have scaled CRF by body mass (BM) possibly inflating the association between CRF and cardiometabolic health. We investigated the associations of peak oxygen uptake (V̇ O2peak) and peak power output (Wpeak) scaled either by BM-1, fat free mass (FFM-1), or by allometric methods with individual cardiometabolic risk factors and clustering of cardiometabolic risk factors in 55 overweight or obese adults with metabolic syndrome. METHODS V̇ O2peak and Wpeak were assessed by a maximal cycle ergometer exercise test. FFM was measured by air displacement plethysmograph and glucose, insulin, HbA1c, triglycerides, and total, LDL, and HDL cholesterol from fasting blood samples. HOMA-IR and metabolic syndrome score (MetS) were computed. RESULTS V̇ O2peak and Wpeak scaled by BM-1 were inversely associated with insulin (β=-0.404 to -0.372, 95% CI=-0.704 to -0.048), HOMA-IR (β=-0.442 to -0.440, 95% CI=-0.762 to -0.117), and MetS (β=-0.474 to -0.463, 95% CI's=-0.798 to -0.127). Other measures of CRF were not associated with cardiometabolic risk factors. CONCLUSIONS Our results suggest that using BM-1 as a scaling factor confounds the associations between CRF and cardiometabolic risk in overweight/obese adults with the metabolic syndrome.
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Affiliation(s)
- Eero A Haapala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland - .,Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland -
| | - Tanja Sjöros
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Saara Laine
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Taru Garthwaite
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Petri Kallio
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Henri Vähä-Ypyä
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | | | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Noora Houttu
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kari Kalliokoski
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ilkka H A Heinonen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.,Rydberg Laboratory of Applied Sciences, University of Halmstad, Halmstad, Sweden
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Garthwaite T, Sjöros T, Koivumäki M, Laine S, Vähä-Ypyä H, Saarenhovi M, Kallio P, Löyttyniemi E, Sievänen H, Houttu N, Laitinen K, Kalliokoski K, Vasankari T, Knuuti J, Heinonen I. Standing is associated with insulin sensitivity in adults with metabolic syndrome. J Sci Med Sport 2021; 24:1255-1260. [PMID: 34489177 DOI: 10.1016/j.jsams.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine how components of accelerometer-measured sedentary behavior (SB) and physical activity (PA), and fitness are associated with insulin sensitivity in adults with metabolic syndrome. DESIGN Cross-sectional. METHODS Target population was middle-aged (40-65 years) sedentary adults with metabolic syndrome. SB, breaks in SB, standing, and PA were measured for four weeks with hip-worn accelerometers. VO2max (ml/min/kg) was measured with maximal cycle ergometry. Insulin sensitivity was determined by hyperinsulinaemic-euglycaemic clamp (M-value) and fasting blood sampling (HOMA-IR, insulin). Multivariable regression was used for analyses. RESULTS Sixty-four participants (37 women; 58.3 [SD 6.8] years) were included. Participants spent 10.0 (1.0) h sedentary, 1.8 (0.6) h standing, and 2.7 (0.6) h in PA and took 5149 (1825) steps and 29 (8) breaks daily. In sex-, age- and accelerometer wear time-adjusted model SB, standing, steps and VO2max were associated with M-value (β = -0.384; β = 0.400; β = 0.350; β = 0.609, respectively), HOMA-IR (β = 0.420; β = -0.548; β = -0.252; β = -0.449), and insulin (β = 0.433; β = -0.541; β = -0.252; β = -0.453); all p-values < 0.05. Breaks associated only with M-value (β = 0.277). When further adjusted for body fat %, only standing remained significantly associated with HOMA-IR (β = -0.381) and insulin (β = -0.366); significance was maintained even when further adjusted for SB, PA and fitness. Light and moderate-to-vigorous PA were not associated with insulin sensitivity. CONCLUSIONS Standing is associated with insulin sensitivity markers. The association with HOMA-IR and insulin is independent of adiposity, PA, SB and fitness. Further studies are warranted, but these findings encourage replacing sitting with standing for potential improvements in insulin sensitivity in adults at increased type 2 diabetes risk.
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Affiliation(s)
- Taru Garthwaite
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
| | - Tanja Sjöros
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Mikko Koivumäki
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Saara Laine
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Henri Vähä-Ypyä
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Petri Kallio
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland; Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
| | | | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Noora Houttu
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kari Kalliokoski
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilkka Heinonen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Rydberg Laboratory of Applied Sciences, University of Halmstad, Halmstad, Sweden
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9
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Oldgren J, Laurila S, Åkerblom A, Latva-Rasku A, Rebelos E, Isackson H, Saarenhovi M, Eriksson O, Heurling K, Johansson E, Wilderäng U, Karlsson C, Esterline R, Ferrannini E, Oscarsson J, Nuutila P. Effects of 6 weeks of treatment with dapagliflozin, a sodium-glucose co-transporter-2 inhibitor, on myocardial function and metabolism in patients with type 2 diabetes: A randomized, placebo-controlled, exploratory study. Diabetes Obes Metab 2021; 23:1505-1517. [PMID: 33625777 DOI: 10.1111/dom.14363] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 12/31/2022]
Abstract
AIM To explore the early effects of dapagliflozin on myocardial function and metabolism in patients with type 2 diabetes without heart failure. MATERIALS AND METHODS Patients with type 2 diabetes on metformin treatment were randomized to double-blind, 6-week placebo or dapagliflozin 10 mg daily treatment. Investigations included cardiac function and structure with myocardial resonance imaging; cardiac oxygen consumption, perfusion and efficiency with [11 C]-acetate positron emission tomography (PET); and cardiac and hepatic fatty acid uptake with [18 F]-6-thia-heptadecanoic acid PET, analysed by ANCOVA as least square means with 95% confidence intervals. RESULTS Evaluable patients (placebo: n = 24, dapagliflozin: n = 25; 53% males) had a mean age of 64.4 years, a body mass index of 30.2 kg/m2 and an HbA1c of 6.7%. Body weight and HbA1c were significantly decreased by dapagliflozin versus placebo. Dapagliflozin had no effect on myocardial efficiency, but external left ventricular (LV) work (-0.095 [-0.145, -0.043] J/g/min) and LV oxygen consumption were significantly reduced (-0.30 [-0.49, -0.12] J/g/min) by dapagliflozin, although the changes were not statistically significant versus changes in the placebo group. Change in left atrial maximal volume with dapagliflozin versus placebo was -3.19 (-6.32, -0.07) mL/m2 (p = .056). Peak global radial strain decreased with dapagliflozin versus placebo (-3.92% [-7.57%, -0.28%]; p = .035), while peak global longitudinal and circumferential strains were unchanged. Hepatic fatty acid uptake was increased by dapagliflozin versus placebo (0.024 [0.004, 0.044] μmol/g/min; p = .018), while cardiac uptake was unchanged. CONCLUSIONS This exploratory study indicates reduced heart work but limited effects on myocardial function, efficiency and cardiac fatty acid uptake, while hepatic fatty acid uptake increased, after 6 weeks of treatment with dapagliflozin.
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Affiliation(s)
- Jonas Oldgren
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sanna Laurila
- Heart Center, Turku University Hospital, Turku, Finland
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Satakunta Central Hospital, Pori, Finland
| | - Axel Åkerblom
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Aino Latva-Rasku
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Eleni Rebelos
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Henrik Isackson
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Saarenhovi
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | | | | | | | | | | | | | - Ele Ferrannini
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Jan Oscarsson
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
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10
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Lankinen R, Hakamäki M, Metsärinne K, Koivuviita N, Pärkkä JP, Saarenhovi M, Hellman T, Järvisalo MJ. Association of maximal stress ergometry performance with troponin T and abdominal aortic calcification score in advanced chronic kidney disease. BMC Nephrol 2021; 22:50. [PMID: 33541279 PMCID: PMC7863467 DOI: 10.1186/s12882-021-02251-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background Cardiac biomarkers Troponin T (TnT) and N-terminal pro-B-type natriuretic peptide (proBNP) and abdominal aortic calcification score (AAC) are associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD). The effects of cardiac biomarkers and AAC on maximal exercise capacity in CKD are unknown and were studied. Methods One hundred seventy-four CKD 4–5 patients not on maintenance dialysis underwent maximal bicycle ergometry stress testing, lateral lumbar radiograph to study AAC, echocardiography and biochemical assessments. Results The subjects with proportional maximal ergometry workload (WMAX%) less than 50% of the expected values had higher TnT, proBNP, AAC, left ventricular end-diastolic diameter, left ventricular mass index, E/e’ and pulse pressure, and lower global longitudinal strain compared to the better performing patients. TnT (β = − 0.09, p = 0.02), AAC (β = − 1.67, p < 0.0001) and diabetes (β = − 11.7, p < 0.0001) remained significantly associated with WMAX% in the multivariable model. Maximal ergometry workload (in Watts) was similarly associated with TnT and AAC in addition to age, male gender, hemoglobin and diastolic blood pressure in a respective multivariate model. AAC and TnT showed fair predictive power for WMAX% less than 50% of the expected value with AUCs of 0.70 and 0.75, respectively. Conclusions TnT and AAC are independently associated with maximal ergometry stress test workload in patients with advanced CKD. Trial registration http://www.ClinicalTrials.gov NCT04223726. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02251-y.
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Affiliation(s)
- Roosa Lankinen
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Markus Hakamäki
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Niina Koivuviita
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi P Pärkkä
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Hellman
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko J Järvisalo
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland. .,Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland. .,Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Building 18, TG3B, Hämeentie 11, FIN-20520, Turku, Finland.
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11
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Hakamäki M, Lankinen R, Hellman T, Koivuviita N, Pärkkä JP, Saarenhovi M, Metsärinne K, Järvisalo MJ. Quality of Life Is Associated with Cardiac Biomarkers, Echocardiographic Indices, and Mortality in CKD Stage 4-5 Patients Not on Dialysis. Blood Purif 2020; 50:347-354. [PMID: 33105133 DOI: 10.1159/000510984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients with CKD have an impaired health-related quality of life (QoL). Most studies have been conducted on dialysis patients, and less is known about QoL and its determinants in predialysis patients. We studied the association between QoL and comorbidities, cardiac biomarkers, echocardiography, and mortality in patients with CKD stage 4-5 not on dialysis. METHODS A total of 140 patients enrolled in the Chronic Arterial Disease, Quality of Life and Mortality in Chronic Kidney Injury (CADKID) study filled the Kidney Disease Quality of Life Short Form (KDQOL-SF) at the beginning of the study. Echocardiography and biochemical parameters were obtained at baseline. Patients were followed up for at least 2 years or until death. RESULTS The median age was 66 years, and 51 (36%) patients were female. The median estimated glomerular filtration rate was 13 mL/min per 1.73 m2. Obesity, diabetes, atrial fibrillation, and congestive heart failure were associated with lower QoL scores in multiple KDQOL-SF domains. Cardiac biomarkers, troponin T (p = 0.02), N-terminal pro-B-type natriuretic peptide (p = 0.006), and the echocardiographic parameter of cardiac systolic function left ventricular global longitudinal strain (p = 0.02) were significant predictors of lower physical component summary (PCS) score in multivariable regression models after controlling for age, BMI, and diabetes. A low PCS score predicted mortality in a multivariable Cox proportional hazards model [HR 0.96 (95% CI 0.92-0.99), p = 0.03]. QoL was not associated with kidney disease progression. CONCLUSION Impaired QoL in CKD stage 4-5 patients not on dialysis is associated with cardiac biomarker levels, echocardiographic indices, and mortality.
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Affiliation(s)
- Markus Hakamäki
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland,
| | - Roosa Lankinen
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Hellman
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Niina Koivuviita
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi P Pärkkä
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko J Järvisalo
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland.,Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland.,Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
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12
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Oldgren J, Laurila S, Åkerblom A, Latva-Rasku A, Rebelos E, Isackson H, Saarenhovi M, Eriksson O, Heurling K, Johansson E, Wilderäng U, Karlsson C, Esterline R, Ferrannini E, Oscarsson J, Nuutila P. EFFECTS OF 6 WEEKS OF TREATMENT WITH DAPAGLIFLOZIN, A SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITOR, ON MYOCARDIAL FUNCTION AND METABOLISM IN TYPE 2 DIABETES PATIENTS: A RANDOMIZED PLACEBO-CONTROLLED STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32237-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Pietilä-Effati P, Saarinen JT, Löyttyniemi E, Autio R, Saarenhovi M, Haanpää MK, Kantola I. Natural course of Fabry disease with the p. Arg227Ter (p.R227*) mutation in Finland: Fast study. Mol Genet Genomic Med 2019; 7:e00930. [PMID: 31411008 PMCID: PMC6785458 DOI: 10.1002/mgg3.930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/06/2019] [Accepted: 07/23/2019] [Indexed: 12/02/2022] Open
Abstract
Background Fabry disease is caused by a deficient or an absent alfa‐galactosidase A activity and is an X‐linked disorder that results in organ damage and a shortened life span, especially in males. The severity of the disease depends on the type of mutation, gender, skewed X‐chromosome inactivation, and other still unknown factors. Methods In this article, we describe the natural course of a common classic Fabry disease mutation, p.Arg227Ter or p.R227*, in Finland. Results Four males and ten females belonged to two extended families. The mean age was 46 years (SD 18.4). Six patients (43%) had cardiac hypertrophy, three patients (21%) had ischemic stroke, and none had severe kidney dysfunction. Three patients had atrial fibrillation; two patients who had atrial fibrillation also had pacemakers. All males over 30 years of age had at least one of the following manifestations: cardiac hypertrophy, stroke, or proteinuria. In females, the severity of Fabry disease varied from classic multiorgan disease to a condition that mimicked the attenuated cardiac variant. No one was totally asymptomatic without any signs of Fabry disease. Cardiac magnetic resonance imaging was performed on nine of 14 patients was the most sensitive for detecting early cardiac manifestations. Five patients (55%) had late gadolinium enhancement‐positive segments. Conclusion Cardiac involvement should be effectively detected in females before considering them asymptomatic mutation carriers.
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Affiliation(s)
| | | | | | - Reijo Autio
- Department of Radiology, Vaasa Central Hospital, Vaasa, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Maria K Haanpää
- Department of Clinical Genetics, Turku University Hospital, Turku, Finland
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
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14
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Saarenhovi M, Salo P, Scheinin M, Lehto J, Lovró Z, Tiihonen K, Lehtinen MJ, Junnila J, Hasselwander O, Tarpila A, Raitakari OT. The effect of an apple polyphenol extract rich in epicatechin and flavan-3-ol oligomers on brachial artery flow-mediated vasodilatory function in volunteers with elevated blood pressure. Nutr J 2017; 16:73. [PMID: 29078780 PMCID: PMC5660451 DOI: 10.1186/s12937-017-0291-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/27/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The primary aim of this study was to test the hypothesis that an orally ingested apple polyphenol extract rich in epicatechin and flavan-3-ol oligomers improves endothelium-dependent brachial artery flow-mediated vasodilatation (FMD) in volunteers with borderline hypertension. The secondary aim of the study was to test whether the investigational product would improve endothelium-independent nitrate-mediated vasodilatation (NMD). METHODS This was a single centre, repeated-dose, double-blind, placebo-controlled, crossover study in 60 otherwise healthy subjects (26 men, 34 women; aged 40-65 years) with borderline hypertension (blood pressure 130-139/85-89 mmHg) or unmedicated mild hypertension (blood pressure 140-165/90-95 mmHg). The subjects were randomised to receive placebo or the apple polyphenol extract to provide a daily dose of 100 mg epicatechin for 4 weeks, followed by a four to five-week wash-out period, and then 4 weeks intake of the product that they did not receive during the first treatment period. FMD and NMD of the left brachial artery were investigated with ultrasonography at the start and end of both treatment periods, and the per cent increase of the arterial diameter (FMD% and NMD%) was calculated. RESULTS With the apple extract treatment, a significant acute improvement was detected in the mean change of maximum FMD% at the first visit 1.16 (p = 0.04, 95% CI: 0.04; 2.28), last visit 1.37 (p = 0.02, 95% CI: 0.22; 2.52) and for both visits combined 1.29 (p < 0.01, 95% CI: 0.40; 2.18). However, such improvement was not statistically significant when apple extract was compared with placebo. The overall long-term effect of apple extract on FMD% was not different from placebo. No statistically significant differences between the apple extract and placebo treatments were observed for endothelium-independent NMD. CONCLUSIONS A significant acute improvement in maximum FMD% with apple extract administration was found. However, superiority of apple extract over placebo was not statistically significant in our study subjects with borderline hypertension or mild hypertension. The study raised no safety concerns regarding the daily administration of an apple polyphenol extract rich in epicatechin. TRIAL REGISTRATION The trial is registered at http://clinicaltrials.gov (identifier: NCT01690676 ). Registered 25th May 2012.
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Affiliation(s)
- Maria Saarenhovi
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland. .,Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, P.O. Box 52, FI-20521, Turku, Finland.
| | - Pia Salo
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Mika Scheinin
- Clinical Research Services Turku (CRST), University of Turku, and Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Jussi Lehto
- Clinical Research Services Turku (CRST), University of Turku, and Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Zsófia Lovró
- Clinical Research Services Turku (CRST), University of Turku, and Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | | | | | | | | | | | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, P.O. Box 52, FI-20521, Turku, Finland
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