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Duscha BD, Ross LM, Hoselton AL, Piner LW, Pieper CF, Kraus WE. A Detailed Analysis of Cardiac Rehabilitation on 180-Day All-Cause Hospital Readmission and Mortality. J Cardiopulm Rehabil Prev 2024; 44:99-106. [PMID: 38113355 PMCID: PMC10913862 DOI: 10.1097/hcr.0000000000000835] [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] [Indexed: 12/21/2023]
Abstract
PURPOSE Cardiac rehabilitation (CR) is endorsed for coronary artery disease (CAD), but studies report inconsistent findings regarding efficacy. The objective of this study was to determine whether confounding factors, potentially contributing to these heterogeneous findings, impact the effect of CR on all-cause readmission and mortality. METHODS Patients (n = 2641) with CAD, CR eligible, and physically able were identified. Electronic medical records were inspected individually for each patient to extract demographic, clinical characteristic, readmission, and mortality information. Patients (n = 214) attended ≥1 CR session (CR group). Survival was considered free from: all-cause readmission; or composite outcome of all-cause readmission or death. Cox proportional hazards models, adjusting for demographics, comorbidities, and discharge criteria, were used to determine HR with 95% CI and to compare 180-d survival rates between the CR and no-CR groups. RESULTS During 180 d of follow-up, 12.1% and 18.7% of the CR and non-CR patients were readmitted to the hospital. There was one death (0.5%) in the CR group, while 98 deaths (4.0%) occurred in the non-CR group. After adjustment for age, sex, race, depression, anxiety, dyslipidemia, hypertension, obesity, smoking, type 2 diabetes, and discharge criteria, the final model revealed a significant 42.7% reduction in readmission or mortality risk for patients who attended CR (HR = 0.57: 95% CI, 0.33-0.98; P = .043). CONCLUSIONS Regardless of demographic characteristics, comorbidities, and cardiovascular discharge criteria, the risk of 180-d all-cause readmission or death was markedly decreased in patients who attended CR compared with those who did not.
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Affiliation(s)
- Brian D. Duscha
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Leanna M. Ross
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Andrew L. Hoselton
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Lucy W. Piner
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Carl F. Pieper
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - William E. Kraus
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
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Gray SM, Hoselton AL, Krishna R, Slentz CA, D’Alessio DA. GLP-1 Receptor Blockade Reduces Stimulated Insulin Secretion in Fasted Subjects With Low Circulating GLP-1. J Clin Endocrinol Metab 2022; 107:2500-2510. [PMID: 35775723 PMCID: PMC9387711 DOI: 10.1210/clinem/dgac396] [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: 08/24/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Glucagon-like peptide 1 (GLP-1), an insulinotropic peptide released into the circulation from intestinal enteroendocrine cells, is considered a hormonal mediator of insulin secretion. However, the physiological actions of circulating GLP-1 have been questioned because of the short half-life of the active peptide. Moreover, there is mounting evidence for localized, intra-islet mediation of GLP-1 receptor (GLP-1r) signaling including a role for islet dipeptidyl-peptidase 4 (DPP4). OBJECTIVE To determine whether GLP-1r signaling contributes to insulin secretion in the absence of enteral stimulation and increased plasma levels, and whether this is affected by DPP4. METHODS Single-site study conducted at an academic medical center of 20 nondiabetic subjects and 13 subjects with type 2 diabetes. This was a crossover study in which subjects received either a DPP4 inhibitor (DPP4i; sitagliptin) or placebo on 2 separate days. On each day they received a bolus of intravenous (IV) arginine during sequential 60-minute infusions of the GLP-1r blocker exendin[9-39] (Ex-9) and saline. The main outcome measures were arginine-stimulated secretion of C-Peptide (C-PArg) and insulin (InsArg). RESULTS Plasma GLP-1 remained at fasting levels throughout the experiments and IV arginine stimulated both α- and β-cell secretion in all subjects. Ex-9 infusion reduced C-PArg in both the diabetic and nondiabetic groups by ~14% (P < .03 for both groups). Sitagliptin lowered baseline glycemia but did not affect the primary measures of insulin secretion. However, a significant interaction between sitagliptin and Ex-9 suggested more GLP-1r activation with DPP4i treatment in subjects with diabetes. CONCLUSION GLP-1r activation contributes to β-cell secretion in diabetic and nondiabetic people during α-cell activation, but in the absence of increased circulating GLP-1. These results are compatible with regulation of β-cells by paracrine signals from α-cells. This process may be affected by DPP4 inhibition.
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Affiliation(s)
- Sarah M Gray
- Duke University Division of Endocrinology, Durham, NC 27710, USA
- Department of Medicine, Durham, NC 27710, USA
- Duke Molecular Physiology Institute, Durham, NC 27710, USA
| | - Andrew L Hoselton
- Department of Medicine, Durham, NC 27710, USA
- Duke Molecular Physiology Institute, Durham, NC 27710, USA
| | - Radha Krishna
- Duke University Division of Endocrinology, Durham, NC 27710, USA
- Department of Medicine, Durham, NC 27710, USA
- Duke Molecular Physiology Institute, Durham, NC 27710, USA
| | - Cris A Slentz
- Department of Medicine, Durham, NC 27710, USA
- Duke Molecular Physiology Institute, Durham, NC 27710, USA
| | - David A D’Alessio
- Correspondence: David A. D’Alessio, MD, Duke University Medical Center, Division of Endocrinology, Metabolism and Nutrition, DUMC Box 3921, Durham, NC 27710, USA. david.d'
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Wohlgemuth KJ, Arieta LR, Brewer GJ, Hoselton AL, Gould LM, Smith-Ryan AE. Sex differences and considerations for female specific nutritional strategies: a narrative review. J Int Soc Sports Nutr 2021; 18:27. [PMID: 33794937 PMCID: PMC8015182 DOI: 10.1186/s12970-021-00422-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 12/17/2022] Open
Abstract
Although there is a plethora of information available regarding the impact of nutrition on exercise performance, many recommendations are based on male needs due to the dominance of male participation in the nutrition and exercise science literature. Female participation in sport and exercise is prevalent, making it vital for guidelines to address the sex-specific nutritional needs. Female hormonal levels, such as estrogen and progesterone, fluctuate throughout the mensural cycle and lifecycle requiring more attention for effective nutritional considerations. Sex-specific nutritional recommendations and guidelines for the active female and female athlete have been lacking to date and warrant further consideration. This review provides a practical overview of key physiological and nutritional considerations for the active female. Available literature regarding sex-specific nutrition and dietary supplement guidelines for women has been synthesized, offering evidenced-based practical information that can be incorporated into the daily lives of women to improve performance, body composition, and overall health.
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Affiliation(s)
- Kealey J Wohlgemuth
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Luke R Arieta
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Gabrielle J Brewer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Andrew L Hoselton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Lacey M Gould
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Abbie E Smith-Ryan
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Nutrition, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA.
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Willis LH, Slentz CA, Johnson JL, Kelly LS, Craig KP, Hoselton AL, Kraus WE. Effects of Exercise Training With and Without Ranolazine on Peak Oxygen Consumption, Daily Physical Activity, and Quality of Life in Patients With Chronic Stable Angina Pectoris. Am J Cardiol 2019; 124:655-660. [PMID: 31296368 DOI: 10.1016/j.amjcard.2019.05.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
Ranolazine reduces angina frequency and increases exercise capacity. We hypothesized that exercise training with ranolazine would allow subjects to train at greater intensities, resulting in greater improvements in exercise capacity, physical activity, and health-related quality of life (HRQOL). In a pilot study, subjects with chronic stable angina pectoris were randomized to ranolazine (n = 13) or placebo (n = 16). After a 2-week drug titration period, subjects participated in a 12-week exercise program. Peak VO2, physical activity (via accelerometer), and HRQOL were assessed before and after training. After exercise training, peak VO2increased twice as much with ranolazine (2.1 ± 3.4 ml/kg/min) as with placebo (0.9 ± 1.5) (both p <0.05). After exercise training, both groups significantly improved HRQOL score (p <0.05); however, the improvement with ranolazine (19 ± 21) was almost 50% greater than with placebo (13 ± 18). There was a significant decrease in maximal heart rate after training with ranolazine but not with placebo (group difference, p = 0.04). Oxygen pulse (peak VO2/peak HR) increased in both groups after training; but, the increase was 4 times greater with ranolazine - resulting in a significant difference between groups (p = 0.044). In conclusion, patients with angina, the addition of ranolazine to an exercise program may improve aerobic fitness, physical activity, and HRQOL beyond the results of an exercise training program alone. Exercise training with ranolazine led to significantly greater increases in oxygen pulse, which is significantly correlated with stroke volume and is an independent predictor of mortality.
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