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Kleiven Ø, Bjørkavoll-Bergseth MF, Omland T, Aakre KM, Frøysa V, Erevik CB, Greve OJ, Melberg TH, Auestad B, Skadberg Ø, Edvardsen T, Ørn S. Endurance exercise training volume is not associated with progression of coronary artery calcification. Scand J Med Sci Sports 2020; 30:1024-1032. [PMID: 32100340 DOI: 10.1111/sms.13643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/18/2019] [Accepted: 02/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent cross-sectional studies have suggested a dose-dependent relationship between lifelong exposure to physical activity and the burden of calcified coronary artery disease (CAD). No longitudinal studies have addressed this concern. HYPOTHESIS Exercise volume is associated with progression of coronary artery calcium (CAC), defined as ≥10 units increase in CAC score. METHODS Sixty-one recreational athletes who were assessed by coronary computed tomography angiography (CCTA) as part of the NEEDED 2013/14 study were re-assessed 4-5 years later, in 2018. RESULTS Subjects were 45.9 ± 9.6 years old at inclusion, and 46 (74%) were male. Between 2013 and 2018, the participants reported median 5 (range: 0-20, 25th-75th percentile: 4-6) hours of high-intensity exercise per week. None of the included subjects smoked during follow-up. At inclusion, 21 (33%) participants had coronary artery calcifications. On follow-up CCTA in 2018, 15 (25%) subjects had progressive coronary calcification (≥10 Agatston units increase in CAC). These subjects were older (53 ± 9 vs 44 ± 9 years old, P = .002) and had higher levels of low-density lipoprotein at baseline (3.5 (2.9-4.3) vs 2.9 (2.3-3.5) mmol/L, P = .031) as compared to subjects with stable condition. No relationship was found between hours of endurance training per week and progression of coronary artery calcification. In multiple regression analysis, age and baseline CAC were the only significant predictors of progressive CAC. CONCLUSION No relationship between exercise training volume and the progression of coronary artery calcification was found in this longitudinal study of middle-aged recreational athletes.
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Affiliation(s)
- Øyunn Kleiven
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Torbjørn Omland
- Department of Medicine, Akershus University Hospital, Lorenskog, Norway.,University of Oslo, Oslo, Norway
| | - Kristin M Aakre
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Vidar Frøysa
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway
| | | | - Ole J Greve
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Tor H Melberg
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Auestad
- Department of Research, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Øyvind Skadberg
- Department of Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Thor Edvardsen
- University of Oslo, Oslo, Norway.,Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stein Ørn
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
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Franklin BA, Thompson PD, Al-Zaiti SS, Albert CM, Hivert MF, Levine BD, Lobelo F, Madan K, Sharrief AZ, Eijsvogels TMH. Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective-An Update: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e705-e736. [PMID: 32100573 DOI: 10.1161/cir.0000000000000749] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As a result, worldwide participation in endurance training, competitive long distance endurance events, and high-intensity interval training has increased markedly since the previous American Heart Association statement on exercise risk. On the other hand, vigorous physical activity, particularly when performed by unfit individuals, can acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible people. Recent studies have also shown that large exercise volumes and vigorous intensities are both associated with potential cardiac maladaptations, including accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, and atrial fibrillation. The relationship between these maladaptive responses and physical activity often forms a U- or reverse J-shaped dose-response curve. This scientific statement discusses the cardiovascular and health implications for moderate to vigorous physical activity, as well as high-volume, high-intensity exercise regimens, based on current understanding of the associated risks and benefits. The goal is to provide healthcare professionals with updated information to advise patients on appropriate preparticipation screening and the benefits and risks of physical activity or physical exertion in varied environments and during competitive events.
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Zheng Y, Mao M, Ji M, Zheng Q, Liu L, Zhao Z, Wang H, Wei X, Wang Y, Chen J, Zhou H, Liang Q, Chen Y, Zhang X, Wang L, Cheng Y, Zhang X, Teng M, Lu X. Does a pulmonary rehabilitation based ERAS program (PREP) affect pulmonary complication incidence, pulmonary function and quality of life after lung cancer surgery? Study protocol for a multicenter randomized controlled trial. BMC Pulm Med 2020; 20:44. [PMID: 32070326 PMCID: PMC7029521 DOI: 10.1186/s12890-020-1073-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). Preliminary evidence suggests that ERAS processes can reduce overall incidence of PPCs as short- and long-term recovery improved by supporting units to adopt evidence-based care. However, the evidence is inconclusive due to insufficient high-level studies in this research field. No well-designed, adequately powered, randomized controlled trials (RCTs) have investigated the effects of pulmonary rehabilitation based ERAS program (PREP) on post-operative pulmonary complications, pulmonary function, and health related quality of life following lung cancer surgery. METHODS The PREP trial is a pragmatic, investigator-initiated, multi-center, randomized controlled, parallel group, clinical trial. Five hundred patients scheduled for minimally invasive pulmonary resection at six hospitals in China will be randomized with concealed allocation to receive either i) a pre-operative assessment and an information booklet or ii) a pre-operative assessment, an information booklet, plus an additional education, a 30-min pulmonary rehabilitation training session and the post-operative pulmonary rehabilitation program. The primary outcome is incidence of PPCs defined with the Melbourne Group Scale diagnostic scoring tool. Secondary outcomes include incidence of cardiopulmonary and other complications, pulmonary function, cardiopulmonary endurance, muscle strength, activity level, health-related quality of life (HRQoL), pre- and post-operative hospital length of stay (LOS), and total hospital LOS. DISCUSSION The PREP trial is designed to verify the hypothesis that pulmonary rehabilitation based ERAS program reduces incidence of PPCs and improves pulmonary function and HRQoL in patients following lung cancer surgery. This trial will furthermore contribute significantly to the limited knowledge about the pulmonary rehabilitation based ERAS program following lung cancer surgery, and may thereby form the basis of future recommendations in the surgical community. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1900024646, 21 July 2019.
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Affiliation(s)
- Yu Zheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Mao Mao
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Meifang Ji
- Department of Rehabilitation Therapy, the Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Road, Haikou, 570100, China
| | - Qiugang Zheng
- Department of Rehabilitation Therapy, the Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Road, Haikou, 570100, China
| | - Liang Liu
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, China
| | - Zhigang Zhao
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, China
| | - Haiming Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 East of Jianshe Road, Zhengzhou, 450052, China
| | - Xiangyang Wei
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 East of Jianshe Road, Zhengzhou, 450052, China
| | - Yulong Wang
- Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6 Renmin Road, Dapeng New District, Shenzhen, 518000, China
| | - Jiamin Chen
- Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6 Renmin Road, Dapeng New District, Shenzhen, 518000, China
| | - Huiqing Zhou
- Department of Rehabilitation Therapy, Taizhou Enze Medical Center, Enze Hospital, No. 1 East of Tongyang Road, Taizhou, 318050, China
| | - Qiaoqiao Liang
- Department of Rehabilitation Therapy, Taizhou Enze Medical Center, Enze Hospital, No. 1 East of Tongyang Road, Taizhou, 318050, China
| | - Ying Chen
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xintong Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Lu Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Yihui Cheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xiu Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Meiling Teng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China.
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Aengevaeren VL, Eijsvogels TMH. Coronary atherosclerosis in middle-aged athletes: Current insights, burning questions, and future perspectives. Clin Cardiol 2020; 43:863-871. [PMID: 32031291 PMCID: PMC7403658 DOI: 10.1002/clc.23340] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/08/2020] [Accepted: 01/24/2020] [Indexed: 01/01/2023] Open
Abstract
Regular exercise training is considered healthy as it reduces the risk of cardiovascular events and mortality. Nevertheless, athletes are not immune to the development of cardiovascular diseases and recent studies reported a higher prevalence of coronary artery calcifications and atherosclerotic plaques in athletes compared to less active controls. These observations have raised many questions among sport scientists, sports cardiologists, amateur athletes, and the general population. For example, Are athletes (not) immune for coronary atherosclerosis? How to assess coronary atherosclerosis in athletes? What about chalk (calcified plaque) and cheese (mixed plaque)? Does exercise intensity play a role? Are there sport‐related differences? Are there sex differences? Can sports medical evaluation detect coronary atherosclerosis? Do athletes get worried? Should athletes get worried? How should athletes with coronary atherosclerosis be managed? The goal of this review is to discuss the latest scientific insights and to answer these important questions. Furthermore, we will explore potential clinical implications and point out directions for further research.
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Affiliation(s)
- Vincent L Aengevaeren
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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107
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Thomas IC, Takemoto ML, Forbang NI, Larsen BA, Michos ED, McClelland RL, Allison MA, Budoff MJ, Criqui MH. Associations of recreational and non-recreational physical activity with coronary artery calcium density vs. volume and cardiovascular disease events: the Multi-Ethnic Study of Atherosclerosis. Eur Heart J Cardiovasc Imaging 2020; 21:132-140. [PMID: 31670763 PMCID: PMC7850103 DOI: 10.1093/ehjci/jez271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/07/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS The benefits of physical activity (PA) on cardiovascular disease (CVD) are well known. However, studies suggest PA is associated with coronary artery calcium (CAC), a subclinical marker of CVD. In this study, we evaluated the associations of self-reported recreational and non-recreational PA with CAC composition and incident CVD events. Prior studies suggest high CAC density may be protective for CVD events. METHODS AND RESULTS We evaluated 3393 participants of the Multi-Ethnic Study of Atherosclerosis with prevalent CAC. After adjusting for demographics, the highest quintile of recreational PA was associated with 0.07 (95% confidence interval 0.01-0.13) units greater CAC density but was not associated with CAC volume. In contrast, the highest quintile of non-recreational PA was associated with 0.08 (0.02-0.14) units lower CAC density and a trend toward 0.13 (-0.01 to 0.27) log-units higher CAC volume. There were 520 CVD events over a 13.7-year median follow-up. Recreational PA was associated with lower CVD risk (hazard ratio 0.88, 0.79-0.98, per standard deviation), with an effect size that was not changed with adjustment for CAC composition or across levels of prevalent CAC. CONCLUSION Recreational PA may be associated with a higher density but not a higher volume of CAC. Non-recreational PA may be associated with lower CAC density, suggesting these forms of PA may not have equivalent associations with this subclinical marker of CVD. While PA may affect the composition of CAC, the associations of PA with CVD risk appear to be independent of CAC.
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Affiliation(s)
- Isac C Thomas
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, 9452 Medical Center Drive, La Jolla, CA 92037-7411, USA
| | - Michelle L Takemoto
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Nketi I Forbang
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Britta A Larsen
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, 6200 NE 74th St, Seattle, WA 98115, USA
| | - Matthew A Allison
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, 1124 W Carson St., Torrance, CA 90502, USA
| | - Michael H Criqui
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
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108
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Coronary Atherosclerosis in Masters Athletes: Mechanisms and Implications for Cardiovascular Disease Risk. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:87. [DOI: 10.1007/s11936-019-0798-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
Abstract
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine , New Orleans, LA, USA
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL, USA
| | - Sergey Kachur
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine , New Orleans, LA, USA
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110
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Kim K, Choi S, Hwang SE, Son JS, Lee JK, Oh J, Park SM. Changes in exercise frequency and cardiovascular outcomes in older adults. Eur Heart J 2019; 41:1490-1499. [DOI: 10.1093/eurheartj/ehz768] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/28/2019] [Accepted: 10/11/2019] [Indexed: 01/19/2023] Open
Abstract
Abstract
Aims
Little is known about the association of changes in moderate to vigorous physical activity (MVPA) level with cardiovascular disease (CVD), especially in older adults whose ability to engage in frequent MVPA naturally wanes as they age. We aimed to examine the association of changes in MVPA and CVD in older adults.
Methods and results
In a nationwide cohort study of older adults aged 60 years or older, we identified more than 1.1 million subjects without previous history of CVD at baseline who underwent two consecutive national health screening from 2009 to 2012. We prospectively assessed the risk of CVD occurred between 2013 and 2016 according to changes in frequency of MVPA by initial MVPA status. Compared to those who were continuously physically inactive, those who increased their frequency of MVPA from physically inactive to 1–2 times per week [0.7/1000 person-years (PY) decrease in incidence rate (IR); adjusted hazard ratio (aHR) 0.95; 95% confidence interval (CI) 0.92–0.99], 3–4 times per week (1.5/1000 PY decrease in IR; aHR 0.89; 95% CI 0.84–0.94), ≥5 times per week (0.4/1000 PY decrease in IR; aHR 0.91; 95% CI 0.85–0.97) had a significantly reduced risk for total CVD (P for trend <0.001). Older adults who became physically inactive from engaging in more than 1–2 times of MVPA per week had a higher CVD risk compared to those who maintained their frequency of MVPA.
Conclusion
Among older adults, engaging in higher frequency of MVPA or maintaining MVPA level was associated with reduced risk of CVD.
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Affiliation(s)
- Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Biomedical Science Building 117, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Biomedical Science Building 117, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Seo Eun Hwang
- Department of Family Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Joung Sik Son
- Department of Family Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Jong-Koo Lee
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Rd, Durham, NC 27705, USA
- JW Lee Center for Global and Office of Health Society and Education, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03087, Republic of Korea
| | - Juhwan Oh
- JW Lee Center for Global and Office of Health Society and Education, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03087, Republic of Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Biomedical Science Building 117, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
- Department of Family Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
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111
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Paana T, Jaakkola S, Bamberg K, Saraste A, Tuunainen E, Wittfooth S, Kallio P, Heinonen OJ, Knuuti J, Pettersson K, Airaksinen KJ. Cardiac troponin elevations in marathon runners. Role of coronary atherosclerosis and skeletal muscle injury. The MaraCat Study. Int J Cardiol 2019; 295:25-28. [DOI: 10.1016/j.ijcard.2019.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/12/2019] [Accepted: 08/06/2019] [Indexed: 12/12/2022]
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112
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Shimada K, Nishitani-Yokoyma M, Takahashi T, Daida H. Physical activity and long-term prognosis in patients with stable coronary artery disease: How often, how intense, and how long? Eur J Prev Cardiol 2019; 27:422-425. [PMID: 31610706 DOI: 10.1177/2047487319881238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Miho Nishitani-Yokoyma
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Faculty of Health Science, Juntendo University, Tokyo, Japan
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113
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Demer LL, Tintut Y. Interactive and Multifactorial Mechanisms of Calcific Vascular and Valvular Disease. Trends Endocrinol Metab 2019; 30:646-657. [PMID: 31279666 PMCID: PMC6708492 DOI: 10.1016/j.tem.2019.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 12/12/2022]
Abstract
Calcific vascular and valvular disease (CVVD) is widespread and has major health consequences. Although coronary artery calcification has long been associated with hyperlipidemia and increased mortality, recent evidence suggests that its progression is increased in association with cholesterol-lowering HMG-CoA reductase inhibitors ('statins') and long-term, high-intensity exercise. A nationwide trial showed no cardiovascular benefit of vitamin D supplements. Controversy remains as to whether calcium deposits in plaque promote or prevent plaque rupture. CVVD appears to occur through mechanisms similar to those of intramembranous, endochondral, and osteophytic skeletal bone formation. New evidence implicates autotaxin, endothelial-mesenchymal transformation, and microRNA and long non-coding RNA (lncRNA) as novel regulatory factors. New therapeutic options are being developed.
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Affiliation(s)
- Linda L Demer
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095-1679, USA; Department of Physiology, University of California at Los Angeles, Los Angeles, CA 90095-1751, USA; Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA 90095-1600, USA.
| | - Yin Tintut
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095-1679, USA; Department of Physiology, University of California at Los Angeles, Los Angeles, CA 90095-1751, USA; Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, CA 90095, USA
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114
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Sanchis-Gomar F, Perez-Quilis C, Pareja-Galeano H, Lippi G. Undetected coronary artery disease in apparently healthy athletes. Eur J Prev Cardiol 2019; 26:2009-2011. [PMID: 31266350 DOI: 10.1177/2047487319859970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, University of Valencia and INCLIVA Biomedical Research Institute, Spain
| | - Carme Perez-Quilis
- Department of Physiology, University of Valencia and INCLIVA Biomedical Research Institute, Spain
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Italy
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115
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Kuller LH. Risks of High Coronary Artery Calcium. JAMA Cardiol 2019; 4:712. [DOI: 10.1001/jamacardio.2019.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Lewis H. Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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116
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DeFina LF, Radford NB, Levine BD. Risks of High Coronary Artery Calcium-Reply. JAMA Cardiol 2019; 4:713. [PMID: 31090884 DOI: 10.1001/jamacardio.2019.1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Benjamin D Levine
- Institute for Environmental and Exercise Medicine, Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas
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117
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Affiliation(s)
- Kashif Shaikh
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
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118
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Dayer MJ, Green I. Mortality during marathons: a narrative review of the literature. BMJ Open Sport Exerc Med 2019; 5:e000555. [PMID: 31321073 PMCID: PMC6606059 DOI: 10.1136/bmjsem-2019-000555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 12/12/2022] Open
Abstract
Background Millions of community-dwelling individuals run marathons each year. There are infrequent deaths, which are often reported widely, and may create unnecessary alarm about the potential risks. Equally, sensible planning for such eventualities is important when staging an event. Objective The aim of the review was to determine the risk of death from running a marathon and the likely location of such deaths in order to inform the public of the likely risks and improve planning for such events. Design Narrative review. Data sources Primary: PubMed. Secondary: contact was made with the organisers and medical teams of specific marathons and online data sought where necessary. Eligibility criteria for selecting studies Studies had to report the number of participants and deaths during, or within 24 hours of completing the marathon. Results relevant to half marathons or ultramarathons or other endurance events, such as triathlons, were not included. Deaths due to terrorist activity were not included. Results The risk of death estimated by these studies was approximately 0.67 per 100 000 finishers, that is, 1 death per 149 968 participants. From those studies that reported deaths by sex, the rate of male deaths was 0.98/100 000 (1 per 102 503) vs 0.41/100 000 (1 per 243 879) in females. Deaths tended to occur in the last quarter of the race. Summary/conclusion The risk of death from participating in a marathon is small. Men are more at risk than women. Deaths tend to occur later in the race.
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Affiliation(s)
- Mark Jeremy Dayer
- Cardiology, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK.,University of Exeter, Exeter, UK
| | - Ian Green
- eCo Financial Technology, London, UK
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Extreme Physical Activity May Increase Coronary Calcification, But Fitness Still Prevails. Mayo Clin Proc Innov Qual Outcomes 2019; 3:103-105. [PMID: 31193848 PMCID: PMC6543500 DOI: 10.1016/j.mayocpiqo.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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120
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Thanassoulis G, Gregoire J, Pearson GJ. The 2018 ACC/AHA Lipid Guidelines: A Little More or Less Canadian? Can J Cardiol 2019; 35:558-563. [PMID: 31030858 DOI: 10.1016/j.cjca.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- George Thanassoulis
- Preventive and Genomic Cardiology, Divisions of Cardiology and Clinical Epidemiology, McGill University Health Center and Research Institute, Montréal, Québec, Canada.
| | - Jean Gregoire
- Division of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Glen J Pearson
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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