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Franklin BA, Lavie CJ. Impact of Statins on Physical Activity and Fitness: Ally or Adversary? Mayo Clin Proc 2015; 90:1314-9. [PMID: 26434957 DOI: 10.1016/j.mayocp.2015.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, MI; Oakland University William Beaumont School of Medicine, Rochester, MI.
| | - 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
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102
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Hung RK, Al-Mallah MH, Qadi MA, Shaya GE, Blumenthal RS, Nasir K, Brawner CA, Keteyian SJ, Blaha MJ. Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy: The Henry Ford ExercIse Testing Project. Am Heart J 2015; 170:390-9. [PMID: 26299238 DOI: 10.1016/j.ahj.2015.04.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/15/2015] [Indexed: 12/21/2022]
Abstract
AIMS We sought to evaluate the effect of cardiorespiratory fitness (CRF) in predicting mortality, myocardial infarction (MI), and revascularization in patients with hyperlipidemia after stratification by gender and statin therapy. METHODS AND RESULTS This retrospective cohort study included 33,204 patients with hyperlipidemia (57 ± 12 years old, 56% men, 25% black) who underwent physician-referred treadmill stress testing at the Henry Ford Health System from 1991 to 2009. Patients were stratified by gender, baseline statin therapy, and estimated metabolic equivalents from stress testing. We computed hazard ratios using Cox regression models after adjusting for demographics, cardiac risk factors, comorbidities, pertinent medications, interaction terms, and indication for stress testing. RESULTS There were 4,851 deaths, 1,962 MIs, and 2,686 revascularizations over a median follow-up of 10.3 years. In men and women not on statin therapy and men and women on statin therapy, each 1-metabolic equivalent increment in CRF was associated with hazard ratios of 0.86 (95% CI 0.85-0.88), 0.83 (95% CI 0.81-0.85), 0.85 (95% CI 0.83-0.87), and 0.84 (95% CI 0.81-0.87) for mortality; 0.93 (95% CI 0.90-0.96), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.86-0.92), and 0.90 (95% CI 0.86-0.95) for MI; and 0.91 (95% CI 0.88-0.93), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.87-0.92), and 0.90 (95% CI 0.86-0.94) for revascularization, respectively. No significant interactions were observed between CRF and statin therapy (P > .23). CONCLUSION Higher CRF attenuated risk for mortality, MI, and revascularization independent of gender and statin therapy in patients with hyperlipidemia. These results reinforce the prognostic value of CRF and support greater promotion of CRF in this patient population.
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Affiliation(s)
- Rupert K Hung
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Mouaz H Al-Mallah
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; King Abdul-Aziz Cardiac Center, Riyadh, Saudi Arabia
| | - Mohamud A Qadi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Gabriel E Shaya
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; University of Miami Miller School of Medicine, Miami, FL
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Baptist Health South Florida, Miami, FL
| | | | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
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103
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Stress: the good, the bad and the ugly? Z Gerontol Geriatr 2015; 48:503-4. [DOI: 10.1007/s00391-015-0936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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104
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Banach M, Rizzo M, Toth PP, Farnier M, Davidson MH, Al-Rasadi K, Aronow WS, Athyros V, Djuric DM, Ezhov MV, Greenfield RS, Hovingh GK, Kostner K, Serban C, Lighezan D, Fras Z, Moriarty PM, Muntner P, Goudev A, Ceska R, Nicholls SJ, Broncel M, Nikolic D, Pella D, Puri R, Rysz J, Wong ND, Bajnok L, Jones SR, Ray KK, Mikhailidis DP. Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel. Expert Opin Drug Saf 2015; 14:935-55. [PMID: 25907232 DOI: 10.1517/14740338.2015.1039980] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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105
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Kokkinos P, Faselis C, Myers J, Sui X, Zhang J, Tsimploulis A, Chawla L, Palant C. Exercise capacity and risk of chronic kidney disease in US veterans: a cohort study. Mayo Clin Proc 2015; 90:461-8. [PMID: 25792243 DOI: 10.1016/j.mayocp.2015.01.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 01/12/2015] [Accepted: 01/14/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the association between exercise capacity and the risk of developing chronic kidney disease (CKD). PATIENTS AND METHODS Exercise capacity was assessed in 5812 male veterans (mean age, 58.4±11.5 years) from the Veterans Affairs Medical Center, Washington, DC. Study participants had an estimated glomerular filtration rate of 60 mL/min per 1.73 m(2) or more 6 months before exercise testing and no evidence of CKD. Those who developed CKD during follow-up were initially identified by the International Classification of Diseases, Ninth Revision and further verified by at least 2 consecutive estimated glomerular filtration rate values of less than 60 mL/min per 1.73 m(2) 3 months or more apart. Normal kidney function for CKD-free individuals was confirmed by sequential normal eGFR levels. We established 4 fitness categories on the basis of age-stratified quartiles of peak metabolic equivalents (METs) achieved: least-fit (≤25%; 4.8±0.90 METs; n=1258); low-fit (25.1%-50%; 6.5±0.96 METs; n=1614); moderate-fit (50.1%-75%; 7.7±0.91 METs; n=1958), and high-fit (>75%; 9.5±1.0 METs; n=1436). Multivariable Cox proportional hazard models were used to assess the association between exercise capacity and CKD. RESULTS During a median follow-up period of 7.9 years, 1010 developed CKD (20.4/1000 person-years). Exercise capacity was inversely related to CKD incidence. The risk was 22% lower (hazard ratio, 0.78; 95% CI, 0.75-0.82; P<.001) for every 1-MET increase in exercise capacity. Compared with the least-fit individuals, hazard ratios were 0.87 (95% CI, 0.74-1.03) for low-fit, 0.55 (95% CI, 0.47-0.65) for moderate-fit, and 0.42 (95% CI, 0.33-0.52) for high-fit individuals. CONCLUSION Higher exercise capacity attenuated the risk of developing CKD. The association was independent and graded.
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Affiliation(s)
- Peter Kokkinos
- Cardiology Department, Veterans Affairs Medical Center, Washington, DC; Georgetown University Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
| | - Charles Faselis
- George Washington University School of Medicine, Washington, DC; Department of Medicine, Veterans Affairs Medical Center, Washington, DC
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford University, Stanford, CA
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | | | - Lakhmir Chawla
- George Washington University School of Medicine, Washington, DC; Nephrology Department, Veterans Affairs Medical Center, Washington, DC
| | - Carlos Palant
- George Washington University School of Medicine, Washington, DC; Nephrology Department, Veterans Affairs Medical Center, Washington, DC
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106
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Opie LH. Present status of statin therapy. Trends Cardiovasc Med 2015; 25:216-25. [DOI: 10.1016/j.tcm.2014.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 01/17/2023]
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107
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Bonfim MR, Oliveira ASB, do Amaral SL, Monteiro HL. Treatment of dyslipidemia with statins and physical exercises: recent findings of skeletal muscle responses. Arq Bras Cardiol 2015; 104:324-31. [PMID: 25993596 PMCID: PMC4415869 DOI: 10.5935/abc.20150005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 12/31/2022] Open
Abstract
Statin treatment in association with physical exercise practice can substantially reduce cardiovascular mortality risk of dyslipidemic individuals, but this practice is associated with myopathic event exacerbation. This study aimed to present the most recent results of specific literature about the effects of statins and its association with physical exercise on skeletal musculature. Thus, a literature review was performed using PubMed and SciELO databases, through the combination of the keywords "statin" AND "exercise" AND "muscle", restricting the selection to original studies published between January 1990 and November 2013. Sixteen studies evaluating the effects of statins in association with acute or chronic exercises on skeletal muscle were analyzed. Study results indicate that athletes using statins can experience deleterious effects on skeletal muscle, as the exacerbation of skeletal muscle injuries are more frequent with intense training or acute eccentric and strenuous exercises. Moderate physical training, in turn, when associated to statins does not increase creatine kinase levels or pain reports, but improves muscle and metabolic functions as a consequence of training. Therefore, it is suggested that dyslipidemic patients undergoing statin treatment should be exposed to moderate aerobic training in combination to resistance exercises three times a week, and the provision of physical training prior to drug administration is desirable, whenever possible.
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Affiliation(s)
- Mariana Rotta Bonfim
- Programa de Pós-Graduação em Ciências da
Motricidade, Instituto de Biociências, Universidade Estadual Paulista
“Júlio de Mesquita Filho” (UNESP), Rio Claro, SP – Brazil
| | - Acary Souza Bulle Oliveira
- Setor de Doenças Neuromusculares, Escola Paulista de Medicina,
Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
| | - Sandra Lia do Amaral
- Departamento de Educação Física, Faculdade de
Ciências, UNESP, Bauru, SP – Brazil
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108
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Banach M, Rizzo M, Toth PP, Farnier M, Davidson MH, Al-Rasadi K, Aronow WS, Athyros V, Djuric DM, Ezhov MV, Greenfield RS, Hovingh GK, Kostner K, Serban C, Lighezan D, Fras Z, Moriarty PM, Muntner P, Goudev A, Ceska R, Nicholls SJ, Broncel M, Nikolic D, Pella D, Puri R, Rysz J, Wong ND, Bajnok L, Jones SR, Ray KK, Mikhailidis DP. Statin intolerance - an attempt at a unified definition. Position paper from an International Lipid Expert Panel. Arch Med Sci 2015; 11:1-23. [PMID: 25861286 PMCID: PMC4379380 DOI: 10.5114/aoms.2015.49807] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/08/2015] [Accepted: 03/10/2015] [Indexed: 02/07/2023] Open
Abstract
Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin associated muscle symptoms (SAMS), and avoided the use of the term 'statin intolerance'. Although muscle syndromes are the most common adverse effects observed after statin therapy, excluding other side effects might underestimate the number of patients with statin intolerance, which might be observed in 10-15% of patients. In clinical practice, statin intolerance limits effective treatment of patients at risk of, or with, cardiovascular disease. Knowledge of the most common adverse effects of statin therapy that might cause statin intolerance and the clear definition of this phenomenon is crucial to effectively treat patients with lipid disorders. Therefore, the aim of this position paper was to suggest a unified definition of statin intolerance, and to complement the recent EAS statement on SAMS, where the pathophysiology, diagnosis and the management were comprehensively presented.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Peter P. Toth
- University of Illinois College of Medicine, Peoria, IL, USA
| | | | | | | | - Wilbert S. Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
| | - Vasilis Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dragan M. Djuric
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marat V. Ezhov
- Department of Atherosclerosis, Cardiology Research Center, Moscow, Russia
| | | | - G. Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karam Kostner
- Mater Hospital, University of Queensland, St Lucia, QLD, Australia
| | - Corina Serban
- University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
| | - Daniel Lighezan
- University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
| | - Zlatko Fras
- Department of Vascular Medicine, Preventive Cardiology Unit, University Medical Centre Ljubljana, Slovenia Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Patrick M. Moriarty
- Department of Medicine, Schools of Pharmacy and Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Assen Goudev
- Department of Cardiology, Queen Giovanna University Hospital, Sofia, Bulgaria
| | - Richard Ceska
- 3 Department of Internal Medicine, Charles University, Praha, Czech Republic
| | - Stephen J. Nicholls
- South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, Australia
| | - Marlena Broncel
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Lodz, Poland
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Daniel Pella
- First Department Of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Košice, Slovakia
| | | | - Jacek Rysz
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, USA
| | - Laszlo Bajnok
- First Department of Medicine, University of Pecs, Pecs, Hungary
| | - Steven R. Jones
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Kausik K. Ray
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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Shendre A, Beasley TM, Brown TM, Hill CE, Arnett DK, Limdi NA. Influence of regular physical activity on warfarin dose and risk of hemorrhagic complications. Pharmacotherapy 2015; 34:545-54. [PMID: 25032265 DOI: 10.1002/phar.1401] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the influence of regular physical activity on stable warfarin dose and risk of major hemorrhage in patients on chronic anticoagulation therapy. DESIGN Regular physical activity (maintained over > 80% of visits) was ascertained by self-report at initiation of warfarin therapy (target international normalized ratio [INR] = 2-3) in 1272 patients, with changes documented at monthly anticoagulation clinic visits in a population-based prospective cohort. Multi-variable linear regression and survival analysis, respectively, were used to assess influence on warfarin and risk of hemorrhage. SETTING Outpatient anticoagulation clinic PARTICIPANTS 1272 anticoagulated patients MEASUREMENT AND MAIN RESULTS There were 683 (53.7%) patients who were regularly physically active (≥ 30 min ≥ 3 times/week). Physically active patients required warfarin doses that were 6.9% higher (p=0.006) than in physically inactive patients after controlling for sociodemographic factors, vitamin K intake, clinical factors, and genetic variations.The overall incidence of major hemorrhagic events was 7.6/100 person-years (p-yrs, 95% confidence interval [CI] 6.4-8.9) in our population. The incidence was lower for physically active patients (5.6/100 p-yrs, 95% CI 4.2-7.2) than in inactive patients (10.3/100 p-yrs, 95% CI 8.2-12.9, p=0.0004). Active patients had a 38% lower risk of hemorrhage (hazard ratio 0.62, 95% CI 0.42-0.98, p=0.03) compared with inactive patients. CONCLUSIONS Regular physical activity is associated with higher warfarin dose requirements and lower risk of hemorrhage. The influence of physical activity on drug response needs to be further explored, and the mechanisms through which it exerts these effects need to be elucidated
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Deichmann RE, Lavie CJ, Asher T, DiNicolantonio JJ, O'Keefe JH, Thompson PD. The Interaction Between Statins and Exercise: Mechanisms and Strategies to Counter the Musculoskeletal Side Effects of This Combination Therapy. Ochsner J 2015; 15:429-437. [PMID: 26730228 PMCID: PMC4679305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Broad indications for the use of statin medications are resulting in more patients using these therapies. Simultaneously, healthcare professionals are strongly advocating recommendations to increase exercise training (ET) as a means of decreasing cardiovascular disease (CVD) risk and improving other parameters of fitness. METHODS We review the literature to explore mechanisms that may increase the risk of statin/ET interactions, examine the benefits and risks of combining ET and statin use, and offer strategies to minimize the hazards of this combination therapy. RESULTS The combined use of statins and ET can result in health gains and decreased CVD risk; however, multiple factors may increase the risk of adverse events. Some of the events that have been reported with the combination of statins and ET include decreased athletic performance, muscle injury, myalgia, joint problems, decreased muscle strength, and fatigue. The type of statin, the dose, drug interactions, genetic variants, coenzyme Q10 deficiency, vitamin D deficiency, and underlying muscle diseases are among the factors that may predispose patients to intolerance of this combined therapy. CONCLUSION Effective strategies exist to help patients who may be intolerant of combined statin therapy and ET so they may benefit from this proven therapy. Careful attention to identifying high-risk groups and strategies to prevent or treat side effects that may occur should be employed.
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Affiliation(s)
- Richard E. Deichmann
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Carl J. Lavie
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
- Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - Timothy Asher
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - James J. DiNicolantonio
- Department of Cardiology, Mid America Heart Institute, Saint Luke's Health System, Kansas City, MO
| | - James H. O'Keefe
- Department of Cardiology, Mid America Heart Institute, Saint Luke's Health System, Kansas City, MO
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113
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Myers J, McAuley P, Lavie CJ, Despres JP, Arena R, Kokkinos P. Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status. Prog Cardiovasc Dis 2014; 57:306-14. [PMID: 25269064 DOI: 10.1016/j.pcad.2014.09.011] [Citation(s) in RCA: 433] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The evolution from hunting and gathering to agriculture, followed by industrialization, has had a profound effect on human physical activity (PA) patterns. Current PA patterns are undoubtedly the lowest they have been in human history, with particularly marked declines in recent generations, and future projections indicate further declines around the globe. Non-communicable health problems that afflict current societies are fundamentally attributable to the fact that PA patterns are markedly different than those for which humans were genetically adapted. The advent of modern statistics and epidemiological methods has made it possible to quantify the independent effects of cardiorespiratory fitness (CRF) and PA on health outcomes. Based on more than five decades of epidemiological studies, it is now widely accepted that higher PA patterns and levels of CRF are associated with better health outcomes. This review will discuss the evidence supporting the premise that PA and CRF are independent risk factors for cardiovascular disease (CVD) as well as the interplay between both PA and CRF and other CVD risk factors. A particular focus will be given to the interplay between CRF, metabolic risk and obesity.
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Affiliation(s)
- Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States; Stanford University School of Medicine, Stanford, CA, United States.
| | - Paul McAuley
- Winston-Salem State University, Winston-Salem, NC, United States
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, Queensland School of Medicine, New Orleans, LA, United States
| | | | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Peter Kokkinos
- Veterans Affairs Medical Center, Washington DC, United States
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Kokkinos P, Faselis C, Myers J, Sui X, Zhang J, Blair SN. Age-Specific Exercise Capacity Threshold for Mortality Risk Assessment in Male Veterans. Circulation 2014; 130:653-8. [DOI: 10.1161/circulationaha.114.009666] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Mortality risk decreases beyond a certain fitness level. However, precise definition of this threshold is elusive and varies with age. Thus, fitness-related mortality risk assessment is difficult.
Methods and Results—
We studied 18 102 male veterans (8305 blacks and 8746 whites). All completed an exercise test between 1986 and 2011 with no evidence of ischemia. We defined the peak metabolic equivalents (METs) level associated with no increase in all-cause mortality risk (hazard ratio, 1.0) for the age categories of <50, 50 to 59, 60 to 69, and ≥70 years. We used this as the threshold group to form additional age-specific fitness categories based on METs achieved below and above it: least-fit (>2 METs below threshold; n=1692), low-fit (2 METs below threshold; n=4884), moderate-fit (2 METs above threshold; n=4646), fit (2.1–4 METs above threshold; n=1874), and high-fit (>4 METs above threshold; n=1301) categories. Multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality across fitness categories. During follow-up (median=10.8 years), 5102 individuals died. Mortality risk for the cohort and each age category increased for the least-fit and low-fit categories (HR, 1.51; 95% CI, 1.37–1.66; and HR, 1.21; 95% CI, 1.12–1.30, respectively) and decreased for the moderate-fit; fit and high-fit categories (HR, 0.71; 95% CI, 0.65–0.78; HR, 0.63; 95% CI, 0.56–0.78; and HR, 0.49; 95% CI, 0.41–0.58, respectively). The trends were similar for 5- and 10-year mortality risk.
Conclusion—
We defined age-specific exercise capacity thresholds to guide assessment of mortality risk in individuals undergoing a clinical exercise test.
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Affiliation(s)
- Peter Kokkinos
- From the Veterans Affairs Medical Center, Cardiology Department, Washington, DC (P.K., C.F.); Georgetown University School of Medicine, Washington, DC (P.K.); George Washington University School of Medicine, Washington, DC (P.K., C.F.); University of South Carolina, Department of Exercise Science, Arnold School of Public Health (P.K., J.M., X.S., S.N.B.) and Department of Epidemiology and Biostatistics (J.Z., S.N.B.), Columbia; Veterans Affairs Palo Alto Health Care System, Cardiology Division, Palo
| | - Charles Faselis
- From the Veterans Affairs Medical Center, Cardiology Department, Washington, DC (P.K., C.F.); Georgetown University School of Medicine, Washington, DC (P.K.); George Washington University School of Medicine, Washington, DC (P.K., C.F.); University of South Carolina, Department of Exercise Science, Arnold School of Public Health (P.K., J.M., X.S., S.N.B.) and Department of Epidemiology and Biostatistics (J.Z., S.N.B.), Columbia; Veterans Affairs Palo Alto Health Care System, Cardiology Division, Palo
| | - Jonathan Myers
- From the Veterans Affairs Medical Center, Cardiology Department, Washington, DC (P.K., C.F.); Georgetown University School of Medicine, Washington, DC (P.K.); George Washington University School of Medicine, Washington, DC (P.K., C.F.); University of South Carolina, Department of Exercise Science, Arnold School of Public Health (P.K., J.M., X.S., S.N.B.) and Department of Epidemiology and Biostatistics (J.Z., S.N.B.), Columbia; Veterans Affairs Palo Alto Health Care System, Cardiology Division, Palo
| | - Xuemei Sui
- From the Veterans Affairs Medical Center, Cardiology Department, Washington, DC (P.K., C.F.); Georgetown University School of Medicine, Washington, DC (P.K.); George Washington University School of Medicine, Washington, DC (P.K., C.F.); University of South Carolina, Department of Exercise Science, Arnold School of Public Health (P.K., J.M., X.S., S.N.B.) and Department of Epidemiology and Biostatistics (J.Z., S.N.B.), Columbia; Veterans Affairs Palo Alto Health Care System, Cardiology Division, Palo
| | - Jiajia Zhang
- From the Veterans Affairs Medical Center, Cardiology Department, Washington, DC (P.K., C.F.); Georgetown University School of Medicine, Washington, DC (P.K.); George Washington University School of Medicine, Washington, DC (P.K., C.F.); University of South Carolina, Department of Exercise Science, Arnold School of Public Health (P.K., J.M., X.S., S.N.B.) and Department of Epidemiology and Biostatistics (J.Z., S.N.B.), Columbia; Veterans Affairs Palo Alto Health Care System, Cardiology Division, Palo
| | - Steven N. Blair
- From the Veterans Affairs Medical Center, Cardiology Department, Washington, DC (P.K., C.F.); Georgetown University School of Medicine, Washington, DC (P.K.); George Washington University School of Medicine, Washington, DC (P.K., C.F.); University of South Carolina, Department of Exercise Science, Arnold School of Public Health (P.K., J.M., X.S., S.N.B.) and Department of Epidemiology and Biostatistics (J.Z., S.N.B.), Columbia; Veterans Affairs Palo Alto Health Care System, Cardiology Division, Palo
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Toyama K, Sugiyama S, Oka H, Iwasaki Y, Sumida H, Tanaka T, Tayama S, Jinnouchi H, Ogawa H. Statins combined with exercise are associated with the increased renal function mediated by high-molecular-weight adiponectin in coronary artery disease patients. J Cardiol 2014; 64:91-7. [DOI: 10.1016/j.jjcc.2013.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/07/2013] [Accepted: 11/27/2013] [Indexed: 12/30/2022]
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Clearfield M, Pearce M, Nibbe Y, Crotty D, Wagner A. The "New Deadly Quartet" for cardiovascular disease in the 21st century: obesity, metabolic syndrome, inflammation and climate change: how does statin therapy fit into this equation? Curr Atheroscler Rep 2014; 16:380. [PMID: 24338517 DOI: 10.1007/s11883-013-0380-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite population-based improvements in cardiovascular risk factors, such as blood pressure, cholesterol and smoking, cardiovascular disease still remains the number-one cause of mortality in the United States. In 1989, Kaplan coined the term "Deadly Quartet" to represent a combination of risk factors that included upper body obesity, glucose intolerance, hypertriglyceridemia and hypertension [Kaplan in Arch Int Med 7:1514-1520, 1989]. In 2002, the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III) essentially added low HDL-C criteria and renamed this the "metabolic syndrome." [The National Cholesterol Education Program (NCEP) in JAMA 285:2486-2497, 2001] However, often forgotten was that a pro-inflammatory state and pro-thrombotic state were also considered components of the syndrome, albeit the panel did not find enough evidence at the time to recommend routine screening for these risk factors [The National Cholesterol Education Program (NCEP) in JAMA 285:2486-2497, 2001]. Now over a decade later, it may be time to reconsider this deadly quartet by reevaluating the roles of obesity and subclinical inflammation as they relate to the metabolic syndrome. To complete this new quartet, the addition of increased exposure to elevated levels of particulate matter in the atmosphere may help elucidate why this cardiovascular pandemic continues, despite our concerted efforts. In this article, we will summarize the evidence, focusing on how statin therapy may further impact this new version of the "deadly quartet".
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Murlasits Z, Radák Z. The Effects of Statin Medications on Aerobic Exercise Capacity and Training Adaptations. Sports Med 2014; 44:1519-30. [DOI: 10.1007/s40279-014-0224-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
The positive health benefits of statins extend beyond the cardiovascular and include increased flow mediated dilation, decreased atrial fibrillation, modest antihypertensive effects and reduced risks of malignancies. Prominent among the statin side-effects are myalgia and muscular weakness, which may be associated with a rise in circulating creatine kinase values. In increasing severity and decreasing incidence, the statin-induced muscle related conditions are myalgia, myopathy with elevated creatine kinase (CK) levels with or without symptoms, and rhabdomyolysis. Statin use may increase CK levels without decreasing average muscle strength or exercise performance. In one large study, only about 2 % had myalgia that could be attributed to statin use. A novel current hypothesis is that statins optimize cardiac mitochondrial function but impair the vulnerable skeletal muscle by inducing different levels of reactive oxygen species (ROS) in these two sites. In an important observational study, both statins and exercise reduced the adverse outcomes of cardiovascular disease, and the effects were additive. The major unresolved problem is that either can cause muscular symptoms with elevation of blood creatine kinase levels. There is, as yet, no clearly defined outcomes based policy to deal with such symptoms from use of either statins or exercise or both. A reasonable practical approach is to assess the creatine kinase levels, and if elevated to reduce the statin dose or the intensity of exercise.
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Affiliation(s)
- Lionel H Opie
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town Medical School, Anzio Road, Observatory, Cape Town, 7925, South Africa,
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Myers J. New American Heart Association/American College of Cardiology guidelines on cardiovascular risk: when will fitness get the recognition it deserves? Mayo Clin Proc 2014; 89:722-6. [PMID: 24809757 DOI: 10.1016/j.mayocp.2014.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/03/2014] [Accepted: 03/12/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Stanford University, Stanford, CA.
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Kokkinos P, Faselis C, Myers J, Pittaras A, Sui X, Zhang J, McAuley P, Kokkinos JP. Cardiorespiratory fitness and the paradoxical BMI-mortality risk association in male veterans. Mayo Clin Proc 2014; 89:754-62. [PMID: 24943694 DOI: 10.1016/j.mayocp.2014.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/09/2014] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the effect of fitness status on the paradoxical body mass index (BMI)-mortality risk association. PATIENTS AND METHODS From February 1, 1986, through December 30, 2011, we assessed fitness and BMI in 18,033 male veterans (mean age, 58.4 ± 11.4 years) in 2 Veterans Affairs Medical centers. We established 3 fitness categories on the basis of peak metabolic equivalents achieved during an exercise test as well as 5 BMI categories. The primary outcome was all-cause mortality. RESULTS During the follow-up period (median, 10.8 years, comprising a total of 207,168 person-years), 5070 participants (28%) died. After adjusting for age, risk factors, muscle-wasting diseases, medications, and year of entry, mortality risk was higher for individuals with a BMI of 20.1 to 23.9 kg/m(2) (hazard ratio [HR], 1.21; 95% CI, 1.12-1.30) and 18.5 to 20.0 kg/m(2) (HR, 1.56; 95% CI, 1.37-1.77) than for those with a BMI of 24.0 to 27.9 kg/m(2); mortality risk was not increased for those with a BMI of 28.0 kg/m(2) or greater. When stratified by fitness, the trend was similar for low-fit and moderate-fit individuals. However, mortality risk was not increased for high-fit individuals across BMI categories. When fitness status was considered within each BMI category, mortality risk increased progressively with decreased fitness and was more pronounced for moderate-fit (HR, 2.52; 95% CI, 2.06-3.08) and low-fit (HR, 2.48; 95% CI, 2.0-3.06) individuals with a BMI of 18.5-20.0 kg/m(2). Mortality risk was not significantly increased for high-fit individuals (HR, 1.17; 95% CI, 0.78-1.78; P=.45). CONCLUSION A high mortality risk associated with low BMI levels was observed only in moderate-fit and low-fit individuals, and not in high-fit individuals. Thus, fitness greatly affects the paradoxical BMI-mortality risk association. Furthermore, our findings indicate that lower BMI levels do not increase the risk for premature death as long as they are associated with high fitness. Thus, the paradoxically higher mortality risk observed with lower body weight as represented by lower BMI is likely the result of unhealthy reduction in body weight and, perhaps most importantly, considerable loss of lean body mass.
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Affiliation(s)
- Peter Kokkinos
- Cardiology Department, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC; George Washington University School of Medicine, Washington, DC.
| | - Charles Faselis
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford University, Stanford, CA
| | - Andreas Pittaras
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Paul McAuley
- Department of Human Performance and Sports Science, Winston-Salem State University, Winston-Salem, NC
| | - John Peter Kokkinos
- Department of Endocrinology, Veterans Affairs Medical Center, Washington, DC
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Arnarson A, Ramel A, Geirsdottir OG, Jonsson PV, Thorsdottir I. Changes in body composition and use of blood cholesterol lowering drugs predict changes in blood lipids during 12 weeks of resistance exercise training in old adults. Aging Clin Exp Res 2014; 26:287-92. [PMID: 24293371 DOI: 10.1007/s40520-013-0172-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 11/12/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Aging is associated with an impairment of blood lipids. The present study investigated the response of blood lipids to resistance exercise in old adults. The particular aim was to investigate whether the response of blood lipids is associated with changes in body composition of blood lipid medication. METHODS Subjects (N = 236, 73.7 ± 5.7 years, 58.2 % female) participated in a 12-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80 % of the 1-repetition maximum), designed to increase strength and muscle mass of major muscle groups. Body composition, drug use, triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were assessed at baseline and endpoint. RESULTS The concentrations of HDL (-6 mg/dl), LDL (-18 mg/dl), TC (-26 mg/dl) and TG (-12 mg/g) decreased significantly during the study period. A reduction in fat mass by 1 kg predicted a reduction in TG (5.0 mg/dl, P = 0.017) and a gain in lean body mass by 1 kg predicted also a reduction in TG (-4.5 mg/dl, P = 0.023). The use of blood cholesterol lowering drugs predicted greater reductions in TC (-16.9 mg/dl, P = 0.032) and LDL (-11.8 mg/dl, P = 0.038) during training. CONCLUSIONS TG, TC, LDL and HDL decreased significantly after 12 weeks of progressive resistance exercise in old adults. Changes in body composition, i.e., reduction in fat mass and gain in lean body mass improved the blood lipid profile. Use of blood lipid lowering drugs was associated with greater reductions in TC and LDL after the training.
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Affiliation(s)
- A Arnarson
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, University of Iceland, Eiriksgata 29, IS-101, Reykjavik, Iceland
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Abstract
PURPOSE OF REVIEW The aim of this review is to critically examine the relevant literature and ascertain whether the current evidence supports the validity of claims that statins increase the risk of diabetes. RECENT FINDINGS In the past several years, a large number of studies and several meta-analyses based on these reports have suggested a significantly increased risk of type 2 diabetes associated with statin use, ranging from 6 to 48%. SUMMARY Close examination and deconstruction of these reports reveal numerous flaws in the designs of the studies, insufficient or missing data, and misdirected or spinned assumptions that render the conclusions as highly inaccurate and misleading. These reports have contributed to significant concern among healthcare providers and patients who are taking statins or are candidates for statin therapy. This review shows that the discovery and diagnosis of diabetes during statin therapy are limited to patients with multiple pre-existing diabetogenic risk factors, including sedentary lifestyle, diabetogenic and obesogenic diet, abdominal obesity, metabolic syndrome, hypertension, family history of diabetes, dysglycemia, prediabetes, and unrecognized diabetes. Diabetes diagnosed during the course of statin therapy is not statin-induced, but is discovered in individuals with pre-existing diabetogenic risk factors, who would have developed diabetes, with or without statin therapy.
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Affiliation(s)
- Michael Mogadam
- Cardiothoracic Institute, George Washington University School of Medicine, Washington, DC, USA
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Rengo JL, Savage PD, Toth MJ, Ades PA. Statin therapy does not attenuate exercise training response in cardiac rehabilitation. J Am Coll Cardiol 2014; 63:2050-1. [PMID: 24657681 DOI: 10.1016/j.jacc.2014.02.554] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Jason L Rengo
- Division of Cardiology, Cardiac Rehabilitation and Prevention, Fletcher Allen Health Care, Burlington, Vermont
| | - Patrick D Savage
- Division of Cardiology, Cardiac Rehabilitation and Prevention, Fletcher Allen Health Care, Burlington, Vermont
| | - Michael J Toth
- University of Vermont College of Medicine, Burlington, Vermont
| | - Philip A Ades
- University of Vermont College of Medicine, Burlington, Vermont.
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Kokkinos P, Faselis C, Myers J, Kokkinos JP, Doumas M, Pittaras A, Kheirbek R, Manolis A, Panagiotakos D, Papademetriou V, Fletcher R. Statin therapy, fitness, and mortality risk in middle-aged hypertensive male veterans. Am J Hypertens 2014; 27:422-30. [PMID: 24436326 DOI: 10.1093/ajh/hpt241] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypertension often coexists with dyslipidemia, accentuating cardiovascular risk. Statins are often prescribed in hypertensive individuals to lower cardiovascular risk. Higher fitness is associated with lower mortality, but exercise capacity may be attenuated in hypertension. The combined effects of fitness and statin therapy in hypertensive individuals have not been assessed. Thus, we assessed the combined health benefits of fitness and statin therapy in hypertensive male subjects. METHODS Peak exercise capacity was assessed in 10,202 hypertensive male subjects (mean age = 60.4 ± 10.6 years) in 2 Veterans Affairs Medical Centers. We established 4 fitness categories based on peak metabolic equivalents (METs) achieved and 8 categories based on fitness status and statin therapy. RESULTS During the follow-up period (median = 10.2 years), there were 2,991 deaths. Mortality risk was 34% lower (hazard ratio (HR) = 0.66; 95% confidence interval (CI) = 0.59-0.74; P < 0.001) among individuals treated with statins compared with those not on statins. The fitness-related mortality risk association was inverse and graded regardless of statin therapy status. Risk reduction associated with exercise capacity of 5.1-8.4 METs was similar to that observed with statin therapy. However, those achieving ≥8.5 METs had 52% lower risk (HR = 0.48; 95% CI = 0.37-0.63) when compared with the least-fit subjects (≤5 METs) on statin therapy. CONCLUSIONS The combination of statin therapy and higher fitness lowered mortality risk in hypertensive individuals more effectively than either alone. The risk reduction associated with moderate increases in fitness was similar to that achieved by statin therapy. Higher fitness was associated with 52% lower mortality risk when compared with the least fit subjects on statin therapy.
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Affiliation(s)
- Peter Kokkinos
- Department of Cardiology, Veterans Affairs Medical Center, Washington, DC, USA
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Charansonney OL, Vanhees L, Cohen-Solal A. Physical activity: From epidemiological evidence to individualized patient management. Int J Cardiol 2014; 170:350-7. [DOI: 10.1016/j.ijcard.2013.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/26/2013] [Accepted: 11/02/2013] [Indexed: 11/29/2022]
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Lew KN, Kent DJ, Muñoz AA, Melkus GD. Therapeutic options for lowering LDL-C in type 2 diabetes: a nurse practitioner's perspective. J Am Assoc Nurse Pract 2013; 25:488-94. [PMID: 24170653 DOI: 10.1002/2327-6924.12053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The majority of patients with type 2 diabetes mellitus (T2DM) have multiple risk factors for cardiovascular disease (CVD). Low-density lipoprotein cholesterol (LDL-C) is a key therapeutic target to reduce CVD risk. This article reviews therapeutic strategies that nurse practitioners (NPs) may use in the management of patients with T2DM requiring lipid management. DATA SOURCES The evidence used in developing this review included evidence-based reviews, clinical trials, guidelines, and consensus statements. Relevant publications were identified through a search of the literature using PubMed and other search engines. CONCLUSIONS Lowering LDL-C levels may reduce CVD risk, but achieving goals can be challenging. Lifestyle modifications (including diet, exercise, and smoking cessation) are key components of lipid management and reduction of CVD risk. Statins can be effective to reduce lipids. However, patients may not achieve lipid goals with monotherapy or may experience intolerable adverse effects. Alternative statins or statins along with other lipid-lowering agents remain good options. IMPLICATIONS FOR PRACTICE Achieving LDL-C goals requires a comprehensive treatment plan that incorporates lifestyle and pharmacologic interventions. Patient commitment in setting goals and self-management is essential. NPs can play an important role in educating patients as well as prescribing appropriate treatments.
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Arsenault BJ, Larose E. Appreciating the local and systemic effects of exercise training on vascular health. Atherosclerosis 2013; 231:15-7. [PMID: 24125403 DOI: 10.1016/j.atherosclerosis.2013.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Benoit J Arsenault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec, Canada.
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Gouni-Berthold I, Berthold HK, Huh JY, Berman R, Spenrath N, Krone W, Mantzoros CS. Effects of lipid-lowering drugs on irisin in human subjects in vivo and in human skeletal muscle cells ex vivo. PLoS One 2013; 8:e72858. [PMID: 24023786 PMCID: PMC3759413 DOI: 10.1371/journal.pone.0072858] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/15/2013] [Indexed: 01/12/2023] Open
Abstract
Context and Objective The myokine irisin has been proposed to regulate energy homeostasis. Little is known about its association with metabolic parameters and especially with parameters influencing pathways of lipid metabolism. In the context of a clinical trial, an exploratory post hoc analysis has been performed in healthy subjects to determine whether simvastatin and/or ezetimibe influence serum irisin levels. The direct effects of simvastatin on irisin were also examined in primary human skeletal muscle cells (HSKMCs). Design and Participants A randomized, parallel 3-group study was performed in 72 men with mild hypercholesterolemia and without apparent cardiovascular disease. Each group of 24 subjects received a 14-day treatment with either simvastatin 40 mg, ezetimibe 10 mg, or their combination. Results Baseline irisin concentrations were not significantly correlated with age, BMI, estimated GFR, thyroid parameters, glucose, insulin, lipoproteins, non-cholesterol sterols, adipokines, inflammation markers and various molecular markers of cholesterol metabolism. Circulating irisin increased significantly in simvastatin-treated but not in ezetimibe-treated subjects. The changes were independent of changes in LDL-cholesterol and were not correlated with changes in creatine kinase levels. In HSKMCs, simvastatin significantly increased irisin secretion as well as mRNA expression of its parent peptide hormone FNDC5. Simvastatin significantly induced cellular reactive oxygen species levels along with expression of pro- and anti-oxidative genes such as Nox2, and MnSOD and catalase, respectively. Markers of cellular stress such as atrogin-1 mRNA and Bax protein expression were also induced by simvastatin. Decreased cell viability and increased irisin secretion by simvastatin was reversed by antioxidant mito-TEMPO, implying in part that irisin is secreted as a result of increased mitochondrial oxidative stress and subsequent myocyte damage. Conclusions Simvastatin increases irisin concentrations in vivo and in vitro. It remains to be determined whether this increase is a result of muscle damage or a protective mechanism against simvastatin-induced cellular stress. Trial Registration ClinicalTrials.gov NCT00317993 NCT00317993.
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Affiliation(s)
- Ioanna Gouni-Berthold
- University of Cologne, Center for Endocrinology, Diabetes and Preventive Medicine, Cologne, Germany
- * E-mail:
| | - Heiner K. Berthold
- Charité University Medicine Berlin, Evangelical Geriatrics Center Berlin (EGZB) and Virchow Clinic Campus, Lipid Clinic at the Interdisciplinary Metabolism Center, Berlin, Germany
| | - Joo Young Huh
- Section of Endocrinology, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Reena Berman
- Section of Endocrinology, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nadine Spenrath
- University of Cologne, Center for Endocrinology, Diabetes and Preventive Medicine, Cologne, Germany
| | - Wilhelm Krone
- University of Cologne, Center for Endocrinology, Diabetes and Preventive Medicine, Cologne, Germany
| | - Christos S. Mantzoros
- Section of Endocrinology, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
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Thompson PD, Parker B. Statins, Exercise, and Exercise Training. J Am Coll Cardiol 2013; 62:715-6. [DOI: 10.1016/j.jacc.2013.03.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/01/2013] [Indexed: 10/27/2022]
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Kiss Z, Nagy L, Reiber I, Paragh G, Molnar MP, Rokszin G, Abonyi-Toth Z, Mark L. Persistence with statin therapy in Hungary. Arch Med Sci 2013; 9:409-17. [PMID: 23847660 PMCID: PMC3701976 DOI: 10.5114/aoms.2013.35327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/23/2013] [Accepted: 04/13/2013] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Persistence with lipid-lowering drug therapy by cardiovascular patients in Hungary has not been studied previously. This study was designed to determine the rate with which Hungarian patients with hyperlipidemia persist in taking lipid-lowering agents, and to compare this with rates reported from other countries. MATERIAL AND METHODS This was a retrospective study that utilized data from the Institutional Database of the National Health Insurance Fund to analyze persistence rates with statins and ezetimibe. The study included data for patients who started lipid-lowering therapy between January 1, 2007, and March 31, 2009. Variables included type of lipid-lowering therapy, year of therapy start, and patient age. Main outcome measures were medians of persistence in months, percentages of patients persisting in therapy for 6 and 12 months, and Kaplan-Meier persistence plots. RESULTS The percentage of patients who persisted with overall statin therapy was 46% after 1 month, 40.3% after 2 months, 27% after 6 months, and 20.1% after 12 months. Persistence was slightly greater for statin therapy started during 2008 than during 2007. Older patients were more persistent with therapy than younger patients. Persistence with the combination of ezetimibe-statin therapy was greater than with statin or ezetimibe monotherapy. CONCLUSIONS Persistence with statin therapy by patients in Hungary was low compared with other countries. Low persistence may have negated potential clinical benefits of long-term statin therapy.
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Affiliation(s)
| | | | - Istvan Reiber
- St. George Fejer County Hospital, 4 Department of Medicine, Szekesfehervar, Hungary
| | - György Paragh
- Medical and Health Science Centre, University of Debrecen, 1 Department of Medicine, Debrecen, Hungary
| | | | | | | | - Laszlo Mark
- Pandy Kalman Bekes County Hospital, 2 Department of Medicine – Cardiology, Gyula, Hungary
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Abstract
Obesity in the UK was assumed to have developed against a population decline in physical activity, with health messages focused on diet and exercise prevention strategies. Doubly-labelled water (DLW) studies of energy expenditure have indicated the alternative scenario that the increased obesity prevalence reflects excessive food energy intake with physical activity levels unchanged. This analysis is questionable, deriving in part from a weakness of the DLW methodology in identifying changing physical activity levels within populations of increasing body weight. This has resulted in an underestimation of the reduction in physical activity in the overweight and obese, as revealed by direct studies of such behaviour. Furthermore, a close examination of food energy supply, household food purchases and individual food energy consumption since 1955, in relation to likely estimates of current intakes indicated by simple modelling of predicted energy expenditure, identifies: (a) food energy supply as markedly overestimating energy intakes; (b) individual food energy consumption as markedly underestimating energy intakes; and (c) household food purchase data as the closest match to predicted current food energy intakes. Energy intakes indicated by this latter method have fallen by between 20 to 30 %, suggesting comparable falls in physical activity. Although unequivocal evidence for a matching UK trend in falling physical activity is limited, as is evidence that obesity follows reductions in physical activity, such a link has been recently suggested in a large prospective study in adolescents. Thus, for the UK, obesity has developed within a ‘move less–eat somewhat less but still too much’ scenario. A focus on both diet and exercise should remain the appropriate public health policy.
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Kokkinos P, Faselis C, Myers J, Panagiotakos D, Doumas M. Statin and exercise prescription - Authors' reply. Lancet 2013; 381:1622-3. [PMID: 23663943 DOI: 10.1016/s0140-6736(13)61018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mikus CR, Boyle LJ, Borengasser SJ, Oberlin DJ, Naples SP, Fletcher J, Meers GM, Ruebel M, Laughlin MH, Dellsperger KC, Fadel PJ, Thyfault JP. Simvastatin impairs exercise training adaptations. J Am Coll Cardiol 2013; 62:709-14. [PMID: 23583255 DOI: 10.1016/j.jacc.2013.02.074] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/06/2013] [Accepted: 02/14/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to determine if simvastatin impairs exercise training adaptations. BACKGROUND Statins are commonly prescribed in combination with therapeutic lifestyle changes, including exercise, to reduce cardiovascular disease risk in patients with metabolic syndrome. Statin use has been linked to skeletal muscle myopathy and impaired mitochondrial function, but it is unclear whether statin use alters adaptations to exercise training. METHODS This study examined the effects of simvastatin on changes in cardiorespiratory fitness and skeletal muscle mitochondrial content in response to aerobic exercise training. Sedentary overweight or obese adults with at least 2 metabolic syndrome risk factors (defined according to National Cholesterol Education Panel Adult Treatment Panel III criteria) were randomized to 12 weeks of aerobic exercise training or to exercise in combination with simvastatin (40 mg/day). The primary outcomes were cardiorespiratory fitness and skeletal muscle (vastus lateralis) mitochondrial content (citrate synthase enzyme activity). RESULTS Thirty-seven participants (exercise plus statins: n = 18; exercise only: n = 19) completed the study. Cardiorespiratory fitness increased by 10% (p < 0.05) in response to exercise training alone, but was blunted by the addition of simvastatin resulting in only a 1.5% increase (p < 0.005 for group by time interaction). Similarly, skeletal muscle citrate synthase activity increased by 13% in the exercise-only group (p < 0.05), but decreased by 4.5% in the simvastatin-plus-exercise group (p < 0.05 for group-by-time interaction). CONCLUSIONS Simvastatin attenuates increases in cardiorespiratory fitness and skeletal muscle mitochondrial content when combined with exercise training in overweight or obese patients at risk of the metabolic syndrome. (Exercise, Statins, and the Metabolic Syndrome; NCT01700530).
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Affiliation(s)
- Catherine R Mikus
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
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Greenhill C. Dyslipidaemia: Exercise reduces mortality in patients receiving statins. Nat Rev Endocrinol 2013; 9:66. [PMID: 23296161 DOI: 10.1038/nrendo.2012.241] [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: 11/09/2022]
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Taylor F, Huffman MD, Macedo AF, Moore THM, Burke M, Davey Smith G, Ward K, Ebrahim S. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2013; 2013:CD004816. [PMID: 23440795 PMCID: PMC6481400 DOI: 10.1002/14651858.cd004816.pub5] [Citation(s) in RCA: 504] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Reducing high blood cholesterol, a risk factor for cardiovascular disease (CVD) events in people with and without a past history of CVD is an important goal of pharmacotherapy. Statins are the first-choice agents. Previous reviews of the effects of statins have highlighted their benefits in people with CVD. The case for primary prevention was uncertain when the last version of this review was published (2011) and in light of new data an update of this review is required. OBJECTIVES To assess the effects, both harms and benefits, of statins in people with no history of CVD. SEARCH METHODS To avoid duplication of effort, we checked reference lists of previous systematic reviews. The searches conducted in 2007 were updated in January 2012. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2022, Issue 4), MEDLINE OVID (1950 to December Week 4 2011) and EMBASE OVID (1980 to 2012 Week 1).There were no language restrictions. SELECTION CRITERIA We included randomised controlled trials of statins versus placebo or usual care control with minimum treatment duration of one year and follow-up of six months, in adults with no restrictions on total, low density lipoprotein (LDL) or high density lipoprotein (HDL) cholesterol levels, and where 10% or less had a history of CVD. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion and extracted data. Outcomes included all-cause mortality, fatal and non-fatal CHD, CVD and stroke events, combined endpoints (fatal and non-fatal CHD, CVD and stroke events), revascularisation, change in total and LDL cholesterol concentrations, adverse events, quality of life and costs. Odds ratios (OR) and risk ratios (RR) were calculated for dichotomous data, and for continuous data, pooled mean differences (MD) (with 95% confidence intervals (CI)) were calculated. We contacted trial authors to obtain missing data. MAIN RESULTS The latest search found four new trials and updated follow-up data on three trials included in the original review. Eighteen randomised control trials (19 trial arms; 56,934 participants) were included. Fourteen trials recruited patients with specific conditions (raised lipids, diabetes, hypertension, microalbuminuria). All-cause mortality was reduced by statins (OR 0.86, 95% CI 0.79 to 0.94); as was combined fatal and non-fatal CVD RR 0.75 (95% CI 0.70 to 0.81), combined fatal and non-fatal CHD events RR 0.73 (95% CI 0.67 to 0.80) and combined fatal and non-fatal stroke (RR 0.78, 95% CI 0.68 to 0.89). Reduction of revascularisation rates (RR 0.62, 95% CI 0.54 to 0.72) was also seen. Total cholesterol and LDL cholesterol were reduced in all trials but there was evidence of heterogeneity of effects. There was no evidence of any serious harm caused by statin prescription. Evidence available to date showed that primary prevention with statins is likely to be cost-effective and may improve patient quality of life. Recent findings from the Cholesterol Treatment Trialists study using individual patient data meta-analysis indicate that these benefits are similar in people at lower (< 1% per year) risk of a major cardiovascular event. AUTHORS' CONCLUSIONS Reductions in all-cause mortality, major vascular events and revascularisations were found with no excess of adverse events among people without evidence of CVD treated with statins.
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Affiliation(s)
- Fiona Taylor
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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Novelle MG, Contreras C, Romero-Picó A, López M, Diéguez C. Irisin, two years later. Int J Endocrinol 2013; 2013:746281. [PMID: 24298283 PMCID: PMC3835481 DOI: 10.1155/2013/746281] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/01/2013] [Indexed: 12/16/2022] Open
Abstract
In January 2012, Boström and colleagues identified a new muscle tissue secreted peptide, which they named irisin, to highlight its role as a messenger that comes from skeletal muscle to other parts of the body. Irisin is a cleaved and secreted fragment of FNDC5 (also known as FRCP2 and PeP), a member of fibronectin type III repeat containing gene family. Major interest in this protein arose because of its great therapeutic potential in diabetes and perhaps also therapy for obesity. Here we review the most important aspects of irisin's action and discuss its involvement in energy and metabolic homeostasis and whether the beneficial effects of exercise in these disease states could be mediated by this protein. In addition the effects of irisin at the central nervous system (CNS) are highlighted. It is concluded that although current and upcoming research on irisin is very promising it is still necessary to deepen in several aspects in order to clarify its full potential as a meaningful drug target in human disease states.
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Affiliation(s)
- Marta G. Novelle
- Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria (IDIS), 15782 Santiago de Compostela, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), 15706 Santiago de Compostela, Spain
- *Marta G. Novelle: and
| | - Cristina Contreras
- Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria (IDIS), 15782 Santiago de Compostela, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), 15706 Santiago de Compostela, Spain
| | - Amparo Romero-Picó
- Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria (IDIS), 15782 Santiago de Compostela, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), 15706 Santiago de Compostela, Spain
| | - Miguel López
- Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria (IDIS), 15782 Santiago de Compostela, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), 15706 Santiago de Compostela, Spain
| | - Carlos Diéguez
- Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria (IDIS), 15782 Santiago de Compostela, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), 15706 Santiago de Compostela, Spain
- *Carlos Diéguez:
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