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Hupin D, Oriol M, Laukkanen JA, Abraham P, Dulac N, Laugier S, Trauchessec G, Carmaux A, Haber B, Bertoletti L, Costa AD, Roche F. Screening Sportsmen and Sportswomen Over Age 35: The Relevance of an Exercise Electrocardiogram. Data From the SEEPRED Study. Scand J Med Sci Sports 2024; 34:e14686. [PMID: 38961532 DOI: 10.1111/sms.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION The importance of exercise electrocardiogram (ECG) is still controversial in the prevention of cardiovascular events among sportsmen and sportswomen. The aim of this study was to assess the relevance of exercise ECG as a screening tool to prevent cardiovascular events when any cardiovascular disease (CVD) risk factors are present. METHODS The study included leisure time asymptomatic sportsmen and sportswomen over age 35 evaluated from 2011 to 2016 at the University Hospital of Saint-Etienne (France). Major adverse cardiovascular events (MACE) and atrial fibrillation were collected at 3 years. RESULTS Of the cohort of 2457 sportsmen and sportswomen (mean age 50.2 ± 9.4 years), 50 (2%) had a high-risk SCORE2. A total of 256 exercise ECGs (10%) were defined as positive, most of them due to silent myocardial ischemia (SMI) (n = 196; 8%). These 196 SMI cases led to 33 coronary angiograms (1%), which revealed 23 significant coronary stenoses requiring revascularization. In multivariate logistic regression analysis, having at least two CVD risk factors was independently associated with (1) positive exercise ECG (OR = 1.80 [95% CI: 1.29-2.52], p = 0.0006), with (2) suspected SMI (OR = 2.57 [95% CI: 1.10-6.02], p = 0.0304), with (3) confirmed SMI (OR = 8.20 [95% CI: 3.46-19.46], p < 0.0001) and with (4) cardiovascular events (MACE or atrial fibrillation) (OR = 6.95 [95% CI: 3.49-13.81], p < 0.0001) at 3 years (median). CONCLUSIONS The study supports the European recommendations for the use of exercise ECG in evaluation of asymptomatic leisure time sportsmen over age 35. Having at least two CVD risk factors was the best predictor for presence of coronary artery stenosis that may increase the risk for adverse events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT06024863.
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Affiliation(s)
- David Hupin
- Univ Jean Monnet, Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
| | - Mathieu Oriol
- Support and Education Technic Centre of Health Examination Centres, CETAF, Saint-Etienne, France
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pierre Abraham
- IMITOVASC Institute, UMR CNRS 6015 UMR INSERM 1083, University of Angers, Angers, France
- Sports and Exercise Medicine and Vascular Medicine, University Hospital, Angers, France
| | - Nathan Dulac
- Faculty of Medicine, UJM-Saint-Etienne, Saint-Etienne, France
| | - Simon Laugier
- Faculty of Medicine, UJM-Saint-Etienne, Saint-Etienne, France
| | | | - Antoine Carmaux
- Univ Jean Monnet, Department of Cardiology, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
| | - Benjamain Haber
- Univ Jean Monnet, Department of Cardiology, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
| | - Laurent Bertoletti
- Univ Jean Monnet, Department of Vascular and Therapeutic Medicine, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
| | - Antoine Da Costa
- Univ Jean Monnet, Department of Cardiology, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
| | - Frédéric Roche
- Univ Jean Monnet, Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
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Volterrani M, Caminiti G. High-intensive interval training for inducing coronary plaque regression: is it the best choice? Eur J Prev Cardiol 2024; 31:e4-e6. [PMID: 36799952 DOI: 10.1093/eurjpc/zwad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Maurizio Volterrani
- Department of Rehabilitation Cardiology, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, via di Val Cannuta, 247, 00166 Rome, Italy
| | - Giuseppe Caminiti
- Department of Rehabilitation Cardiology, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, via di Val Cannuta, 247, 00166 Rome, Italy
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BERGE KRISTIAN, AENGEVAEREN VINCENTL, MOSTERD AREND, VELTHUIS BIRGITTAK, LYNGBAKKEN MAGNUSN, OMLAND TORBJØRN, SCHALKWIJK CASPERG, EIJSVOGELS THIJSMH. Plasma Advanced Glycation End Products and Dicarbonyl Compounds Are Not Associated with Coronary Atherosclerosis in Athletes. Med Sci Sports Exerc 2023; 55:1143-1150. [PMID: 36849122 PMCID: PMC10241437 DOI: 10.1249/mss.0000000000003152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
PURPOSE Coronary atherosclerosis is the leading cause of sudden death among athletes >35 yr old, but current cardiovascular risk prediction algorithms have not been validated for athletes. Advanced glycation end products (AGE) and dicarbonyl compounds have been associated with atherosclerosis and rupture-prone plaques in patients and ex vivo studies. The detection of AGE and dicarbonyl compounds might be a novel screening tool for high-risk coronary atherosclerosis in older athletes. METHODS Concentrations of three different AGE and the dicarbonyl compounds methylglyoxal, glyoxal, and 3-deoxyglucosone were measured in plasma with ultraperformance liquid chromatography tandem mass spectrometry in athletes from the Measuring Athletes' Risk of Cardiovascular Events 2 study cohort. Coronary plaques, plaque characteristics (calcified, noncalcified or mixed), and coronary artery calcium (CAC) scores were assessed with coronary computed tomography, and potential associations with AGE and dicarbonyl compounds were analyzed using linear and logistic regression. RESULTS A total of 289 men were included (60 [quartiles 1-3 = 56-66] yr old, body mass index = 24.5 [22.9-26.6] kg·m -2 ), with a weekly exercise volume of 41 (25-57) MET-hours. Coronary plaques were detected in 241 participants (83%), with a dominant plaque type of calcified plaques in 42%, noncalcified plaques in 12% and mixed plaques in 21%. No AGE or dicarbonyl compounds were associated with total number of plaques or any of the plaque characteristics in adjusted analyses. Similarly, AGE and dicarbonyl compounds were not associated with CAC score. CONCLUSIONS Concentrations of plasma AGE and dicarbonyl compounds do not predict the presence of coronary plaques, plaque characteristics or CAC scores, in middle-age and older athletes.
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Affiliation(s)
- KRISTIAN BERGE
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, NORWAY
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, NORWAY
| | - VINCENT L. AENGEVAEREN
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | - AREND MOSTERD
- Department of Cardiology, Meander Medical Center, Amersfoort, THE NETHERLANDS
| | | | - MAGNUS N. LYNGBAKKEN
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, NORWAY
| | - TORBJØRN OMLAND
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, NORWAY
| | - CASPER G. SCHALKWIJK
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, University Hospital Maastricht, Maastricht, 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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de la Guía-Galipienso F, Ugedo-Alzaga K, Grazioli G, Quesada-Ocete FJ, Feliu-Rey E, Perez MV, Quesada-Dorador A, Sanchis-Gomar F. Arrhythmogenic Cardiomyopathy and Athletes - A Dangerous Relationship. Curr Probl Cardiol 2023:101799. [PMID: 37172878 DOI: 10.1016/j.cpcardiol.2023.101799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a disease characterized by a progressive replacement of myocardium by fibro-adipose material, predisposing to ventricular arrhythmias (VA) and sudden cardiac death (SCD). Its prevalence is estimated at 1:2000 to 1:5000, with a higher incidence in males, and clinical onset is usually between the 2nd and 4th decade of life. The prevalence of ACM in SCD victims is relatively high, making it one of the most common etiologies in young patients with SCD, especially if they are athletes. Cardiac events occur more frequently in individuals with ACM who participate in competitive sports and/or high-intensity training. In effect, exercise activity can worsen RV function in cases of hereditary ACM. Estimating the incidence of SCD caused by ACM in athletes remains challenging, being reported frequency ranging from 3-20%. Here, we review the potential implications of exercising on the clinical course of the classical genetic form of ACM, as well as the diagnostic tools, risk stratification, and the different therapeutic tools available for managing ACM.
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Affiliation(s)
- Fernando de la Guía-Galipienso
- From the Glorieta Policlinic, Denia, Alicante, Spain; REMA-Sports Cardiology Clinic, Denia, Alicante, Spain; Cardiology Service, Hospital HCB Benidorm, Alicante, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
| | | | | | - Francisco Javier Quesada-Ocete
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Eloísa Feliu-Rey
- Magnetic Resonance Unit, Inscanner, General University Hospital of Alicante, Alicante, Spain
| | - Marco V Perez
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Aurelio Quesada-Dorador
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Fabian Sanchis-Gomar
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA..
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Rao P, Belanger MJ, Robbins JM. Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases. Cardiol Rev 2022; 30:167-178. [PMID: 34560712 PMCID: PMC8920940 DOI: 10.1097/crd.0000000000000416] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation (AF), respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary prevention of ASCVD, including their beneficial effects on both traditional and nontraditional risk mediators; exercise "prescriptions" for ASCVD; the role of PA regular exercise in the prevention and treatment of heart failure; and the relationships between, PA, exercise, and AF. While our understanding of the relationship between exercise and CVD has evolved considerably, several key questions remain including the association between extreme volumes of exercise and subclinical ASCVD and its risk; high-intensity exercise and resistance (strength) training as complementary modalities to continuous aerobic exercise; and dose- and intensity-dependent associations between exercise and AF. Recent advances in molecular profiling technologies (ie, genomics, transcriptomics, proteomics, and metabolomics) have begun to shed light on interindividual variation in cardiometabolic responses to PA and exercise and may provide new opportunities for clinical prediction in addition to mechanistic insights.
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Affiliation(s)
- Prashant Rao
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Jeremy M. Robbins
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Achmad BF, Alim S, Kusumawati HI, Fitriawan AS, Kurniawan D, Kafil RF. Cardiovascular Disease Risk Profiles in Indonesian Athletes. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Notwithstanding how physical exercise lessens cardiovascular and all-cause mortality, young and active athletes might have cardiovascular risk factors or fundamental cardiovascular diseases (CVDs), putting them at increased risk for sudden cardiac death during times of strenuous exercise.
AIM: The study aimed to assess the cardiovascular risk profile possessed by Indonesian athletes.
METHODS: This research was a quantitative study using a cross-sectional design, involving 234 Indonesian athletes (163 men and 71 women) from three sports, including football, basketball, and swimming. Data were collected between December 2020 to March 2021 using the Jakarta Cardiovascular Risk Score instrument adapted from the Framingham risk score. Descriptive statistics were utilized to dissect data information for frequency distribution, percentage, mean, and standard deviation.
RESULTS: Most of the participants in this study had excessive weekly exercise duration (more than 255 minutes/week) (n=177 athletes, 75.64%). Twenty-one participants (8.97%) had a higher MAP more than normal, and 51 participants (21.79%) had overweight BMI. In addition, 142 participants (60.68%) had a cardiovascular genetic disease from their parents (family history) and most of the participants also were active smokers (n=150, 64.10%). Based on the Jakarta Cardiovascular Risk Score, the Indonesian athletes who participated in this study had a mean cardiovascular risk of -1.5 (SD= 3.088, min-max= (-7) – 6). Most of the participants had low cardiovascular risk (n= 193, 82.48%). However, some participants had moderate and high cardiovascular risk, 32 (13.67%) and 9 (3.85%), respectively.
CONCLUSION: Most of the participants had low cardiovascular risk, however some of the participants had moderate and high cardiovascular risk.
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Sanchis-Gomar F, Arnau-Moyano M, Daimiel L, Lippi G, Leischik R, Vallecillo N, Yvert T, Jiménez SL, Santiago C, Pareja-Galeano H. Circulating microRNAs fluctuations in exercise-induced cardiac remodeling: A systematic review. Am J Transl Res 2021; 13:13298-13309. [PMID: 35035676 PMCID: PMC8748080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/30/2021] [Indexed: 06/14/2023]
Abstract
MicroRNAs (miRNAs) are small non-coding RNAs that participate in gene expression regulation. It has been observed that circulating levels of miRNAs may fluctuate during exercise, showing numerous cardiac biological and physiological effects such as structural and functional adaptations. We aimed to provide an overview of the currently available information concerning the role of circulating miRNAs in cardiovascular adaptations in response to acute and/or chronic exercise training. Relevant studies published were searched in three databases: PubMed, Web of Science and Scopus. A combination of the following keywords was used: ("microRNA" OR "miRNA" OR "miR" AND "exercise" OR "training" OR "physical activity") AND "(heart hypertrophy" OR "cardiac remodeling" OR "cardiac muscle mass" OR "cardiac hypertrophy"). Only experimental studies, written in English and conducted in healthy individuals were included. Five articles met the inclusion criteria and were finally included in this systematic review after reviewing both title, abstract and full-text. A total of thirty-six circulating cardiac-related miRNAs were analyzed, but only five of them (miR-1, miR-133a, miR-146a, miR-206 and miR-221) were directly associated with cardiac adaptations parameters, while two of them (miR-1 and miR-133a) were related to cardiac hypertrophy. Most of them were upregulated immediately after a marathon and returned to basal levels at longer times. Therefore, we conclude that, although evidence is still limited, and long-term studies are needed to obtain more robust evidence, exercise is more likely to affect circulating cardiac-related miRNAs levels.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research InstituteValencia, Spain
| | | | - Lidia Daimiel
- Nutritional Control of The Epigenome Group, Instituto Madrileño de Estudios Avanzados (IMDEA) Food, CEI UAM+CSICMadrid 28049, Spain
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of VeronaVerona, Italy
| | - Roman Leischik
- School of Medicine, Faculty of Health, Witten/Herdecke UniversityWitten, Germany
| | - Néstor Vallecillo
- Faculty of Biomedical and Health Sciences, Universidad Europea de MadridMadrid, Spain
| | - Thomas Yvert
- Faculty of Sport Sciences, Universidad Europea de MadridMadrid, Spain
| | - Sergio L Jiménez
- Centre for Sport Studies, Rey Juan Carlos UniversityMadrid, Spain
| | - Catalina Santiago
- Faculty of Sport Sciences, Universidad Europea de MadridMadrid, Spain
| | - Helios Pareja-Galeano
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de MadridMadrid, Spain
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Castelletti S, Gati S. The Female Athlete's Heart: Overview and Management of Cardiovascular Diseases. Eur Cardiol 2021; 16:e47. [PMID: 34950243 PMCID: PMC8674625 DOI: 10.15420/ecr.2021.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
The number of female athletes taking part in elite and amateur sport is ever increasing. In contrast with male athletes, few studies have focused on cardiovascular adaptations to exercise in women, the effects of lifelong exercise on heart muscle and electrical tissue, the risk of exerciserelated sudden cardiac death and the management of cardiovascular disease. Women have a lower prevalence of large QRS complexes, repolarisation changes including inferior and lateral T-wave inversion, and cardiac dimensions exceeding predicted limits compared with men. The risk of exercise-related sudden cardiac death is significantly lower in women than men. Also, women who have engaged in lifelong exercise do not have a higher prevalence of AF, coronary artery calcification or myocardial fibrosis than their sedentary counterparts. Apart from providing an overview of the existing literature relating to cardiac adaptations, this review explores possible reasons for the sex differences and focuses on the management of cardiovascular disorders that affect female athletes.
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Affiliation(s)
- Silvia Castelletti
- Cardiomyopathy Unit and Center for Cardiac Arrhythmias of Genetic Origin, Department of Cardiovascular, Neural and Metabolic Science, Istituto Auxologico Italiano IRCCSMilan, Italy
| | - Sabiha Gati
- National Heart and Lung Institute, Imperial College LondonUK
- Department of Cardiology, Royal Brompton HospitalLondon, UK
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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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