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Laukkanen JA, Jae SY, Kauhanen J, Kunutsor SK. The Interplay between Systolic Blood Pressure, Sauna Bathing, and Cardiovascular Mortality in Middle-Aged and Older Finnish Men: A Cohort Study. J Nutr Health Aging 2023; 27:348-353. [PMID: 37248758 DOI: 10.1007/s12603-023-1895-1] [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: 11/10/2022] [Accepted: 02/25/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Elevated systolic blood pressure (SBP) is associated with an increased risk of cardiovascular disease (CVD) mortality, whereas frequent sauna bathing reduces the risk. Whether frequent sauna bathing mitigates CVD mortality among adults with elevated SBP has not been previously investigated. DESIGN AND SETTING We examined the interactions between SBP and frequency of sauna bathing (FSB) with the risk of CVD mortality in a cohort of Caucasian men. PARTICIPANTS The Kuopio Ischaemic Heart Disease Study cohort comprising of 2,575 men aged 42-61 years at baseline was employed for this prospective study analysis. MEASUREMENTS Resting blood pressure was measured using a standardized protocol and sauna bathing habits were assessed by a self-administered questionnaire. Systolic blood pressure was categorized as normal and high (<140 and ≥140 mmHg, respectively) and FSB as low and high (defined as ≤ 2 and 3-7 sessions/week, respectively). RESULTS A total of 744 CVD deaths were recorded during a median follow-up of 27.8 yr. Comparing high vs normal SBP, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.44 (1.23-1.68). Comparing low vs high FSB, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.24 (1.03-1.51). The associations persisted following mutual adjustment for each exposure. Compared with men with normal SBP-high FSB, high SBP-low FSB was associated with an increased risk of CVD mortality 1.81 (1.39-2.36), with attenuated but persisting evidence of an association for men with high SBP and high FSB 1.52 (1.06-2.16). When SBP was categorized as normal and high (<130 and ≥130 mmHg, respectively), there was no evidence of an association for men with high SBP and high FSB 1.11 (0.77-1.61). CONCLUSION There might be an interaction between SBP, sauna bathing and CVD mortality risk in middle-aged and older Caucasian males. Frequent sauna baths may offset the increased risk of CVD mortality in men with high-normal SBP but not elevated SBP.
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Affiliation(s)
- J A Laukkanen
- Prof. Jari Laukkanen, Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, P.O. Box 1627, FIN-70211 Kuopio, Finland, Fax: +358-17-162936, Tel +358-50-5053013, E-mail:
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Kunutsor SK, Jae SY, Kurl S, Kauhanen J, Laukkanen JA. Inflammation, sauna bathing, and all-cause mortality in middle-aged and older Finnish men: a cohort study. Eur J Epidemiol 2022; 37:1225-1231. [PMID: 36255556 PMCID: PMC9792415 DOI: 10.1007/s10654-022-00926-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/26/2022] [Indexed: 12/30/2022]
Abstract
Inflammation and sauna bathing are each related to the risk of all-cause mortality. The interplay between inflammation, sauna bathing and all-cause mortality is not well understood. We aimed to evaluate the separate and joint associations of inflammation (high sensitivity C-reactive protein, hsCRP) and frequency of sauna bathing (FSB) with all-cause mortality in a cohort of Caucasian men. We used the Kuopio Ischaemic Heart Disease Study cohort comprising 2575 men aged 42-61 years at baseline. Serum hsCRP was measured using an immunometric assay and sauna bathing habits were assessed by a self-administered questionnaire. High sensitivity CRP was categorized as normal and high (≤ 3 and > 3 mg/L, respectively) and FSB as low and high (defined as ≤ 2 and 3-7 sessions/week respectively). A total of 1618 deaths occurred during a median follow-up of 27.8 years. Comparing high vs normal hsCRP levels, the multivariable-adjusted HR (95% CI) for all-cause mortality was 1.27 (1.13-1.44). Comparing high vs low FSB, the multivariable-adjusted HR (95% CI) for all-cause mortality was 0.86 (0.76-0.97). Compared with normal hsCRP-low FSB, high hsCRP-low FSB was associated with an increased risk of all-cause mortality 1.28 (1.12-1.47), with no evidence of an association for high hsCRP-high FSB and all-cause mortality risk 1.06 (0.81-1.40). Positive additive and multiplicative interactions were found between hsCRP and FSB in relation to mortality. In a general Finnish male population, both hsCRP and FSB are each independently associated with all-cause mortality. However, frequent sauna baths appear to offset the increased all-cause mortality risk related to high hsCRP levels.
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Affiliation(s)
- Setor K. Kunutsor
- grid.410421.20000 0004 0380 7336National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK ,grid.5337.20000 0004 1936 7603Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB UK ,grid.9918.90000 0004 1936 8411Diabetes Research Centre, Leicester General Hospital, University of Leicester, Gwendolen Road, Leicester, LE5 4WP UK
| | - Sae Young Jae
- grid.267134.50000 0000 8597 6969Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea ,grid.267134.50000 0000 8597 6969Department of Sport Science, University of Seoul, Seoul, South Korea ,grid.267134.50000 0000 8597 6969Department of Urban Big Data Convergence, University of Seoul, Seoul, Republic of Korea
| | - Sudhir Kurl
- grid.9668.10000 0001 0726 2490Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jussi Kauhanen
- grid.9668.10000 0001 0726 2490Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A. Laukkanen
- grid.9668.10000 0001 0726 2490Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland ,grid.9668.10000 0001 0726 2490Department of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland ,grid.460356.20000 0004 0449 0385Department of Medicine, Central Finland Health Care District, Hospital District, Jyvaskyla, Finland
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Attenuated Risk of Pneumonia Due to Inflammation by Frequent Sauna Baths: A PROSPECTIVE COHORT STUDY. J Cardiopulm Rehabil Prev 2021; 42:59-63. [PMID: 33797457 DOI: 10.1097/hcr.0000000000000598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Inflammatory pathways are involved in the pathogenesis of pneumonia. Frequent sauna sessions may reduce the risk of respiratory tract infections including pneumonia independent of inflammation. We aimed to evaluate the independent and joint associations of high-sensitivity C-reactive protein (hsCRP) and frequency of sauna bathing (FSB) with risk of pneumonia in a prospective cohort study. METHODS Serum hsCRP as an inflammatory marker was measured using an immunometric assay and FSB was assessed by self-reported sauna bathing habits at baseline in 2264 men aged 42-61 yr. Serum hsCRP was categorized as normal and high (≤3 and >3 mg/L, respectively) and FSB as low and high (defined as ≤1 and 2-7 sessions/wk, respectively). Multivariable-adjusted HRs (CIs) were calculated for incident pneumonia. RESULTS A total of 528 cases of pneumonia occurred during a median follow-up of 26.6 yr. Comparing high versus normal hsCRP, the multivariable-adjusted risk for pneumonia was HR = 1.30 (95% CI, 1.04-1.62). The corresponding risk was HR = 0.79 (95% CI, 0.66-0.95) comparing high versus low FSB. Compared with men with normal hsCRP and low FSB, high hsCRP and low FSB was associated with an increased risk of pneumonia in multivariable analysis (HR = 1.67: 95% CI, 1.21-2.29), with no evidence of an association for high hsCRP and high FSB and pneumonia (HR = 0.94: 95% CI, 0.69-1.29). CONCLUSIONS In a general middle-aged to older male Caucasian population, frequent sauna baths attenuated the increased risk of pneumonia due to inflammation.
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Gravel H, Behzadi P, Cardinal S, Barry H, Neagoe PE, Juneau M, Nigam A, Sirois MG, Gagnon D. Acute Vascular Benefits of Finnish Sauna Bathing in Patients With Stable Coronary Artery Disease. Can J Cardiol 2021; 37:493-499. [DOI: 10.1016/j.cjca.2020.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/26/2020] [Accepted: 06/25/2020] [Indexed: 01/20/2023] Open
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Shepley BR, Ainslie PN, Hoiland RL, Donnelly J, Sekhon MS, Zetterberg H, Blennow K, Bain AR. Negligible influence of moderate to severe hyperthermia on blood-brain barrier permeability and neuronal parenchymal integrity in healthy men. J Appl Physiol (1985) 2021; 130:792-800. [PMID: 33444119 DOI: 10.1152/japplphysiol.00645.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
With growing use for hyperthermia as a cardiovascular therapeutic, there is surprisingly little information regarding the acute effects it may have on the integrity of the neurovascular unit (NVU). Indeed, relying on animal data would suggest hyperthermia comparable to levels attained in thermal therapy will disrupt the blood-brain barrier (BBB) and damage the cerebral parenchymal cells. We sought to address the hypothesis that controlled passive hyperthermia is not sufficient to damage the NVU in healthy humans. Young men (n = 11) underwent acute passive heating until +2°C or absolute esophageal temperature of 39.5°C. The presence of BBB opening was determined by trans-cerebral exchange kinetics (radial-arterial and jugular venous cannulation) of S100B. Neuronal parenchymal damage was determined by the trans-cerebral exchange of tau protein, neuron-specific enolase (NSE), and neurofilament-light protein (NF-L). Cerebral blood flow to calculate exchange kinetics was measured by duplex ultrasound of the right internal carotid and left vertebral artery. Passive heating was performed via a warm-water perfused suit. In hyperthermia, there was no increase in the cerebral exchange of S100B (P = 0.327), tau protein (P = 0.626), NF-L (P = 0.447), or NSE (P = 0.908) suggesting the +2°C core temperature is not sufficient to acutely stress the NVU in healthy men. However, there was a significant condition effect (P = 0.028) of NSE, corresponding to a significant increase in arterial (P = 0.023) but not venous (P = 0.173) concentrations in hyperthermia, potentially indicating extra-cerebral release of NSE. Collectively, results from the present study support the notion that in young men there is little concern for NVU damage with acute hyperthermia of +2 °C.NEW & NOTEWORTHY The acute effects of passive whole-body hyperthermia on the integrity of the neurovascular unit (NVU) in humans have remained unclear. We demonstrate that passive heating for ∼1 h until an increase of +2°C esophageal temperature in healthy men does not increase the cerebral release of neuronal parenchymal stress biomarkers, suggesting the NVU integrity is maintained. This preliminary study indicates passive heating is safe for the brain, at least in young healthy men.
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Affiliation(s)
- Brooke R Shepley
- University of Windsor, Faculty of Human Kinetics, Department of Kinesiology, Windsor, ON, Canada
| | - Philip N Ainslie
- University of British Columbia, Kelowna, Centre for Heart Lung and Vascular Health, Vancouver, BC, Canada
| | - Ryan L Hoiland
- University of British Columbia, Kelowna, Centre for Heart Lung and Vascular Health, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, Vancouver General Hospital, Vancouver, BC, Canada
| | - Joseph Donnelly
- Brain Physics Laboratory, Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Mypinder S Sekhon
- University of British Columbia, Kelowna, Centre for Heart Lung and Vascular Health, Vancouver, BC, Canada.,Division of Critical Care Medicine and Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Anthony R Bain
- University of Windsor, Faculty of Human Kinetics, Department of Kinesiology, Windsor, ON, Canada
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Liikkanen LA, Laukkanen JA. Sauna bathing frequency in Finland and the impact of COVID-19. Complement Ther Med 2020; 56:102594. [PMID: 33197669 DOI: 10.1016/j.ctim.2020.102594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/14/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Recent research has revealed multiple potential health benefits of frequent sauna bathing. Finland is a country with extraordinary sauna culture and bathing opportunities. However, coronavirus disease 2019 (COVID-19) pandemic introduced regulations and unprecedented closures to shared sauna facilities. In this study we aimed to examine the previously unknown baseline bathing frequency and its possible change during the epidemic. DESIGN We investigated several aspects of sauna bathing with self-reports: the frequency, its possible changes, reasons for change, and beliefs about its health effects among a representative sample of thousand Finns aged 18-75 years. This online survey was administered in May 2020. RESULTS Before the pandemic, 59 % of our respondents had enjoyed sauna at least once a week. Since the pandemic began, up to 23 % had reduced or stopped their bathing. This was often due to restricted sauna access. However, 11 % of respondents bathed more frequently and attributed this change to seeking relaxation and passing time. These findings demonstrate a surprising flexibility in this health-promoting national pastime. Men were more active bathers than women overall and women under 35 enjoy sauna more seldom than older women. Only 7.9 % of all respondents bathed at least four times a week, exceeding a suggested threshold for maximum health benefits. CONCLUSIONS Finnish people are active sauna bathers. The COVID-19 pandemic demonstrated that the frequency of bathing is dependent on good access to sauna facilities. This flexibility and wide access could be exploited to improve public health in the long term if more frequent bathing became a standard.
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Affiliation(s)
- Lassi A Liikkanen
- Aalto Design Factory, School of Engineering, Aalto University, P.O. Box 17700, FI-00076 Aalto, Finland; Qvik Ltd., Helsinki, Finland.
| | - Jari A Laukkanen
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District, Department of Medicine, Jyväskylä, Finland
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Impact of Finnish sauna bathing on circulating markers of inflammation in healthy middle-aged and older adults: A crossover study. Complement Ther Med 2020; 52:102486. [PMID: 32951736 DOI: 10.1016/j.ctim.2020.102486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Finnish sauna bathing is associated with a reduced risk of adverse health outcomes. The acute physiological responses elicited by Finnish sauna bathing that could explain this association remain understudied. This study characterized the acute effect of Finnish sauna bathing on circulating markers of inflammation in healthy middle-aged and older adults. DESIGN With the use of a crossover study design, 20 healthy middle-aged and older adults (9 men/11 women, 66 ± 6 years old) performed 3 interventions in random order: 1) 1 x 10 min of Finnish sauna bathing (80 °C, 20 % humidity); 2) 2 x 10 min of Finnish sauna bathing; 3) a time-control period during which participants sat outside of the sauna for 10 min. MAIN OUTCOMES Venous blood samples were obtained before (≤15 min) and after (∼65 min) each intervention to determine circulating concentrations of interleukin 6 (IL-6), interleukin 1 receptor antagonist (IL-1RA), and C-reactive protein (CRP). RESULTS IL-6 increased in response to 2 x 10 min of sauna bathing (+0.92 pg/mL [+0.16, +1.68], P = 0.02), but not following the 1 x 10 min session (+0.17 pg/mL [-0.13, +0.47], P = 0.26). IL1-RA increased during the 1 x 10 min (+51.27 pg/mL [+20.89, +81.65], P < 0.01) and 2 x 10 min (+30.78 pg/mL [+3.44, +58.12], P = 0.03) sessions. CRP did not change in response to either sauna session (P = 0.34). CONCLUSION These results demonstrate that typical Finnish sauna bathing sessions acutely increase IL-6 and IL1-RA in healthy middle-aged and older adults.
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Laukkanen JA, Kunutsor SK. Is sauna bathing protective of sudden cardiac death? A review of the evidence. Prog Cardiovasc Dis 2019; 62:288-293. [PMID: 31102597 DOI: 10.1016/j.pcad.2019.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
Sudden cardiac death (SCD) is a global public health burden accounting for 15-20% of all deaths. Though established atherosclerotic risk factors explain a large proportion of the risk of SCD, these factors are often absent in a large proportion of SCD victims and the pathogenesis of SCD is still not fully established. It therefore appears that additional factors may be involved. Sauna bathing is a traditional Finnish activity that is mainly used for the purposes of relaxation and pleasure. Beyond its use for these purposes, sauna bathing has been linked with several health benefits. Emerging evidence suggests that sauna bathing is associated with reduced risk of adverse cardiovascular (CV) disease (CVD) and non-CVD outcomes as well as mortality. A number of reports have linked sauna bathing with reduced or increased risk of SCD, but the evidence is uncertain. This review summarizes available studies linking sauna bathing with SCD, the postulated mechanistic pathways underlying these associations, outlines areas of outstanding uncertainty, and the implications for prevention. We employed a comprehensive search for observational studies, randomized controlled trials (RCTs), and non-RCTs from MEDLINE and Embase since their inception until March 2019. Observational data suggest that regular sauna bathing is associated with a substantial risk reduction in SCD. Furthermore, the data suggest that a combination of regular physical activity and sauna baths confers substantial risk reduction for SCD compared with either modality alone. Few reports have linked sauna baths with SCDs, but these single case incidents have been attributed to the effects of dehydration, hypotension, and cardiac arrhythmias due to a combination of sauna exposure and alcohol consumption. Sauna bathing is generally safe for most healthy people and even among patients with stable CVD, if used sensibly and with caution. Plausible pathways underlying the protective effect of sauna bathing on SCD may be linked to the impact on CV function via reduced arterial stiffness, decreases in inflammation and oxidative stress, stabilization of the autonomic nervous system, beneficial changes in circulating lipid profiles and other CVD risk markers, and lowering of systemic blood pressure. Sauna is a potential novel tool to promote SCD prevention in addition to other known means, being an enjoyable way to take care of general health and well-being.
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Affiliation(s)
- Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Central Finland Healthcare District, Department of Internal Medicine, Jyväskylä, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
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