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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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Baars EW, Zoen EBV, Breitkreuz T, Martin D, Matthes H, von Schoen-Angerer T, Soldner G, Vagedes J, van Wietmarschen H, Patijn O, Willcox M, von Flotow P, Teut M, von Ammon K, Thangavelu M, Wolf U, Hummelsberger J, Nicolai T, Hartemann P, Szőke H, McIntyre M, van der Werf ET, Huber R. The Contribution of Complementary and Alternative Medicine to Reduce Antibiotic Use: A Narrative Review of Health Concepts, Prevention, and Treatment Strategies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:5365608. [PMID: 30854009 PMCID: PMC6378062 DOI: 10.1155/2019/5365608] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/23/2018] [Indexed: 12/18/2022]
Abstract
AIM The aim of this narrative review was to explore the potential contributions of CAM to reduce antibiotic use. METHODS We searched PubMed, Embase, and Cochrane Database of Systematic Reviews with a specific, limited set of search terms and collected input from a group of expert CAM researchers to answer the question: What is known about the contribution of CAM health and health promotion concepts, infection prevention, and infection treatment strategies to reduce antibiotic use? Results. The worldview-related CAM health concepts enable health promotion oriented infection prevention and treatment aimed at strengthening or supporting the self-regulating ability of the human organism to cope with diseases. There is some evidence that the CAM concepts of health (promotion) are in agreement with current conceptualization of health and that doctors who practice both CAM and conventional medicine prescribe less antibiotics, although selection bias of the presented studies cannot be ruled out. There is some evidence that prevention and some treatment strategies are effective and safe. Many CAM treatment strategies are promising but overall lack high quality evidence. CONCLUSIONS CAM prevention and treatment strategies may contribute to reducing antibiotic use, but more rigorous research is necessary to provide high quality evidence of (cost-)effectiveness.
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Affiliation(s)
- Erik W. Baars
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | - Eefje Belt-van Zoen
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | | | - David Martin
- University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Harald Matthes
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | | | - Georg Soldner
- Medical section of the Goetheanum, Rüttiweg 45 4143 Dornach, Switzerland
| | - Jan Vagedes
- ARCIM institute, Im Haberschlai 7, 70794 Filderstadt, Germany
| | | | - Olga Patijn
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
| | - Merlin Willcox
- University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Paschen von Flotow
- Sustainable Business Institute, Zehnthofstr. 1, 65375 Oestrich-Winkel, Germany
| | - Michael Teut
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | - Klaus von Ammon
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Madan Thangavelu
- European Ayurveda Association e.V., In den Forstwiesen 27, D- 56745 Bell, Germany
| | - Ursula Wolf
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | | | - Ton Nicolai
- Eurocam, Rue du Trône 194, 1050 Brussels, Belgium
| | - Philippe Hartemann
- University of Lorraine, School of Medicine, 7 avenue de la Forêt de Haye, 54500 Vandoeuvre-Nancy, France
| | - Henrik Szőke
- University of Pécs, 7622 Pécs, Vasvári Pál str. 4., Hungary
| | - Michael McIntyre
- Midsummer Clinic, Church Westcote, Chipping Norton, Oxon, Ox7 6SF, UK
| | - Esther T. van der Werf
- Taylor's University, School of Medicine, 1, Jalan Taylor's, 47500 Subang Jaya, Selangor D.E., Malaysia
- University of Bristol, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Roman Huber
- University of Freiburg, Faculty of Medicine, Breisacher Str. 115b, 79106 Freiburg, Germany
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