1
|
Pușcaș A, Buț MG, Vari CE, Ősz BE, Ștefănescu R, Filip C, Jîtcă G, Istrate TI, Tero-Vescan A. Meldonium Supplementation in Professional Athletes: Career Destroyer or Lifesaver? Cureus 2024; 16:e63634. [PMID: 39092347 PMCID: PMC11292090 DOI: 10.7759/cureus.63634] [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] [Accepted: 06/29/2024] [Indexed: 08/04/2024] Open
Abstract
Meldonium is a substance with known anti-anginal effects demonstrated by numerous studies and human clinical trials; however, it does not possess marketing authorization within the European Union, only in ex-Soviet republics. Since 2016, meldonium has been included by the World Anti-doping Agency (WADA) on the S4 list of metabolic modulators. In performance athletes, meldonium is now considered a doping agent due to its capacity to decrease lactate production during and after exercise, its capability to enhance the storage and utilization of glycogen, and its protective action against oxidative stress. Together, these attributes can significantly improve aerobic endurance, cardiac function, and capacity as well as shorten recovery times (allowing higher intensity training), thereby enhancing performance. The purpose of this review is to highlight the most important mechanisms underlying the protective effect of meldonium against mitochondrial dysfunction (MD), which is responsible for oxidative stress, inflammation, and the cardiac changes known as "athletic heart syndrome." Meldonium acts as an inhibitor of γ-butyrobetaine hydroxylase (BBOX), preventing the de novo synthesis of carnitine and its absorption at the intestinal level via the organic cation/carnitine transporter 2 (OCTN2) and directing the oxidation of fatty acids to the peroxisomes. The decrease in mitochondrial β-oxidation of fatty acids leads to a reduction in lipid peroxidation products that cause oxidative stress and prevent the formation of acyl/acetyl-carnitines involved in numerous pathological disorders. Given the recent findings of the potentially detrimental effects of prolonged high-intensity exercise on cardiovascular health and coronary atherosclerosis, there may be legitimate arguments for the justification of the use of substances like meldonium as protective supplements for athletes.
Collapse
Affiliation(s)
- Amalia Pușcaș
- Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, ROU
| | - Mădălina-Georgiana Buț
- Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, ROU
| | - Camil-Eugen Vari
- Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, ROU
| | - Bianca-Eugenia Ősz
- Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, ROU
| | - Ruxandra Ștefănescu
- Pharmacognosy and Phytotherapy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, ROU
| | - Cristina Filip
- Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, ROU
| | - George Jîtcă
- Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, ROU
| | - Tudor-Ionuț Istrate
- Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, ROU
| | - Amelia Tero-Vescan
- Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, ROU
| |
Collapse
|
2
|
Shuval K, Leonard D, DeFina LF, Barlow CE, Berry JD, Turlington WM, Pavlovic A, Radford NB, Gabriel KP, Khera A, Levine BD. Physical Activity and Progression of Coronary Artery Calcification in Men and Women. JAMA Cardiol 2024; 9:659-666. [PMID: 38748444 PMCID: PMC11097096 DOI: 10.1001/jamacardio.2024.0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/10/2024] [Indexed: 05/18/2024]
Abstract
Importance Prior cross-sectional studies have suggested that very high levels of physical activity (PA) are associated with a higher prevalence of coronary artery calcium (CAC). However, less is known regarding the association between high-volume PA and progression of CAC over time. Objective To explore the association between PA (measured at baseline and during follow-up) and the progression of CAC over time. Design, Setting, and Participants This cohort study included data from 8771 apparently healthy men and women 40 years and older who had multiple preventive medicine visits at the Cooper Clinic (Dallas, Texas), with a mean (SD) follow-up time of 7.8 (4.7) years between the first and last clinic visit. Participants with reported PA and CAC measurements at each visit during 1998 to 2019 were included in the study. Data were analyzed from March 2023 to February 2024. Exposures PA reported at baseline and follow-up, examined continuously per 500 metabolic equivalent of task minutes per week (MET-min/wk) and categorically: less than 1500, 1500 to 2999, 3000 or more MET-min/wk. Main Outcomes and Measures Negative binomial regression was used to estimate the rate of mean CAC progression between visits, with potential modification by PA volume, calculated as the mean of PA at baseline and follow-up. In addition, proportional hazards regression was used to estimate hazard ratios for baseline PA as a predictor of CAC progression to 100 or more Agatston units (AU). Results Among 8771 participants, the mean (SD) age at baseline was 50.2 (7.3) years for men and 51.1 (7.3) years for women. The rate of mean CAC progression per year from baseline was 28.5% in men and 32.1% in women, independent of mean PA during the same time period. That is, the difference in the rate of CAC progression per year was 0.0% per 500 MET-min/wk for men and women (men: 95% CI, -0.1% to 0.1%; women: 95% CI, -0.4% to 0.5%). Moreover, baseline PA was not associated with CAC progression to a clinically meaningful threshold of 100 AU or more over the follow-up period. The hazard ratio for a baseline PA value of 3000 or more MET-min/wk vs less than 1500 MET-min/wk to cross this threshold was 0.84 (95% CI, 0.66 to 1.08) in men and 1.16 (95% CI, 0.57 to 2.35) in women. Conclusions and Relevance This study found that PA volume was not associated with progression of CAC in a large cohort of healthy men and women who were initially free of overt cardiovascular disease.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amit Khera
- University of Texas Southwestern Medical Center, Dallas
| | - Benjamin D. Levine
- University of Texas Southwestern Medical Center, Dallas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas
| |
Collapse
|
3
|
Kodesh E, Navot-Mintzer D, Livshitz L, Shub I, Or T. The effects of a multi-day cross-country mountain bike race on myocardial function, stress, inflammation and cardiac biomarkers in amateur master athletes. Res Sports Med 2024; 32:425-442. [PMID: 36134901 DOI: 10.1080/15438627.2022.2125316] [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: 01/20/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
This study aimed to examine the effects of a multi-day mountain bike race on amateur master athlete cyclists (AMA). AMA (50±5 years) completed 2 stages of a mountain bike race. Six weeks before racing, echocardiography, blood and maximal cardiopulmonary exercise tests (CPET) were performed. One hour after completion of each race stage, echocardiography measurements were taken and blood was sampled for stress, inflammatory and cardiac biomarkers. Main outcomes of the CPET were maximal oxygen consumption (VO2max) 50.7±6.5 ml/kg/min; maximal power 328±45 Watt and ventilatory threshold of 86%VO2max. Participants completed 95.7km with an elevation of 1650m on the first day, and 92.5km with an elevation of 1410m on the second day, with completion times of 357±42 and 390 ±43 minutes, respectively. After racing, increases in Creatine Phosphokinase and C-reactive protein (3-6 fold) (p<0.001), Troponin I (4-fold) (p<0.001) and N-terminal pro-brain natriuretic peptide (NT-Pro BNP) (4-7-fold) (p<0.001) were noted, with a reduction in the myocardial global work index of 17-24% (p<0.001). No correlations were found between Troponin I or NT-Pro BNP and myocardial global work index. Highly aerobically fit AMA participating in demanding endurance events demonstrated elevated stress, inflammatory, muscle damage and cardiac biomarkers. However, these changes did not significantly correlate with altered cardiac function. In addition, consecutive days of demanding prolonged cycling exercise did not have cumulative effects on the measured myocardial parameters.
Collapse
Affiliation(s)
- Einat Kodesh
- Physical Therapy department, University of Haifa, Haifa, Israel
| | - Dalya Navot-Mintzer
- The Ribstein Center for Sports Medicine and Research, Wingate Institute, Netanya, Israel
| | - Liora Livshitz
- Cardiology Department, Galilee Medical Center, Nahariya, Israel
| | - Idit Shub
- The Ribstein Center for Sports Medicine and Research, Wingate Institute, Netanya, Israel
| | - Tsafrir Or
- Cardiology Department, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Israel
| |
Collapse
|
4
|
Herraiz-Adillo Á, Ahlqvist VH, Higueras-Fresnillo S, Hedman K, Hagström E, Fortuin-de Smidt M, Daka B, Lenander C, Berglind D, Östgren CJ, Rådholm K, Ortega FB, Henriksson P. Physical fitness in male adolescents and atherosclerosis in middle age: a population-based cohort study. Br J Sports Med 2024; 58:bjsports-2023-107663. [PMID: 38355280 DOI: 10.1136/bjsports-2023-107663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To examine the associations between physical fitness in male adolescents and coronary and carotid atherosclerosis in middle age. METHODS This population-based cohort study linked physical fitness data from the Swedish Military Conscription Register during adolescence to atherosclerosis data from the Swedish CArdioPulmonary bioImage Study in middle age. Cardiorespiratory fitness was assessed using a maximal cycle-ergometer test, and knee extension muscular strength was evaluated through an isometric dynamometer. Coronary atherosclerosis was evaluated via Coronary Computed Tomography Angiography (CCTA) stenosis and Coronary Artery Calcium (CAC) scores, while carotid plaques were evaluated by ultrasound. The associations were analysed using multinomial logistic regression, adjusted (marginal) prevalences and restricted cubic splines. RESULTS The analysis included 8986 male adolescents (mean age 18.3 years) with a mean follow-up of 38.2 years. Physical fitness showed a reversed J-shaped association with CCTA stenosis and CAC, but no consistent association was observed for carotid plaques. After adjustments, compared with adolescents in the lowest tertile of cardiorespiratory fitness and muscular strength, those in the highest tertile had 22% (OR 0.78; 95% CI 0.61 to 0.99) and 26% (OR 0.74; 95% CI 0.58 to 0.93) lower ORs for severe (≥50%) coronary stenosis, respectively. The highest physical fitness group (high cardiorespiratory fitness and muscular strength) had 33% (OR 0.67; 95% CI 0.52 to 0.87) lower OR for severe coronary stenosis compared with those with the lowest physical fitness. CONCLUSION This study supports that a combination of high cardiorespiratory fitness and high muscular strength in adolescence is associated with lower coronary atherosclerosis, particularly severe coronary stenosis, almost 40 years later.
Collapse
Affiliation(s)
- Ángel Herraiz-Adillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sara Higueras-Fresnillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Physical Education, Sport and Human Motricity, Universidad Autónoma de Madrid, Madrid, Spain
| | - Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | | | - Bledar Daka
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Cecilia Lenander
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden
| | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Centre of Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS) and CIBEROBN Physiopathology of Obesity and Nutrition, University of Granada, Granada, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
5
|
Javed W, Malhotra A, Swoboda P. Cardiac magnetic resonance assessment of athletic myocardial fibrosis; Benign bystander or malignant marker? Int J Cardiol 2024; 394:131382. [PMID: 37741350 DOI: 10.1016/j.ijcard.2023.131382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
The benefits of exercise are irrefutable with a well-established dose-dependent relationship between exercise intensity and reduction in cardiovascular disease. Differentiating the physiological adaptation to exercise, termed the "athlete's heart" from cardiomyopathies, has been advanced by the advent of more sophisticated imaging modalities such as cardiac magnetic resonance imaging (CMR). Myocardial fibrosis on CMR is a mutual finding amongst seemingly healthy endurance athletes and individuals with cardiomyopathy. As a substrate for arrhythmias, fibrosis is traditionally associated with increased cardiovascular risk. In this article, we discuss the aetiologies, distribution and potential implications of myocardial fibrosis in athletes.
Collapse
Affiliation(s)
- Wasim Javed
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aneil Malhotra
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Peter Swoboda
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| |
Collapse
|
6
|
Kyrouac D, Levine BD. Editorial commentary: The athlete's heart: Friend or foe? Trends Cardiovasc Med 2024; 34:26-28. [PMID: 36150628 DOI: 10.1016/j.tcm.2022.09.002] [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: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Douglas Kyrouac
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin D Levine
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA.
| |
Collapse
|
7
|
Isath A, Koziol KJ, Martinez MW, Garber CE, Martinez MN, Emery MS, Baggish AL, Naidu SS, Lavie CJ, Arena R, Krittanawong C. Exercise and cardiovascular health: A state-of-the-art review. Prog Cardiovasc Dis 2023; 79:44-52. [PMID: 37120119 DOI: 10.1016/j.pcad.2023.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Cardiovascular (CV) disease (CVD) is the leading cause of global morbidity and mortality, and low levels of physical activity (PA) is a leading independent predictor of poor CV health and associated with an increased prevalence of risk factors that predispose to CVD development. In this review, we evaluate the benefits of exercise on CV health. We discuss the CV adaptations to exercise, focusing on the physiological changes in the heart and vasculature. We review the impact and benefits of exercise on specific CV prevention, including type II diabetes, hypertension, hyperlipidemia, coronary artery disease, and heart failure, in addition to CVD-related and all-cause mortality. Lastly, we evaluate the current PA guidelines and various modes of exercise, assessing the current literature for the effective regimens of PA that improve CVD outcomes.
Collapse
Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Centre and New York Medical College, Valhalla, NY, United States of America
| | - Klaudia J Koziol
- New York Medical College, School of Medicine, Valhalla, NY, United States of America
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Sports Cardiology and Hypertrophic Cardiomyopathy, Atlantic Health, Morristown Medical Center, Morristown, NJ, United States of America
| | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Program in Applied Physiology, Teachers College, Columbia University, United States of America
| | - Matthew N Martinez
- Department of Pediatric Cardiology, NYU Grossman School of Medicine and Langone Medical Center, NYU Langone Health, New York, NY, United States of America
| | - Michael S Emery
- Vascular and Thoracic Institute, Section of Clinical Cardiology, Cleveland Clinic, Cleveland, OH, United States of America
| | - Aaron L Baggish
- Cardiovascular Performance Program, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States of America
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Centre and New York Medical College, Valhalla, NY, United States of America
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States of America
| | | |
Collapse
|
8
|
Richardson CE, Tovar AP, Davis BA, Van Loan MD, Keim NL, Casazza GA. An Intervention of Four Weeks of Time-Restricted Eating (16/8) in Male Long-Distance Runners Does Not Affect Cardiometabolic Risk Factors. Nutrients 2023; 15:nu15040985. [PMID: 36839342 PMCID: PMC9961388 DOI: 10.3390/nu15040985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Timing of nutrient intake for athletes may affect exercise performance and cardiometabolic factors. Our objective was to examine the effect of time-restricted eating (TRE) on cardiometabolic health. Using a cross-over study design, 15 endurance-trained male runners were randomized to either a normal dietary pattern (ND) first (12 h eating/fasting times) followed by time-restricted eating (TRE) pattern (16 h fast; 8 h eating) or the reverse, with a 4-week washout period between interventions. Body composition, resting energy expenditure, blood pressure and serum insulin, glucose and lipids were measured using standard laboratory methods. Exercise training and dietary intake (calories and macronutrients) were similar across interventions. No significant differences were observed in resting energy expenditure, markers of insulin resistance, serum lipids or blood pressure. Body composition did change significantly (p < 0.05) with whole body fat mass (-0.8 ± 1.3 kg with TRE vs. +0.1 ± 4.3 kg with ND), leg fat mass (-0.3 ± 0.5 kg with TRE vs. +0.1 ± 0.4 kg with ND), and percent body fat (-1.0 ± 1.5% with TRE vs. +0.1 ± 1.3% with ND) declining more in the TRE intervention, with no change in fat-free mass. This study is one of a few to investigate the effects of an isocaloric 16/8 TRE eating pattern in trained endurance athletes and confirms no change in cardiometabolic risk factors. In conclusion, TRE is not detrimental to cardiometabolic health in endurance-trained male runners but could be beneficial on exercise performance by reducing fat mass.
Collapse
Affiliation(s)
- Christine E. Richardson
- Department of Nutrition, University of California, Davis, CA 95616, USA
- USDA, ARS, Western Human Nutrition Research Center, Davis, CA 95616, USA
| | - Ashley P. Tovar
- Department of Nutrition, University of California, Davis, CA 95616, USA
- USDA, ARS, Western Human Nutrition Research Center, Davis, CA 95616, USA
| | - Brian A. Davis
- Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA 95816, USA
| | - Marta D. Van Loan
- Department of Nutrition, University of California, Davis, CA 95616, USA
- USDA, ARS, Western Human Nutrition Research Center, Davis, CA 95616, USA
| | - Nancy L. Keim
- Department of Nutrition, University of California, Davis, CA 95616, USA
- USDA, ARS, Western Human Nutrition Research Center, Davis, CA 95616, USA
| | - Gretchen A. Casazza
- Department of Kinesiology, California State University, Sacramento, CA 95819, USA
- Correspondence:
| |
Collapse
|
9
|
Patel R, Kemp CL, Hafejee M, Peckham N, Jain V, McCann GP, Pallikadavath S. The Underrepresentation of Females in Studies Assessing the Impact of High-Dose Exercise on Cardiovascular Outcomes: a Scoping Review. SPORTS MEDICINE-OPEN 2021; 7:30. [PMID: 33914201 PMCID: PMC8085142 DOI: 10.1186/s40798-021-00320-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/18/2021] [Indexed: 11/24/2022]
Abstract
High-dose exercise-induced cardiac outcomes may vary between sexes. However, many studies investigating the cardiovascular effects of high-dose exercise have excluded or under-recruited females. This scoping review aimed to describe the recruitment of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and describe how this has changed over time. This scoping review followed the protocol outlined by Arksey and O’Malley and is reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. The OVID and EMBASE databases were searched for studies that assessed the effects of high-dose exercise on cardiovascular outcomes. Both professional and nonprofessional groups were included. The review found 2973 studies, and 250 met the inclusion criteria including cumulatively 17,548,843 subjects. Over half the studies (n = 127) excluded females entirely, and only 8 (3.2%) studies recruited all-female participants. The overall mean percentage of females recruited was 18.2%. The mean percentage was 14.5% in studies conducted before 2011 and 21.8% in studies conducted after 2011. Females are an underrepresented group in studies assessing the cardiovascular outcomes related to high-dose exercise. As cardiovascular outcomes vary between sexes, translating findings from a largely male-based evidence may not be appropriate. Future investigators should aim to establish and overcome barriers to female recruitment.
Collapse
Affiliation(s)
- Roshan Patel
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Caitlin L Kemp
- College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Nicholas Peckham
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Vageesh Jain
- Institute for Global Health, University College London, London, UK
| | - Gerry P McCann
- NIHR Leicester Biomedical Research Centre for Cardiovascular Disease, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Susil Pallikadavath
- NIHR Leicester Biomedical Research Centre for Cardiovascular Disease, Glenfield Hospital, University of Leicester, Leicester, UK.
| |
Collapse
|
10
|
Stöhr EJ, Pugh CJA. The endurance athlete's circulation: Ultra-risky or a long road to safety? Atherosclerosis 2021; 320:89-91. [PMID: 33546824 DOI: 10.1016/j.atherosclerosis.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Eric J Stöhr
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, CF5 2YB, UK; Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, NY, 10032, USA.
| | - Christopher J A Pugh
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, CF23 6XD, UK.
| |
Collapse
|
11
|
Mehta A, Kondamudi N, Laukkanen JA, Wisloff U, Franklin BA, Arena R, Lavie CJ, Pandey A. Running away from cardiovascular disease at the right speed: The impact of aerobic physical activity and cardiorespiratory fitness on cardiovascular disease risk and associated subclinical phenotypes. Prog Cardiovasc Dis 2020; 63:762-774. [PMID: 33189764 DOI: 10.1016/j.pcad.2020.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 02/06/2023]
Abstract
Higher levels of physical activity (PA) and cardiorespiratory fitness (CRF) are associated with lower risk of incident cardiovascular disease (CVD). However, the relationship of aerobic PA and CRF with risk of atherosclerotic CVD outcomes and heart failure (HF) seem to be distinct. Furthermore, recent studies have raised concerns of potential toxicity associated with extreme levels of aerobic exercise, with higher levels of coronary artery calcium and incident atrial fibrillation noted among individuals with very high PA levels. In contrast, the relationship between PA levels and measures of left ventricular structure and function and risk of HF is more linear. Thus, personalizing exercise levels to optimal doses may be key to achieving beneficial outcomes and preventing adverse CVD events among high risk individuals. In this report, we provide a comprehensive review of the literature on the associations of aerobic PA and CRF levels with risk of adverse CVD outcomes and the preceding subclinical cardiac phenotypes to better characterize the optimal exercise dose needed to favorably modify CVD risk.
Collapse
Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Ulrik Wisloff
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Barry A Franklin
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
12
|
Aengevaeren VL, Mosterd A, Sharma S, Prakken NHJ, Möhlenkamp S, Thompson PD, Velthuis BK, Eijsvogels TMH. Exercise and Coronary Atherosclerosis: Observations, Explanations, Relevance, and Clinical Management. Circulation 2020; 141:1338-1350. [PMID: 32310695 PMCID: PMC7176353 DOI: 10.1161/circulationaha.119.044467] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Physical activity and exercise training are effective strategies for reducing the risk of cardiovascular events, but multiple studies have reported an increased prevalence of coronary atherosclerosis, usually measured as coronary artery calcification, among athletes who are middle-aged and older. Our review of the medical literature demonstrates that the prevalence of coronary artery calcification and atherosclerotic plaques, which are strong predictors for future cardiovascular morbidity and mortality, was higher in athletes compared with controls, and was higher in the most active athletes compared with less active athletes. However, analysis of plaque morphology revealed fewer mixed plaques and more often only calcified plaques among athletes, suggesting a more benign composition of atherosclerotic plaques. This review describes the effects of physical activity and exercise training on coronary atherosclerosis in athletes who are middle-aged and older and aims to contribute to the understanding of the potential adverse effects of the highest doses of exercise training on the coronary arteries. For this purpose, we will review the association between exercise and coronary atherosclerosis measured using computed tomography, discuss the potential underlying mechanisms for exercise-induced coronary atherosclerosis, determine the clinical relevance of coronary atherosclerosis in middle-aged athletes and describe strategies for the clinical management of athletes with coronary atherosclerosis to guide physicians in clinical decision making and treatment of athletes with elevated coronary artery calcification scores.
Collapse
Affiliation(s)
- Vincent L Aengevaeren
- Department of Physiology (V.L.A., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands (A.M.)
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's University of London, United Kingdom (S.S.)
| | - Niek H J Prakken
- Department of Radiology, University Medical Center Groningen, The Netherlands (N.H.J.P.)
| | - Stefan Möhlenkamp
- Clinic of Cardiology and Intensive Care Medicine, Bethanien Hospital Moers, Germany (S.M.)
| | | | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, The Netherlands (B.K.V.)
| | - Thijs M H Eijsvogels
- Department of Physiology (V.L.A., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Churchill TW, Baggish AL. Cardiovascular Care of Masters Athletes. J Cardiovasc Transl Res 2020; 13:313-321. [PMID: 32189198 DOI: 10.1007/s12265-020-09987-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/11/2020] [Indexed: 01/31/2023]
Abstract
Masters athletes (MA), men and woman older than 35 years who participate in competitive athletics, is a rapidly growing population that is increasingly encountered in clinical cardiovascular practice. Although the high levels of exercise typically performed by MA confer numerous health advantages, no amount of exercise confers complete immunity from cardiovascular disease. The review was written to cover the clinical management of MA with cardiovascular disease. Focus is dedicated to four of the most common clinical scenarios including atrial fibrillation, myocardial fibrosis, coronary artery disease, and dilation of the ascending aorta.
Collapse
Affiliation(s)
- Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Harvard Medical School, Yawkey Suite 5B, 55 Fruit Street, Boston, MA, 02114, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Harvard Medical School, Yawkey Suite 5B, 55 Fruit Street, Boston, MA, 02114, USA.
| |
Collapse
|
14
|
Lechner K, Spanier B, Lechner B, Scherr J. Your athlete-patient has a high coronary artery calcification score-'Heart of Stone'. What should you advise? Is exercise safe? Br J Sports Med 2020; 55:1001-1002. [PMID: 32139369 DOI: 10.1136/bjsports-2019-100769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Katharina Lechner
- Department of Prevention and Sports Medicine, Technical University Munich, Munich, Germany
| | - Bianca Spanier
- Department of Prevention and Sports Medicine, Technical University Munich, Munich, Germany
| | - Benjamin Lechner
- Department of Internal Medicine IV, Ludwig Maximillians University Munich, Munich, Germany
| | - Johannes Scherr
- Department of Prevention and Sports Medicine, Technical University Munich, Munich, Germany.,University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| |
Collapse
|
15
|
Franklin BA, Thompson PD, Al-Zaiti SS, Albert CM, Hivert MF, Levine BD, Lobelo F, Madan K, Sharrief AZ, Eijsvogels TMH. Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective-An Update: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e705-e736. [PMID: 32100573 DOI: 10.1161/cir.0000000000000749] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As a result, worldwide participation in endurance training, competitive long distance endurance events, and high-intensity interval training has increased markedly since the previous American Heart Association statement on exercise risk. On the other hand, vigorous physical activity, particularly when performed by unfit individuals, can acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible people. Recent studies have also shown that large exercise volumes and vigorous intensities are both associated with potential cardiac maladaptations, including accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, and atrial fibrillation. The relationship between these maladaptive responses and physical activity often forms a U- or reverse J-shaped dose-response curve. This scientific statement discusses the cardiovascular and health implications for moderate to vigorous physical activity, as well as high-volume, high-intensity exercise regimens, based on current understanding of the associated risks and benefits. The goal is to provide healthcare professionals with updated information to advise patients on appropriate preparticipation screening and the benefits and risks of physical activity or physical exertion in varied environments and during competitive events.
Collapse
|
16
|
Panhuyzen-Goedkoop NM, Wellens HJ, Verbeek AL, Jørstad HT, Smeets JR, Peters RJ. ECG criteria for the detection of high-risk cardiovascular conditions in master athletes. Eur J Prev Cardiol 2020; 27:1529-1538. [PMID: 31996014 PMCID: PMC7469710 DOI: 10.1177/2047487319901060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective Structured electrocardiography (ECG) analysis is used to screen athletes for high-risk cardiovascular conditions (HRCC) to prevent sudden cardiac death. ECG criteria have been specified and recommended for use in young athletes ≤ 35 years. However, it is unclear whether these ECG criteria can also be applied to master athletes >35 years. Aim The purpose of this study was to test whether the existing ECG criteria for detecting HRCC in young athletes can be applied to master athletes. Methods We conducted a cross-sectional study among athletes >35 years screened for HRCC between 2006 and 2010. We performed a blinded retrospective analysis of master athletes’ ECGs, separately applying European Society of Cardiology (ESC)-2005, Seattle, and International criteria. HRCC were defined using recommendations from the international cardiac societies American Heart Association and American College of Cardiology, and ESC, based on ECG screening and cardiovascular evaluation (CVE). Results We included 2578 master athletes in the study, of whom 494 had initial screening abnormalities mandating CVE. Atrial enlargement (109, 4.1%) and left ventricular hypertrophy (98, 3.8%) were the most common ECG abnormalities found using the ESC-2005 or Seattle criteria. Applying the International criteria, ST-segment deviation (66, 2.6%), and T-wave inversion (58, 2.2%) were most frequent. The ESC-2005 criteria detected more HRCC (46, 1.8%) compared with the Seattle (36, 1.4%) and International criteria (33, 1.3%). The most frequently detected HRCC was coronary artery disease (24, 0.9%). Conclusion ECG criteria recommended for use in young athletes can be applied to master athletes’ ECGs to detect HRCC. The ESC-2005 criteria had the highest sensitivity for detecting HRCC among master athletes.
Collapse
Affiliation(s)
- Nicole M Panhuyzen-Goedkoop
- Heart Centre, Amsterdam University Medical Centers, AMC Amsterdam, the Netherlands.,Sports Medical Centre Papendal, Arnhem, the Netherlands
| | | | - André Lm Verbeek
- Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Harald T Jørstad
- Heart Centre, Amsterdam University Medical Centers, AMC Amsterdam, the Netherlands
| | - Joep Rlm Smeets
- Heart Centre, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ron Jg Peters
- Heart Centre, Amsterdam University Medical Centers, AMC Amsterdam, the Netherlands
| |
Collapse
|
17
|
Rao P, Shipon D. Exercise Recommendations for the Athlete With Coronary Artery Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:82. [PMID: 31820188 DOI: 10.1007/s11936-019-0795-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF THE REVIEW We provide a framework for formulating exercise prescriptions for those with CAD in order to achieve the "optimal" dose of exercise for each individual. RECENT FINDINGS Multiple epidemiological studies demonstrate that exercise is inversely associated with atherosclerotic coronary artery disease (CAD), yet the risk of an acute coronary event is transiently elevated during vigorous exercise. In turn, CAD is the most common cause of exercise-related sudden cardiac death (SCD) in older athletes. When prescribing exercise recommendations for athletes with CAD, we should maintain equipoise between the benefits derived from sports participation and the risk of an adverse cardiac event. Athletes are not immune from atherosclerotic CAD, and we should perform risk assessments regardless of physical and athletic prowess. Cardiopulmonary exercise testing may be a useful tool to develop individualized exercise regimens for athletes with CAD.
Collapse
Affiliation(s)
- Prashant Rao
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - David Shipon
- Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW This review was designed to provide a scientific and clinical framework for the care of physically active men and women with an emphasis on the management of T2DM. RECENT FINDINGS The preventative and therapeutic benefits of physical activity (PA) on adult onset or Type 2 Diabetes Mellitus (T2DM) are well established. Individuals diagnosed with or are at risk for T2DM should be counseled and maximally supported to pursue an active or athletic lifestyle. Optimally, this translates into the adoption of an athletic lifestyle. "Masters athletes", men and women above the age of 35 who regularly train for and/or participate in competitive sport, represent a rapidly growing segment of the population. Although the high level of exercise characteristic of this population has numerous health benefits, it does not confer immunity from T2DM or cardiovascular (CV) disease. Providing effective care for men and women above the age of 35 who regularly train for and/or participate in competitive sport requires an understanding of the interplay between basic exercise physiology and the pathogenesis of insulin resistance.
Collapse
Affiliation(s)
- Erika J Parisi
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Yawkey Building Suite 5B, 55 Fruit Street, Boston, MA, 02114, USA.
| |
Collapse
|
19
|
Lechner K, Halle M, Scherr J, Drezner JA. Exercise recommendations in athletes with coronary artery calcification. Eur J Prev Cardiol 2019; 27:882-884. [PMID: 31604400 DOI: 10.1177/2047487319881700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Katharina Lechner
- Technical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany
| | - Martin Halle
- Technical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Johannes Scherr
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Switzerland
| | - Jonathan A Drezner
- Department of Family Medicine and the Center for Sports Cardiology, University of Washington, Seattle, USA
| |
Collapse
|
20
|
Halle M, Esefeld K, Schindler M, Schunkert H. Exercise hypertension: Link to myocardial fibrosis in athletes? Eur J Prev Cardiol 2019; 27:89-93. [DOI: 10.1177/2047487319868795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Martin Halle
- Technical University Munich, School of Medicine, University Hospital ‘Klinikum rechts der Isar’, Department of Prevention, Rehabilitation and Sports Medicine, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Germany
| | - Katrin Esefeld
- Technical University Munich, School of Medicine, University Hospital ‘Klinikum rechts der Isar’, Department of Prevention, Rehabilitation and Sports Medicine, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Germany
| | - Michael Schindler
- Technical University Munich, School of Medicine, University Hospital ‘Klinikum rechts der Isar’, Department of Prevention, Rehabilitation and Sports Medicine, Germany
| | - Heribert Schunkert
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Germany
- Technical University Munich, School of Medicine, German Heart Centre, Department of Cardiology, Germany
| |
Collapse
|
21
|
Extreme Physical Activity May Increase Coronary Calcification, But Fitness Still Prevails. Mayo Clin Proc Innov Qual Outcomes 2019; 3:103-105. [PMID: 31193848 PMCID: PMC6543500 DOI: 10.1016/j.mayocpiqo.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
22
|
Affiliation(s)
- Prashant Rao
- Thomas Jefferson University Hospital, Philadelphia, Pa.
| | - Adolph M Hutter
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Mass
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Mass
| |
Collapse
|
23
|
DeFina LF, Radford NB, Barlow CE, Willis BL, Leonard D, Haskell WL, Farrell SW, Pavlovic A, Abel K, Berry JD, Khera A, Levine BD. Association of All-Cause and Cardiovascular Mortality With High Levels of Physical Activity and Concurrent Coronary Artery Calcification. JAMA Cardiol 2019; 4:174-181. [PMID: 30698608 PMCID: PMC6439619 DOI: 10.1001/jamacardio.2018.4628] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/14/2018] [Indexed: 12/12/2022]
Abstract
Importance Few data are available to guide clinical recommendations for individuals with high levels of physical activity in the presence of clinically significant coronary artery calcification (CAC). Objective To assess the association among high levels of physical activity, prevalent CAC, and subsequent mortality risk. Design, Setting, and Participants The Cooper Center Longitudinal Study is a prospective observational study of patients from the Cooper Clinic, a preventive medicine facility. The present study included participants seen from January 13, 1998, through December 30, 2013, with mortality follow-up through December 31, 2014. A total of 21 758 generally healthy men without prevalent cardiovascular disease (CVD) were included if they reported their physical activity level and underwent CAC scanning. Data were analyzed from September 26, 2017, through May 2, 2018. Exposures Self-reported physical activity was categorized into at least 3000 (n = 1561), 1500 to 2999 (n = 3750), and less than 1500 (n = 16 447) metabolic equivalent of task (MET)-minutes/week (min/wk). The CAC scores were categorized into at least 100 (n = 5314) and less than 100 (n = 16 444) Agatston units (AU). Main Outcomes and Measures All-cause and CVD mortality collected from the National Death Index Plus. Results Among the 21 758 male participants, baseline mean (SD) age was 51.7 (8.4) years. Men with at least 3000 MET-min/wk were more likely to have prevalent CAC of at least 100 AU (relative risk, 1.11; 95% CI, 1.03-1.20) compared with those accumulating less physical activity. In the group with physical activity of at least 3000 MET-min/wk and CAC of at least 100 AU, mean (SD) CAC level was 807 (1120) AU. After a mean (SD) follow-up of 10.4 (4.3) years, 759 all-cause and 180 CVD deaths occurred, including 40 all-cause and 10 CVD deaths among those with physical activity of at least 3000 MET-min/wk. Men with CAC of less than 100 AU and physical activity of at least 3000 MET-min/wk were about half as likely to die compared with men with less than 1500 MET-min/wk (hazard ratio [HR], 0.52; 95% CI, 0.29-0.91). In the group with CAC of at least 100 AU, men with at least 3000 MET-min/wk did not have a significant increase in all-cause mortality (HR, 0.77; 95% CI, 0.52-1.15) when compared with men with physical activity of less than 1500 MET-min/wk. In the least active men, those with CAC of at least 100 AU were twice as likely to die of CVD compared with those with CAC of less than 100 AU (HR, 1.93; 95% CI, 1.34-2.78). Conclusions and Relevance This study suggests there is evidence that high levels of physical activity (≥3000 MET-min/wk) are associated with prevalent CAC but are not associated with increased all-cause or CVD mortality after a decade of follow-up, even in the presence of clinically significant CAC levels.
Collapse
Affiliation(s)
| | - Nina B. Radford
- Department of Cardiovascular Medicine, Cooper Clinic, Dallas, Texas
| | | | | | - David Leonard
- Research Division, The Cooper Institute, Dallas, Texas
| | | | | | | | - Katelyn Abel
- Research Division, The Cooper Institute, Dallas, Texas
| | - Jarett D. Berry
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Amit Khera
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Benjamin D. Levine
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas
| |
Collapse
|
24
|
Aspirin to Prevent Sudden Cardiac Death in Athletes with High Coronary Artery Calcium Scores. Am J Med 2019; 132:138-141. [PMID: 30296406 DOI: 10.1016/j.amjmed.2018.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 12/29/2022]
Abstract
While proficient cardiac resuscitation has improved survival following cardiac arrest during road races in Japan, this accomplishment does not address coronary artery disease as the underlying cause of an increasing frequency of cardiac arrest in middle-aged men during marathons and ironman triathlons in the United States since the year 2000. Based on the high prevalence of subclinical coronary artery disease by cardiac computed tomography in endurance athletes with low conventional cardiac risk-factor profiles, we recommend coronary artery calcium scores as a more reliable and independent predictor of incident cardiac events, including death, as validated among adults aged 30-46 years. Scores of over 100 Agatston units indicate a 10-year cardiac risk of 7.5%, at which additional measures for primary prevention are recommended, including aspirin, as shown conclusively to reduce first myocardial infarctions in same-aged men in a prospective double-blind controlled trial. Targeted screening for subclinical coronary atherosclerosis with coronary artery calcium scores is prudent to guide appropriately dosed aspirin use to mitigate the increasing frequency of sports-related sudden cardiac death due to plaque rupture.
Collapse
|
25
|
Lavie CJ, Wisløff U, Blumenthal RS. Extreme Physical Activity and Coronary Artery Calcification—Running Heavily and Safely With “Hearts of Stone”. JAMA Cardiol 2019; 4:182-183. [DOI: 10.1001/jamacardio.2018.4647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Carl J. Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana
| | - Ulrik Wisløff
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roger S. Blumenthal
- John Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| |
Collapse
|
26
|
Abstract
Purpose of the review For many years, competitive sport has been dominated by men. Recent times have witnessed a significant increase in women participating in elite sports. As most studies investigated male athletes, with few reports on female counterparts, it is crucial to have a better understanding on physiological cardiac adaptation to exercise in female athletes, to distinguish normal phenotypes from potentially fatal cardiac diseases. This review reports on cardiac adaptation to exercise in females. Recent findings Recent studies show that electrical, structural, and functional cardiac changes due to physiological adaptation to exercise differ in male and female athletes. Women tend to exhibit eccentric hypertrophy, and while concentric hypertrophy or concentric remodeling may be a normal finding in male athletes, it should be evaluated carefully in female athletes as it may be a sign of pathology. Although few studies on veteran female athletes are available, women seem to be affected by atrial fibrillation, coronary atherosclerosis, and myocardial fibrosis less than male counterparts. Summary Males and females exhibit many biological, anatomical, and hormonal differences, and cardiac adaptation to exercise is no exception. The increasing participation of women in sports should stimulate the scientific community to develop large, longitudinal studies aimed at a better understanding of cardiac adaptation to exercise in female athletes.
Collapse
Affiliation(s)
- Clea Simone S S Colombo
- MSc Sports Cardiology, Cardiology Clinical Academic Group, St George's University of London, Cranmer Terrace, SW 17 0RE, London, UK. .,Cuore Dello Sport, Valinhos, R. Luiz Spiandorelli Neto, 60, s307. Valinhos, São Paulo, Brazil.
| | - Gherardo Finocchiaro
- Cardiology Clinical Academic Group, St George's University of London, Cranmer Terrace, SW 17 0RE, London, UK
| |
Collapse
|
27
|
Abstract
The cardiovascular benefits of regular exercise are well established. A mortality benefit has clearly been demonstrated for those that participate in light and moderate exercise. Less is known regarding the long-term effects of vigorous regular running over an extended period. In recent years, myocardial fibrosis, arrhythmias, and coronary artery calcium have been demonstrated in high-intensity exercisers. However, the prognostic implication of these findings remains unknown, and thus, there is insufficient evidence, and potentially not a need, to recommend a maximal running dose or limit for healthy individuals who already train intensively. For those otherwise healthy individuals who wish to run for cardiovascular health benefits, following the standard guidelines of 150 min of moderate-intensity exercise or 75 min of vigorous exercise weekly is recommended. Prevention and screening remain as key to lowering morbidity and mortality in all individuals.
Collapse
Affiliation(s)
- Christopher W McMullen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Mark A Harrast
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
28
|
Karam N, Pechmajou L, Dumas F, Bougouin W, Sharifzadehgan A, Beganton F, Bonnet G, Jost D, Lamhaut L, Varenne O, Aubry P, Sideris G, Spaulding C, Cariou A, Marijon E, Jouven X. Comprehensive Assessment of Coronary Artery Disease in Sports-Related Sudden Cardiac Arrest. Circulation 2018; 138:429-431. [DOI: 10.1161/circulationaha.118.034664] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicole Karam
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Université Paris Descartes, France (N.K., L.P., F.D., W.B., A.S., O.V., C.S., A.C., E.M., X.J.)
- European Hospital Georges Pompidou, Cardiology Department, Paris, France (N.K., W.B., A.S., G.B., C.S., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
| | - Louis Pechmajou
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Université Paris Descartes, France (N.K., L.P., F.D., W.B., A.S., O.V., C.S., A.C., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
| | - Florence Dumas
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Université Paris Descartes, France (N.K., L.P., F.D., W.B., A.S., O.V., C.S., A.C., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
- Département des Urgences, Hôpital Cochin, Paris, France (F.D.)
| | - Wulfran Bougouin
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Université Paris Descartes, France (N.K., L.P., F.D., W.B., A.S., O.V., C.S., A.C., E.M., X.J.)
- European Hospital Georges Pompidou, Cardiology Department, Paris, France (N.K., W.B., A.S., G.B., C.S., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
| | - Ardalan Sharifzadehgan
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Université Paris Descartes, France (N.K., L.P., F.D., W.B., A.S., O.V., C.S., A.C., E.M., X.J.)
- European Hospital Georges Pompidou, Cardiology Department, Paris, France (N.K., W.B., A.S., G.B., C.S., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
| | - Frankie Beganton
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
| | - Guillaume Bonnet
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- European Hospital Georges Pompidou, Cardiology Department, Paris, France (N.K., W.B., A.S., G.B., C.S., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
| | - Daniel Jost
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
- Service Médical d’Urgence–Brigade de Sapeurs-Pompiers de Paris, France (D.J.)
| | - Lionel Lamhaut
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
- Service d’Aide Médicale Urgente de Paris, France (L.L.)
| | - Olivier Varenne
- Université Paris Descartes, France (N.K., L.P., F.D., W.B., A.S., O.V., C.S., A.C., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
- Département de Cardiologie, Hôpital Cochin, Paris, France (O.V.)
| | - Pierre Aubry
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
- Département de Cardiologie, Hôpital Bichat, Paris, France (P.A.)
| | - Georgios Sideris
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
- Département de Cardiologie, Hôpital Lariboisière, Paris, France (G.S.)
| | - Christian Spaulding
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Université Paris Descartes, France (N.K., L.P., F.D., W.B., A.S., O.V., C.S., A.C., E.M., X.J.)
- European Hospital Georges Pompidou, Cardiology Department, Paris, France (N.K., W.B., A.S., G.B., C.S., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
| | - Alain Cariou
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Université Paris Descartes, France (N.K., L.P., F.D., W.B., A.S., O.V., C.S., A.C., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
- Département de Réanimation Médicale, Hôpital Cochin, Paris, France (A.C.)
| | - Eloi Marijon
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Université Paris Descartes, France (N.K., L.P., F.D., W.B., A.S., O.V., C.S., A.C., E.M., X.J.)
- European Hospital Georges Pompidou, Cardiology Department, Paris, France (N.K., W.B., A.S., G.B., C.S., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
| | - Xavier Jouven
- Institut National de la Santé et de la Recherche Médicale Unit 970, Paris Cardiovascular Research Center, Paris (N.K., L.P., F.D., W.B., A.S., F.B., G.B., L.L., C.S., A.C., E.M., X.J.)
- Université Paris Descartes, France (N.K., L.P., F.D., W.B., A.S., O.V., C.S., A.C., E.M., X.J.)
- European Hospital Georges Pompidou, Cardiology Department, Paris, France (N.K., W.B., A.S., G.B., C.S., E.M., X.J.)
- Sudden Death Expertise Center, Paris, France (N.K., L.P., F.D., W.B., A.S., F.B., G.B., D.J., L.L., O.V., P.A., G.S., C.S., A.C., E.M., X.J.)
| |
Collapse
|
29
|
Laddu DR, Rana JS, Murillo R, Sorel ME, Quesenberry CP, Allen NB, Gabriel KP, Carnethon MR, Liu K, Reis JP, Lloyd-Jones D, Carr JJ, Sidney S. 25-Year Physical Activity Trajectories and Development of Subclinical Coronary Artery Disease as Measured by Coronary Artery Calcium: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Mayo Clin Proc 2017; 92:1660-1670. [PMID: 29050797 PMCID: PMC5679779 DOI: 10.1016/j.mayocp.2017.07.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate 25-year physical activity (PA) trajectories from young to middle age and assess associations with the prevalence of coronary artery calcification (CAC). PATIENTS AND METHODS This study includes 3175 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study who self-reported PA by questionnaire at 8 follow-up examinations over 25 years (from March 1985-June 1986 through June 2010-May 2011). The presence of CAC (CAC>0) at year 25 was measured using computed tomography. Group-based trajectory modeling was used to identify PA trajectories with increasing age. RESULTS We identified 3 distinct PA trajectories: trajectory 1, below PA guidelines (n=1813; 57.1%); trajectory 2, meeting PA guidelines (n=1094; 34.5%); and trajectory 3, 3 times PA guidelines (n=268; 8.4%). Trajectory 3 participants had higher adjusted odds of CAC>0 (adjusted odds ratio [OR], 1.27; 95% CI, 0.95-1.70) vs those in trajectory 1. Stratification by race showed that white participants who engaged in PA 3 times the guidelines had higher odds of developing CAC>0 (OR, 1.80; 95% CI, 1.21-2.67). Further stratification by sex showed higher odds for white males (OR, 1.86; 95% CI, 1.16-2.98), and similar but nonsignificant trends were noted for white females (OR, 1.71; 95% CI, 0.79-3.71). However, no such higher odds of CAC>0 for trajectory 3 were observed for black participants. CONCLUSION White individuals who participated in 3 times the recommended PA guidelines over 25 years had higher odds of developing coronary subclinical atherosclerosis by middle age. These findings warrant further exploration, especially by race, into possible biological mechanisms for CAC risk at very high levels of PA.
Collapse
Affiliation(s)
- Deepika R. Laddu
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL
| | - Jamal S. Rana
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- Division of Cardiology, Kaiser Permanente Northern California, Oakland, CA
| | - Rosenda Murillo
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX
| | - Michael E. Sorel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Norrina B. Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kelley P. Gabriel
- Department of Epidemiology, Human Genetics and Environmental Sciences. University of Texas Health Science Center at Houston, School of Public Health – Austin Campus, Austin, TX
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jared P. Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - J. Jeffrey Carr
- Departments of Radiology and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| |
Collapse
|
30
|
Baggish AL, Battle RW, Beckerman JG, Bove AA, Lampert RJ, Levine BD, Link MS, Martinez MW, Molossi SM, Salerno J, Wasfy MM, Weiner RB, Emery MS. Sports Cardiology. J Am Coll Cardiol 2017; 70:1902-1918. [DOI: 10.1016/j.jacc.2017.08.055] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 08/27/2017] [Indexed: 01/02/2023]
|