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Pavlovic A, DeFina LF, Leonard D, Radford NB, Farrell SW, Barlow CE, Shuval K, Berry JD, Levine BD. Coronary Artery Calcification and High-Volume Physical Activity: Role of Lower Intensity versus Longer Duration of Exercise. Eur J Prev Cardiol 2024:zwae150. [PMID: 38651686 DOI: 10.1093/eurjpc/zwae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
AIM While high-volume physical activity (PA) has been linked to elevated coronary artery calcification (CAC), the role of intensity versus duration of PA has not been investigated. The purpose of the study was to examine the role of intensity versus duration of PA in relation to CAC. METHODS Data are from 23,383 apparently healthy men who completed a PA questionnaire and underwent CAC scanning as part of a preventive exam. Self-reported PA was categorized into 4 groups of average intensity and weekly duration of PA and (average intensity: 1, 3-5.9, 6-8.9, and 9-12 metabolic equivalents of task [METs]; weekly duration: 0, > 0-<2, 2-<5, and ≥5 hours/week). Mean CAC and CAC ≥ 100 Agatston Units (AU) were regressed separately on continuous or categorical average intensity and weekly duration of PA. RESULTS The mean and standard deviation (SD) age was 51.7 (8.3) years, and mean CAC was 174.8 (543.6) AU with 23.5% of men presenting with CAC ≥ 100 AU. Higher average intensity of PA was related to lower mean CAC (-3.1%/MET, 95% confidence interval [CI]: -4.6, -1.6%/MET) and lower relative risk (RR) of CAC ≥ 100 AU (RR: 0.99, 95% CI: 0.98, 1.00/MET). Opposite trend was observed for the duration component wherein higher weekly duration of PA was significantly associated with greater mean CAC and RR of CAC ≥ 100 AU. CONCLUSIONS Elevated CAC was associated with lower average intensity and longer duration of PA in men, providing new insight into the complex relationship between leisure-time PA behaviors and risk of CAC.
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Affiliation(s)
| | - Laura F DeFina
- The Cooper Institute, 12330 Preston Rd., Dallas, TX 75230
| | - David Leonard
- The Cooper Institute, 12330 Preston Rd., Dallas, TX 75230
| | | | | | | | - Kerem Shuval
- The Cooper Institute, 12330 Preston Rd., Dallas, TX 75230
| | | | - Benjamin D Levine
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas
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Craig DW, Walker TJ, Sharma SV, Cuccaro P, Heredia NI, Pavlovic A, DeFina LF, Kohl HW, Fernandez ME. Examining associations between school-level determinants and the implementation of physical activity opportunities. Transl Behav Med 2024; 14:89-97. [PMID: 37713255 PMCID: PMC10849171 DOI: 10.1093/tbm/ibad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
School-based physical activity (PA) opportunities can help students engage in greater amounts of daily PA, meet PA guidelines, and lead to improved health and educational outcomes. However, we do not completely understand the organizational challenges to implementing these opportunities successfully. This exploratory study examined associations between school-level determinants and the implementation of school-based PA opportunities. We analyzed cross-sectional survey data from schools (n = 46) participating in the Healthy Zone School Program (HZSP) (Dallas, Texas, USA) during 2019-2020. Respondents completed an electronic survey that included measures of school-level determinants (e.g. culture, leadership, priority) and the implementation of school-based PA opportunities. We used linear regression models to examine associations between determinants and implementation outcomes (number of PA opportunities delivered, perceived overall success of each PA program/activity used). After adjusting for campus type (i.e. elementary, middle, high, K-12), student race/ethnicity, and percentage of economically disadvantaged students, no constructs were associated with the number of PA opportunities implemented. Linear regression models suggest access to knowledge and information (β = 0.39, P = .012, 95% CI = 0.24-1.44) and implementation climate (β = 0.34, P = .045, 95% CI = 0.02-1.59) were positively associated with the success of school-based PA opportunities. Our findings provide suggestive evidence that access to knowledge and information and a supportive school climate may improve the overall success of PA opportunities provided to students. Future research should examine additional school-level determinants to understand their importance to implementation and inform the development of strategies to improve schools' capacity for implementing PA opportunities successfully.
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Affiliation(s)
- Derek W Craig
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX 77030,USA
| | - Timothy J Walker
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX 77030,USA
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX 77030,USA
| | - Natalia I Heredia
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX 77030,USA
| | - Andjelka Pavlovic
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA
| | - Laura F DeFina
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA
| | - Harold W Kohl
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Boulevard, Austin, TX 78712, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe Street, Austin, TX 78701USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX 77030,USA
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Onadeko K, Walker TJ, Craig DW, Szeszulski J, Pavlovic A, DeFina LF, Kohl HW. Comparing the Use and Effectiveness of In-Person and Remote Physical Education Delivery During the COVID-19 Pandemic. Am J Health Educ 2024; 55:24-32. [PMID: 38264143 PMCID: PMC10803051 DOI: 10.1080/19325037.2023.2277945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/29/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Physical Education is a key component to improve youth health, but there is limited information on Physical Education delivery in different formats. PURPOSE We compared PE formats (in-person versus remote) across evaluation aspects: weekly minutes; perceived effectiveness; and student-to-teacher ratio. METHODS We distributed questionnaires (2020-2021 school year) to school contacts who represented NFL Play 60 FitnessGram® Project (n=216) schools in multiple US cities. Questionnaires entailed learning format, weekly PE minutes, perceived effectiveness, and student-to-teacher ratio. We used linear mixed models to compare PE formats across evaluation variables. RESULTS Among 165 schools, 10% (n=17) offered in-person instruction, 31% (n=51) offered remote instruction, and 59% offered both (n=97). Results revealed higher in-person PE minutes (77.2±7.3) compared to remote minutes (67.1±14.6), but results were not significantly different (p=0.19). School contacts reported significantly more effective in-person PE (4.0) than remote PE (2.8, p<0.001). In-person PE also had significantly smaller reported student-to-teacher ratio (16.7) compared to remote PE (23.7, p<0.001). DISCUSSION Findings indicate PE was offered during the pandemic, but remote learning appeared less effective than in-person PE. TRANSLATION to HEALTH EDUCATION PRACTICE Efforts are needed to improve remote PE to reinforce high-quality PE in the future.
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Affiliation(s)
- Kempson Onadeko
- The University of Texas Health Science Center at Houston School of Public Health
| | - Timothy J Walker
- The University of Texas Health Science Center at Houston School of Public Health
| | - Derek W Craig
- The University of Texas Health Science Center at Houston School of Public Health
| | | | | | | | - Harold W Kohl
- The University of Texas Health Science Center at Houston School of Public Health
- The University of Texas at Austin
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Li C, Palka JM, Abdullah N, Adler-Neal A, Banner B, Efseroff B, Jones C, Clark I, Munoz-Puga M, Boswell N, Karlay B, Siddiqui R, Hergert S, Newton S, Narapureddy S, Tran V, Leonard D, DeFina LF, Barlow CE, Brown ES. Link between depression and bone mineral density in Cooper Center Longitudinal Study: Indirect effects of vitamin D, inflammation, and physical activity. J Affect Disord 2024; 344:277-283. [PMID: 37827262 DOI: 10.1016/j.jad.2023.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND To examine the effect of depressive symptom severity on bone mineral density (BMD) and the potential mediators of the relationship. METHOD This study used data from n = 7273 participants in the Cooper Center Longitudinal Study at the Cooper Clinic in Dallas. Participants were included if they had data for all study variables, including left and right femoral neck (BMD), age, sex, body mass index, smoking status, antidepressant (SSRI/SNRI) use, standard alcoholic drinks consumed per week, and depressive symptom severity as measured with the Center for Epidemiological Studies-Depression (CESD)-10. To evaluate the effect of depressive symptoms on both L/R femur BMD, two multiple linear regression analyses were conducted. To examine effects of vitamin D, high sensitivity C-reactive protein (hs-CRP), and physical activity (MET units) on the relationship between depressive symptom severity and BMD, parallel mediation analyses were conducted. RESULTS Depressive symptom severity (CES-D 10 score) significantly predicted both L/R BMD (L: β = -0.048, R: β = -0.047, both p ≤ .001). Only physical activity significantly mediated the relationship between depressive symptom severity and L/R BMD (L: β = -0.008, 95 % CI [-0.011, -0.005]; R: β = -0.007, 95 % CI [-0.010, -0.005]). LIMITATIONS The sample may not be generalizable to all patient populations. CONCLUSION Depressive symptom severity was inversely related to both L/R femur BMD in a large cohort of relatively healthy adults. Physical activity, but not vitamin D or hs-CRP, mediated this relationship. Future research might examine the effect of physical activity interventions both on depression and BMD. IMPACT STATEMENT We certify that this work is both novel and confirmatory of recent clinical research (Lee et al., 2015; Amsterdam and Hooper, 1998; Hlis et al., 2018; Wainstein et al., 2016; Blair et al., 1989; Farrell et al., 2022; Ainsworth et al., 2011). We demonstrated a negative relationship between depression and BMD in a large cohort of adults and expanded on previous findings by demonstrating that physical activity acts as a mediator of this relationship. Physical activity is known to stimulate osteogenesis in osteoporotic patients, and this study further expands on its role in depressive symptoms in this population. KEY POINTS
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Affiliation(s)
- Chengxi Li
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jayme M Palka
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nora Abdullah
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adrienne Adler-Neal
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Barbara Banner
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brayden Efseroff
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Cassandra Jones
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Isabel Clark
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marisela Munoz-Puga
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nicholas Boswell
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brittany Karlay
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rija Siddiqui
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah Hergert
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott Newton
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sravan Narapureddy
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vincent Tran
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Gafni T, Weinstein G, Leonard D, Barlow CE, DeFina LF, Pettee Gabriel K, Berry JD, Shuval K. Independent and joint associations of cardiorespiratory fitness and BMI with dementia risk: the Cooper Center Longitudinal Study. BMJ Open 2023; 13:e075571. [PMID: 38086580 PMCID: PMC10729062 DOI: 10.1136/bmjopen-2023-075571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aimed to examine the association of midlife fitness and body mass index (BMI) with incident dementia later in life. DESIGN AND PARTICIPANTS A cohort study of 6428 individuals (mean age 50.9±7.6 years) from the Cooper Center Longitudinal Study. MEASURES Cardiorespiratory fitness and BMI were assessed twice (1970-1999) during visits to the Cooper Clinic, a preventive medicine clinic in Dallas, Texas. These measures were examined as continuous and categorical variables. As continuous variables, fitness and BMI were examined at baseline (averaged of two examinations) and as absolute change between exams (mean time 2.1±1.8 years). Variables were categorised: unfit versus fit and normal versus overweight/obese. Medicare claims data were used to obtain all-cause dementia incidence (1999-2009). Mean follow-up between midlife examinations and Medicare surveillance was 15.7 ((SD=6.2) years. Multivariable models were used to assess the associations between fitness, BMI and dementia. RESULTS During 40 773 person years of Medicare surveillance, 632 cases of dementia were identified. After controlling for BMI and covariates, each 1-metabolic equivalent increment in fitness was associated with 5% lower (HR 0.95; 95% CI 0.90 to 0.99) dementia risk. In comparison, after controlling for fitness and covariates, each 1 kg/m2 increment in BMI was associated with a 3.0% (HR 1.03; 95% CI 1.00 to 1.07) higher risk for dementia, yet without significance (p=0.051). Similar findings were observed when the exposures were categorised. Changes in fitness and BMI between examinations were not related to dementia. Jointly, participants who were unfit and overweight/obese had the highest (HR 2.28 95% CI 1.57 to 3.32) dementia risk compared with their fit and normal weight counterparts. CONCLUSION Lower midlife fitness is a risk marker for dementia irrespective of weight status. Being unfit coupled with overweight/obese status might increase one's risk for dementia even further.
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Affiliation(s)
- Tal Gafni
- Department of Epidemiology, University of Haifa, Haifa, Israel
| | - Galit Weinstein
- Department of Epidemiology, University of Haifa, Haifa, Israel
| | - David Leonard
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Carolyn E Barlow
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Laura F DeFina
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabam, USA
| | | | - Kerem Shuval
- Department of Research, The Cooper Institute, Dallas, Texas, USA
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Farrell SW, Leonard D, Li Q, Barlow CE, Shuval K, Berry JD, Pavlovic A, DeFina LF. Association between baseline levels of muscular strength and risk of stroke in later life: The Cooper Center Longitudinal Study. J Sport Health Sci 2023:S2095-2546(23)00101-1. [PMID: 37839524 DOI: 10.1016/j.jshs.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/22/2023] [Accepted: 09/16/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Muscular strength is an important component of physical fitness. We evaluated the relationship between baseline muscular strength and risk of stroke among adults who were aged ≥65 years during follow-up. METHODS 7627 healthy adults (mean age 43.9 years, 86.0% male) underwent a baseline physical examination between 1980 and 1989. Muscular strength was determined by 1-repetition maximum measures for bench press and leg press and categorized into age and sex-specific tertiles for each measure. Cardiorespiratory fitness (CRF) was assessed via a maximal treadmill exercise test. Those enrolled in fee-for-service Medicare from 1999 to 2019 were included in the analyses. Associations between baseline strength and stroke outcomes were estimated using a modified Cox proportional hazards model. In a secondary analysis, we examined stroke risk by categories of CRF where Quintile 1 = low, Quintiles 2-3 = moderate, and Quintiles 4-5 = high CRF based on age and sex. RESULTS After 70,072 person-years of Medicare follow-up, there were 1211 earliest indications of incident stroke. In multivariable analyses, the hazard ratio (HR) (95% confidence interval (95%CI)) for stroke across bench press categories were 1.0 (referent), 0.96 (0.83-1.11), and 0.89 (0.77-1.04), respectively (p trend = 0.14). The trend across categories of leg press was also non-significant (p trend = 0.79). Adjusted HR (95%CI) for stroke across ordered CRF categories were 1.0 (referent), 0.90 (0.71-1.13), and 0.72 (0.57-0.92) (p trend < 0.01). CONCLUSION While meeting public health guidelines for muscular strengthening activities is likely to improve muscular strength as well as many health outcomes in older adults, performing such activities may not be helpful in preventing stroke. Conversely, meeting guidelines for aerobic activity is likely to improve CRF and lower stroke risk.
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Affiliation(s)
| | - David Leonard
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
| | - Qing Li
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
| | | | - Kerem Shuval
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
| | - Jarett D Berry
- Department of Internal Medicine, University of Texas at Tyler School of Medicine, Tyler, TX 75799, USA
| | | | - Laura F DeFina
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
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7
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Doughty KN, Blazek J, Leonard D, Barlow CE, DeFina LF, Omree Shuval, Farrell SW, Shuval K. Omega-3 index, cardiorespiratory fitness, and cognitive function in mid-age and older adults. Prev Med Rep 2023; 35:102364. [PMID: 37601829 PMCID: PMC10432782 DOI: 10.1016/j.pmedr.2023.102364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023] Open
Abstract
Higher levels of omega-3 fatty acids in red blood cell membranes (omega-3 index or O3I) and cardiorespiratory fitness (CRF) are each associated with reduced cognitive impairment, but little research has examined the relationship between O3I and cognitive function while accounting for CRF. We analyzed cross-sectional data from 5,464 healthy men and women aged 55-85 years who had preventive medical examinations between 2009 and 2023. Primary exposures included O3I (<4.0%, 4.0-7.9%, or ≥ 8.0%) and age- and sex-based CRF quintile (1 = low, 2-3 = moderate, 4-5 = high). Cognitive impairment was defined as a Montreal Cognitive Assessment score of ≤ 25. We used Poisson regression to estimate relative risks (RR) of cognitive impairment, controlling for covariates. O3I < 4% was associated with increased cognitive impairment relative to ≥ 8.0% (RR, 1.21; 95% CI, 1.01-1.44) in a partially adjusted model. This association did not remain statistically significant in the fully adjusted model which included CRF. Low versus high CRF was associated with cognitive impairment (RR, 1.28; 95% CI, 1.07-1.53), independent of O3I and clinical biomarkers. The interaction between CRF and O3I was not significant (P = 0.8). In joint association analysis, risk of cognitive impairment was elevated with lower omega-3 index or CRF or both. Additional research is needed to fully understand the association between O3I and cognitive function at varying CRF levels.
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Affiliation(s)
- Kimberly N. Doughty
- Marion Peckham Egan School of Nursing & Health Studies, Fairfield University, Fairfield, CT, USA
| | - Juliana Blazek
- Department of Research, The Cooper Institute, Dallas, TX, USA
| | - David Leonard
- Department of Research, The Cooper Institute, Dallas, TX, USA
| | | | - Laura F. DeFina
- Department of Research, The Cooper Institute, Dallas, TX, USA
| | | | | | - Kerem Shuval
- Department of Research, The Cooper Institute, Dallas, TX, USA
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Farrell SW, Leonard D, Barlow CE, Shuval K, Pavlovic A, Cooper KH, DeFina LF. Associations among cardiorespiratory fitness, C-reactive protein, and all-cause mortality in men and women. J Investig Med 2023; 71:372-379. [PMID: 36692144 DOI: 10.1177/10815589221149190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We examined individual and joint associations among high-sensitivity C-reactive protein (CRP), cardiorespiratory fitness (fitness), and mortality in healthy men and women. Between January 1, 2000 and December 31, 2016, 30,077 adults (31.3% women) received a comprehensive physical examination. Fitness was determined from maximal treadmill exercise test duration. Participants were categorized as unfit (Quintile 1) and fit (Quintiles 2-5), and by normal (<2 mg/L) and elevated (≥2 mg/L) CRP categories. Adjusted hazard ratios (HRs) with 95% confidence interval (CI) for all-cause mortality were computed with Cox regression. During an average of 10.1 years of follow-up, 576 deaths occurred. Following adjustment for age, smoking status, sex, exam year, body mass index, systolic blood pressure, total cholesterol, triglyceride:high-density lipoprotein ratio, and fasting glucose, HR (95% CI) for all-cause mortality were 1.0 (referent) and 1.52 (1.14-2.02) for fit and unfit categories, respectively. Corresponding values for normal and elevated CRP categories were 1.0 and 1.50 (1.20-1.89), respectively. When grouped by fitness and CRP category, there was significantly greater mortality risk in the unfit than the fit category within the elevated CRP category (HR = 1.77 (1.14-2.75)), but not in the normal CRP category (HR = 1.38 (0.96-1.98)). Each 1 metabolic equivalent increment in fitness and 1 mg/L increment in CRP were associated with 10.0% (95% CI: 5.1-14.8%) decreased and 7.3% (95% CI: 2.0%-12.9%) increased mortality hazard, respectively. Compared to the unfit, fit individuals have an attenuated mortality risk within each CRP category. Thus, higher fitness appears to provide some protection against all-cause mortality, particularly among those with elevated levels of inflammation.
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Farrell SW, Leonard D, Shuval K, Barlow CE, DeFina LF, Pavlovic A, Haskell WL. Cardiorespiratory Fitness and All-Cause Mortality in Women with Metabolic Syndrome. Metab Syndr Relat Disord 2023; 21:148-155. [PMID: 36856601 DOI: 10.1089/met.2022.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Purpose: To examine the association between cardiorespiratory fitness (fitness) and all-cause mortality in women with metabolic syndrome (MetSyn). Methods: The sample included 1798 women with MetSyn (mean age 50.2 years) who received a comprehensive preventive baseline examination between 1978 and 2016, with mortality follow-up through December 31, 2017. MetSyn was identified using Adult Treatment Panel-III Guidelines. Fitness was determined by duration of a maximal treadmill exercise test and grouped as fit or unfit on the basis of the upper 80% and lower 20% of the age-standardized fitness distribution. Age- and smoking-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated in a proportional hazards regression model. Results: During a mean follow-up of 16.6 ± 8.7 years, 204 deaths occurred. Crude all-cause mortality rates were 6.8 and 6.9 deaths per 10,000 woman-years in fit and unfit groups, respectively. The adjusted HR (95% CI) for all-cause mortality in unfit versus fit women (referent) with MetSyn was 1.36 (95% CI 1.01-1.83). Conclusions: Higher levels of fitness significantly attenuate the risk of all-cause mortality in women with MetSyn. In accordance with the American Heart Association scientific statement, to more accurately determine mortality risk in this population, health care professionals should measure or estimate fitness and should strongly encourage women to meet current public health guidelines for physical activity with the goal of reaching higher fitness levels.
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Affiliation(s)
| | - David Leonard
- Research Division, The Cooper Institute, Dallas, Texas, USA
| | - Kerem Shuval
- Research Division, The Cooper Institute, Dallas, Texas, USA
| | | | - Laura F DeFina
- Research Division, The Cooper Institute, Dallas, Texas, USA
| | | | - William L Haskell
- Department of Medicine, Stanford University, Palo Alto, California, USA
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10
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Shuval K, Qadan M, Leonard D, Barlow CE, Drope J, DiPietro L, Oetjen R, Li Q, DeFina LF. Pandemic-Related Life Events and Physical Inactivity During COVID-19 Among Israeli Adults: The Smoking and Lifestyles in Israel Study. J Phys Act Health 2023; 20:45-49. [PMID: 36379212 DOI: 10.1123/jpah.2022-0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/31/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public health measures to contain the COVID-19 pandemic have led to disruptions in daily life, such as job loss and changes in activity. The present study examines the relationship between pandemic-related life events and disuse (prolonged sitting coupled with inactivity) among adults. METHODS A cross-sectional study of 4084 adults in Israel (September 2020). The primary independent variables were pandemic-related life events, such as job loss. The primary dependent variable was disuse as measured by the Rapid Assessment Disuse Index (RADI). The RADI was examined continuously and dichotomously as a low RADI score (<26: yes/no). RESULTS Linear regression indicated that experiencing a major life event during the pandemic was associated with lower RADI scores (-1.04; 95% confidence interval, -1.48 to -0.61). Similarly, logistic regression revealed that those experiencing a major life event had 1.18 (95% confidence interval, 1.03 to 1.34) times greater odds for low RADI scores in comparison to those not experiencing an event. CONCLUSIONS Experiencing pandemic-related major life events was linked to less sitting time and increased activity levels among Israeli adults. Future research should examine underlying mechanisms explaining this relationship to facilitate the design and implementation of targeted interventions.
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Affiliation(s)
- Kerem Shuval
- Department of Research, The Cooper Institute, Dallas, TX, USA
| | - Mahmoud Qadan
- Faculty of Social Sciences, School of Business Administration, University of Haifa, Haifa, Israel
| | - David Leonard
- Department of Research, The Cooper Institute, Dallas, TX, USA
| | | | - Jeffrey Drope
- Health Policy & Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Reid Oetjen
- School of Global Health Management and Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, FL, USA
| | - Qing Li
- Department of Research, The Cooper Institute, Dallas, TX, USA
| | - Laura F DeFina
- Department of Research, The Cooper Institute, Dallas, TX, USA
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11
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Gafni T, Weinstein G, David L, Carolyn BE, DeFina LF, Gabriel KP, Berry JD, Shuval K. Cardiorespiratory Fitness, BMI, and Dementia risk: Findings from The Cooper Center Longitudinal Study. Alzheimers Dement 2022. [DOI: 10.1002/alz.067490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | - Jarett D Berry
- University of Texas Southwestern Medical Center Dallas TX USA
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12
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Shuval K, Leonard D, DeFina LF, Barlow CE, Drope J, Amir O, Gneezy A, Tzafrir S, Chartier KG, Qadan M. Cardiorespiratory Fitness and Depression Symptoms among Adults During the COVID-19 Pandemic: Cooper Center Longitudinal Study. Prev Med Rep 2022; 30:102065. [PMCID: PMC9677558 DOI: 10.1016/j.pmedr.2022.102065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/31/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
This study examined the relation between cardiorespiratory fitness (fitness) and depression symptoms prior to and during COVID-19 among adults seeking preventive medical care. Participants consisted of 967 patients attending the Cooper Clinic (Dallas, TX) pre-pandemic (March 2018-December 2019) and during the pandemic (March-December 2020). The outcome, depression symptoms, was based on the Center for Epidemiological Studies-Depression (CES-D). Maximal metabolic equivalents task (MET) levels for fitness were determined from the final treadmill speed and grade. Multiple linear regression models were computed by sex. Analysis revealed that mean fitness decreased from 11.4 METs (SD=2.1) prior to the pandemic to 10.9 METs (SD=2.3) during the pandemic (p-value<0.001). The mean CES-D score increased from 2.8 (SD= 3.1) before to pandemic to 3.1 (SD=3.2) during the pandemic (p-value=0.003). Results from multiple linear regression indicate that increased fitness was associated with a statistically significant decrease in depression scores in men (-0.17 per MET; 95%CI -0.33, -0.02) but not women. This modest decrease may have been tempered by high fitness levels and low depression scores at baseline in this well-educated sample.
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Affiliation(s)
- Kerem Shuval
- The Cooper Institute, Dallas, Texas 75230, USA,School of Business Administration, University of Haifa, Haifa 3498838, Israel,School of Public Health, University of Haifa, Haifa 3498838, Israel,Corresponding author
| | | | | | | | - Jeffrey Drope
- Health Policy & Administration, School of Public Health, University of Illinois at Chicago, Illinois, USA
| | - On Amir
- Rady School of Management, University of California San Diego, CA, USA
| | - Ayelet Gneezy
- Rady School of Management, University of California San Diego, CA, USA
| | - Shay Tzafrir
- School of Business Administration, University of Haifa, Haifa 3498838, Israel
| | - Karen G. Chartier
- School of Social Work and Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Mahmoud Qadan
- School of Business Administration, University of Haifa, Haifa 3498838, Israel
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13
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Farrell SW, Leonard D, Shuval K, Barlow CE, DeFina LF, Pavlovic A, Haskell WL. Is There A Gradient Of Mortality Risk Among Low Fit Women? Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000882276.27043.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Pavlovic A, Farrell SW, Leonard D, Shuval K, Barlow CE, DeFina LF. Handgrip Strength And Cognitive Impairment In Midlife And Older Adults: Cooper Center Longitudinal Study (CCLS). Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000878704.12357.d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Farrell SW, Leonard D, Shuval K, DeFina LF, Barlow CE, Pavlovic A, Haskell WL. Cardiorespiratory fitness, white blood cell count, and mortality in men and women. J Sport Health Sci 2022; 11:605-612. [PMID: 34740872 PMCID: PMC9532609 DOI: 10.1016/j.jshs.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND We examined the associations of cardiorespiratory fitness (CRF) and white blood cell count (WBC) with mortality outcomes. METHODS A total of 52,056 apparently healthy adults completed a comprehensive health examination, including a maximal treadmill test and blood chemistry analyses. CRF was categorized as high, moderate, or low by age and sex; WBC was categorized as sex-specific quartiles. RESULTS During 17.8 ± 9.5 years (mean ± SD) of follow-up, a total of 4088 deaths occurred. When regressed jointly, significantly decreased all-cause mortality across CRF categories was observed within each quartile of WBC in men. Within WBC Quartile 1, all-cause mortality hazard ratios (HRs) with a 95% confidence interval (95%CI) were 1.0 (referent), 1.29 (95%CI: 1.06‒1.57), and 2.03 (95%CI: 1.42‒2.92) for high, moderate, and low CRF categories, respectively (p for trend < 0.001). Similar trends were observed in the remaining 3 quartiles. With the exception of cardiovascular disease (CVD) mortality within Quartile 1 (p for trend = 0.743), there were also similar trends across CRF categories within WBC quartiles in men for both CVD and cancer mortality (p for trend < 0.01 for all). For women, there were no significant trends across CRF categories for mortality outcomes within Quartiles 1-3. However, we observed significantly decreased all-cause mortality across CRF categories within WBC Quartile 4 (HR = 1.05 (95%CI: 0.76‒1.44), HR = 1.63 (95%CI:1.20‒2.21), and HR = 1.87 (95%CI:1.29‒2.69) for high, moderate, and low CRF, respectively (p for trend = 0.002)). Similar trends in women were observed for CVD and cancer mortality within WBC Quartile 4 only. CONCLUSION There are strong joint associations between CRF, WBC, and all-cause, CVD, and cancer mortality in men; these associations are less consistent in women.
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Affiliation(s)
| | - David Leonard
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
| | - Kerem Shuval
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
| | - Laura F DeFina
- Research Division, The Cooper Institute, Dallas, TX 75230, USA
| | | | | | - William L Haskell
- Department of Medicine, Stanford University, Palo Alto, CA 94305, USA
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16
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Farrell SW, Leonard D, Barlow CE, Shuval K, Pavlovic A, DeFina LF. Examining the Gradient of All-Cause Mortality Risk in Women across the Cardiorespiratory Fitness Continuum. Med Sci Sports Exerc 2022; 54:1904-1910. [DOI: 10.1249/mss.0000000000002988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Charvat JM, Leonard D, Barlow CE, DeFina LF, Willis BL, Lee SMC, Stenger MB, Mercaldo SF, Van Baalen M. Long-term Cardiovascular Risk in Astronauts: Comparing NASA Mission Astronauts With a Healthy Cohort From the Cooper Center Longitudinal Study. Mayo Clin Proc 2022; 97:1237-1246. [PMID: 35787853 DOI: 10.1016/j.mayocp.2022.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the long-term cardiovascular disease risk of astronauts with spaceflight exposure compared with a well-matched cohort. METHODS National Aeronautics and Space Administration (NASA) astronauts are selected into their profession based upon education, unique skills, and health and are exposed to cardiovascular disease risk factors during spaceflight. The Cooper Center Longitudinal Study (CCLS) is a generally healthy cohort from a preventive medicine clinic in Dallas, Texas. Using a matched cohort design, astronauts who were selected beginning April 1, 1959, (and each subsequent selection class through 2009) and exposed to spaceflight were matched to CCLS participants who met astronaut selection criteria; 1514 CCLS participants matched to 303 astronauts in a 5-to-1 ratio on sex, date of birth, and age. The outcome of cardiovascular mortality through December 31, 2016, was determined by death certificate or National Death Index. RESULTS There were 11 deaths caused by cardiovascular disease (CVD) among astronauts and 46 among CCLS participants. There was no evidence of increased mortality risk in astronauts (hazard ratio [HR]=1.10; 95% confidence interval [CI], 0.50 to 2.45) with adjustment for baseline cardiovascular covariates. However, the secondary outcome of CVD events showed an increased adjusted risk in astronauts (HR=2.41; 95% CI, 1.26 to 4.63). CONCLUSION No increased risk of CVD mortality was observed in astronauts with spaceflight exposure compared with a well-matched cohort, but there was evidence of increased total CVD events. Given that the duration of spaceflight will increase, particularly on missions to Mars, continued surveillance and mitigation of CVD risk is needed to ensure the safety of those who venture into space.
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Affiliation(s)
| | | | | | | | | | - Stuart M C Lee
- JSC Cardiovascular and Vision Laboratory, KBR, Houston, Texas, USA
| | | | - Sarah F Mercaldo
- Lifetime Surveillance of Astronaut Health, KBR, Houston, Texas, USA
| | - Mary Van Baalen
- National Aeronautics and Space Administration, Houston, Texas, USA
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18
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Schuchardt JP, Cerrato M, Ceseri M, DeFina LF, Delgado GE, Gellert S, Hahn A, Howard BV, Kadota A, Kleber ME, Latini R, Maerz W, Manson JE, Mora S, Park Y, Sala-Vila A, von Schacky C, Sekikawa A, Tintle N, Tucker KL, Vasan RS, Harris WS. Red blood cell fatty acid patterns from 7 countries: Focus on the Omega-3 index. Prostaglandins Leukot Essent Fatty Acids 2022; 179:102418. [PMID: 35366625 PMCID: PMC10440636 DOI: 10.1016/j.plefa.2022.102418] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Red blood cell (RBC) fatty acid (FA) patterns are becoming recognized as long-term biomarkers of tissue FA composition, but different analytical methods have complicated inter-study and international comparisons. Here we report RBC FA data, with a focus on the Omega-3 Index (EPA + DHA in% of total FAs in RBC), from samples of seven countries (USA, Canada, Italy, Spain, Germany, South Korea, and Japan) including 167,347 individuals (93% of all samples were from the US). FA data were generated by a uniform methodology from a variety of interventional and observational studies and from clinical laboratories. The cohorts differed in size, demographics, health status, and year of collection. Only the Canadian cohort was a formal, representative population-based survey. The mean Omega-3 Index of each country was categorized as desirable (>8%), moderate (>6% to 8%), low (>4% to 6%), or very low (≤4%). Only cohorts from Alaska (treated separately from the US), South Korea and Japan showed a desirable Omega-3 Index. The Spanish cohort had a moderate Omega-3 Index, while cohorts from the US, Canada, Italy, and Germany were all classified as low. This study is limited by the use of cohorts of convenience and small sample sizes in some countries. Countries undertaking national health status studies should utilize a uniform method to measure Omega-3 FA levels.
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Affiliation(s)
- Jan Philipp Schuchardt
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Am Kleinen Felde 30, Hannover 30167, Germany; The Fatty Acid Research Institute, Sioux Falls, SD, USA.
| | - Marianna Cerrato
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Martina Ceseri
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Graciela E Delgado
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sandra Gellert
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Am Kleinen Felde 30, Hannover 30167, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Am Kleinen Felde 30, Hannover 30167, Germany
| | | | - Aya Kadota
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Marcus E Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; SYNLAB MVZ Humangenetik Mannheim, Mannheim, Germany
| | - Roberto Latini
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Winfried Maerz
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Medical Clinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; SYNLAB Academy, Mannheim, Germany
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samia Mora
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yongsoon Park
- The Fatty Acid Research Institute, Sioux Falls, SD, USA; Department of Food and Nutrition, Hanyang University, Seoul, South Korea
| | - Aleix Sala-Vila
- The Fatty Acid Research Institute, Sioux Falls, SD, USA; Cardiovascular risk and nutrition group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Akira Sekikawa
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nathan Tintle
- The Fatty Acid Research Institute, Sioux Falls, SD, USA; Department of Population Health Nursing Science, College of Nursing, University of Illinois - Chicago, Chicago, IL, USA
| | - Katherine L Tucker
- Department of Biomedical Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Ramachandran S Vasan
- Department of Medicine, Preventive Medicine & Epidemiology, School of Medicine, Boston University, Boston, MA, USA
| | - William S Harris
- The Fatty Acid Research Institute, Sioux Falls, SD, USA; Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
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19
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Walker TJ, Craig DW, Pavlovic A, Thiele S, Natale B, Szeszulski J, DeFina LF, Kohl HW. Physical Activity and Healthy Eating Programming in Schools to Support Student's Health-Related Fitness: An Observational Study. Int J Environ Res Public Health 2021; 18:ijerph182111069. [PMID: 34769588 PMCID: PMC8583401 DOI: 10.3390/ijerph182111069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022]
Abstract
Centers for Disease Control (CDC) guidelines recommend schools use a coordinated health approach to support healthy eating and physical activity. This study examines whether the number of healthy eating and physical activity programs and activities used by schools and their perceived success relate to students’ health-related fitness. This observational study used data from the Healthy Zone Schools Program. Data (collected in 2017–2019) were integrated from three sources: (1) school surveys, (2) FitnessGram®, and (3) the Texas Education Agency. Independent variables were the number of health promotion programs and activities and their perceived success; dependent variables were meeting Healthy Fitness Zone Standards (HFZ) for aerobic capacity and body mass index (BMI). We used mixed-effects logistic regression models. Fifty-six schools were in the analytic sample (n = 15,096 students with aerobic capacity data and n = 19,969 with BMI data). Results indicated the perceived success of physical activity programs/activities was significantly associated with students meeting HFZ standards for aerobic capacity (OR = 1.32, CI = 1.06–1.63). There was a significant direct association between the number of physical activity and healthy eating activities implemented (OR = 1.04, CI = 1.01–1.06) and students meeting HFZ for BMI. Schools using multiple health programs and activities need to balance the number provided with their capacity to maintain success.
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Affiliation(s)
- Timothy J. Walker
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030, USA; (D.W.C.); (J.S.)
- Correspondence:
| | - Derek W. Craig
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030, USA; (D.W.C.); (J.S.)
| | - Andjelka Pavlovic
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA; (A.P.); (S.T.); (B.N.); (L.F.D.)
| | - Shelby Thiele
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA; (A.P.); (S.T.); (B.N.); (L.F.D.)
| | - Breanna Natale
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA; (A.P.); (S.T.); (B.N.); (L.F.D.)
| | - Jacob Szeszulski
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030, USA; (D.W.C.); (J.S.)
| | - Laura F. DeFina
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA; (A.P.); (S.T.); (B.N.); (L.F.D.)
| | - Harold W. Kohl
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Austin Regional Campus, Austin, TX 78701, USA;
- Department of Kinesiology and Health Education, The University of Texas at Austin, 1616 Guadalupe, Austin, TX 78701, USA
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Shuval K, Stoklosa M, Nargis N, Drope J, Tzafrir S, Keinan-Boker L, DeFina LF, Qadan M. Cigarette Prices and Smoking Behavior in Israel: Findings from a National Study of Adults (2002-2017). Int J Environ Res Public Health 2021; 18:ijerph18168367. [PMID: 34444117 PMCID: PMC8394522 DOI: 10.3390/ijerph18168367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
Tobacco taxation and price policies are considered the most effective for lowering demand for tobacco products. While this statement is based on research from numerous countries, scant evidence exists on this topic for Israel. Accordingly, we assessed the association between cigarette prices and smoking prevalence and intensity from a national sample of adults in Israel (2002-2017). Data on smoking behavior were derived from the Israeli Knowledge Attitudes and Practices (KAP) survey, a repeated cross-sectional survey. Price information is from the Economist Intelligence Unit (EIU) since it was not collected in the KAP survey. We used the price of a pack of 20 cigarettes for Marlboro and the local brand. These two price variables were the primary independent variables, and we adjusted for inflation. The dependent variables were current smoking (yes/no) and smoking intensity, defined as the number of cigarettes smoked per week. Multivariable analysis was employed using a two-part model while adjusting for covariates. The first step of the model utilized logistic regression with current smoking as the dependent variable. The second step examining smoking intensity as the dependent variable, used OLS regression. Price elasticity was estimated as well. Analysis revealed that a one-unit increase (Israeli currency) in the price of local brand of cigarettes was related to 2.0% (OR = 0.98; 95%CI 0.98, 0.99) lower odds of being a current smoker, adjusting for covariates including household income. Moreover, a one unit increase in the price of the local brand of cigarettes was related to consuming 1.49 (95% CI -1.97, -1.00) fewer weekly cigarettes, controlling for household income and covariates. Similar results were found with the Marlboro cigarette prices. The total price elasticity of cigarette demand, given by the sum of price elasticities of smoking prevalence and intensity, showed that a 10.0% increase in the price is associated with a 4.6-9.2% lower cigarette consumption among Israeli adults. Thus, increasing cigarette prices will likely lead to a reduction in cigarette smoking thereby improving public health in Israel.
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Affiliation(s)
- Kerem Shuval
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa 3498838, Israel; (S.T.); (M.Q.)
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel;
- The Cooper Institute, Dallas, TX 75230, USA;
- Correspondence:
| | - Michal Stoklosa
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608, USA;
| | - Nigar Nargis
- Economic and Health Policy Research, American Cancer Society, Atlanta, GA 30303, USA;
| | - Jeffrey Drope
- Health Policy & Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL 60608, USA;
| | - Shay Tzafrir
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa 3498838, Israel; (S.T.); (M.Q.)
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel;
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Ramat Gan 5262160, Israel
| | | | - Mahmoud Qadan
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa 3498838, Israel; (S.T.); (M.Q.)
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21
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Pavlovic A, DeFina LF, Natale BL, Thiele SE, Walker TJ, Craig DW, Vint GR, Leonard D, Haskell WL, Kohl HW. Keeping children healthy during and after COVID-19 pandemic: meeting youth physical activity needs. BMC Public Health 2021; 21:485. [PMID: 33706744 PMCID: PMC7948663 DOI: 10.1186/s12889-021-10545-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to: 1) examine the maintenance of Physical Education and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curricula, and 3) understand the challenges experienced by educators during distance learning. Methods A survey was sent to a cohort of school-based fitness assessment software users. Respondents were largely school-based individuals including PE teachers (n = 1789), school (n = 62) and district administrators (n = 64), nurses (n = 3), and “other” (n = 522). Results Of 2440 respondents, most were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status (60.4%), an indicator of low socioeconomic status. Most campuses were closed during the COVID-19 pandemic (97.8%). Of the schools closed during the pandemic, only 2.8% had no prior PE requirements and that increased to 21% during the pandemic. In schools that remained open during the pandemic, 7.7% had no prior PE requirements and this increased to 60.5%. Importantly, 79% of respondents reported that students were either “significantly less” or “somewhat less” physically active during the closure. For closed schools, the most frequently cited challenges included “student access to online learning“, “teacher/student communication” and “teacher remote work arrangements”. For open schools, the most commonly reported challenges included “social distancing”, “access to gymnasium/equipment”, and “concern for personal health and wellbeing”. Conclusion The COVID-19 pandemic has caused important reductions in PE requirements and time engaged in physical activity. Challenges experienced by teachers were identified for closed and open schools. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10545-x.
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Affiliation(s)
| | - Laura F DeFina
- The Cooper Institute, 12330 Preston Road, Dallas, TX, 75230, USA
| | - Breanna L Natale
- The Cooper Institute, 12330 Preston Road, Dallas, TX, 75230, USA
| | - Shelby E Thiele
- The Cooper Institute, 12330 Preston Road, Dallas, TX, 75230, USA
| | - Timothy J Walker
- Univeristy of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Derek W Craig
- Univeristy of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Georgina R Vint
- The Cooper Institute, 12330 Preston Road, Dallas, TX, 75230, USA
| | - David Leonard
- The Cooper Institute, 12330 Preston Road, Dallas, TX, 75230, USA
| | - William L Haskell
- Department of Cardiovascular Medicine, Stanford University, Palo Alto, California, USA
| | - Harold W Kohl
- Univeristy of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.,University of Texas at Austin, Austin, TX, USA
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22
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Willis BL, Radford NB, Barlow CE, Leonard D, Franklin BA, DeFina LF. Divergent association of high levels of physical activity with cardiac versus noncardiac arterial calcification. Am Heart J 2021; 233:10-13. [PMID: 33245904 DOI: 10.1016/j.ahj.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022]
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23
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Farrell SW, DeFina LF, Tintle NL, Leonard D, Cooper KH, Barlow CE, Haskell WL, Pavlovic A, Harris WS. Association of the Omega-3 Index with Incident Prostate Cancer with Updated Meta-Analysis: The Cooper Center Longitudinal Study. Nutrients 2021; 13:nu13020384. [PMID: 33530576 PMCID: PMC7912448 DOI: 10.3390/nu13020384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background: The association between long-chain omega-3 polyunsaturated fatty acids (n-3 PUFA) and prostate cancer (PC) remains unclear. Methods: We compared incident PC rates as a function of the Omega-3 Index [O3I, erythrocyte eicosapentaenoic and docosahexaenoic acids (EPA + DHA)] in 5607 men (40–80 years of age) seen at the Cooper Clinic who were free of PC at baseline. The average follow-up was 5.1 ± 2.8 years until censoring or reporting a new PC diagnosis. Proportional hazards regression was used to model the linear association between baseline O3I and the age-adjusted time to diagnosis. A meta-analysis of n-3 PUFA biomarker-based studies and incident PC was updated with the present findings. Results: A total of 116 cases of incident PC were identified. When O3I was examined as a continuous variable, the age-adjusted hazard ratio (HR) (95% CI) was 0.98 (0.89, 1.07; p = 0.25) for each 1% increment in the O3I. The updated meta-analysis with 10 biomarker-based studies found no significant relationship between EPA or DHA levels and risk for PC. Conclusions: We find no evidence in this study nor in a meta-analysis of similar studies that consuming n-3 PUFA-rich fish or using fish oil supplements affects the risk of PC.
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Affiliation(s)
- Stephen W. Farrell
- The Cooper Institute, Dallas, TX 75230, USA; (S.W.F.); (L.F.D.); (D.L.); (C.E.B.); (A.P.)
| | - Laura F. DeFina
- The Cooper Institute, Dallas, TX 75230, USA; (S.W.F.); (L.F.D.); (D.L.); (C.E.B.); (A.P.)
| | - Nathan L. Tintle
- Fatty Acid Research Institute, Sioux Falls, SD 57106, USA;
- Department of Mathematics & Statistics, Dordt University, Sioux Center, IA 51250, USA
| | - David Leonard
- The Cooper Institute, Dallas, TX 75230, USA; (S.W.F.); (L.F.D.); (D.L.); (C.E.B.); (A.P.)
| | | | - Carolyn E. Barlow
- The Cooper Institute, Dallas, TX 75230, USA; (S.W.F.); (L.F.D.); (D.L.); (C.E.B.); (A.P.)
| | | | - Andjelka Pavlovic
- The Cooper Institute, Dallas, TX 75230, USA; (S.W.F.); (L.F.D.); (D.L.); (C.E.B.); (A.P.)
| | - William S. Harris
- Fatty Acid Research Institute, Sioux Falls, SD 57106, USA;
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
- Correspondence:
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Harris WS, Leonard D, Radford NB, Barlow CE, Steele MR, Farrell SW, Pavlovic A, Willis BL, DeFina LF. Increases in erythrocyte DHA are not associated with increases in LDL-cholesterol: Cooper center longitudinal study. J Clin Lipidol 2020; 15:212-217. [PMID: 33339757 DOI: 10.1016/j.jacl.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/03/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The effects of fish oil products containing docosahexaenoic acid (DHA) on LDL-C levels are controversial. OBJECTIVE To determine if changes in erythrocyte DHA are associated with changes in LDL-C levels. METHODS In this prospective observational study, erythrocyte DHA levels and LDL-C levels were measured in 9253 individuals who presented for at least two examinations at a medical clinic. Changes in DHA levels and the reported use of omega-3 dietary supplements were correlated with changes in LDL-C in multi-variable adjusted models including the use of LDL-C-lowering drugs. RESULTS Mean (standard deviation) age at baseline was 52.6 (10.6) years, and the time between exams averaged 1.9 (1.4) years. As a group, erythrocyte DHA increased from 5.0% (1.3) to 5.3% (1.3) (p < 0.001), and LDL-C was not significantly changed (109 (33) to 108 (33) mg/dL, p = 0.875). However, in multivariable-adjusted models of within-participant changes, a 1% increase in erythrocyte DHA was associated with a 1.9 mg/dL reduction in LDL-C (95% confidence interval (1.6, 2.2), p < 0.001). Similar relationships were seen with changes in erythrocyte EPA and EPA + DHA. In adjusted analyses, an increased use of omega-3 supplements was associated with a significant increase in erythrocyte DHA and a decrease in LDL-C in both users and non-users of lipid-lowering drugs. CONCLUSIONS In a predominantly male, normolipidemic, middle-aged cohort, increases in erythrocyte DHA were associated with decreases in LDL-C, and initiating fish oil supplement use did not increase LDL-C. These findings may serve to reassure individuals who, in adopting a more heart-healthy lifestyle, want to increase their omega-3 fatty acid intake.
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Affiliation(s)
- William S Harris
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, the Fatty Acid Research Institute, Sioux Falls, SD, USA.
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Farrell SW, DeFina LF, Tintle N, Barlow CE, Leonard D, Haskell WL, Berry JD, Willis BL, Pavlovic A, Harris WS. Higher omega-3 index is associated with more rapid heart rate recovery in healthy men and women. Prostaglandins Leukot Essent Fatty Acids 2020; 163:102206. [PMID: 33227647 DOI: 10.1016/j.plefa.2020.102206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/07/2020] [Accepted: 11/07/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Previous studies have suggested that omega-3 polyunsaturated fatty acids (n-3 PUFA) can favorably influence cardiac autonomic tone. However, data regarding n-3 PUFA status and heart rate recovery (HRR) in healthy adults are sparse. PURPOSE To examine the association between n-3 PUFA status and HRR. METHODS Participants included 13,912 patients who underwent a comprehensive examination at the Cooper Clinic, Dallas TX. Fitness was determined from a maximal exercise test. HRR was calculated by subtracting the heart rate at 1, 3, and 5 min of an active recovery period from the maximal heart rate. Participants were categorized as having a low (<4%), normal (4-8%) or optimal (>8%) Omega-3 Index (O3I) (i.e., erythrocyte levels of eicosapentaenoic and docosahexaenoic acids). Multiple linear regression was used to model the association between O3I and HRR adjusting for age, maximal METs, body mass index, and smoking by sex. RESULTS Higher categories of O3I were associated with greater HRR at 1 min (men: 23.7, 23.9, 24.6 beats/min; women: 23.9, 24.6, 25.9 and 3 min (men: 52.4, 52.9, 53.6 beats/min; women: 51.9, 53.4, 54.6), p trend <0.01 for all. Corresponding HRR at 5 min were (men: 60.0, 60.2, 60.7 beats/min, p trend=0.09; women: 59.4, 60.8, 61.6, p trend <0.001). The HRR gradients across O3I categories were steeper in women than men at 1, 3, and 5 min (p<0.03 for all sex x O3I category interactions with HRR). CONCLUSIONS A direct relationship between HRR and O3I values was observed in both men and women, with a steeper gradient in women. These findings suggest a potential cardioprotective mechanism for n-3 PUFA.
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Affiliation(s)
| | | | - Nathan Tintle
- Fatty Acid Research Institute, Sioux Falls, SD; and Department of Mathematics & Statistics; Dordt University; Sioux Center; IA
| | | | | | - William L Haskell
- Department of Medicine, Stanford University, Palo Alto, CA United States
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas TX United States
| | | | | | - William S Harris
- Fatty Acid Research Institute, Sioux Falls, SD; and Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
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Gafni T, Weinstein G, Shuval K, Carolyn BE, Gabriel KP, Willis BL, David L, Haskell WL, DeFina LF. Sitting time, physical activity, and cognitive impairment in mid‐life adults: Findings from the Cooper Center Longitudinal Study. Alzheimers Dement 2020. [DOI: 10.1002/alz.041724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kinser K, Barlow CE, Leonard D, Farrell SW, Pavlovic A, Kaporis HG, Brown ES, Willis BL, DeFina LF. Tanning bed use and depression in a preventive medicine cohort: The Cooper Center Longitudinal Study. J Am Acad Dermatol 2020; 83:1200-1202. [PMID: 32088271 DOI: 10.1016/j.jaad.2020.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/29/2020] [Accepted: 02/14/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | | | | | | | | | | | - E Sherwood Brown
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
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Lee J, Chen B, Kohl HW, Barlow CE, Lee CD, Radford NB, DeFina LF, Gabriel KP. The Association of Self-Reported Muscle-Strengthening Activities With Carotid Intima-Media Thickness in Older Adults: Cooper Center Longitudinal Study. J Aging Phys Act 2020; 28:534-539. [PMID: 31810061 PMCID: PMC8754400 DOI: 10.1123/japa.2019-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
Abstract
The purpose of the current investigation was to examine the cross-sectional associations of participation in muscle-strengthening activities (MSAs) with carotid intima-media thickness (CIMT) among older adults. The data are from 2,557 older adult participants enrolled in an observational cohort who reported no history of cardiovascular disease. MSA was determined using a questionnaire. Carotid ultrasound was performed to measure the CIMT of the common carotid artery bilaterally. Logistic regression models were constructed to estimate the association of MSA with CIMT after adjustment for potential confounders. The participants were aged 68.6 ± 7.0 years, and the majority were male (71.7%) and White (96.5%); 18% had abnormal CIMT. Meeting the physical activity guidelines for MSA was inversely associated with abnormal CIMT after adjustment for age and sex. However, this observed inverse relation became statistically null after further adjustment for cardiovascular disease risk factors, including aerobic physical activity.
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Lee J, Chen B, Kohl HW, Barlow CE, do Lee C, Radford NB, DeFina LF, Gabriel KP. The Association of Physical Activity With Carotid Intima Media Thickening in a Healthy Older Population: Cooper Center Longitudinal Study. J Aging Phys Act 2020; 28:448-454. [PMID: 31801110 PMCID: PMC7266725 DOI: 10.1123/japa.2019-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to examine the association between self-reported physical activity (PA) and mean common carotid artery intima-media thickness (CCA IMT) among older adults. The data are from 1,811 Cooper Center Longitudinal Study participants, who were aged ≥60 years, with no history of cardiovascular disease. A medical history questionnaire was used to assess PA. Carotid ultrasound was performed to measure CCA IMT and the presence of plaque and stenosis. Logistic regression models were constructed to estimate the association between PA and CCA IMT after adjustment for covariates. The participants were aged 69.2 ± 5.9 years, and the majority were male (73.3%) and White (96.7%). The odds ratio of abnormal thickening of CCA IMT was 0.72 (95% confidence interval [0.54, 0.96]) in physically active participants (≥500 metabolic equivalent·min/week) after adjustment for covariates. In the current study, meeting PA guidelines in older adulthood was associated with lower odds of abnormal thickening of CCA IMT.
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Farrell SW, DeFina LF, Radford NB, Leonard D, Barlow CE, Pavlovic A, Willis BL, Haskell WL, Lee IM. Relevance of Fitness to Mortality Risk in Men Receiving Contemporary Medical Care. J Am Coll Cardiol 2020; 75:1538-1547. [DOI: 10.1016/j.jacc.2020.01.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
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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 2020; 4:174-181. [PMID: 30698608 DOI: 10.1001/jamacardio.2018.4628] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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.
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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
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Farrell SW, Pavlovic A, Barlow CE, Leonard D, DeFina JR, Willis BL, DeFina LF, Haskell WL. Functional Movement Screening Performance and Association With Key Health Markers in Older Adults. J Strength Cond Res 2019; 35:3021-3027. [PMID: 31895281 DOI: 10.1519/jsc.0000000000003273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Farrell, SW, Pavlovic, A, Barlow, CE, Leonard, D, DeFina, JR, Willis, BL, DeFina, LF, and Haskell, WL. Functional movement screening performance and association with key health markers in older adults. J Strength Cond Res XX(X): 000-000, 2019-We examined Functional Movement Screening (FMS) performance and associations with key health markers among adults aged 55 years or older. Apparently healthy men (n = 425) and women (n = 158) completed a preventive medical examination between 2013 and 2018. Subjects were grouped by age and sex to determine mean scores for individual FMS items as well as total FMS score. We examined partial correlations between total FMS score and key health markers. We computed odds ratios (ORs) for having a total FMS score ≤14. The mean FMS scores for men and women were 11.7 ± 2.8 and 11.9 ± 2.3, respectively. Several differences were found between men who participated in FMS (takers) compared with FMS nontakers, whereas women FMS takers were generally similar to women FMS nontakers. After controlling for age, sex, and smoking, FMS scores were directly associated with physical activity (PA), cardiorespiratory fitness, frequency of resistance training, serum vitamin D, omega-3 index, low-density lipoprotein, and high-density lipoprotein (HDL)-cholesterol, and were inversely associated with body mass index (BMI), waist circumference (WC), blood glucose, HbA1c, and metabolic syndrome (p ≤ 0.02 for each). Adjusted OR for scoring ≤14 was significantly greater for those who were BMI and WC-obese, those with metabolic syndrome, those with low HDL-cholesterol, and those not meeting current PA guidelines. This study provides characteristics and mean values for FMS in a large older population and demonstrates that FMS performance is associated with key health markers. Prospective studies of older adults are needed to determine the utility of FMS in predicting future musculoskeletal injury and other chronic disease-related health outcomes.
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Affiliation(s)
| | | | | | - David Leonard
- Research Division, The Cooper Institute, Dallas, Texas
| | | | | | | | - William L Haskell
- Stanford Prevention Research Center, Stanford University, Palo Alto, California
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DeFina LF, Radford NB, Leonard D, Wilson RK, Cooper TC, Clark SM, Vega GL, Barlow CE, Willis BL, Gibbons LW, Gruntmanis U. Traditional signs and symptoms commonly attributed to hypogonadism do not correlate with testosterone levels: the Cooper Center Longitudinal Study Experience. J Investig Med 2019; 68:378-382. [PMID: 31540967 DOI: 10.1136/jim-2019-001083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2019] [Indexed: 01/09/2023]
Abstract
Evidence suggests that substantial testosterone therapy is occurring without checking levels of testosterone, presumably based on the presence of symptoms alone. We sought to explore the relationship between total testosterone level and non-specific symptoms, metabolic abnormalities, and sexual dysfunction associated with hypogonadism. This cross-sectional study included 2994 generally healthy men aged 50-79 years examined at a preventive medicine clinic in Dallas, TX from January 2012 to March 2016. Symptoms of hypogonadism were assessed. Screening morning total testosterone levels were measured and categorized into low (<250 ng/dL), low normal (250-399 ng/dL), and normal (≥400 ng/dL). Multiple logistic regression models were used to test the associations between total testosterone and signs and symptoms of hypogonadism. When considering symptoms and signs of hypogonadism, only decreased libido (OR 1.31, 95% CI 1.00 to 1.70), fasting glucose ≥100 mg/dL (OR 1.47, CI 1.15 to 1.88), and hemoglobin A1c over 6% (OR 1.47, 95% CI 1.06 to 2.03) were associated with increased odds of low testosterone after adjustment for age, body mass index, and cardiorespiratory fitness. Testosterone levels were not associated with fatigue, depression, or erectile dysfunction in our study (p>0.6). In this preventive medicine cohort, symptoms commonly attributed to testosterone deficiency were not associated with low total testosterone levels.
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Affiliation(s)
| | | | | | | | | | | | - Gloria Lena Vega
- School of Health Professions, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | | | | | | | - Ugis Gruntmanis
- School of Health Professions, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
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Farrell SW, Barlow CE, Willis BL, Leonard D, Pavlovic A, DeFina LF, Haskell WL. Cardiorespiratory Fitness, Different Measures of Adiposity, and Cardiovascular Disease Mortality Risk in Women. J Womens Health (Larchmt) 2019; 29:319-326. [PMID: 31532335 DOI: 10.1089/jwh.2019.7793] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Associations among cardiorespiratory fitness (CRF), different adiposity exposures, and cardiovascular disease (CVD) mortality in women are not well defined. Materials and Methods: A total of 19,838 women completed a baseline examination between 1971 and 2013. Measures included body mass index (BMI), waist circumference (WC), waist-to-height (W:HT) ratio, skinfold-derived percent body fat (% Fat), and CRF estimated from a maximal treadmill test. CRF categories were low (quintile 1), moderate (quintiles 2-3), and high (quintiles 4-5); standard cut points were used for adiposity exposures. Hazard ratios (HRs) were estimated using Cox regression. Results: During a mean follow-up period of 19.2 ± 10.3 years, 391 cardiovascular deaths occurred. HRs (95% confidence interval) for CVD in moderate and low CRF groups, using high CRF as the referent, were 1.87 (1.46-2.38) and 2.54 (1.93-3.35), respectively (p trend <0.001). HRs of obese women within each adiposity exposure were higher when compared with normal-weight women (p ≤ 0.03). Joint associations of CRF × adiposity showed a positive trend in CVD mortality across decreasing categories of CRF within each category of W:HT and % Fat, as well as within the normal and overweight BMI categories and the normal WC category (p ≤ 0.03 for each). Conclusion: Higher levels of CRF are associated with lower CVD mortality risk in women, and predict lower risk of CVD mortality in normal-weight women and in obese women. Using different measures of adiposity to predict CVD mortality risk in women may be misleading unless CRF is taken into account. These results support the American Heart Association (AHA) recommendation for including CRF as a clinical vital sign.
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Affiliation(s)
| | | | | | - David Leonard
- Research Division, The Cooper Institute, Dallas, Texas
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DeFina LF, Radford NB, Levine BD. Risks of High Coronary Artery Calcium-Reply. JAMA Cardiol 2019; 4:713. [PMID: 31090884 DOI: 10.1001/jamacardio.2019.1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Benjamin D Levine
- Institute for Environmental and Exercise Medicine, Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas
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Pavlovic A, Willis BL, Leonard DS, Farrell SW, Barlow CE, DeFina LF. Is Midlife Quadriceps Muscular Strength Protective Against Later Life Osteoarthritis and Subsequent Total Joint Replacement? Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561837.48207.9d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Farrell SW, Barlow CE, Willis BL, Leonard D, Pavlovic A, DeFina LF, Haskell WL. Cardiorespiratory Fitness, Serum 25-hydroxyvitamin D, and Risk of Metabolic Syndrome Among Men: The Cooper Center Longitudinal Study. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562112.41614.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Martinez-Miller EE, Kohl HW, Barlow CE, Willis BL, DeFina LF. Metabolic Syndrome and Cognitive Impairment among High Socioeconomic, Nondemented Older US Adults. J Am Geriatr Soc 2019; 67:1437-1443. [PMID: 30854644 DOI: 10.1111/jgs.15836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Nondemented cognitive impairment (CI) presents opportunities for early interventions among individuals at risk for dementia. Identification of modifiable determinants is paramount to the development of effective clinical interventions. Metabolic syndrome (MetS) was theorized as a risk factor, but current research yields inconsistent findings. Few studies have examined the association between MetS and CI among US populations, and global results may be ungeneralizable. We investigated the MetS-CI association among high socioeconomic, nondemented older US adults, examining the roles of sociodemographic, clinical, behavioral, and genetic factors. DESIGN Cross-sectional. SETTING Cooper Clinic of Dallas, Texas: Cooper Center Longitudinal Study (2009-2017). PARTICIPANTS A total of 5200 dementia-free older adult Cooper Clinic patients. MEASUREMENTS CI was detected with a Montreal Cognitive Assessment (MoCA) score lower than 26. MetS was established based on National Cholesterol Education Program Adult Treatment Panel guidelines. Unadjusted and multivariable log-binomial regression were used to assess the MetS-CI association, with modification assessment by age, sex, education, cardiorespiratory fitness (CRF), and apolipoprotein-ε4 carrier status (APOE-ε4). RESULTS MetS was not associated with CI when adjusting for age, sex, minority status, education, and marital status (prevalence ratio [PR] = 1.09; 95% confidence interval = .97-1.23) or when additionally adjusting for body mass index, CRF, alcohol consumption, current smoking status, and APOE-ε4 (PR = 1.07; 95% confidence interval = .80-1.45). The association was not modified by age, sex, CRF, or APOE-ε4 (P for interaction >.05). CONCLUSION In contrast with some global and US studies, MetS and CI were not associated among our study population of nondemented older US adults. MetS may not be a suitable intervention target for poor cognitive outcomes among high socioeconomic older US adults, although separate MetS components may have different recommendations. Future studies should explore more diverse older US populations. If replicated, these findings would inform clinical efforts to reduce the burden of poor cognitive outcomes in the United States.
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Affiliation(s)
- Erline E Martinez-Miller
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Epidemiology; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Harold W Kohl
- Division of Epidemiology, Human Genetics and Environmental Sciences; University of Texas School of Public Health, Austin, University of Texas Health Science Center at Houston, Austin, Texas
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Lee J, Chen B, Kohl HW, Barlow CE, Lee CD, Radford NB, DeFina LF, Gabriel KP. The association of midlife cardiorespiratory fitness with later life carotid atherosclerosis: Cooper Center Longitudinal Study. Atherosclerosis 2019; 282:137-142. [PMID: 30731286 DOI: 10.1016/j.atherosclerosis.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/19/2018] [Accepted: 01/10/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS While numerous cross-sectional studies have demonstrated an inverse relationship between cardiorespiratory fitness (CRF) and carotid atherosclerosis in middle age, much less is known about the association of midlife CRF with carotid atherosclerosis in later life. METHODS We studied 1094 participants, free of cardiovascular disease, who completed a maximal exercise test (GXT) for an objective measure of CRF between ages 40 and 59 and carotid ultrasound after the age of 59, with at least five years between studies. Carotid intima media thickness was measured. Assessments were also made regarding the presence of plaque and percent stenosis in four regions: common carotid, bulb, internal carotid and external carotid arteries. Multivariable logistic regression models were constructed to estimate the association of CRF with carotid artery disease. RESULTS At the time of GXT and carotid scan, participants were aged 50.7 ± 5.7 years and 69.3 ± 6.4 years, respectively. Almost half of participants had high midlife CRF (48.6%); 41.3% and 10.1% had moderate and low CRF, respectively. Over a mean follow-up period of 18.6 ± 8.5 years, the odds of having carotid artery disease in later life in the high CRF group was 0.50 (95% CI: 0.29-0.87) compared with the low CRF group. Each 1 MET increase in CRF was associated with 10% lower odds of having carotid artery disease (OR = 0.89, 95% CI: 0.80-0.98). CONCLUSIONS Midlife CRF was inversely associated with carotid artery disease measured almost two decades later. This may represent a mechanistic link between high midlife CRF and reduced risk of stroke in later life.
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Affiliation(s)
- Joowon Lee
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center (UTHeath) at Houston School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX, 78701, USA; Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue Suite 470, Boston, MA, 02118, USA.
| | - Baojiang Chen
- Department of Biostatistics and Data Science, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center (UTHealth) at Houston School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX, 78701, USA
| | - Harold W Kohl
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center (UTHeath) at Houston School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX, 78701, USA; Department of Kinesiology and Health Education, The University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA
| | | | - Chong do Lee
- School of Nutrition and Health Promotion, Arizona State University, 550 N. Third St, Phoenix, AZ, 85004, USA
| | - Nina B Radford
- Cooper Clinic, 12200 Preston Road, Dallas, TX, 75230, USA
| | - Laura F DeFina
- Cooper Institute, 12330 Preston Road, Dallas, TX, 75230, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center (UTHeath) at Houston School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX, 78701, USA; Department of Kinesiology and Health Education, The University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA; Department of Women's Health Dell Medical School, The University of Texas at Austin, 1501 Red River Street, Austin, TX, 78712, USA
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DeFina LF, Radford NB, Leonard D, Wilson RK, Cooper TC, Clark SM, Willis BL, Vega GL, Barlow CE, Farrell SW, Gibbons LW, Yildiz BO, Gruntmanis U. The association of cardiorespiratory fitness, body mass index, and age with testosterone levels at screening of healthy men undergoing preventive medical examinations: The Cooper Center Longitudinal Study. Maturitas 2018; 118:1-6. [DOI: 10.1016/j.maturitas.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/08/2018] [Accepted: 09/26/2018] [Indexed: 12/20/2022]
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Willis BL, Leonard D, Barlow CE, Martin SB, DeFina LF, Trivedi MH. Association of Midlife Cardiorespiratory Fitness With Incident Depression and Cardiovascular Death After Depression in Later Life. JAMA Psychiatry 2018; 75:911-917. [PMID: 29955781 PMCID: PMC6142909 DOI: 10.1001/jamapsychiatry.2018.1467] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Cardiorespiratory fitness (hereinafter referred to as fitness) as estimated by exercise testing is a modifiable risk factor independently associated with chronic diseases, cardiovascular disease (CVD) events, and mortality, but the association of fitness at midlife with incidence of later-life depression and the risk of CVD mortality after a depression diagnosis is unknown. OBJECTIVE To determine whether fitness measured in midlife would be inversely associated with later-life CVD mortality with antecedent depression. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study at a single-center, community-based preventive medicine clinic was performed as part of the Cooper Center Longitudinal Study. Data were collected from January 13, 1971, through December 31, 2009, and analyzed from October 6, 2015, through August 14, 2017. Participants included generally healthy men and women who presented for preventive medicine examinations at midlife and who were eligible for Medicare from 1999 to 2010. Those with a self-reported history of depression, myocardial infarction, or stroke at examination were excluded. EXPOSURES Objective midlife fitness estimated from results of treadmill exercise testing. MAIN OUTCOMES AND MEASURES Depression diagnosis from Medicare claims files using established algorithms and CVD mortality from National Death Index records. RESULTS A total of 17 989 participants (80.2% men) with a mean (SD) age of 50.0 (8.7) years were included. After 117 218 person-years of Medicare follow-up, 2701 depression diagnoses, 610 deaths due to CVD without prior depression, and 231 deaths due to CVD after depression were observed. A high level of fitness in midlife was associated with a 16% lower risk of depression (hazard ratio [HR], 0.84; 95% CI, 0.74-0.95) compared with a low level of fitness. A high fitness level was also associated with a 61% lower risk of death due to CVD without depression (HR, 0.39; 95% CI, 0.31-0.48) compared with a low level of fitness. After a diagnosis of depression, a high fitness level was associated with a 56% lower risk of death due to CVD (HR, 0.44; 95% CI, 0.31-0.64) compared with a low fitness level. CONCLUSIONS AND RELEVANCE Midlife fitness is associated with a lower risk of later-life depression, CVD mortality, and CVD mortality after incident later-life depression. These findings suggest the importance of midlife fitness in primary prevention of depression and subsequent CVD mortality in older age and should encourage physicians to consider fitness and physical activity in promoting healthy aging.
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Affiliation(s)
| | | | | | - Scott B. Martin
- Department of Kinesiology, Recreation, and Health Promotion, University of North Texas, Denton
| | | | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
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Pavlovic A, Abel K, Barlow CE, Farrell SW, Weiner M, DeFina LF. The association between serum vitamin d level and cognitive function in older adults: Cooper Center Longitudinal Study. Prev Med 2018; 113:57-61. [PMID: 29753804 DOI: 10.1016/j.ypmed.2018.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 01/10/2023]
Abstract
Low blood level of vitamin D and low physical activity have been linked to the development of cognitive impairment in older adults. The purpose of the present study was to examine the relationship between serum vitamin D and cognition as measured via the Montreal Cognitive Assessment (MoCA) in a healthy, older population. The study sample consisted of 4358 patients from the Cooper Clinic in Dallas, TX. All participants underwent a maximal graded exercise test to determine cardiorespiratory fitness (CRF). Cognitive impairment was defined as a MoCA score <25. Low vitamin D status was defined as serum 25-hydroxyvitamin D <30 ng/mL. Multivariable logistic regression analysis was employed to evaluate the association between vitamin D blood level and MoCA score. A low MoCA score was directly associated with higher age (OR: 1.75, 95% CI: 1.53, 1.99), and inversely associated with female sex (OR: 0.63, 95% CI: 0.51, 0.77), and years of education (OR: 0.87, 95% CI: 0.84, 0.91). When controlling for significant predictors (age, sex, and education), the low vitamin D group had a significantly greater likelihood of having a low MoCA score (OR: 1.26, 95% CI: 1.04, 1.51). The vitamin D effect remained significant when CRF was added to the model (OR: 1.23, 95% CI: 1.02, 1.48). In conclusion, low vitamin D was shown to be associated with cognitive impairment. Therefore, preventive measures such as vitamin D supplementation may play a protective role in memory loss and/or age-associated cognitive decline.
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Affiliation(s)
- Andjelka Pavlovic
- The Cooper Institute, 12330 Preston Rd., Dallas, TX 75230, United States.
| | - Katelyn Abel
- The Cooper Institute, 12330 Preston Rd., Dallas, TX 75230, United States
| | - Carolyn E Barlow
- The Cooper Institute, 12330 Preston Rd., Dallas, TX 75230, United States
| | - Stephen W Farrell
- The Cooper Institute, 12330 Preston Rd., Dallas, TX 75230, United States
| | - Myron Weiner
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Laura F DeFina
- The Cooper Institute, 12330 Preston Rd., Dallas, TX 75230, United States
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Farrell SW, Abramowitz AR, Willis BL, Barlow CE, Weiner M, Falkowski J, Leonard D, Pavlovic A, DeFina LF. The Relationship between Cardiorespiratory Fitness and Montreal Cognitive Assessment Scores in Older Adults. Gerontology 2018; 64:440-445. [PMID: 29843126 DOI: 10.1159/000489336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 04/18/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Relatively little is known regarding the association between objective measures of physical function such as cardiorespiratory fitness (CRF) and cognitive function tests in healthy older adults. OBJECTIVE To evaluate the relationship between CRF and cognitive function in adults aged 55 and older. METHODS Between 2008 and 2017, 4,931 men and women underwent a comprehensive preventive physical exam at the Cooper Clinic in Dallas, Texas. CRF was determined by duration of a maximal treadmill exercise test. Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA). In a multivariate model, adjusted odds ratios with 95% confidence intervals for MoCA scores < 26 (i.e., cognitive impairment) were determined by using CRF as both a continuous and a categorical variable. RESULTS The mean age of the sample was 61.0 ± 6.0 years; mean maximal MET values were 10.0 ± 2.2. Mean MoCA scores were 26.9 ± 2.2; 23.4% of the sample had MoCA scores indicative of cognitive impairment. The odds ratio for cognitive impairment was 0.93 (0.88-0.97) per 1-MET increment in CRF. When examined as a categorical variable, and using the lowest CRF quintile as the referent, there was a significantly reduced likelihood for cognitive impairment across the remaining ordered CRF categories (p trend = 0.004). CONCLUSION The association between CRF and MoCA score in older adults suggests that meeting or exceeding public health guidelines for physical activity is likely to increase CRF in low fit individuals, maintain CRF in those with a moderate to high level of CRF, and thereby help to maintain cognitive function in healthy older adults.
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Affiliation(s)
| | | | | | | | - Myron Weiner
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jed Falkowski
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Farrell SW, Barlow CE, Willis BL, Leonard D, Pavlovic A, DeFina LF. Cardiorespiratory Fitness, Different Adiposity Exposures, and Cardiovascular Disease Mortality Risk in Healthy Women. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535311.77020.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Leonard D, Shah NS, Barlow CE, DeFina LF, Willis BL, Maron DJ. The Reply. Am J Med 2018; 131:e211. [PMID: 29673492 DOI: 10.1016/j.amjmed.2017.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022]
Affiliation(s)
| | - Nilay S Shah
- Department of Medicine, Stanford University School of Medicine, Calif
| | | | | | | | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Calif
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Vaisar T, Couzens E, Hwang A, Russell M, Barlow CE, DeFina LF, Hoofnagle AN, Kim F. Type 2 diabetes is associated with loss of HDL endothelium protective functions. PLoS One 2018; 13:e0192616. [PMID: 29543843 PMCID: PMC5854245 DOI: 10.1371/journal.pone.0192616] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/27/2018] [Indexed: 11/18/2022] Open
Abstract
Aims/Hypothesis One of the hallmarks of diabetes is impaired endothelial function. Previous studies showed that HDL can exert protective effects on endothelium stimulating NO production and protecting from inflammation and suggested that HDL in obese people with diabetes and dyslipidemia may have lower endothelial protective function. We aimed to investigate whether type 2 diabetes impairs HDL endothelium protective functions in people with otherwise normal lipid profile. Methods In a case-control study (n = 41 per group) nested in the Cooper Center Longitudinal Study we tested the ability of HDL to protect endothelium by stimulating endothelial nitric oxide synthase activity and suppressing NFκB-mediated inflammatory response in endothelial cells. In parallel we measured HDL protein composition, sphinogosine-1-phosphate and P-selectin. Results Despite similar levels of plasma HDL-C the HDL in individuals with type 2 diabetes lost almost 40% of its ability to stimulate eNOS activity (P<0.001) and 20% of its ability to suppress TNFα-dependent NFκB-mediated inflammatory response in endothelial cells (P<0.001) compared to non-T2D controls despite similar BMI and lipid profile (HDL-C, LDL-C, TC, TG). Significantly, the ability of HDL to stimulate eNOS activity was negatively associated with plasma levels of P-selectin, an established marker of endothelial dysfunction (r = −0.32, P<0.001). Furthermore, sphingosine-1-phosphate (S1P) levels were decreased in diabetic plasma (P = 0.017) and correlated with HDL-mediated eNOS activation. Conclusions/Interpretations Collectively, our data suggest that HDL in individuals with type 2 diabetes loses its ability to maintain proper endothelial function independent of HDL-C, perhaps due to loss of S1P, and may contribute to development of diabetic complications.
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Affiliation(s)
- Tomáš Vaisar
- UW Medicine Diabetes Institute, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Erica Couzens
- UW Medicine Diabetes Institute, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Arnold Hwang
- UW Medicine Diabetes Institute, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Michael Russell
- UW Medicine Diabetes Institute, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | | | - Laura F DeFina
- The Cooper Institute, Dallas, Texas, United States of America
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | - Francis Kim
- UW Medicine Diabetes Institute, Department of Medicine, University of Washington, Seattle, Washington, United States of America
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Radford NB, DeFina LF, Leonard D, Barlow CE, Willis BL, Gibbons LW, Gilchrist SC, Khera A, Levine BD. Cardiorespiratory Fitness, Coronary Artery Calcium, and Cardiovascular Disease Events in a Cohort of Generally Healthy Middle-Age Men: Results From the Cooper Center Longitudinal Study. Circulation 2018; 137:1888-1895. [PMID: 29343464 DOI: 10.1161/circulationaha.117.032708] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 12/15/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND A robust literature demonstrates that coronary artery calcification (CAC) and cardiorespiratory fitness (CRF) are independent predictors of cardiovascular disease (CVD) events. Much less is known about the joint associations of CRF and CAC with CVD risk. In the setting of high CAC, high versus low CRF has been associated with decreased CVD events. The goal of this study was to assess the effect of continuous levels of CRF on CVD risk in the setting of increasing CAC burden. METHODS We studied 8425 men without clinical CVD who underwent preventive medicine examinations that included an objective measurement of CRF and CAC between 1998 and 2007. There were 383 CVD events during an average follow-up of 8.4 years. Parametric proportional hazards regression models based on a Gompertz mortality rule were used to estimate total CVD incidence rates at 70 years of age as well as hazard ratios for the included covariates. RESULTS CVD events increased with increasing CAC and decreased with increasing CRF. Adjusting for CAC level (scores of 0, 1-99, 100-399, and ≥400), for each additional MET of fitness, there was an 11% lower risk for CVD events (hazard ratio, 0.89; 95% confidence interval, 0.84-0.94). When CAC and CRF were considered together, there was a strong association between continuous CRF and CVD incidence rates in all CAC groups. CONCLUSIONS In a large cohort of generally healthy men, there is an attenuation of CVD risk at all CAC levels with higher CRF.
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Affiliation(s)
| | - Laura F DeFina
- Cooper Institute, Dallas, TX (L.F.D., D.L., C.E.B., B.L.W., L.W.G.)
| | - David Leonard
- Cooper Institute, Dallas, TX (L.F.D., D.L., C.E.B., B.L.W., L.W.G.)
| | - Carolyn E Barlow
- Cooper Institute, Dallas, TX (L.F.D., D.L., C.E.B., B.L.W., L.W.G.)
| | | | - Larry W Gibbons
- Cooper Institute, Dallas, TX (L.F.D., D.L., C.E.B., B.L.W., L.W.G.)
| | - Susan C Gilchrist
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston (S.C.G.)
| | - Amit Khera
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (A.K., B.D.L.)
| | - Benjamin D Levine
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (A.K., B.D.L.) .,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (B.D.L.)
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Farrell SW, Finley CE, Barlow CE, Willis BL, DeFina LF, Haskell WL, Vega GL. Moderate to High Levels of Cardiorespiratory Fitness Attenuate the Effects of Triglyceride to High-Density Lipoprotein Cholesterol Ratio on Coronary Heart Disease Mortality in Men. Mayo Clin Proc 2017; 92:1763-1771. [PMID: 29157534 DOI: 10.1016/j.mayocp.2017.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/18/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the prospective relationships among cardiorespiratory fitness (CRF), fasting blood triglyceride to high density lipoprotein cholesterol ratio (TG:HDL-C), and coronary heart disease (CHD) mortality in men. METHODS A total of 40,269 men received a comprehensive baseline clinical examination between January 1, 1978, and December 31, 2010. Their CRF was determined from a maximal treadmill exercise test. Participants were divided into CRF categories of low, moderate, and high fit by age group and by TG:HDL-C quartiles. Hazard ratios for CHD mortality were computed using Cox regression analysis. RESULTS A total of 556 deaths due to CHD occurred during a mean ± SD of 16.6±9.7 years (669,678 man-years) of follow-up. A significant positive trend in adjusted CHD mortality was shown across decreasing CRF categories (P for trend<.01). Adjusted hazard ratios were significantly higher across increasing TG:HDL-C quartiles as well (P for trend<.01). When grouped by CRF category and TG:HDL-C quartile, there was a significant positive trend (P=.04) in CHD mortality across decreasing CRF categories in each TG:HDL-C quartile. CONCLUSION Both CRF and TG:HDL-C are significantly associated with CHD mortality in men. The risk of CHD mortality in each TG:HDL-C quartile was significantly attenuated in men with moderate to high CRF compared with men with low CRF. These results suggest that assessment of CRF and TG:HDL-C should be included for routine CHD mortality risk assessment and risk management.
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Affiliation(s)
| | | | | | | | | | | | - Gloria L Vega
- Center for Human Nutrition/Department of Clinical Nutrition, University of Texas Southwestern Medical Center, Dallas
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Abdullah SM, Barkley KW, Bhella PS, Hastings JL, Matulevicius S, Fujimoto N, Shibata S, Carrick-Ranson G, Palmer MD, Gandhi N, DeFina LF, Levine BD. Lifelong Physical Activity Regardless of Dose Is Not Associated With Myocardial Fibrosis. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005511. [PMID: 27903541 DOI: 10.1161/circimaging.116.005511] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/27/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Recent reports have suggested that long-term, intensive physical training may be associated with adverse cardiovascular effects, including the development of myocardial fibrosis. However, the dose-response association of different levels of lifelong physical activity on myocardial fibrosis has not been evaluated. METHODS AND RESULTS Seniors free of major chronic illnesses were recruited from predefined populations based on the consistent documentation of stable physical activity over >25 years and were classified into 4 groups by the number of sessions/week of aerobic activities ≥30 minutes: sedentary (group 1), <2 sessions; casual (group 2), 2 to 3 sessions; committed (group 3), 4 to 5 sessions; and Masters athletes (group 4), 6 to 7 sessions plus regular competitions. All subjects underwent cardiopulmonary exercise testing and cardiac magnetic resonance imaging, including late gadolinium enhancement assessment of fibrosis. Ninety-two subjects (mean age 69 years, 27% women) were enrolled. No significant differences in age or sex were seen between groups. Median peak oxygen uptake was 25, 26, 32, and 40 mL/kg/min for groups 1, 2, 3, and 4, respectively. Cardiac magnetic resonance imaging demonstrated increasing left ventricular end-diastolic volumes, end-systolic volumes, stroke volumes, and masses with increasing doses of lifelong physical activity. One subject in group 2 had late gadolinium enhancement in a noncoronary distribution, and no subjects in groups 3 and 4 had evidence of late gadolinium enhancement. CONCLUSIONS A lifelong history of consistent physical activity, regardless of dose ranging from sedentary to competitive marathon running, was not associated with the development of focal myocardial fibrosis.
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Affiliation(s)
- Shuaib M Abdullah
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - Kyler W Barkley
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - Paul S Bhella
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - Jeffrey L Hastings
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - Susan Matulevicius
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - Naoki Fujimoto
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - Shigeki Shibata
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - Graeme Carrick-Ranson
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - M Dean Palmer
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - Nainesh Gandhi
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - Laura F DeFina
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas
| | - Benjamin D Levine
- From the Department of Internal Medicine, University of Texas-Southwestern Medical Center, Dallas (S.M.A., K.W.B., P.S.B., J.L.H., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.); North Texas Veteran's Affair's Medical Center, Dallas (S.M.A., J.L.H.); The Cooper Institute, Dallas, TX (L.F.D.); Division of Cardiology, John Peter Smith Health Network (P.S.B.) and The Institute for Exercise and Environmental Medicine (S.M.A., K.W.B., P.S.B., S.M., N.F., S.S., G.C.-R., M.D.P., N.G., B.D.L.), Texas Health Presbyterian Hospital, Dallas.
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Vaisar T, Couzens E, Hwang A, Hoofnagle AN, Barlow CE, DeFina LF, Kim F. Abstract 557: Type 2 Diabetes is Associated With Impaired High-Density Lipoprotein Endothelial Protective Function. Arterioscler Thromb Vasc Biol 2017. [DOI: 10.1161/atvb.37.suppl_1.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim:
One of the hallmarks of diabetes is impaired endothelial function. High density lipoproteins (HDL) can exert protective effects on endothelium stimulating NO production and protecting from inflammation. Previous study suggested that HDL in obese people with diabetes and metabolic syndrome and markedly low HDL-C lost endothelial protective function. We aimed to test whether type 2 diabetes impairs HDL endothelium protective functions in people with otherwise normal lipid profile.
Methods:
In a case-control study (n=40 per group) nested in the Cooper Center Longitudinal Study, we isolated HDL and measured its ability to stimulate activity of endothelial nitric oxide synthase (eNOS; phosphorylation of Ser1177) in endothelial cells and the ability of HDL to suppress inflammatory response of endothelial cells (NFkB activation). Additionally, we also measured by LCMS levels of sphingosine-1-phosphate (S1P) and plasma P-selectin by ELISA.
Results:
The HDL in people with type 2 diabetes lost almost 40% of its ability to stimulate eNOS activity (P<0.001) and 20% of its ability to suppress inflammation in endothelial cells (
P
<0.001) compared to non-diabetic controls despite similar BMI and lipid profile (HDL-C, LDL-C, TC, TG).The ability of HDL to stimulate eNOS activity was negatively associated with plasma levels of P-selectin, an established marker of endothelial dysfunction (r=–0.32,
P
<0.001). Furthermore, sphingosine-1-phosphate (S1P) levels were decreased in plasma of people with diabetes (
P
=0.017) and correlated strongly with HDL-mediated eNOS activation.
Conclusions:
Collectively, our data suggest that HDL in individuals with type 2 diabetes loses its ability to maintain proper endothelial function independent of HDL-C, perhaps due to loss of S1P, and may contribute to development of diabetic complications.
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