Repaired coarctation of the aorta does not affect four-dimensional flow metrics in bicuspid aortic valve disease

OBJECTIVES

The objective of this study was primarily to compare four-dimensional flow magnetic resonance imaging metrics in the ascending aorta (AA) of patients with right-left fusion type bicuspid aortic valve (RL-BAV) and repaired coarctation of the aorta (CoA) to RL-BAV without CoA. Metrics of patients with RL-BAV were also compared to the matched group of patients with common tricuspid aortic valve (TAV).

METHODS

Eleven patients with RL-BAV and CoA, 11 patients with RL-BAV without CoA and 22 controls with TAV were investigated. Peak velocity (cm/s), peak flow (ml/s) and flow displacement (%) were analysed at 5 pre-defined AA levels. In addition, regional wall shear stress (WSS, mN/m2), circumferential WSS (WSSc) and axial WSS (WSSa) at all levels were quantified in 6 sectors of the aortic circle. Averaged WSS values on each level (WSSavg, WSSc, avg and WSSa, avg) were calculated as well.

RESULTS

Peak velocity at the proximal tubular AA was significantly lower in BAV and CoA group (P = 0.047) compared to BAV without CoA. In addition, the WSSa, avg was found to be higher for the BAV and CoA group at proximal AA respectively (P = 0.040). No other significant differences were found between these groups. BAV group's peak velocity was higher at every level (P < 0.001-0.004) compared to TAV group. Flow displacement was significantly higher for the BAV group at every level (P < 0.001) besides at the most distal level. All averaged WSS values were significantly higher in BAV patients in distal AA (P < 0.001-0.018).

CONCLUSIONS

Repaired CoA does not relevantly alter four-dimensional flow metrics in the AA of patients with RL-BAV. However, RL-BAV majorly alters flow dynamics in the AA when compared to patients with TAV.

CLINICAL TRIAL REGISTRATION NUMBER

https://www.clinicaltrials.gov/study/NCT05065996, Unique Protocol ID 5063566.

Age But Not Menopausal Status Is Linked to Lower Resting Energy Expenditure

CONTEXT

It remains uncertain whether aging before late adulthood and menopause are associated with fat-free mass and fat mass-adjusted resting energy expenditure (REEadj).

OBJECTIVES

We investigated whether REEadj differs between middle-aged and younger women and between middle-aged women with different menopausal statuses. We repeated the age group comparison between middle-aged mothers and their daughters to partially control for genotype. We also explored whether serum estradiol and FSH concentrations explain REEadj in midlife.

METHODS

We divided 120 women, including 16 mother-daughter pairs, into age groups; group I (n = 26) consisted of participants aged 17 to 21, group II (n = 35) of those aged 22 to 38, and group III (n = 59) of those aged 41 to 58 years. The women in group III were further categorized as pre- or perimenopausal (n = 19), postmenopausal (n = 30), or postmenopausal hormone therapy users (n = 10). REE was assessed using indirect calorimetry, body composition using dual-energy X-ray absorptiometry, and hormones using immunoassays.

RESULTS

The REEadj of group I was 126 kcal/day [95% confidence interval (CI): 93-160] higher than that of group III, and the REEadj of group II was 88 kcal/day (95% CI: 49-127) higher. Furthermore, daughters had a 100 kcal/day (95% CI: 63-138 kcal/day) higher REEadj than their middle-aged mothers (all P < .001). In group III, REEadj was not lower in postmenopausal women and did not vary by sex hormone concentrations.

CONCLUSIONS

We demonstrated that REEadj declines with age in women before late adulthood, also when controlling partially for genetic background, and that menopause may not contribute to this decline.

Durability is improved by both low and high intensity endurance training

Introduction: This is one of the first intervention studies to examine how low- (LIT) and high-intensity endurance training (HIT) affect durability, defined as 'time of onset and magnitude of deterioration in physiological-profiling characteristics over time during prolonged exercise'. Methods: Sedentary and recreationally active men (n = 16) and women (n = 19) completed either LIT (average weekly training time 6.8 ± 0.7 h) or HIT (1.6 ± 0.2 h) cycling for 10 weeks. Durability was analyzed before and after the training period from three factors during 3-h cycling at 48% of pretraining maximal oxygen uptake (VO_2max): 1) by the magnitude and 2) onset of drifts (i.e. gradual change in energy expenditure, heart rate, rate of perceived exertion, ventilation, left ventricular ejection time, and stroke volume), 3) by the 'physiological strain', defined to be the absolute responses of heart rate and its variability, lactate, and rate of perceived exertion. Results: When all three factors were averaged the durability was improved similarly (time x group p = 0.42) in both groups (LIT: p = 0.03, g = 0.49; HIT: p = 0.01, g = 0.62). In the LIT group, magnitude of average of drifts and their onset did not reach statistically significance level of p < 0.05 (magnitude: 7.7 ± 6.8% vs. 6.3 ± 6.0%, p = 0.09, g = 0.27; onset: 106 ± 57 min vs. 131 ± 59 min, p = 0.08, g = 0.58), while averaged physiological strain improved (p = 0.01, g = 0.60). In HIT, both magnitude and onset decreased (magnitude: 8.8 ± 7.9% vs. 5.4 ± 6.7%, p = 0.03, g = 0.49; onset: 108 ± 54 min vs. 137 ± 57 min, p = 0.03, g = 0.61), and physiological strain improved (p = 0.005, g = 0.78). VO_2max increased only after HIT (time x group p < 0.001, g = 1.51). Conclusion: Durability improved similarly by both LIT and HIT based on reduced physiological drifts, their postponed onsets, and changes in physiological strain. Despite durability enhanced among untrained people, a 10-week intervention did not alter drifts and their onsets in a large amount, even though it attenuated physiological strain.

FinnGen provides genetic insights from a well-phenotyped isolated population

Population isolates such as those in Finland benefit genetic research because deleterious alleles are often concentrated on a small number of low-frequency variants (0.1% ≤ minor allele frequency < 5%). These variants survived the founding bottleneck rather than being distributed over a large number of ultrarare variants. Although this effect is well established in Mendelian genetics, its value in common disease genetics is less explored^1,2. FinnGen aims to study the genome and national health register data of 500,000 Finnish individuals. Given the relatively high median age of participants (63 years) and the substantial fraction of hospital-based recruitment, FinnGen is enriched for disease end points. Here we analyse data from 224,737 participants from FinnGen and study 15 diseases that have previously been investigated in large genome-wide association studies (GWASs). We also include meta-analyses of biobank data from Estonia and the United Kingdom. We identified 30 new associations, primarily low-frequency variants, enriched in the Finnish population. A GWAS of 1,932 diseases also identified 2,733 genome-wide significant associations (893 phenome-wide significant (PWS), P < 2.6 × 10^-11) at 2,496 (771 PWS) independent loci with 807 (247 PWS) end points. Among these, fine-mapping implicated 148 (73 PWS) coding variants associated with 83 (42 PWS) end points. Moreover, 91 (47 PWS) had an allele frequency of <5% in non-Finnish European individuals, of which 62 (32 PWS) were enriched by more than twofold in Finland. These findings demonstrate the power of bottlenecked populations to find entry points into the biology of common diseases through low-frequency, high impact variants.

Associations of resting and peak fat oxidation with sex hormone profile and blood glucose control in middle-aged women

BACKGROUND AND AIMS

Menopause may reduce fat oxidation. We investigated whether sex hormone profile explains resting fat oxidation (RFO) or peak fat oxidation (PFO) during incremental cycling in middle-aged women. Secondarily, we studied associations of RFO and PFO with glucose regulation.

METHOD AND RESULTS

We measured RFO and PFO of 42 women (age 52-58 years) with indirect calorimetry. Seven participants were pre- or perimenopausal, 26 were postmenopausal, and nine were postmenopausal hormone therapy users. Serum estradiol (E2), follicle-stimulating hormone, progesterone, and testosterone levels were quantified with immunoassays. Insulin sensitivity (Matsuda index) and glucose tolerance (area under the curve) were determined by glucose tolerance testing. Body composition was assessed with dual-energy X-ray absorptiometry; physical activity with self-report and accelerometry; and diet, with food diaries. Menopausal status or sex hormone levels were not associated with the fat oxidation outcomes. RFO determinants were fat mass (β = 0.44, P = 0.006) and preceding energy intake (β = -0.40, P = 0.019). Cardiorespiratory fitness (β = 0.59, P = 0.002), lean mass (β = 0.49, P = 0.002) and physical activity (self-reported β = 0.37, P = 0.020; accelerometer-measured β = 0.35, P = 0.024) explained PFO. RFO and PFO were not related to insulin sensitivity. Higher RFO was associated with poorer glucose tolerance (β = 0.52, P = 0.002).

CONCLUSION

Among studied middle-aged women, sex hormone profile did not explain RFO or PFO, and higher fat oxidation capacity did not indicate better glucose control.

Menopause modulates the circulating metabolome: evidence from a prospective cohort study

AIMS

We studied the changes in the circulating metabolome and their relation to the menopausal hormonal shift in 17β-oestradiol and follicle-stimulating hormone levels among women transitioning from perimenopause to early postmenopause.

METHODS AND RESULTS

We analysed longitudinal data from 218 Finnish women, 35 of whom started menopausal hormone therapy during the study. The menopausal transition was monitored with menstrual diaries and serum hormone measurements. The median follow-up was 14 months (interquartile range: 8-20). Serum metabolites were quantified with targeted nuclear magnetic resonance metabolomics. The model results were adjusted for age, follow-up duration, education, lifestyle, and multiple comparisons. Menopause was associated with 85 metabolite measures. The concentration of apoB (0.17 standard deviation [SD], 99.5% confidence interval [CI] 0.03-0.31), very-low-density lipoprotein triglycerides (0.25 SD, CI 0.05-0.45) and particles (0.21 SD, CI 0.05-0.36), low-density lipoprotein (LDL) cholesterol (0.17 SD, CI 0.01-0.34) and particles (0.17 SD, CI 0.03-0.31), high-density lipoprotein (HDL) triglycerides (0.24 SD, CI 0.02-0.46), glycerol (0.32 SD, CI 0.07-0.58) and leucine increased (0.25 SD, CI 0.02-0.49). Citrate (-0.36 SD, CI -0.57 to -0.14) and 3-hydroxybutyrate concentrations decreased (-0.46 SD, CI -0.75 to -0.17). Most metabolite changes were associated with the menopausal hormonal shift. This explained 11% and 9% of the LDL cholesterol and particle concentration increase, respectively. Menopausal hormone therapy was associated with increased medium-to-large HDL particle count and decreased small-to-medium LDL particle and glycine concentration.

CONCLUSIONS

Menopause is associated with proatherogenic circulating metabolome alterations. Female sex hormones levels are connected to the alterations, highlighting their impact on women's cardiovascular health.

Differences in cardiometabolic risk profiles between Chinese and Finnish older adults with glucose impairment and central obesity

BACKGROUND

Obesity and ethnicity play important roles in cardiovascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to compare cardiometabolic risk profiles between Chinese and Finnish older adults of central obesity with prediabetes or T2DM.

METHODS

Study subjects were 60-74 years old and originated from two population samples. The Finnish subjects came from the Kuopio Ischemic Heart Disease (KIHD) study (n = 1089), and the Chinese subjects came from the Shanghai High-risk Diabetic Screen (SHiDS) study (n = 818). The KIHD and SHiDS studies used similar questionnaires to determine participants' baseline characteristics regarding the history of medication use and diseases and lifestyle factors. All study subjects participated in glucose tolerance tests and anthropometry assessments, including waist circumference measurements.

RESULTS

Among study subjects of central obesity with prediabetes (n = 298), fasting and 2-h glucose, and fasting insulin and insulin resistance were significantly higher in Chinese than in Finnish (p < 0.0001-0.016). In addition, triglyceride (TG) level was higher and the low-density lipoprotein cholesterol (LDL) and LDL to high-density lipoprotein cholesterol (HDL) ratio were lower in Chinese than in Finnish (p < 0.0001-0.003). Among subjects of central obesity with T2DM (n = 251), Chinese subjects had significantly less proportions of antihypertensive, glycaemic control medication, and statin users as well as lower level of physical activity (p < 0.0001 for all), while higher blood pressure (p = 0.002 for systolic blood pressure and p < 0.0001 for diastolic blood pressure), TG levels (p < 0.05) and HDL (p = 0.002) than the Finnish counterparts. There were no differences in β-cell function (HOMA-β) between Chinese and Finnish both in prediabetes and T2DM.

CONCLUSIONS

Our results indicated that Chinese and Finnish older adults of central obesity with prediabetes and T2DM had similar β-cell function. However, Chinese individuals with prediabetes are prone to insulin resistance. Meanwhile, lipid metabolism dysfunction is also different between Chinese and Finnish. Chinese older adults of central obesity with prediabetes showed higher TG, but Finnish showed higher LDL and LDL/HDL. Strategic for T2DM prevention and treatment should be ethnically specific.

Measuring psychosocial stress with heart rate variability-based methods in different health and age groups

Autonomic nervous system function and thereby bodily stress and recovery reactions may be assessed by wearable devices measuring heart rate (HR) and its variability (HRV). So far, the validity of HRV-based stress assessments has been mainly studied in healthy populations. In this study, we determined how psychosocial stress affects physiological and psychological stress responses in both young (18-30 yrs) and middle-aged (45-64 yrs) healthy individuals as well as in patients with arterial hypertension and/or either prior evidence of prediabetes or type 2 diabetes. We also studied how an HRV-based stress index (Relax-Stress Intensity, RSI) relates to perceived stress (PS) and cortisol (CRT) responses during psychosocial stress.

APPROACH

A total of 197 participants were divided into three groups: 1) healthy young (HY, N=63), 2) healthy middle-aged (HM, N=61) and 3) patients with cardiometabolic risk factors (Pts, N=73, 32-65 yrs). The participants underwent a group version of Trier Social Stress Test (TSST-G). HR, HRV (quantified as root mean square of successive differences of R-R intervals, RMSSD), RSI, PS, and salivary CRT were measured regularly during TSST-G and a subsequent recovery period.

MAIN RESULTS

All groups showed significant stress reactions during TSST-G as indicated by significant responses of HR, RMSSD, RSI, PS, and salivary CRT. Between-group differences were also observed in all measures. Correlation and regression analyses implied RSI being the strongest predictor of CRT response, while HR was more closely associated with PS.

SIGNIFICANCE

The HRV-based stress index mirrors responses of CRT, which is an independent marker for physiological stress, around TSST-G. Thus, the HRV-based stress index may be used to quantify physiological responses to psychosocial stress across various health and age groups.

Non-invasive home telemonitoring in patients with decompensated heart failure: a systematic review and meta-analysis

We planned this systematic review and meta-analysis to study an estimate of the effect of non-invasive home telemonitoring (TM) in the treatment of patients with recently decompensated heart failure (HF). A systematic literature search was conducted in the Medline, Cinahl, and Scopus databases to look for randomized controlled studies comparing TM with standard care in the treatment of patients with recently decompensated HF. The main outcomes of interest were all-cause hospitalizations and mortality. Eleven original articles met our eligibility criteria. The pooled estimate of the relative risk of all-cause hospitalization in the TM group compared with standard care was 0.95 (95% CI 0.84-1.08, P = 0.43) and the relative risk of all-cause death was 0.83 (95% CI 0.63-1.09, P = 0.17). There was significant clinical heterogeneity among primary studies. HF medication could be directly altered in three study interventions, and two of these had a statistically significant effect on all-cause hospitalizations. The pooled effect estimate of TM interventions on all-cause hospitalizations and all-cause death in patients with recently decompensated heart failure was neutral.

Nurse-led counseling for coronary artery disease patients: A 1-year follow-up study

Nurse-led counseling and systematic follow-up have been shown to reduce cardiovascular risk factor levels. The study aims were to investigate if cardiovascular risk factor levels could be reduced in patients with coronary artery disease with a nurse-led intervention and to report patients' evaluations of nurse-led counseling. The study design was a real-life longitudinal follow-up counseling intervention. Data were collected from November 2017 to May 2020. The nurse-led intervention and patients' follow-up time was 1 year. Of the 78 patients recruited, 74 completed the study. The most significant findings were in the levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides at every follow-up visit compared to their baseline levels and that waist circumference decreased during the 1-year follow-up. Patients assessed the quality of nurse-led counseling to be very good, though it decreased slightly during follow-up. The results suggest the integrated care path and specialized and primary care for coronary artery disease patients need further development. More research is needed on how to strengthen patients' self-management and what kind of counseling would best promote it.

Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era

This Delphi consensus by 28 experts from the European Association of Preventive Cardiology (EAPC) provides initial recommendations on how cardiovascular rehabilitation (CR) facilities should modulate their activities in view of the ongoing coronavirus disease 2019 (COVID-19) pandemic. A total number of 150 statements were selected and graded by Likert scale [from -5 (strongly disagree) to +5 (strongly agree)], starting from six open-ended questions on (i) referral criteria, (ii) optimal timing and setting, (iii) core components, (iv) structure-based metrics, (v) process-based metrics, and (vi) quality indicators. Consensus was reached on 58 (39%) statements, 48 'for' and 10 'against' respectively, mainly in the field of referral, core components, and structure of CR activities, in a comprehensive way suitable for managing cardiac COVID-19 patients. Panelists oriented consensus towards maintaining usual activities on traditional patient groups referred to CR, without significant downgrading of intervention in case of COVID-19 as a comorbidity. Moreover, it has been suggested to consider COVID-19 patients as a referral group to CR per se when the viral disease is complicated by acute cardiovascular (CV) events; in these patients, the potential development of COVID-related CV sequelae, as well as of pulmonary arterial hypertension, needs to be focused. This framework might be used to orient organization and operational of CR programmes during the COVID-19 crisis.

Cold weather-related cardiorespiratory symptoms predict higher morbidity and mortality

BACKGROUND

Symptoms perceived in cold weather reflect physiological responses to body cooling and may worsen the course of a pre-existing disease or precipitate disease events in ostensibly healthy individuals. However, the associations between cold-related symptoms and their health effects have remained unknown. We examined whether cold-related cardiac and respiratory symptoms perceived in cold weather predict future morbidity and mortality.

METHODS

Cold-related symptoms were inquired in four national FINRISK surveys conducted in 1997, 2002, 2007, 2012 in Finland including altogether 17 040 respondents. A record linkage was made to national hospital discharge and cause-of-death registers. The participants were followed up until the first hospital admission due to a cardiovascular or respiratory disease or death, or until the end of 2015. The individual follow-up times ranged from 0 to 18 years (mean 11 years). The association of cold-related symptoms with morbidity and mortality was examined by Kaplan-Meyer and Cox-regression analyses.

RESULTS

Cold-related cardiac [hazard ratio (HR), 1.76 and its 95% confidence interval (95% CI), 1.44-2.15] and combined cardiac and respiratory symptoms [1.50 (1.29-1.73)] were associated with hospitalization due to cardiovascular causes. The respective HRs for admissions due to respiratory causes were elevated for cold-related respiratory [1.22 (1.07-1.40)], cardiac [1.24 (0.88-1.75)] and cardiorespiratory [1.82 (1.50-2.22)] symptoms. Cold-related cardiorespiratory symptoms were associated with deaths from all natural [1.38 (1.11-1.72)], cardiovascular [1.77 (1.28-2.44)] and respiratory [2.19 (0.95-5.06)] causes.

INTERPRETATION

Cold weather-related symptoms predict a higher occurrence of hospital admissions and mortality. The information may prove useful in planning measures to reduce cold-related adverse health effects.

Acute Neuromuscular and Hormonal Responses to Different Exercise Loadings Followed by a Sauna

Rissanen, JA, Häkkinen, A, Laukkanen, J, Kraemer, WJ, and Häkkinen, K. Acute neuromuscular and hormonal responses to different exercise loadings followed by a sauna. J Strength Cond Res 34(2): 313-322, 2020-The purpose of this study was to investigate acute responses of endurance (E + SA), strength (S + SA), and combined endurance and strength exercise (C + SA) followed by a traditional sauna bath (70° C, 18% relative humidity) on neuromuscular performance and serum hormone concentrations. Twenty-seven recreationally physically active men who were experienced with taking a sauna participated in the study. All the subjects performed a sauna bath only (SA) first as a control measurement followed by S + SA and E + SA (paired matched randomization) and C + SA. Subjects were measured PRE (before exercise), MID (immediately after exercise and before sauna), POST (after sauna), POST30min (30 minutes after sauna), and POST24h (24 hours after PRE). Maximal isometric leg press (ILPFmax) and bench press (IBPFmax) forces, maximal rate of force development (RFD) and countermovement vertical jump (CMVJ), serum testosterone (TES), cortisol (COR), and 22-kD growth hormone (GH22kD) concentrations were measured. All exercise loadings followed by a sauna decreased ILPFmax (-9 to -15%) and RFD (-20 to -26%) in POST. ILPFmax, RFD, and CMVJ remained at significantly (p ≤ 0.05) lowered levels after S + SA in POST24h. IBPFmax decreased in POST in S + SA and C + SA and remained lowered in POST24h. SA decreased ILPFmax and IBPFmax in POST and POST30min and remained lowered in ILPFmax (-4.1%) at POST24h. GH22kD, TES, and COR elevated significantly in all loadings measured in the afternoon in MID. SA only led to an elevation (15%) in TES in POST. The strength exercise followed by a sauna was the most fatiguing protocol for the neuromuscular performance. Traditional sauna bathing itself seems to be strenuous loading, and it may not be recommended 24 hours before the next training session. A sauna bath after the loadings did not further change the hormonal responses recorded after the exercise loadings.

The electrocardiographic 'triangular QRS-ST-T waveform' pattern: a marker of severe haemodynamic compromise in Takotsubo syndrome-a case report

Background

Takotsubo cardiomyopathy is characterized by transient regional systolic dysfunction of the left ventricle, mimicking myocardial infarction. Although systolic left ventricular (LV) function normalizes in most cases, the outcome is not always favourable. Recently, a rare electrocardiogram (ECG) finding, lambda wave ST elevation or 'triangular QRS-ST-T waveform', was suggested as a possible marker of poor outcome in Takotsubo patients.

Case summary

After a brief episode of chest pain and shortness of breath, a 67-year-old woman developed cardiogenic shock. Her resting ECG showed widespread ST elevations, which soon evolved into a pattern of triangular QRS-ST-T waveforms in the inferior leads and V3-V6. Emergent coronary angiography was normal. The ejection fraction was 20% with apical ballooning and an LV thrombus. At 1-month follow-up, the patient was asymptomatic and the ECG showed only T-wave inversions.

Discussion

The triangular QRS-ST-T waveform ECG pattern has recently been introduced as a high-risk marker in the Takotsubo syndrome.

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.

Investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis

OBJECTIVE

High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data.

METHODS

To identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data.

RESULTS

Over 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age.

CONCLUSION

Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.

CLINICAL TRIALS REGISTRATION

The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.

Effects of sauna bath on heart failure: A systematic review and meta-analysis

BACKGROUND

Sauna bath has potential as a lifestyle treatment modality for heart failure (HF). It is important to analyze the current evidence to help suggest paths of future study and potential for clinical application.

HYPOTHESIS

Sauna bath has a positive effect on HF patients.

METHODS

PubMed, Cochrane Library, and CINAHL databases were searched to identify randomized and nonrandomized controlled studies to compare effects of sauna bath with no sauna bath. Studies were searched for both infrared sauna bath and Finnish sauna bath. The strength of evidence was rated using a modified GRADE approach. Out of 1444 studies, nine met the inclusion criteria and were included in this review. Seven of these nine studies were included in the meta-analysis. Only studies with infrared sauna bath met the inclusion criteria.

RESULTS

In the meta-analysis, exposure to an infrared sauna bath in 60°C for 15 minutes, followed by a 30-minute rest in warm environment, five times a week for 2 to 4 weeks, was associated with a significant reduction in B-type natriuretic peptide, cardiothoracic ratio, and an improvement in left-ventricular ejection fraction. There was no significant effect on left-ventricular end-diastolic diameter, left atrial diameter, systolic blood pressure, or diastolic blood pressure. The strength of evidence varied from moderate to insufficient.

CONCLUSION

Infrared sauna bath was associated with short-term improvement in cardiac function. More evidence is needed about long-term effects of sauna bath and the effects of a Finnish sauna on cardiovascular health among patients with HF or other cardiovascular diseases.

Efficient reversible phase mask for TiO2 submicron gratings directly printed on cylindrical surfaces

In this article we present a radial phase mask specially designed and manufactured for direct micro-structuration under UV photolithography of a cylindrical surface covered by a photoresist TiO₂ film. The period of the phase mask is sub-micron (between 480 nm and 720 nm) and allows direct printing on several types of cylindrical components. With this dedicated reversible phase mask we have demonstrated the feasibility of a TiO₂ grating with a period of 960 nm, printed on a SiO₂ cylinder or inside a SiO₂ tube of 8 mm diameter.

Exercise capacity and mortality - a follow-up study of 3033 subjects referred to clinical exercise testing

BACKGROUND

Exercise stress testing is used as a diagnostic and prognostic tool. We determined the prognostic significance of exercise test findings for cardiovascular (CVD) and all-cause mortality in men and women.

MATERIAL AND METHODS

3033 subjects underwent a symptom-limited bicycle exercise test. Exercise capacity was defined as the mean of last four minutes of exercise workload.

RESULTS

During an average follow-up of 19 years, 186 (11.6%) CVD and 370 (20.6%) all-cause deaths in men and 57 (5.0%) CVD and 155 (12.5%) all-cause deaths in women occurred. Among exercise test variables (workload, ECG, BP, HR), exercise capacity was the strongest predictor of mortality. Low exercise capacity (1st quartile) was associated with a hazard ratio of 4.2 (95% CI: 1.7, 10.8) for CVD and 4.0 (95% CI: 2.5, 6.4) for all-cause mortality compared with high exercise capacity (4th quartile) among men and in women with a 5.4-fold (95% CI: 1.2, 24.0) risk for CVD and 2.3-fold (95% CI: 1.2, 4.3) risk for all-cause mortality, respectively. The relationship between other exercise test variables and mortality was much weaker.

CONCLUSIONS

Among exercise test variables exercise capacity was the strongest predictor of CVD and all-cause mortality in both genders, and especially CVD deaths in women. Key Messages Exercise capacity was the most powerful predictor of CVD and all-cause mortality in both men and women. Low exercise capacity is a strong predictor of CVD death, especially among women.

[Update on Current Care Guideline: Physical activity and exercise training for adults in sickness and in health]

The purpose of the guideline is to promote physical activity in the prevention, treatment and rehabilitation of diseases. Physical activity plays a key role in the management of several chronic noncommunicable diseases. In this guideline, the following diseases are discussed: endocrinological, cardiovascular, musculoskeletal and respiratory diseases, as well as depression and cancer. In addition, physical activity during pregnancy and in senior citizens is reviewed. Exercise counseling should be included as part of disease management and lifestyle guidance.

[Performance and cardiorespiratory fitness: from exercise physiology to clinical decision-making]

Cardiorespiratory fitness is indicated by the body's ability to transport oxygen from the surrounding air to the contracting muscle, and the muscle's capacity to use oxygen. Cardiorespiratory fitness relies on the effective integration of the cardiovascular pulmonary, hematologic, and skeletal muscle systems. Maximal oxygen uptake is considered the best measure of cardiorespiratory fitness. A low level of maximal oxygen uptake is associated with a markedly increased cardiovascular and all-cause mortality both in healthy subjects and cardiac patients. Randomized, controlled trials are still needed, however, to further clarify the value of the assessment of cardiorespiratory fitness in clinical decision-making.

Meta-analysis of ventricular premature complexes and their relation to cardiac mortality in general populations

Although previous studies have shown that frequent ventricular premature complexes (VPCs) in patients with established heart disease are associated with increased risk of cardiac mortality, the significance of VPCs in general populations is unclear. The aim of this study was to assess the association between VPCs and risk of sudden cardiac death or total cardiac death in general populations by conducting a meta-analysis of published research. The electronic databases MEDLINE and Embase were searched for relevant studies. Data were abstracted using standardized forms. Study-specific relative risk estimates were pooled using a random-effects meta-analysis model. Eleven studies comprising a total of 106,195 participants sampled from general populations were included. Studies generally defined frequent VPCs as occurring ≥1 time during a standard electrocardiographic recording or ≥30 times over a 1-hour recording. The prevalence of frequent VPCs in the studies ranged from 1.2% to 10.7%. The overall adjusted relative risk for sudden cardiac death comparing participants with frequent VPCs versus those without frequent VPCs was 2.64 (95% confidence interval 1.93 to 3.63). The corresponding value for total cardiac death was 2.07 (95% confidence interval 1.71 to 2.50). Although most studies made attempts to exclude high-risk subjects, such as those with histories of cardiovascular disease, they did not test participants for underlying structural heart disease. In conclusion, findings from observational studies in general populations indicate that frequent VPCs are associated with a substantial increase in the risk for sudden cardiac death and total cardiac death. Further study is needed to determine the role of confounding and underlying structural heart disease in the observed association and its utility in cardiovascular risk prediction.

Abstract 1079: Markers of inflammation and risk of prostate cancer: Results from a 20-year follow-up study

Introduction: Evidence from clinical, histopathological and epidemiological studies suggest that inflammation plays a role in prostate carcinogenesis. However, studies investigating these associations using biomarkers of inflammation such as C-reactive protein (CRP) and interleukin-6 (IL-6) have reported conflicting results. A meta-analysis of six studies reported no associations between CRP and risk of prostate cancer while an inverse association was reported for IL-6, although the analysis was limited to only three studies. Because of the conflicting findings from previous studies, we investigated the associations of four markers of inflammation (CRP, fibrinogen albumin and leucocyte) and risk of prostate cancer.

Methods: We investigated these associations in a prospective cohort study involving 2,627 middle-aged men from Eastern Finland who had baseline examination and blood draw between March 1984 and December 1989. During a follow-up period lasting twenty years, with virtually no losses to follow-up, 203 men developed prostate cancer. They were identified through linkage with the nationwide, population-based Finnish Cancer Registry, using the unique personal identification number available to all residents of Finland. Associations between the markers and risk of prostate cancer were examined using Cox proportional hazards model, adjusting for known and potential confounders (age, examination year, socioeconomic status, alcohol consumption, energy intake, cardiorespiratory fitness, body mass index and pack-years of smoking).

Results: Elevated pre-diagnostic serum albumin and leucocyte count, but not serum CRP and fibrinogen concentrations were associated with statistically significantly increased risk of prostate cancer. In multivariate adjusted analyses, the relative risks (RRs, 95%CI) of prostate cancer among men in the highest quartiles of albumin and leucocyte concentrations compared to men in the lowest quartiles were 1.39 (95%CI 1.10-1.91, p-trend=0.04) and 1.60 (95%CI 1.10-2.29, p-trend=0.01), respectively. The relative risks of prostate cancer among men in the highest quartiles of CRP and fibrinogen concentrations compared to those in the lowest quartiles were 1.08 (95%CI 0.74-1.60, p-trend=0.56) and 1.25 (95%CI 0.87-1.81, p-trend=0.14), respectively.

Conclusions: To the best of our knowledge, this is the first prospective study to observe positive associations between pre-diagnostic serum albumin concentrations, leucocyte count and the risk of prostate cancer. Similar to previous epidemiological studies, we observed no significant positive associations between CRP concentrations and the risk of prostate cancer. The results from our study suggest that markers of inflammation may have differential associations with prostate cancer risk.

Citation Format: Adetunji T. Toriola, Jari Laukkanen, Sudhir Kurl, Kimmo Ronkainen, Kristiina Nyyssönen, Jussi Kauhanen. Markers of inflammation and risk of prostate cancer: Results from a 20-year follow-up study. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1079. doi:10.1158/1538-7445.AM2013-1079

Subwavelength cylindrical grating by holistic phase-mask coordinate transform

A periodic grating with an integer number of periods is fabricated at the resist-coated wall of a cylinder by exposing a circularly symmetrical planar high index phase mask to a cylindrical wave. This extends the spatial coherence features easily achievable in a planar 2D space to the 3D space of cylindrical waves and elements.

Leisure-time physical activity, cardiorespiratory fitness and feelings of hopelessness in men

BACKGROUND

Leisure-time physical activity (LTPA) and cardiorespiratory fitness contribute to mental health. Hopelessness has been linked to impaired mental health, cardiovascular events and mortality. Previous studies have focused on physical exercise and depression. We examined the associations of LTPA and cardiorespiratory fitness with feelings of hopelessness.

METHODS

In this cross-sectional study leisure-time physical activity, maximal oxygen uptake (VO2max), hopelessness and cardiovascular risk factors were assessed in a population-based cohort of 2428 men aged 42 - 60 years old at baseline.

RESULTS

Men feeling more hopeless about their future and reaching goals were less physically active, less fit and had a higher prevalence of many cardiovascular risk factors than men with lower levels of hopelessness. In a logistic regression model adjusted for age, smoking, alcohol consumption, cardiovascular disease and socioeconomic status, men engaging in less than 60 min/week of moderate-to-vigorous LTPA were 37% (95% CI 11 - 67%) more likely to feel hopeless than those engaging in at least 2.5 h/wk of LTPA. After further adjusting for elevated depressive symptoms the association of LTPA and hopelessness remained significant. VO2max was also associated with hopelessness, but not after adjustment for depressive symptoms.

CONCLUSION

Moderate and vigorous LTPA and cardiorespiratory fitness were inversely associated with hopelessness in these middle-aged men. These findings suggest that physical inactivity and poor cardiorespiratory fitness is an important associate of hopelessness, a distinct element of low subjective well-being.

Coronary angioplasty in drug eluting stent era for the treatment of unprotected left main stenosis compared to coronary artery bypass grafting

BACKGROUND

Improved outcomes of percutaneous coronary interventions (PCI) with drug-eluting stents (DES) have resulted in their expanded use for left main coronary artery (LMCA) stenosis.

AIM

We compared outcomes of patients undergoing PCI for unprotected LMCA stenosis and patients treated by coronary artery bypass grafting (CABG).

METHOD

Between January 2005 and January 2007, 6705 patients were studied with coronary angiography in northern Finland. All subjects treated with revascularization of LMCA stenosis (n = 287) were included and followed up for a mean of 12+6 months.

RESULTS

From 287 patients, 238 underwent CABG, and 49 had PCI with DES. The incidence of 1-year mortality was 4% among the PCI-treated and 11% among CABG-treated patients (P = 0.136). After the first month, mortality among PCI-or CABG-treated patients did not differ statistically significantly (2% versus 7%, P = 0.133). The most significant independent predictor of mortality was reduced left ventricular systolic function (hazard ratio 14.9, 95% CI 5.5-40.0, P < 0.001).

CONCLUSIONS

PCI with DES for selected LMCA disease patients results in short- and midterm outcomes comparable to results of CABG in general. PCI is a viable therapeutic option in selected patients with LMCA stenosis.

Serum folate and homocysteine and the incidence of acute coronary events: the Kuopio Ischaemic Heart Disease Risk Factor Study

BACKGROUND

Several, but not all, prospective studies have shown that low folate intakes, low circulating folate concentrations, or high plasma total homocysteine (tHcy) concentrations are associated with an increased risk of coronary artery disease (CAD).

OBJECTIVE

We examined the relations of both serum folate and serum tHcy concentrations with acute coronary events in middle-aged men from eastern Finland who had no CAD at baseline.

DESIGN

In a population-based prospective cohort study, 1027 men aged 46-64 y were examined in 1991-1993 as part of the Kuopio Ischaemic Heart Disease Risk Factor Study. During an average follow-up of 7.7 y (7900 person-years of follow-up), 114 acute coronary events were observed in 61 men who had no previous history of CAD (n = 810).

RESULTS

In a Cox model, compared with men whose serum folate concentrations were in the lowest tertile, those whose concentrations were in the highest tertile had a risk factor-adjusted relative risk of acute coronary events of 0.35 (95% CI: 0.17, 0.73; P = 0.005). Serum tHcy concentrations were not significantly associated with the risk of acute coronary events (for the highest tertile compared with the lowest, adjusted relative risk = 1.03; 95% CI: 0.57, 1.87; P = 0.932).

CONCLUSIONS

The results of this prospective cohort study do not support the hypothesis that a high circulating tHcy concentration is a risk factor for acute coronary events in a male population free of prior heart disease. However, they do suggest that moderate-to-high serum folate concentrations are associated with a greatly reduced incidence of acute coronary events.

Intravascular adenovirus-mediated VEGF-C gene transfer reduces neointima formation in balloon-denuded rabbit aorta

BACKGROUND

Gene transfer to the vessel wall may provide new possibilities for the treatment of vascular disorders, such as postangioplasty restenosis. In this study, we analyzed the effects of adenovirus-mediated vascular endothelial growth factor (VEGF)-C gene transfer on neointima formation after endothelial denudation in rabbits. For comparison, a second group was treated with VEGF-A adenovirus and a third group with lacZ adenovirus. Clinical-grade adenoviruses were used for the study.

METHODS AND RESULTS

Aortas of cholesterol-fed New Zealand White rabbits were balloon-denuded, and gene transfer was performed 3 days later. Animals were euthanized 2 and 4 weeks after the gene transfer, and intima/media ratio (I/M), histology, and cell proliferation were analyzed. Two weeks after the gene transfer, I/M in the lacZ-transfected control group was 0. 57+/-0.04. VEGF-C gene transfer reduced I/M to 0.38+/-0.02 (P:<0.05 versus lacZ group). I/M in VEGF-A-treated animals was 0.49+/-0.17 (P:=NS). The tendency that both VEGF groups had smaller I/M persisted at the 4-week time point, when the lacZ group had an I/M of 0.73+/-0.16, the VEGF-C group 0.44+/-0.14, and the VEGF-A group 0. 63+/-0.21 (P:=NS). Expression of VEGF receptors 1, 2, and 3 was detected in the vessel wall by immunocytochemistry and in situ hybridization. As an additional control, the effect of adenovirus on cell proliferation was analyzed by performing gene transfer to intact aorta without endothelial denudation. No differences were seen in smooth muscle cell proliferation or I/M between lacZ adenovirus and 0.9% saline-treated animals.

CONCLUSIONS

Adenovirus-mediated VEGF-C gene transfer may be useful for the treatment of postangioplasty restenosis and vessel wall thickening after vascular manipulations.

Adenovirus-mediated gene transfer of a secreted form of human macrophage scavenger receptor inhibits modified low-density lipoprotein degradation and foam-cell formation in macrophages

BACKGROUND

Macrophage scavenger receptors (MSRs) play an important role in the pathogenesis of atherosclerosis. Therefore, local modulation of MSR activity could have a beneficial effect on atherogenesis.

METHODS AND RESULTS

We cloned a secreted "decoy" MSR (sMSR) that contains an extracellular portion of the human MSR type AI and constructed an adenoviral vector that directs high-level expression of sMSR in macrophages under the control of the human CD68 promoter. Expression of the sMSR protein inhibited the degradation of (125)I-labeled acetylated LDL and oxidized LDL by murine macrophages up to 90%. sMSRs also reduced acetylated LDL degradation in MSR knockout mouse peritoneal macrophages by 60% to 80%, which suggests that the decoy construct can compete for the uptake mediated via other related scavenger receptors. In addition, sMSRs inhibited foam-cell formation in murine macrophages in the presence of cytochalasin D. The mechanism of inhibition is through ligand binding to the sMSRs, which prevents the ligand binding to MSRs on cell membranes.

CONCLUSIONS

The demonstration that recombinant adenovirus-mediated gene transfer of decoy sMSRs can block foam-cell formation suggests a possible new strategy for gene therapy of atherosclerosis and for the treatment of lipid accumulation after arterial manipulations.

Complement and anti-alpha-galactosyl natural antibody-mediated inactivation of murine retrovirus occurs in adult serum but not in umbilical cord serum

Many retroviral vectors for hematopoietic cell and other clinical gene therapy are derived from murine packaging cell lines. The exposure of these retroviruses and packaging cell lines to adult human serum (AS) inactivates them by complement and anti-alpha-galactosyl natural antibody-mediated mechanisms. We show that virus stability and infection efficiency of CRIP/BAG, a murine packaging cell line derived amphotropic retrovirus vector is reduced > 95% following a 30-min incubation in AS. This inactivation is prevented by replacing AS with umbilical cord serum (CS), wherein full retroviral transduction efficiency is maintained after 30 min of incubation. The loss of retrovirus transduction efficiency in AS was smaller upon blockage of anti-alpha-galactosyl antibodies with galactose alpha 1-3-galactose. Serum levels of CH 100, as well as C1q complement which inactivates retroviruses by an antibody-independent mechanism were similar in AS and CS. The high stability of CRIP/BAG retrovirus vector in CS is likely due to its lower levels of maternally derived anti-alpha-galactosyl antibodies. These results have implications for in vivo gene transfer in adults and also in newborns since neonates do not produce natural antibodies during the initial months of life.

Beta-galactosidase gene transfer to human malignant glioma in vivo using replication-deficient retroviruses and adenoviruses

Both retro- and adenovirus-mediated gene therapy have been suggested as a novel approach to the treatment of malignant brain tumors. However, little information is available about the gene transfer efficiency in human malignant glioma in vivo. We compared the feasibility and safety of retrovirus- and adenovirus-mediated beta-galactosidase gene transfer in human malignant glioma. Beta-galactosidase gene was transferred to 10 patients with malignant glioma via a catheter inserted into the tumor. The catheter was left in place until the tumor resection. To maximize gene transfer efficiency, gene transfer vectors (BAG retroviruses, titer, 6 x 10(5) CFU; and adenoviruses, titer from 3 x 10(8) to 3 x 10(10) PFU) were injected into the tumor via the catheter once a day for three consecutive days, followed by tumor resection 1-2 days later. Tumor was resected in such a way that the catheter was still in place inside the tumor, which permitted accurate histological analysis of the transduced tumors. X-Gal staining for beta-galactosidase activity was used to study gene transfer efficiency and distribution of the marker gene. Beta-galactosidase gene transfer was well tolerated with both vectors. Except for two patients with clear increases in serum adenovirus antibody titers, no adverse tissue responses or systemic complications were noticed in any of the patients. Gene transfer was successful in all patients. Gene transfer efficiency varied between <0.01 and 4% with retroviruses and between <0.01 and 11% with adenoviruses. However, the transgene activity was not evenly distributed in the tumors. Both glioma cells and endothelium in the tumor blood vessels were transduced with retro- and adenovirus vectors. In conclusion, the safety and feasibility of in vivo gene transfer to human malignant glioma was established with retro- and adenovirus vectors. Adenoviruses were more efficient than retroviruses in achieving in vivo gene transfer. Transduction of endothelial cells may have important consequences for the proposed treatment strategies and selection of treatment genes. The results justify clinical gene therapy trials for malignant glioma.