Inactivity Increases Heart Failure Risk at All Weight Levels | |
| |
BOSTON, 27 dec 2008- Excess weight and physical inactivity can almost triple a man's risk of heart failure, according to data from a large prospective cohort study. Obese, inactive men had almost a 300% greater risk of heart failure compared with lean, active study participants, Satish Kenchaiah, M.D., of Brigham and Women's Hospital and Harvard, and colleagues reported in the Jan. 6 issue of Circulation: Journal of the American Heart Association. For a man who is 5' 10" tall, every seven pounds of weight gain increased the risk of heart failure by 11%, the data suggested. The data also showed that excess weight and physical activity did not influence each other's effect on heart failure risk. "Higher [body mass index] increased the risk of heart failure in active and inactive men," Dr. Kenchaiah said. "By the same token, the beneficial effect of vigorous physical activity in reducing the risk of heart failure was observed in lean, overweight, and also obese men." Although BMI in the obese range (30 kg/m2) is associated with an increased risk of HF, the risk conferred in overweight or preobese (25 to 29.9 kg/m2) individuals had been unclear, the authors said. Numerous health benefits have been ascribed to physical activity, but its influence on the risk of heart failure also had remained unclear, particularly in men. Moreover, the interaction among BMI, physical activity, and heart failure risk had not been examined. To address the unknowns, Dr. Kenchaiah and colleagues analyzed data from the Physicians' Health Study. The analysis included 21,091 men ages 40 to 84 at enrollment and without known coronary heart disease. They completed annual health surveys since the PHS began in 1982. The authors examined the individual and combined effects of BMI and vigorous physical activity on heart failure incidence from 1982 to 2007. Vigorous activity was defined as exercise sufficient to cause sweating. The men were divided into BMI categories of lean (25 kg/m2), overweight (25 to 29.9 kg/m2), and obese (≥30 kg/m2). The authors applied a dichotomous definition to physical activity, defining inactive as rarely or never exercising vigorously and active as vigorous exercise one to three times a month. During follow-up that averaged 20.5 years, 1,109 participants developed new-onset heart failure. In a multivariate analysis, every 1-kg/m2 increase in BMI increased the risk of heart failure by 11%. As compared with lean participants, overweight men had a 49% increase in the risk of heart failure, and obese men had a 180% greater risk. Overall, the data on physical activity showed that men who exercised vigorously five to seven times a week had a 36% reduction in heart failure risk compared with men who reported no physical activity. As compared with men who were both lean and physically active, heart failure risk increased:
"Whereas previous studies have established that obese men have a higher likelihood of developing heart failure, the present investigation has extended this knowledge by pointing out that even overweight or pre-obese men are not spared from this increased risk," said Dr. Kenchaiah.
| |
Primary source: Circulation: Journal of the American Heart Association Source reference: Kenchaiah S, et al "Body mass index and vigorous physical activity and the risk of heart failure among men" Circulation. 2009; 119: DOI: 10.1161/CIRCULATIONAHA.108.807289. |
Showing posts with label Heart Failure Risk. Show all posts
Showing posts with label Heart Failure Risk. Show all posts
Saturday, December 27, 2008
Wednesday, October 24, 2007
Whole-Grain Cereals May Lower Heart Failure Risk for Men
BOSTON, Oct. 23 -- Seven servings of whole-grain breakfast cereals a week led to a 29% reduction in the risk of heart failure for men, researchers here found in a large observational study.
The benefit did not apply to refined cereals, Luc Djoussé, M.D., and J. Michael Gaziano, M.D., of Harvard, reported in the Oct. 22 issue of the Archives of Internal Medicine.
The investigators determined the heart failure benefit of whole-grain cereals on the basis of a semiquantitative food questionnaire that prospectively evaluated 21,376 male participants (mean age 53.7) in the Physicians' Health Study I.
Incident heart failure was determined through annual follow-up questionnaires and validated using Framingham criteria.
During an average follow-up of 19.6 years, 1,018 new cases of heart failure occurred. These included 362 of 6,995 participants who did not eat any cereal, 237 of 4,987 who ate one serving or less a week, 230 of 5,227 who ate two to six servings a week, and 189 of 4,167 who ate seven or more servings a week.
For average weekly cereal consumption of zero servings, the hazard ratio (95% confidence interval) was 1 and this group served as the reference.
For one or fewer servings a week, the HR was, 0.92 (CI, 0.78-1.09). For two to six servings, the HR was 0.79 (CI, 0.67-0.93), and for more than seven servings, the HR was 0.71 (CI, 0.60-0.85), (P<0.001 for trend).
These hazard ratios were calculated after adjustment for age, smoking habits, alcohol consumption, use of multivitamins, physical activity, history of atrial fibrillation, valvular heart disease, and left ventricular hypertrophy.
When the findings were stratified by the type of breakfast cereal, the researchers found an inverse association between whole-grain cereals and heart failure (P<0.001) but not for refined cereals (P=0.70 for trend).
Whole-grain cereals, such as shredded wheat, bran cereal, or oatmeal include the entire kernel, the starchy endosperm, and the nutrient-packed germ. In this study, cereals with at least 25% of whole grain or bran by weight were classified as whole-grain, the researchers said.
Refined grains, as in white rice, white bread, or cornflakes have been processed to remove part of the grain and with it, beneficial nutrients. Usually all that is left after processing is the starchy endosperm.
Whole-grain breakfast cereals and cereal products contain important nutrients, such as vitamins, minerals, fiber, and oil that have been reported to lower cardiovascular risk factors and positively influence glucose and insulin metabolism, Drs. Djoussé and Gaziano said.
In addition, cereals contain phytoestrogens and phenolic acids, which have been shown to have health benefits, they said.
Cereal consumption has also been shown to favorably influence other risk factors for heart failure, including body mass index and weight gain over time in male physicians and female nurses. However, refined grains in these studies were positively associated with weight gain in women although not in men.
There are several biological mechanisms by which whole-grain cereals could offer protection, the investigators said. Nutrients such as potassium contained in whole-grain cereals have been shown to lower blood pressure.
In addition, other constituents of cereals may exert beneficial effects on lipid and homocysteine levels or they may have antioxidant properties.
Phytoestrogens in the cereals may improve lipid levels and insulin sensitivity. Finally, slowing starch digestion and promoting satiety may help control body weight, the investigators said.
Study limitations included the failure to distinguish heart failure with and without preserved left ventricular function. The food frequency questionnaire made it impossible to control for total energy intake and other nutrients in the diet, as well as the possibility of inaccurate reporting of cereal consumption.
In addition, the researchers noted that the participants were highly educated male physicians whose behavior may have differed from that of the general population.
In conclusion, they wrote that the benefits of whole-grain breakfast cereals are likely to be mediated by their effect on risk factors such as hypertension, myocardial infarction, diabetes, and obesity.
Additional studies are warranted to confirm these findings and determine specific nutrients responsible for the cereal's protection, they concluded.
Dr. Gaziano has received investigator-initiated research grants from BASF, DSM Pharmaceuticals, Wyeth Pharmaceuticals, McNeil Consumer Products, and Pliva as well as honoraria from Bayer and Pfizer for speaking engagements. He is a consultant for Bayer, McNeil Consumer Products, Wyeth Pharmaceuticals, Merck, Nutraquest, and GlaxoSmithKline.
The Physicians' Health Study is supported by grants from the National Cancer Institute and National Heart, Lung, and Blood Institute (NHLBI).
Dr. Djoussé is supported by a grant from the NHLBI.Primary source: Archives of Internal MedicineSource reference: Djoussé L, Graziano J "Breakfast Cereals and Risk of Heart Failure in the Physicians' Health Study I" Arch Intern Med 2007; 167: 2080-2085.
BOSTON, Oct. 23 -- Seven servings of whole-grain breakfast cereals a week led to a 29% reduction in the risk of heart failure for men, researchers here found in a large observational study.
The benefit did not apply to refined cereals, Luc Djoussé, M.D., and J. Michael Gaziano, M.D., of Harvard, reported in the Oct. 22 issue of the Archives of Internal Medicine.
The investigators determined the heart failure benefit of whole-grain cereals on the basis of a semiquantitative food questionnaire that prospectively evaluated 21,376 male participants (mean age 53.7) in the Physicians' Health Study I.
Incident heart failure was determined through annual follow-up questionnaires and validated using Framingham criteria.
During an average follow-up of 19.6 years, 1,018 new cases of heart failure occurred. These included 362 of 6,995 participants who did not eat any cereal, 237 of 4,987 who ate one serving or less a week, 230 of 5,227 who ate two to six servings a week, and 189 of 4,167 who ate seven or more servings a week.
For average weekly cereal consumption of zero servings, the hazard ratio (95% confidence interval) was 1 and this group served as the reference.
For one or fewer servings a week, the HR was, 0.92 (CI, 0.78-1.09). For two to six servings, the HR was 0.79 (CI, 0.67-0.93), and for more than seven servings, the HR was 0.71 (CI, 0.60-0.85), (P<0.001 for trend).
These hazard ratios were calculated after adjustment for age, smoking habits, alcohol consumption, use of multivitamins, physical activity, history of atrial fibrillation, valvular heart disease, and left ventricular hypertrophy.
When the findings were stratified by the type of breakfast cereal, the researchers found an inverse association between whole-grain cereals and heart failure (P<0.001) but not for refined cereals (P=0.70 for trend).
Whole-grain cereals, such as shredded wheat, bran cereal, or oatmeal include the entire kernel, the starchy endosperm, and the nutrient-packed germ. In this study, cereals with at least 25% of whole grain or bran by weight were classified as whole-grain, the researchers said.
Refined grains, as in white rice, white bread, or cornflakes have been processed to remove part of the grain and with it, beneficial nutrients. Usually all that is left after processing is the starchy endosperm.
Whole-grain breakfast cereals and cereal products contain important nutrients, such as vitamins, minerals, fiber, and oil that have been reported to lower cardiovascular risk factors and positively influence glucose and insulin metabolism, Drs. Djoussé and Gaziano said.
In addition, cereals contain phytoestrogens and phenolic acids, which have been shown to have health benefits, they said.
Cereal consumption has also been shown to favorably influence other risk factors for heart failure, including body mass index and weight gain over time in male physicians and female nurses. However, refined grains in these studies were positively associated with weight gain in women although not in men.
There are several biological mechanisms by which whole-grain cereals could offer protection, the investigators said. Nutrients such as potassium contained in whole-grain cereals have been shown to lower blood pressure.
In addition, other constituents of cereals may exert beneficial effects on lipid and homocysteine levels or they may have antioxidant properties.
Phytoestrogens in the cereals may improve lipid levels and insulin sensitivity. Finally, slowing starch digestion and promoting satiety may help control body weight, the investigators said.
Study limitations included the failure to distinguish heart failure with and without preserved left ventricular function. The food frequency questionnaire made it impossible to control for total energy intake and other nutrients in the diet, as well as the possibility of inaccurate reporting of cereal consumption.
In addition, the researchers noted that the participants were highly educated male physicians whose behavior may have differed from that of the general population.
In conclusion, they wrote that the benefits of whole-grain breakfast cereals are likely to be mediated by their effect on risk factors such as hypertension, myocardial infarction, diabetes, and obesity.
Additional studies are warranted to confirm these findings and determine specific nutrients responsible for the cereal's protection, they concluded.
Dr. Gaziano has received investigator-initiated research grants from BASF, DSM Pharmaceuticals, Wyeth Pharmaceuticals, McNeil Consumer Products, and Pliva as well as honoraria from Bayer and Pfizer for speaking engagements. He is a consultant for Bayer, McNeil Consumer Products, Wyeth Pharmaceuticals, Merck, Nutraquest, and GlaxoSmithKline.
The Physicians' Health Study is supported by grants from the National Cancer Institute and National Heart, Lung, and Blood Institute (NHLBI).
Dr. Djoussé is supported by a grant from the NHLBI.Primary source: Archives of Internal MedicineSource reference: Djoussé L, Graziano J "Breakfast Cereals and Risk of Heart Failure in the Physicians' Health Study I" Arch Intern Med 2007; 167: 2080-2085.
Tuesday, October 09, 2007
ATA: Mildly Underactive Thyroid Increases Heart Failure Risk
NEW YORK, Oct. 8 -- Subclinical hypothyroidism may modestly increase the risk of heart failure, researchers reported here.Asymptomatic patients with thyroid stimulating hormone levels of 10 mU/L or higher were at almost twice the risk of heart failure as patients without subclinical hypothyroidism, found a large cohort study presented at the American Thyroid Association meeting.
This risk is comparable to that from diabetes and hypertension, both known heart failure risk factors, said Doug Bauer, M.D., of the University of California at San Francisco.
The study excluded patients who were taking thyroid hormones, but Dr. Bauer said the results suggested that treating subclinical hypothyroidism could reduce heart failure risk.
"When we included people treated during follow-up," he said, "the risk of heart failure was attenuated compared with those not treated."
However, he cautioned that the study was not designed to answer that question, and further study is needed.
"People who have heart failure should be evaluated to make sure that their thyroid tests, specifically their TSH, are normal," Dr. Bauer added.
Previous studies linked overt hyperthyroidism and hypothyroidism to heart problems. The Health Aging and Body Composition (Health ABC) study had shown a similar relationship for subclinical hypothyroidism, but without confirmation of the heart abnormalities on echocardiogram.
So Dr. Bauer's group analyzed echocardiographic heart function changes among 3,065 patients 65 and older in the Cardiovascular Health Study who were initially free of heart failure.
During 12 years of follow-up, 660 participants (22%) had adjudicated heart failure events, 16% had subclinical hypothyroidism (TSH levels 4.5 mU/L or higher but normal free thyroxine levels), and 1.4% had subclinical hyperthyroidism (TSH less than 0.45 mU/L).
After controlling for cardiovascular risk factors, including hypertension and diabetes, subclinical hypothyroid patients with TSH levels in the higher range (10 mU/L or greater) were at a modestly elevated risk of heart failure compared with participants with normal thyroid function (hazard ratio 1.88, 95% confidence interval 1.05 to 3.34, P=0.003).
However, subclinical hypothyroid patients with TSH levels in the lower range (4.5 to 9.9 mU/L) were no more likely than euthyroid participants to develop heart failure in the multivariate analysis (HR 0.92, 95% CI 0.73 to 1.17).
Subclinical hyperthyroidism was not associated with more heart failure events than normal thyroid function (HR 0.94, 95% CI 0.48 to 1.83).
Although most baseline echocardiographic parameters were not correlated with thyroid status, patients with a TSH of at least 10.0 mU/L had a higher peak E velocity than those without subclinical hypothyroidism (0.80 versus 0.72 m/sec, P=0.002), which suggested decreased left ventricular compliance, Dr. Bauer said. This was associated with incident heart failure in the overall cohort (P<0.001).
However, changes in echocardiographic parameters during six years of follow-up for this measure were not significantly associated with thyroid status.
The mechanism for an association between heart failure and thyroid function has been fairly well studied and it is likely that "subclinical hypothyroid state results in a less efficient contraction of the heart," Dr. Bauer said. Another possible explanation could include fluid retention, he said.
If the findings are confirmed, "it also suggests the potential that we might screen for abnormal thyroid tests to prevent people from developing heart failure in the future," he concluded.
Dr. Bauer and colleagues reported no conflicts of interest. Primary source: American Thyroid Association meetingSource reference: Rodondi N, et al "Subclinical Thyroid Dysfunction, Cardiac Function and the Risk of Congestive Heart Failure: The Cardiovascular Health Study" ATA meeting 2007; Program number 92.
NEW YORK, Oct. 8 -- Subclinical hypothyroidism may modestly increase the risk of heart failure, researchers reported here.Asymptomatic patients with thyroid stimulating hormone levels of 10 mU/L or higher were at almost twice the risk of heart failure as patients without subclinical hypothyroidism, found a large cohort study presented at the American Thyroid Association meeting.
This risk is comparable to that from diabetes and hypertension, both known heart failure risk factors, said Doug Bauer, M.D., of the University of California at San Francisco.
The study excluded patients who were taking thyroid hormones, but Dr. Bauer said the results suggested that treating subclinical hypothyroidism could reduce heart failure risk.
"When we included people treated during follow-up," he said, "the risk of heart failure was attenuated compared with those not treated."
However, he cautioned that the study was not designed to answer that question, and further study is needed.
"People who have heart failure should be evaluated to make sure that their thyroid tests, specifically their TSH, are normal," Dr. Bauer added.
Previous studies linked overt hyperthyroidism and hypothyroidism to heart problems. The Health Aging and Body Composition (Health ABC) study had shown a similar relationship for subclinical hypothyroidism, but without confirmation of the heart abnormalities on echocardiogram.
So Dr. Bauer's group analyzed echocardiographic heart function changes among 3,065 patients 65 and older in the Cardiovascular Health Study who were initially free of heart failure.
During 12 years of follow-up, 660 participants (22%) had adjudicated heart failure events, 16% had subclinical hypothyroidism (TSH levels 4.5 mU/L or higher but normal free thyroxine levels), and 1.4% had subclinical hyperthyroidism (TSH less than 0.45 mU/L).
After controlling for cardiovascular risk factors, including hypertension and diabetes, subclinical hypothyroid patients with TSH levels in the higher range (10 mU/L or greater) were at a modestly elevated risk of heart failure compared with participants with normal thyroid function (hazard ratio 1.88, 95% confidence interval 1.05 to 3.34, P=0.003).
However, subclinical hypothyroid patients with TSH levels in the lower range (4.5 to 9.9 mU/L) were no more likely than euthyroid participants to develop heart failure in the multivariate analysis (HR 0.92, 95% CI 0.73 to 1.17).
Subclinical hyperthyroidism was not associated with more heart failure events than normal thyroid function (HR 0.94, 95% CI 0.48 to 1.83).
Although most baseline echocardiographic parameters were not correlated with thyroid status, patients with a TSH of at least 10.0 mU/L had a higher peak E velocity than those without subclinical hypothyroidism (0.80 versus 0.72 m/sec, P=0.002), which suggested decreased left ventricular compliance, Dr. Bauer said. This was associated with incident heart failure in the overall cohort (P<0.001).
However, changes in echocardiographic parameters during six years of follow-up for this measure were not significantly associated with thyroid status.
The mechanism for an association between heart failure and thyroid function has been fairly well studied and it is likely that "subclinical hypothyroid state results in a less efficient contraction of the heart," Dr. Bauer said. Another possible explanation could include fluid retention, he said.
If the findings are confirmed, "it also suggests the potential that we might screen for abnormal thyroid tests to prevent people from developing heart failure in the future," he concluded.
Dr. Bauer and colleagues reported no conflicts of interest. Primary source: American Thyroid Association meetingSource reference: Rodondi N, et al "Subclinical Thyroid Dysfunction, Cardiac Function and the Risk of Congestive Heart Failure: The Cardiovascular Health Study" ATA meeting 2007; Program number 92.
Subscribe to:
Posts (Atom)