Moderate physical activity linked with 50 percent reduction in cardiovascular death in over-65s

Moderate physical activity is associated with a greater than 50% reduction in cardiovascular death in over-65s, according to research presented at ESC Congress 2016 today. The 12 year study in nearly 2500 adults aged 65 to 74 years found that moderate physical activity reduced the risk of an acute cardiovascular event by more than 30%. High levels of physical activity led to greater risk reductions.

28 aug 2016--"The role of physical activity in preventing cardiovascular disease (CVD) in people of working age is well established," said Professor Riitta Antikainen, professor of geriatrics at the University of Oulu, Finland. "But relatively little is known about the effect of regular physical activity on CVD risk in older people."
The present study assessed the association between leisure time physical activity and CVD risk and mortality in 2456 men and women aged 65 to 74 years who were enrolled into the National FINRISK Study between 1997 and 2007.
Baseline data collection included self-administered questionnaires on physical activity and other health related behaviour, clinical measurements (blood pressure, weight and height), and laboratory measurements including serum cholesterol. Participants were followed up until the end of 2013. Deaths were recorded from the National Causes of Death Register and incident CVD events (coronary heart disease and stroke) were collected from the National Hospital Discharge register.
The researchers classified self-reported physical activity as:

• Low: reading, watching TV or working in the household without much physical activity.
• Moderate: walking, cycling or practising other forms of light exercise (fishing, gardening, hunting) at least four hours per week.
• High: recreational sports (for example running, jogging, skiing, gymnastics, swimming, ball games or heavy gardening) or intense training or sports competitions at least three hours a week.

During a median follow-up of 11.8 years, 197 participants died from CVD and 416 had a first CVD event.
When the researchers assessed the link between physical activity and outcome they adjusted for other cardiovascular risk factors (blood pressure, smoking and cholesterol) and social factors (marital status and education). To minimise reverse causality, where worse health leads to less physical activity, patients with coronary heart disease, heart failure, cancer, or prior stroke at baseline were excluded from the analysis.
The investigators found that moderate and high leisure time physical activity were associated with a 31% and 45% reduced risk of an acute CVD event, respectively. Moderate and high leisure time physical activity were associated with a 54% and 66% reduction in CVD mortality.
Professor Antikainen said: "Our study provides further evidence that older adults who are physically active have a lower risk of coronary heart disease, stroke, and death from cardiovascular disease. The protective effect of leisure time physical activity is dose dependent - in other words, the more you do, the better. Activity is protective even if you have other risk factors for cardiovascular disease such as high cholesterol."
She concluded: "Physical exercise may become more challenging with ageing. However, it is important for older people to still get enough safe physical activity to stay healthy after their transition to retirement."

More information: "Leisure time physical activity reduces the risk of cardiovascular death and an acute CVD event also among older adults" ESC Congress 2016.


Provided by European Society of Cardiology

Sauna use associated with reduced risk of cardiac, all-cause mortality

A sauna may do more than just make you sweat. A new study suggests men who engaged in frequent sauna use had reduced risks of fatal cardiovascular events and all-cause mortality, according to an article published online by JAMA Internal Medicine.

24 feb 2015--Although some studies have found sauna bathing to be associated with better cardiovascular and circulatory function, the association between regular sauna bathing and risk of sudden cardiac death (SCD) and fatal cardiovascular diseases (CVD) is not known.

Jari A. Laukkanen, M.D., Ph.D., of the University of Eastern Finland, Kuopio, and coauthors investigated the association between sauna bathing and the risk of SCD, fatal coronary heart disease (CHD), fatal CVD and all-cause mortality in a group of 2,315 middle-aged men (42 to 60 years old) from eastern Finland.

Results show that during a median (midpoint) follow-up of nearly 21 years, there were 190 SCDs, 281 fatal CHDs, 407 fatal CVDs and 929 deaths from all causes. Compared with men who reported one sauna bathing session per week, the risk of SCD was 22 percent lower for 2 to 3 sauna bathing sessions per week and 63 percent lower for 4 to 7 sauna sessions per week. The risk of fatal CHD events was 23 percent lower for 2 to 3 bathing sessions per week and 48 percent lower for 4 to 7 sauna sessions per week compared to once a week. CVD death also was 27 percent lower for men who took saunas 2 to 3 times a week and 50 percent lower for men who were in the sauna 4 to 7 times a week compared with men who indulged just once per week. For all-cause mortality, sauna bathing 2 to 3 times per week was associated with a 24 percent lower risk and 4 to 7 times per week with a 40 percent reduction in risk compared to only one sauna session per week.

The amount of time spent in the sauna seemed to matter too. Compared with men who spent less than 11 minutes in the sauna, the risk of SCD was 7 percent lower for sauna sessions of 11 to 19 minutes and 52 percent less for sessions lasting more than 19 minutes. Similar associations were seen for fatal CHDs and fatal CVDs but not for all-cause mortality events.

"Further studies are warranted to establish the potential mechanism that links sauna bathing and cardiovascular health," the study concludes.

Provided by The JAMA Network Journals

Gene expression signature identifies patients at higher risk for cardiovascular death

Georgia Tech Professor Gregory Gibson poses with a chart showing death rate differentials between groups of coronary artery disease patients identified with a new gene expression profile. Credit: Rob Felt

30 may 2014--A study of 338 patients with coronary artery disease has identified a gene expression profile associated with an elevated risk of cardiovascular death. Used with other indicators such as biochemical markers and family history, the profile – based on a simple blood test – may help identify patients who could benefit from personalized treatment and counseling designed to address risk factors.

Researchers found the risk signature by comparing gene expression profiles in 31 study subjects who died of cardiovascular causes against the profiles of living members of the study group. Twenty-five of the 31 deaths occurred in the group with the high-risk profile, though coronary deaths were also recorded among the lower risk members of the study group. All of the patients studied had coronary artery disease (CAD), and about one in five had suffered a heart attack prior to the study.

Researchers from the Georgia Institute of Technology, Emory University and Princeton University participated in the study, which obtained gene expression profiles from blood samples taken from patients undergoing cardiac catheterization at Emory University clinics in Atlanta. The results are scheduled to be published in the open-access journal Genome Medicine on May 29, 2014.

"We envision that with our gene expression-based marker, plus some biochemical markers, genotype information and family history, we could produce a tiered evaluation of people's risks of adverse coronary events," said Gregory Gibson, director of the Center for Integrative Genomics at Georgia Tech and one of the study's senior authors. "This could lead to a personalized medicine approach for people recovering from heart attack or coronary artery bypass grafting."

Coronary artery disease is the leading cause of death for both men and women in the United States. Manifested in the narrowing of blood vessels through the buildup of plaque, CAD sets the stage for heart attacks and long-term heart failure.

As many as half of Americans over the age of 50 suffer from CAD to some extent, so the researchers wondered if they could single out those with the highest risk of death. From a cohort of more than 3,000 persons known as the Emory Cardiovascular Biobank (EmCD), they selected two groups of patients for extensive gene expression analysis based on blood samples.

After following the patients for as long as five years, the researchers examined gene expression patterns in a total of 31 persons from the study group who had suffered coronary deaths. Comparing these patterns against those of other study subjects revealed a pattern in which genes affecting inflammation were up-regulated, while genes affecting T-lymphocytes were down-regulated.

The patients studied ranged in age from 51 to 73, were mostly Caucasian, and 65 percent male. Seventy percent of the subjects had significant CAD, and 18 percent were experiencing an acute myocardial infarction when blood samples were taken. Gene expression was analyzed using microarrays and two different normalization procedures to control for technical and biological covariates. Whole genome genotyping was used to support comparative genome-wide association studies of gene expression. Two phases of the study were conducted independently with the two different groups, and produced similar results.

"What's new in this research is the recognition that this risk pathway exists and that it relates to particular aspects of immune system functions that include T-cell signaling," said Gibson, who is also a professor in Georgia Tech's School of Biology. "We went beyond the signature of coronary artery disease to really provide a signature for adverse outcomes in that high-risk population."

The pattern, said Gibson, doesn't indicate the causes of the disease. The researchers would now like to expand the study to include a larger group of patients and learn more about what causes the disease. They'd also like to know whether the risks can be reversed through diet, exercise or drug therapy.

Cardiologist Arshed Quyyumi, the paper's other senior author, directs Emory University's Clinical Cardiovascular Research Center and created the Biobank five years ago to facilitate cardiovascular research. He says that identifying patients at highest risk could help encourage their compliance with treatment programs, and prioritize introduction of newer therapeutics, such as cholesterol lowering medications like PCSK9 inhibitors.

"A number of patients with CAD are currently not maximally treated," said Quyyumi, who is a professor in Emory's School of Medicine. "In those that appear to have been prescribed adequate medication, a significant proportion of subjects are non-compliant with their medications. Thus, knowledge of a high risk genetic profile in a patient can prompt both the patient and physician to maximize currently available medications and improve patient compliance."

Approximately 15,000 genes are expressed in human blood, but analyzing them is not as daunting as it sounds. Most of the gene expression is correlated, so there may be only a few dozen independent measurements that can be related to disease states, Gibson said. In the study, researchers identified nine "axes" that represented specific biological pathways to disease. Two of them were relevant to the high-risk profile.

Gibson believes identifying the high-risk signatures in CAD patients may lead to opportunities for improving their health.

"Our dream would be a hand-held device that would allow patients to take a droplet of blood, much like diabetics do today, and obtain an evaluation of these transcripts that they could track at home," he said. "If we can use this information to help people adopt healthier behaviors, it will be very positive."

Provided by Georgia Institute of Technology

Risk of cardiovascular death doubled in women with high calcium intake

High intakes of calcium (corresponding to diet and supplements) in women are associated with a higher risk of death from all causes, but cardiovascular disease in particular, compared with women with lower calcium intake, a study published on bmj.com suggests.

15 feb 2013--Experts recommend a high calcium intake (as it plays a pivotal role in human physiology) and as such, more than 60% of middle-aged and older women in the USA now take supplements.

However, recent trials have indicated a higher risk of ischemic heart disease and stroke with calcium supplements but this was not observed in another trial and few studies have examined this association.

Researchers from Uppsala University in Sweden therefore studied 61,443 Swedish women (born between 1914 and 1948) for an average of 19 years to test this association.

Data were taken from the Swedish Cause of Death Registry and data on diet were taken from the Swedish Mammography Cohort. Total calcium intake included supplemental calcium. The mean intake in the lowest quartile was 572mg/day (the equivalent of five slices of cheese ) and in the highest 2137mg/day.

Information was obtained from the women on menopausal status, postmenopausal oestrogen therapy, parity information, weight and height, smoking habits, leisure-time physical activity and educational level.

Results showed that during 19 years of follow-up, 11,944 women (17%) died: 3,862 of these (32%) died from cardiovascular disease, 1932 (16%) heart disease and 1100 (8%) from stroke. Highest rates of all-cause, cardiovascular and heart disease were observed among those with a dietary calcium intake higher than 1400mg/day.

In addition, researchers observed higher death rates among women with an intake below 600mg/day.

Women who had a higher dietary intake of calcium exceeding 1400mg/day and also used supplements had a higher death rate compared to those not taking supplements. Women with a high dietary calcium intake (>1400 mg/day) were more than twice as likely to die compared with women with a 600-999mg/day calcium intake.

The researchers explain their findings by suggesting that diets very low or very high in calcium can override normal homeostatic control causing changes in blood levels of calcium.

The researchers conclude that high calcium is associated with "higher all-cause and cardiovascular mortality rates" and so to prevent fractures in the elderly emphasis should be placed on individuals with a low intake of calcium rather than increasing the intake of those already consuming satisfactory amounts.

Provided by British Medical Journal

Sexual activity is safe for most heart, stroke patients

If you have stable cardiovascular disease, it is more than likely that you can safely engage in sexual activity, according to an American Heart Association scientific statement.

21 jan 2012--The statement, published online in Circulation: Journal of the American Heart Association, contains recommendations by experts from various fields, including heart disease, exercise physiology and sexual counseling.

"Sexual activity is a major quality of life issue for men and women with cardiovascular disease and their partners," said Glenn N. Levine, M.D., lead author of the statement and a professor of medicine at Baylor College of Medicine in Houston, Texas. "Unfortunately, discussions about sexual activity rarely take place in the clinical context."

The recommendations include:

• After a diagnosis of cardiovascular disease, it is reasonable for patients to be evaluated by their physician or healthcare provider before resuming sexual activity.
• Cardiac rehabilitation and regular physical activity can reduce the risk of cardiovascular complications related to sexual activity in people who have had heart failure or a heart attack.
• Women with cardiovascular disease should be counseled on the safety and advisability of contraceptive methods and pregnancy based on their patient profile.
• Patients with severe heart disease who have symptoms with minimal activity or while at rest should not be sexually active until their cardiovascular disease symptoms are stabilized with appropriate treatment.
• Patients should be assessed to see if their sexual dysfunction is related to underlying vascular or cardiac disease, anxiety, depression or other factors.
• Drugs that can improve cardiovascular symptoms or survival should not be withheld due to concerns that such drugs may impact sexual function.
• Drugs to treat erectile dysfunction are generally safe for men who have stable cardiovascular disease. These drugs should not be used in patients receiving nitrate therapy for chest pains due to coronary artery disease (blockages in the arteries that supply the heart with blood), and nitrates should not be administered to patients within 24-48 hours of using an erectile dysfunction drug (depending on the drug used).
• It is reasonable for post-menopausal women with cardiovascular disease to use estrogen that's topically or vaginally inserted for the treatment of painful intercourse.

Decreased sexual activity and function — common in men and women with cardiovascular diseases — is often related to anxiety and depression.

The absolute rate of cardiovascular events during sexual activity, such as heart attacks or chest pain caused by heart disease, is miniscule because sexual activity is usually for a short time.

"Some patients will postpone sexual activity when it is actually relatively safe for them to engage in it," said Levine, who is also director of the Cardiac Care Unit at the Michael E. DeBakey Medical Center in Houston. "On the other hand, there are some patients for whom it may be reasonable to defer sexual activity until they're assessed and stabilized."

Provided by American Heart Association

Ozone Amplifies Summer Heat's Effect on Cardiovascular Mortality


IRVINE, Calif., Nov. 21 -- Ozone appears to be a key to the link between high temperatures and the increased risk of death from heart disease or stroke, according to investigators here.
Action Points
Explain to patients who ask that this study found that high ozone levels amplify the harmful cardiovascular effects of hot weather.
High outdoor ozone levels from air pollutants make hot weather an even more potent force for cardiovascular mortality, Cizao Ren, Ph.D., of the University of California at Irvine, and colleagues reported online in Occupational and Environmental Medicine.
A 10-degree increase in temperature on the same day was associated with an increase in cardiovascular mortality of 1.17% at the lowest ozone concentration and 8.31% for the highest concentration of ozone in all measured areas, the researchers said.
With rising temperatures as a result of global warming, the impact of increasing ozone air pollution on human health is likely to increase, they concluded.
Ozone is strongly tied to weather conditions, particularly the amount of ultraviolet light in the atmosphere. It is generated by a complex photochemical reaction between nitrogen oxides, volatile organic compounds, and oxygen in sunlight, the researchers wrote.
Both ambient ozone and temperature have been separately associated with human health, Dr. Ren said. To explore whether ozone enhances the association between maximum temperature and cardiovascular mortality in the U.S., the researchers obtained data from the U.S. National Morbidity, Mortality, and Air Pollution Study (NMMAPS) website.
The data contained time series information for health outcomes, air pollution, and weather conditions from January 1987 through December 2000. The study included 95 large communities in the mainland with a total population of nearly 100 million and four million cardiovascular deaths (heart attack or stroke) during the study period.
Using two time-series Poisson regression models, the researchers examined the joint effects of summer temperatures (June through September) and ozone levels on cardiovascular mortality.
The communities were divided into seven regions, ranging from the northeast, the industrial midwest, and the upper midwest to the northwest, the southeast, the southwest, and southern California.
Maximum hourly ozone concentrations ranged from 36.74 parts per billion to 142.85 ppb. Mean maximum temperatures ranged from about 69 degrees F to more than 100 degrees F.
The results indicated that ozone positively modified the temperature-cardiovascular associations across the different regions. In general, the higher the ozone concentration, the higher the risk of cardiovascular death attributable to high temperatures, the researchers said.
In general, ozone concentrations were positively and significantly correlated with temperatures in the northeast, industrial midwest, northwest, southeast, and southern California, but no significant modifications were observed in the upper midwest and the southwest. The latter finding may have resulted from smaller numbers of persons in these areas, the researchers suggested.
Because regional classification resulted in a small number of communities especially in certain regions, the researchers redivided the communities using latitude as a cut-off and confirmed the ozone-temperature effect for all these communities.
Previous studies have shown that heat waves are associated with human morbidity and mortality. Because high temperature is often associated with high ozone concentrations, the estimated effects of heat waves may be partly attributable to the ozone effect, the researchers said.
High temperature can aggravate many pre-existing health conditions and is a well-known cause of heat-related mortality. In addition, the researchers said, exposure to ozone may directly affect airways through inhalation and involve modulation of the autonomic nervous system, making people more vulnerable to the effects of temperature variability, the researchers said.
Because the temperature-ozone-mortality risk may vary with areas, multisite studies are needed, Dr. Ren and colleagues wrote.
Secondly, the study estimated the effect on only a single day, so that longer periods need to be examined. Finally, they said, it is important to estimate interactive effects between temperature and multiple pollutants such as ozone, particulate matter, and nitrogen dioxide.
Ozone, a secondary pollutant, is formed by reactions in sunlight with volatile organic compounds, coming from petroleum, solvents, road transport, and industrial processes. It is therefore important to provide warnings to the public on days with both high temperature and high ozone levels, the researchers said.
No financial conflicts were declared. This study was partly funded by an Australia Research Council Discover Grant.Primary source: Occupational and Environmental MedicineSource reference: Ren C, et al "Ozone modifies associations between temperature and cardiovascular mortality: analysis of the NMMAPS data"Occup Environ Med 2007; DOI: 10.1136/oem.2007.033878.

Antioxidants Don't Reduce Risk of MI, Stroke, or Cardiovascular Death in High-Risk Women

BOSTON, Aug. 14 -- Antioxidant vitamins C and E and beta carotene did not reduce the risk of cardiovascular events in more than 8,000 high-risk women, reported researchers here.
Neither Vitamin C (ascorbic acid), vitamin E, or beta carotene reduced the combined primary end point of myocardial infarction, stroke, coronary revascularization, or cardiovascular death, reported Nancy R. Cook, Sc.D., of Brigham and Women's Hospital and Harvard, and colleagues, in the Aug. 13/27 issue of Archives of Internal Medicine.
"For stroke, we found a significant 2-way interaction between ascorbic acid and vitamin E (P=0.03). Those in the active groups for both agents experienced fewer strokes compared with those in placebo groups for both agents (RR 0.69; 95% CI 0.49-0.98 [P=0.04])," they wrote.
And, they noted, there was also "a marginally significant reduction in the primary outcome with active vitamin E among a prespecified group of women with [cardiovascular disease] (RR, 0.89; 95% CI, 0.79-1.00, P=0.04)."
The Women's Antioxidant Cardiovascular Study recruited 8,171 women, average age 61, in 1995 and 1996. All participants had a history of cardiovascular disease or had at least three risk factors for it.
Women were randomized to 500 mg of vitamin C or placebo daily, 500 IU of vitamin E or placebo every other day, and 50 mg of beta carotene or placebo every other day. The study design allowed researchers to assess the efficacy of the vitamins as monotherapy or in combination with other antioxidants.
The women were followed for a mean of 9.4 years during which time 1,450 women had one or more cardiovascular events-274 myocardial infarctions, 298 strokes, and 889 coronary revascularization procedures. There were 995 deaths, 395 of which were from cardiovascular causes.
No additional adverse effects were observed among those taking the vitamins, although there was a small increase in reports of upset stomach among those taking active beta carotene.
Limitations of the study noted by the authors included a lack of complete follow-up and compliance, although, they said, it was above 90% through 2003. Mortality follow-up was 99% complete and compliance was comparable to other trials.
"While additional research into combinations of agents, particularly for stroke, may be of interest, widespread use of these individual agents for cardiovascular protection does not appear warranted," the researchers concluded.
This study was supported by an investigator-initiated grant from the National Heart, Lung, and Blood Institute. Vitamin E and its placebo were supplied by Cognis Corporation. All other agents and their placebos were supplied by BASF Corporation. Pill packaging was provided by Cognis and BASF. The authors disclosed no financial conflicts. Primary source: Archives of Internal MedicineSource reference: Cook NR et al "A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women Results from the Women's Antioxidant Cardiovascular Study" Arch Intern Med. 2007;167:1610-1618.

Poor Health Literacy in the Elderly Predicts All-Cause and Cardiovascular Mortality

July 31, 2007 — Elderly patients with poor health literacy have higher incidence of all-cause mortality and cardiovascular death, according to the results of a prospective cohort study published in the July 23 issue of Archives of Internal Medicine.
"Individuals with low levels of health literacy have less health knowledge, worse self-management of chronic disease, lower use of preventive services, and worse health in cross-sectional studies," write David W. Baker, MD, MPH, from the Feinberg School of Medicine at Northwestern University in Chicago, Illinois, and colleagues. "The number of years of school completed is strongly associated with reading fluency. As a result, individuals with more education tend to have a better capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions: i.e., they have higher levels of health literacy."
The objective of this study was to determine whether low levels of health literacy were independent predictors of overall and cause-specific mortality.
In 4 US metropolitan areas in 1997, the investigators interviewed 3260 Medicare managed-care enrollees, aged 65 years or older, concerning their demographic characteristics, chronic health conditions, self-reported physical and mental health, and health behaviors. They also performed the shortened version of the Test of Functional Health Literacy in Adults that involved 2 reading passages and 4 mathematical questions.
Primary endpoints were deaths from all causes and from cardiovascular, cancer, and other causes, based on data through 2003 from the National Death Index.
During follow-up of 67.8 months' average duration, 815 (25%) participants died. For participants with adequate health literacy (n = 2094; 64.2%), the crude mortality rate was 18.9% compared with 28.7% in those with marginal health literacy (n = 366; 11.2%) and 39.4% in those with inadequate health literacy (n = 800; 24.5%; P < .001).
Compared with participants with adequate health literacy, hazard ratios for all-cause mortality were 1.52 for participants with inadequate health literacy (95% confidence interval, 1.26 - 1.83) and 1.13 for participants with marginal health literacy (95% confidence interval, 0.90 - 1.41), after adjustment for demographic factors, socioeconomic status, and baseline health.
In bivariate analyses, years of school completed was only weakly associated with mortality, and in multivariate models, years of school completed was not a significant predictor of mortality.
"Inadequate health literacy, as measured by reading fluency, independently predicts all-cause mortality and cardiovascular death among community-dwelling elderly persons," the authors write. "Reading fluency is a more powerful variable than education for examining the association between socioeconomic status and health."
Risk-adjusted rates of cardiovascular death, but not of cancer-related death, were higher in participants with inadequate health literacy. During the study, 380 (11.7%) of participants died of cardiovascular disease, including 19.3% of those with inadequate health literacy, 16.7% of those with marginal health literacy, and 7.9% of those with adequate health literacy.
Study limitations include possible unmeasured confounding variables, such as cognitive function.
Several mechanisms suggested by the authors to explain increased mortality in patients with inadequate health literacy include less knowledge regarding chronic disease; worse self-management skills for hypertension, diabetes, asthma, and heart failure; and lower use of cancer screening and vaccinations.
"Most people will have many acute and chronic medical conditions during their life and face many situations in which they must make health and health care choices and decisions," the authors conclude. "As a result of these myriad demands placed on patients today, widespread improvements in health and health care communication will likely be necessary to reduce the association between health literacy and mortality."
The National Institute on Aging and a Career Development Award from the Centers for Disease Control and Prevention supported this study. The authors have disclosed no relevant financial relationships.
Arch Intern Med. 2007;167:1503-1509.