New evidence in the management of cardiovascular risk: the place of heart rate

2007 ◽  
Vol 15 (1) ◽  
pp. 23-24
Author(s):  
D. A. Pijnappels
2019 ◽  
Vol 27 (5) ◽  
pp. 526-535 ◽  
Author(s):  
Pietro Laforgia ◽  
Francesco Bandera ◽  
Eleonora Alfonzetti ◽  
Marco Guazzi

Background Chronotropic insufficiency (CI) is defined as the inability of the heart to increase its rate commensurate with increased demand. Exercise CI is an established predictor of major adverse cardiovascular events in patients with cardiovascular diseases. Aim The aim of this study was to evaluate how exercise CI phenotypes different levels of cardiovascular risk and how it may better perform in defining cardiovascular risk when analysed in the context of cardiopulmonary exercise test (CPET)-derived measures and standard echocardiography in a healthy population with variable cardiovascular risk profile. Methods Apparently healthy individuals ( N = 702, 53.8% females) with at least one major cardiovascular risk factor (MCVRF; hypertension, diabetes, tabagism, dyslipidaemia, body mass index > 25), enrolled in the Euro-EX prevention trial, underwent CPET. CI was defined as the inability to reach 80% of the chronotropic index, that is, the ratio of peak heart rate – rest heart rate/peak heart rate – age predicted maximal heart rate (AMPHR: 220 – age), they were divided into four groups according to the heart rate reserve (<80%>) and respiratory gas exchange ratio (RER; < 1.05>) as a marker of achieved maximal performance. Subjects with a RER < 1.05 ( n = 103) were excluded and the final population ( n = 599) was divided into CI group ( n = 472) and no-CI group ( n = 177). Results Compared with no-CI, CI subjects were more frequently females with a history of hypertension in a high rate. CI subjects also exhibited a significantly lower peak oxygen uptake (VO2) and circulatory power and an echocardiographic pattern indicative of higher left atrial volume index and left ventricular mass index. An inverse stepwise relationship between heart rate reserve and number of MCVRFs was observed (one MCVRF: 0.71 ± 0.23; two MCVRFs: 0.68 ± 0.24, three MCVRFs: 0.64 ± 0.20; four MCVRFs: 0.64 ± 0.23; five MCVRFs: 0.57 ± 18; p < 0.01). In multivariate analysis the only variable found predicting CI was peak VO2 ( p < 0.05; odds ratio 0.91; confidence interval 0.85–0.97). Conclusions In a population of apparently healthy subjects, exercise CI is common and phenotypes the progressive level of cardiovascular risk by a tight relationship with MCVRFs. CI patients exhibit some peculiar abnormal exercise gas exchange patterns (lower peak VO2 and exercise oscillatory ventilation) and echo-derived measures (higher left atrium size and left ventricle mass) that may well anticipate evolution toward heart failure.


2017 ◽  
Vol 8 ◽  
Author(s):  
Valter L. Pereira ◽  
Mirela Dobre ◽  
Sandra G. dos Santos ◽  
Juliana S. Fuzatti ◽  
Carlos R. Oliveira ◽  
...  

Author(s):  
Natsuki Nakayama ◽  
Masahiko Miyachi ◽  
Koji Tamakoshi ◽  
Shuji Morikawa ◽  
Koji Negi ◽  
...  

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Rosa S de Visser ◽  
Rachel Sylvester ◽  
Qingmei Jiang ◽  
Eva Kline-Rogers ◽  
Jean DuRussel-Weston ◽  
...  

Introduction: Millions of children consume school lunches daily. Children from low-income families are eligible for free or reduced-price school meals. While studies show improvement in the nutritional quality of school lunches, the effect of school lunch or lunch brought from home on cardiovascular risk factors among children is unknown. Hypothesis: We hypothesized that frequently consuming school lunch is associated with increased cardiovascular risk factors when compared with lunch brought from home. Methods: All 15,742 sixth graders enrolled in Project Healthy Schools, a school-based wellness intervention, were included in this cross-sectional study (2004-2015). We examined 10,169 behavioral surveys and 1,845 physiological screenings. We compared self-reported diet, physical activity (PA), sedentary behaviors and physiologic parameters (height, weight, blood pressure (BP) and heart rate) in 2 groups, children who reported eating school lunch daily and those who eat home-prepared lunch daily. The groups were further stratified by socioeconomic status (SES); low SES (<$35,000) or high SES (>$50,000) based on the median household income of the school region. Students in the middle SES range ($35,000-$50,000) were excluded from analysis (n=4230). Results: School lunch students were associated with less healthy behaviors (PA, diet [fruit/vegetable servings, meat and sugary beverage intake], and sedentary activities) and physiologic measures (percent of overweight/obesity, systolic BP and recovery heart rate) compared with students bringing lunch from home in low and high SES groups (Table 1). Conclusions: In this large cohort of children, we observed frequent school lunch consumption, even after adjustment for SES, was associated with less healthy behaviors and physiologic parameters. Further research is warranted to determine whether healthier school lunches would improve cardiovascular health characteristics and health behaviors in middle-school students.


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