Sedentary behaviour in cardiovascular disease patients: Risk group identification and the impact of cardiac rehabilitation

Abstract Background Cardiovascular disease (CVD) patients typically report low physical activity levels. Therefore sedentary behaviour (SB) is potentially an important target to improve survival and to reduce recurrence risk. However, information about SB in CVD patients is scarce. Purpose In this study, we 1) compared SB between CVD patients and age-matched controls, 2) identified patient- and disease characteristics associated with high SB levels, and 3) determined the impact of contemporary cardiac rehabilitation on SB. Methods For objective 1, we recruited 131 patients and 117 healthy, age-matched individuals. All participants were asked about their general characteristics and medical history. SB was assessed objectively by an accelerometer. For objective 2, 2,584 patients completed a questionnaire about their general characteristics, lifestyle, medical history and their SB. For objective 3, SB was examined before, after and 2 months after cardiac rehabilitation among 131 patients using an accelerometer. Results Objective 1. Patients spent 10.4 hrs/day (Q25 9.5; Q75 11.2) sedentary which was higher compared to healthy controls (9.4 hrs/day [Q25 8.4; Q75 10.29]). Similarly, patients reported more prolonged sedentary bouts (>30 min) compared to controls (5.9 versus 4.8 bouts/day; P<0.001). Objective 2. Patients being male, single or divorced, employed, physically inactive, reporting high alcohol consumption, living in an urban environment, having comorbidities and cardiac anxiety demonstrated a greater odds for large amounts of sedentary time (>8 hrs/day). Objective 3. Cardiac rehabilitation significantly reduced sedentary time (−0.4 hrs/day [95% CI: −0.7; −0.1]), which remained lower at 2 months after cardiac rehabilitation (−0.3 hrs/day [95% CI: −0.6; −0.03]). In addition, prolonged sedentary bouts decreased significantly after cardiac rehabilitation (−0.4 bouts/day [95% CI: −0.7; −0.1]), but this effect diminished within 2 months after the programme (−0.2 bouts/day [95% CI: −0.5; 0.1]). Conclusions CVD patients had greater amounts of objectively measured sedentary time compared to healthy controls, with more frequent engagement in prolonged sedentary bouts. Sedentarism was associated with personal- and lifestyle characteristics, and comorbidities. Participation in a contemporary cardiac rehabilitation programme slightly reduced sedentary time, but tailored interventions are needed to target the high amount of sedentary time in CVD patients. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Dutch Heart Foundation

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Cancer and cardiovascular disease: The impact of cardiac rehabilitation and cardiorespiratory fitness on survival

International Journal of Cardiology ◽

10.1016/j.ijcard.2021.09.004 ◽

2021 ◽

Vol 343 ◽

pp. 139-145

Author(s):

Tamara Williamson ◽

Chelsea Moran ◽

Daniele Chirico ◽

Ross Arena ◽

Cemal Ozemek ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiac Rehabilitation ◽

Cardiorespiratory Fitness ◽

The Impact

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Comparison of SCORE and Reynolds cardiovascular risk assessments in a cohort without cardiovascular disease

Orvosi Hetilap ◽

10.1556/oh.2013.29730 ◽

2013 ◽

Vol 154 (43) ◽

pp. 1709-1712 ◽

Cited By ~ 1

Author(s):

Csaba Móczár

Keyword(s):

Cardiovascular Disease ◽

Risk Assessment ◽

Cardiovascular Risk ◽

Screening Program ◽

Risk Group ◽

Scoring Systems ◽

High Risk Group ◽

Risk Assessments ◽

Gender And Age ◽

Medium Risk

Introduction: Cardiovascular risk assessment may help in the identification of symptom-free subjects with high cardiovascular risk. Aim: The author studied the correlation between SCORE and Reynolds risk assessment systems based on data from the cardiovascular risk screening program carried out in subjects without cardiovascular disease. Method: Data obtained from 4462 subjects (1977 men and 2485 women; mean age, 47,4 years) were analysed. The comparison was based on risk categories of the SCORE system. Results: There was a strong correlation between the two scoring systems in the low risk population (under <2% SCORE risk the Spearman rho = 1, p < 0.001). A weak correlation was found in the medium risk group (between 3–4% the Spearman rho = 0.59–0.49, p < 0.001 and between 10–14% the Spearman rho = 0.42, ns.) and a stronger correlation in the high risk group (>15% the Spearmen rho = 0.8, p = 0.017). When correlations were analysed in gender and age categories, the weakest correlation was detected in medium risk women over 40 years of age. In cases when the differences between the two scoring systems were significant, the hsCRP levels were significantly higher (4.1 vs. 5.67 mg/L, p < 0.001). Conclusions: Introduction of hsCRP into cardiovascular risk assessments can refine the risk status of symptom-free subjects, especially among intermediate risk middle-age women (two-step risk assessment). Orv. Hetil., 154 (43), 1709–1712.

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IDENTIFICATION AND ASSESSMENT OF RISK FACTORS ROLE IN MYOCARDIAL INFARCTION DEVELOPMENT

Wiadomości Lekarskie ◽

10.36740/wlek201905111 ◽

2019 ◽

Vol 72 (5) ◽

pp. 779-783

Author(s):

Victor A. Ognev ◽

Anna A. Podpriadova ◽

Anna V. Lisova

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Cardiovascular Disease ◽

Cardiovascular System ◽

Control Group ◽

Biological Factors ◽

Prevention And Treatment ◽

High Level ◽

Social Importance ◽

The Impact

Introduction:The high level of morbidity and mortality from cardiovascular disease is largely due toinsufficient influence on the main risk factors that contribute to the development of myocardial infarction.Therefore, a detailed study and assessment of risk factors is among the most important problems of medical and social importance. The aim: To study and evaluate the impact of biological, social and hygienic, social and economic, psychological, natural and climatic risk factors on the development of myocardial infarction. Materials and methods: A sociological survey was conducted in 500 people aged 34 to 85. They were divided into two groups. The main group consisted of 310 patients with myocardial infarction. The control group consisted of 190 practically healthy people, identical by age, gender and other parameters, without diseases of the cardiovascular system. Results: It was defined that 30 factors have a significant impact on the development of myocardial infarction.Data analysis revealed that the leading risk factors for myocardial infarction were biological and socio-hygienic. The main biological factors were: hypertension and hypercholesterolemia. The man socio-hygienic factor was smoking. Conclusions: Identification of risk factors provides new opportunities for the development of more effective approaches for the prevention and treatment of myocardial infarction.

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Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001413 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001413

Author(s):

Jonathan Yap ◽

Kamalesh Anbalakan ◽

Wan Ting Tay ◽

Daniel Ting ◽

Carol Yim Cheung ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Glycemic Control ◽

Microvascular Complications ◽

Population Based ◽

Cardiovascular Outcomes ◽

Microvascular Complication ◽

The Impact ◽

Hba1c Levels

IntroductionDiabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease.Research design and methodsThis was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004–2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry.ResultsA total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8–8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05).ConclusionDiabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes.

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CD133 Expression in the Nucleus Is Associated with Endometrial Carcinoma Staging and Tumor Angioinvasion

Journal of Clinical Medicine ◽

10.3390/jcm10102144 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2144

Author(s):

Milosz Pietrus ◽

Kazimierz Pitynski ◽

Marcin Waligora ◽

Katarzyna Milian-Ciesielska ◽

Monika Bialon ◽

...

Keyword(s):

Endometrial Cancer ◽

Plasma Membrane ◽

Tumor Progression ◽

Endometrial Carcinoma ◽

Molecular Level ◽

Risk Group ◽

High Risk Group ◽

Cd133 Expression ◽

Transmembrane Glycoprotein ◽

The Impact

Background: (1) Endometrial cancer is one of the most common cancers affecting women, with a growing incidence. To better understand the different behaviors associated with endometrial cancer, it is necessary to understand the changes that occur at a molecular level. CD133 is one of the factors that regulate tumor progression, which is primarily known as the transmembrane glycoprotein associated with tumor progression or cancer stem cells. The aim of our study was to assess the impact of subcellular CD133 expression on the clinical course of endometrial cancer. (2) Methods: CD133 expression in the plasma membrane, nucleus, and cytoplasm was assessed by immunohistochemical staining in a group of 64 patients with endometrial cancer representing FIGO I-IV stages, grades 1–3 and accounting for tumor angioinvasion. (3) Results: Nuclear localization of CD133 expression was increased in FIGO IB-IV stages compared to FIGO IA. Furthermore, CD133 expression in the nucleus and plasma membrane is positively and negatively associated with a higher grade of endometrial cancer and angioinvasion, respectively. (4) Conclusions: Our findings suggest that positive nuclear CD133 expression in the tumor may be related to a less favorable prognosis of endometrial carcinoma patients and has emerged as a useful biomarker of a high-risk group.

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Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK

BMC Public Health ◽

10.1186/s12889-021-10606-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Barbara Iyen ◽

Stephen Weng ◽

Yana Vinogradova ◽

Ralph K. Akyea ◽

Nadeem Qureshi ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Body Mass Index ◽

Cohort Study ◽

Body Mass ◽

World Health ◽

Obese Adults ◽

Bmi Trajectories ◽

The Impact

Abstract Background Although obesity is a well-recognised risk factor for cardiovascular disease (CVD), the impact of long-term body mass index (BMI) changes in overweight or obese adults, on the risk of heart failure, CVD and mortality has not been quantified. Methods This population-based cohort study used routine UK primary care electronic health data linked to secondary care and death-registry records. We identified adults who were overweight or obese, free from CVD and who had repeated BMI measures. Using group-based trajectory modelling, we examined the BMI trajectories of these individuals and then determined incidence rates of CVD, heart failure and mortality associated with the different trajectories. Cox-proportional hazards regression determined hazards ratios for incident outcomes. Results 264,230 individuals (mean age 49.5 years (SD 12.7) and mean BMI 33.8 kg/m2 (SD 6.1)) were followed-up for a median duration of 10.9 years. Four BMI trajectories were identified, corresponding at baseline, with World Health Organisation BMI classifications for overweight, class-1, class-2 and class-3 obesity respectively. In all four groups, there was a small, stable upwards trajectory in BMI (mean BMI increase of 1.06 kg/m2 (± 3.8)). Compared with overweight individuals, class-3 obese individuals had hazards ratios (HR) of 3.26 (95% CI 2.98–3.57) for heart failure, HR of 2.72 (2.58–2.87) for all-cause mortality and HR of 3.31 (2.84–3.86) for CVD-related mortality, after adjusting for baseline demographic and cardiovascular risk factors. Conclusion The majority of adults who are overweight or obese retain their degree of overweight or obesity over the long term. Individuals with stable severe obesity experience the worst heart failure, CVD and mortality outcomes. These findings highlight the high cardiovascular toll exacted by continuing failure to tackle obesity.

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Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease

Clinical Research in Cardiology ◽

10.1007/s00392-021-01922-y ◽

2021 ◽

Author(s):

Rutao Wang ◽

Scot Garg ◽

Chao Gao ◽

Hideyuki Kawashima ◽

Masafumi Ono ◽

...

Keyword(s):

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Revascularization ◽

Long Term Outcomes ◽

Vital Status ◽

Increased Risk ◽

Artery Disease ◽

The Impact

Abstract Aims To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Methods The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Results Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08–1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83–1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in ≥ 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11–4.23, p < 0.001) compared to those without CVD. Conclusions The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization. Trial registration SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract

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Left ventricular remodeling: is there a real impact of cardiac rehabilitation?

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.366 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

NPD Cunha ◽

I Aguiar-Ricardo ◽

T Rodrigues ◽

P Silverio Antonio ◽

S Couto Pereira ◽

...

Keyword(s):

Exercise Training ◽

Left Ventricle ◽

Cardiac Rehabilitation ◽

Phase Ii ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Ischemic Disease ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Introduction A number of randomized controlled trials have examined the effect of exercise training on left ventricle (LV) remodeling in individuals with cardiovascular disease. However, the results of these trials have been inconclusive. Purpose Evaluation of the impact of a cardiac rehabilitation program (CRP) on left ventricle remodelling evaluated by echocardiogram. Methods Observational single centre study including consecutive patients, undergoing structured CRP since June 2016 until February 2020. Phase II CRP included 3 months of exercise training, aerobic and strength exercise, individually prescribed, 3 times a week, 60 minutes sessions. All patients were submitted to a clinical evaluation, echocardiogram, and cardiopulmonary exercise test before and after the CRP. Results 205 patients (62.6 ± 11 years, 83.4% men, 82.3% ischemic disease) were included in a phase II CRP. Most patients had ischemic disease (82.3%) and 23.5% of patients had left ventricular ejection fraction (LVEF) <40%. Of the cardiovascular risk factors, hypertension was the most prevalent (76%), followed by dyslipidaemia (67.4%), active smoking (45.9%) and diabetes (26.9%). After the CRP, there was a significant improvement of LVEF (from 48.3 ± 13 to 52 ± 11.6 %, p = 0.001) and a significant reduction of LV volumes (LV end-diastolic volume, LVEDV , decreased from 140 ± 81 to 121 ± 57, p = 0.002; LV end-systolic volume , LVESV , reduced from 80 ± 75 to 64 ± 48, p = 0.004). Considering only the patients with LVEF < 40% (n = 38), the improvement was even greater: LVEF increased from 30 ± 8 to 39 ± 13 (p = 0.002); LVEDV reduced from 206 ± 107 to 159 ± 81 (p = 0.001) and LVESV reduced from 142 ± 99 to 101 ± 66 (p = 0.002). 63.6%(n = 14) of these patients improved at least 10% of LVEF and only 1 of them had a cardiac resynchronization therapy device. Conclusions A phase II CR program was associated with significant improvements in left ventricular reverse remodelling irrespective of baseline EF classification. Those with reduced baseline EF derived an even greater improvement, highlighting the great importance of CR in this subgroup of patients.

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Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: a systematic review and meta-analysis

Heart ◽

10.1136/heartjnl-2020-317901 ◽

2020 ◽

pp. heartjnl-2020-317901

Author(s):

SungA Bae ◽

So Ree Kim ◽

Mi-Na Kim ◽

Wan Joo Shim ◽

Seong-Mi Park

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Relative Risk ◽

Elderly Patients ◽

Meta Analysis ◽

Fatal Outcome ◽

Young Patients ◽

Lower Prevalence ◽

Prevalence Rates ◽

The Impact

ObjectivePrevious studies that evaluated cardiovascular risk factors considered age as a potential confounder. We aimed to investigate the impact of cardiovascular disease (CVD) and its risk factors on fatal outcomes according to age in patients with COVID-19.MethodsA systematic literature review and meta-analysis was performed on data collected from PubMed and Embase databases up to 11 June 2020. All observational studies (case series or cohort studies) that assessed in-hospital patients were included, except those involving the paediatric population. Prevalence rates of comorbid diseases and clinical outcomes were stratified by mean patient age in each study (ranges: <50 years, 50–60 years and ≥60 years). The primary outcome measure was a composite fatal outcome of severe COVID-19 or death.ResultsWe included 51 studies with a total of 48 317 patients with confirmed COVID-19 infection. Overall, the relative risk of developing severe COVID-19 or death was significantly higher in patients with risk factors for CVD (hypertension: OR 2.50, 95% CI 2.15 to 2.90; diabetes: 2.25, 95% CI 1.89 to 2.69) and CVD (3.11, 95% 2.55 to 3.79). Younger patients had a lower prevalence of hypertension, diabetes and CVD compared with older patients; however, the relative risk of fatal outcomes was higher among the former.ConclusionsThe results of the meta-analysis suggest that CVD and its risk factors (hypertension and diabetes) were closely related to fatal outcomes in COVID-19 for patients across all ages. Although young patients had lower prevalence rates of cardiovascular comorbidities than elderly patients, relative risk of fatal outcome in young patients with hypertension, diabetes and CVD was higher than in elderly patients.Prospero registration numberCRD42020198152.

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