scholarly journals Exercise capacity benefit in relation to endogenous testosterone, coronary and central vascular physiology, and the Mediterranean regime in hypertensive males with erectile dysfunction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Angelis ◽  
K Aggeli ◽  
I Dimitroglou ◽  
N Ioakeimidis ◽  
C Georgakopoulos ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Exercise Capacity ◽  
Wave Reflection ◽  
Stress Test ◽  
Linear Regression Analysis ◽  
Well Being ◽  
Metabolic Equivalents ◽  
Flow Reserve ◽  
Vascular Physiology ◽  
The Mediterranean

Abstract Background The Mediterranean diet (Med-diet) benefits cardiovascular health, and erectile dysfunction (ED) often coexists in the hypertensive aging male population were endogenous testosterone (TT) typically declines. Coronary flow reserve (CFR) displays the ability of the coronary circulation to increase flow. Wave reflection amplification as expressed by augmentation index (AIx) exhibits a vital parameter of central vascular stiffness. Purpose To investigate the possible benefits of the Med-diet in exercise capacity, central physiology, CFR and erectile ability in relation to endogenous TT in the middle aged male hypertensive population with ED. Methods 250 hypertensive males (mean age 56 yo) with ED enrolled the study. All underwent a treadmill stress test (Bruce protocol). Exercise capacity was validated as metabolic equivalents (METs). We measured separately the CFR of the left anterior descending artery by an adenosine protocol (max dose 140μg/kg/min over 6 minutes). PW Doppler measurements were achieved at the middle/distal LAD segment under the guidance of color Doppler flow mapping. CFR was validated as ratio between peak diastolic flow velocity following drug infusion and rest. Ratios ≥2 are considered as non-ischemic response, higher values indicate microvascular coronary integrity. TT was measured on blood samples taken before 09:00 am. ED severity and adherence to the Med-diet were assessed by the SHIM-5 (range: 0–25) and the Med-diet (range: 0–55) scores. Higher values indicate a better erectile ability and Med-diet compliance respectively. Finally, central pulse pressure (cPP) and AIx were noninvasively estimated as parameters of central hemodynamic load and wave reflection amplification (Sphygmocor device). Results In bivariate analysis METs were positively associated to the Med-diet, CFR, TT and the SHIM-5 score (all p<0,005) and negatively to the AIx and cPP (both p<0,025). There was also positive association of the Med-diet to the CFR, TT and the SHIM-5 score (p<0,02) and negative to the AIx and cPP (p<0,025). By linear regression analysis association of METs to TT, CFR and Med-diet remained significant after adjustment for age, BMI, diabetes mellitus, use of statins and smoking status (p<0,005). We further subdivide our population according to the TT threshold of hypogonadism (≤3 ng/ml). Hypogonadism patients exhibit a lower exercise capacity comparing to the normal TT group (picture). Conclusion The Med-diet regime benefits exercise tolerance and erectile performance in hypertensive males with ED by enhancing endogenous testosterone and so coronary and central vascular physiology. We strongly recommend this culinary preference promoting thus vascular health and the sense of well being. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Central pulse load and coronary flow benefit in relation to endogenous testosterone and the Mediterranean regime in hypertensive males with erectile dysfunction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Angelis ◽  
K Aggeli ◽  
N Ioakeimidis ◽  
C Georgakopoulos ◽  
K Zisimos ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Pulse Pressure ◽  
Coronary Flow ◽  
Linear Regression Analysis ◽  
Significant Coronary Artery Disease ◽  
Diet Adherence ◽  
Flow Reserve ◽  
Arterial Blood ◽  
The Mediterranean ◽  
Central Pulse Pressure

Abstract Background Central pulse pressure (cPP) is an important parameter of target organ damage (TOD) in essential hypertension. Coronary flow reserve (CFR) displays the ability of both macro and microcirculation to augment flow to the myocardium while endogenous total testosterone (TT) exhibits vasodilator effects. The Mediterranean diet (Med-diet) benefits cardiovascular health and erectile dysfunction (ED) often coexists with the decline of endogenous testosterone in the aging male population. Purpose To investigate the possible benefits of the Med-diet in central PP, CFR and erectile ability in relation to endogenous TT in the primary hypertensive population with ED. Methods 247 male hypertensive patients (mean age 57 yo) with ED enrolled the study. Significant coronary artery disease was formerly excluded by a dobutamine stess echo test. We measured the CFR of the left anterior descending artery by performing an adenosine protocol (maximum dose 140 μg/kg/min over 6 minutes). Measurements by the PW Doppler were achieved at the middle/distal LAD segment under the guidance of color Doppler flow mapping. CFR was validated as ratio between peak diastolic flow velocity following drug infusion and rest. Ratios ≥2 are considered as non-ischemic response and higher values indicate microvascular coronary integrity. TT was measured in all patients on blood samples taken before 09:00 am. ED severity and adherence to the Med-diet were assessed by the SHIM-5 (range: 0–25) and the Med-diet (range: 0–55) scores. Higher values indicate a better erectile ability and Med-diet compliance respectively. Finally, cPP and augmentation index (AIx) were estimated as parameters of central hemodynamic load and wave reflection amplification respectively (sphygmocor device). Results In bivariate analysis Med-diet was favorably related to CFR (p=0.24, r=0.48), TT (p=0.01, r=0.57) and the SHIM-5 score (p=0.01, r=0.45). On the contrary, it was negatively related to cPP (p=0.15, r=−0.60) and AIx (p=0.31, r=−0.45). CFR was strongly related to TT (p=0.001, r=0.8) and the SHIM-5 score (p=0.01, r=0.41). By multiple linear regression analysis the relation of CFR, SHIM-5 and Med-diet score remained significant after adjustment for age, BMI, systolic arterial blood pressure and smoking habits. We further subdivide our population according to the mean Med-diet value (26) into high and low Med-diet adherence groups. Only in the group with the greater Med-diet adherence (n=153, 62%) there were still positive relation with the CFR, TT and SHIM-5 score as well as negative correlation to cPP and AIx (p=0.04). Conclusion In essential hypertensive males with erectile dysfunction the Med-diet regime lessens central pulse pressure while enhancing coronary flow, testosterone levels and so peripheral vascular physiology. We strongly recommend this dietary pattern as a life-style option and strategic component of holistic therapeutic approach. Funding Acknowledgement Type of funding source: None

P6262Coronary microphysiology in relation to low endogenous testosterone and dietary habits in andropause men with erectile dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Angelis ◽  
N loakeimidis ◽  
Y Dimitroglou ◽  
K Zisimos ◽  
C Georgakopoulos ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Erectile Dysfunction ◽  
Coronary Artery ◽  
Pulse Wave ◽  
Dietary Habits ◽  
Linear Regression Analysis ◽  
Male Hypogonadism ◽  
Middle Aged ◽  
Flow Reserve ◽  
Artery Disease

Abstract Background Coronary flow reserve (CFR) in the presence of non-obstructive coronary artery disease displays the ability of microcirculation to augment flow to the myocardium. Endogenous total testosterone (TT) exhibits vasodilator effects and the Mediterranean diet (Med-diet) promotes cardiovascular health. Erectile dysfunction (ED) in a milieu of subclinical microvascular damage often coexists with the decline of endogenous testosterone of the aging male population. Purpose To investigate the effects of male hypogonadism in CFR and the relation between the Med-diet and the TT of the andropause middle aged men with ED. Methods 190 non-diabetic male patients with ED (mean age: 56yo) enrolled the study. Significant epicardial coronary artery disease was excluded after a negative for ischemia dobutamine stress echo test. We measured the CFR of the left anterior descending artery by performing an adenosine protocol (maximum dose 140μg/kg/min over 6 minutes). Measurements by the pulse wave Doppler were achieved at the middle/distal LAD segment under the guidance of color Doppler flow mapping. CFR was estimated as ratio between peak diastolic flow velocity following drug infusion and rest. CFR ratio ≥2 is considered as non-ischemic response and higher values indicate microvascular coronary integrity. TT was measured in all patients on blood samples taken before 09:00 am and hypogonadism was considered when TT <3,5 ng/ml. ED severity and adherence to the Med-diet were assessed by the SHIM-5 (range: 0–25) and the Med-diet (range: 0–55) scores. Higher values point to better erectile function and a great Med-diet compliance respectively. Finally, carotid – femoral pulse wave velocity (PWV) was assessed as index of central vascular stiffness (sphygmocor device). Results In bivariate analysis CFR ratio (mean value: 2,35) was positively related to TT (p<0,001, r=0,9), the SHIM-5 and the Med-diet score (p<0,05 for both r=0,45 and r=0,5 respectively).On the contrary, it was negatively related to the PWV (p<0,05, r=−0,35). Med-diet was related to the SHIM-5 score (p=0,01, r=0,363) and to TT (p=0,02, r=0,46). In multiple linear regression analysis relation of CFR to TT remain significant (p<0,01) after adjustment for age, body mass index (BMI), LDL, PWV, smoking habits and systolic blood pressure. We further stratified our population in to hypogonadics (HYPO, n=38, 20%) and patients with normal TT levels. Poor adherence to the Med-diet was the only factor related to hypogonadism (independent sample t-test p=0,005) as compared with age, BMI and smoking. Conclusion In middle aged men with ED endogenous testosterone enhances coronary microcirculation. Moreover the Med-diet regime may blunt the fall of androgens during andropause independently of other life-style parameters. We emphasize on this culinary preference to assist coronary microvascular physiology and maintain hormonal balance.

scholarly journals Exercise capacity is associated with hospital readmission among patients with diabetes

2020 ◽  
Vol 8 (1) ◽  
pp. e001771
Author(s):  
Yaara Zisman-Ilani ◽  
Kevin Fasing ◽  
Mark Weiner ◽  
Daniel J Rubin
Keyword(s):  
Exercise Capacity ◽  
Hospital Readmission ◽  
Medical Center ◽  
Stress Test ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Metabolic Equivalents ◽  
Patients With Diabetes ◽  
Incidence Of Hospitalization ◽  
Design And Methods

IntroductionPatients with diabetes are at greater risk of hospital readmission than patients without diabetes. There is a need to identify more modifiable risk factors for readmission as potential targets for intervention. Cardiorespiratory fitness is a predictor of morbidity and mortality. The purpose of this study was to examine whether there is an association between exercise capacity based on the maximal workload achieved during treadmill stress testing and readmission among patients with diabetes.Research design and methodsThis retrospective cohort study included adult patients with diabetes discharged from an academic medical center between July 1, 2012 and December 31, 2018 who had a stress test documented before the index discharge. Univariate analysis and multinomial multivariable logistic regressions were used to evaluate associations with readmission within 30 days, 6 months, and 1 year of discharge. Exercise capacity was measured as metabolic equivalents (METs).ResultsA total of 580 patients with 1598 hospitalizations were analyzed. Mean METs of readmitted patients were significantly lower than for non-readmitted patients (5.7 (2.6) vs 6.7 (2.6), p<0.001). After adjustment for confounders, a low METs level (<5) was associated with higher odds of readmission within 30 days (OR 5.46 (2.22–13.45), p<0.001), 6 months (OR 2.78 (1.36–5.65), p=0.005), and 1 year (OR 2.16 (1.12–4.16), p=0.022) compared with medium (5–7) and high (>7) METs level. During the 6.5-year study period, patients with low METs had a mean of 3.2±3.6 hospitalizations, while those with high METs had 2.5±2.4 hospitalizations (p=0.007).ConclusionsLower exercise capacity is associated with a higher risk of readmission within 30 days, 6 months, and 1 year, as well as a greater incidence of hospitalization, in patients with diabetes. Future studies are needed to explore whether exercise reduces readmission risk in this population.

Diastolic stress test echocardiography in patients with hypertrophy cardiomyopathy: association with exercise capacity

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.M Fava ◽  
I Sande Mathias ◽  
A Alashi ◽  
Y Saijo ◽  
Z Popovic ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Maximal Exercise ◽  
Beta Blockers ◽  
Stress Test ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Atrial Volume Index ◽  
Mitral Inflow ◽  
Metabolic Equivalents

Abstract Background Diastolic dysfunction (DD) is a frequent occurrence in hypertrophic cardiomyopathy (HCM) patients. Symptoms of DD are often unmasked only during exercise, as left ventricular (LV) filling pressure is normal at rest. Purpose We sought to establish if abnormal DST parameters are associated with reduced exercise capacity in HCM patients. Methods We examined 590 asymptomatic/minimally symptomatic HCM patients (54±14 years, 57% men, body mass index 30±6 kg/m2, 84% on beta-blockers) with HCM by echocardiography at rest & maximal exercise. Septal and lateral [e'] mitral annular velocity, peak early [E] and late [A] mitral inflow velocity, Mitral E/e' and left atrial volume index (LAVI) was recorded. Exercise functional capacity was stablished as age-gender predicted metabolic equivalents (AGP-METs). Results Echocardiography at rest had LVEF of 62±6, wall thickness of 16.7±0.5 mm, LVMI of 111±43 g m–2, LVOT gradient of 26±33 mmHg, LAVI 34.5±17 mm, E/A ratio of 1.2±0.6, and average E/e' ratio 12.7±0.6. Following maximal exercise had a mean LVOT gradient of 61±59 mmHg, E/A ratio of 1.2±1.0 and average E/e' ratio 12.7±1.0. Only 42% had &gt;85% of age-sex predicted METs. Logistic regression analysis testing the association between various predictors and 85% AGP-METs are shown in table 1. Conclusion There is a significant association between abnormal diastolic response to exercise and reduced exercise capacity in patients with HCM. Funding Acknowledgement Type of funding source: None

Sexual harassment and psychological complaints: student- and class-level associations

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Brolin Låftman ◽  
Y Bjereld ◽  
B Modin ◽  
P Löfstedt
Keyword(s):  
School Climate ◽  
Sexual Harassment ◽  
Linear Regression Analysis ◽  
Well Being ◽  
Negative Effects ◽  
School Class ◽  
School Aged Children ◽  
The Past ◽  
Class Level ◽  
Using Data

Abstract Background Students who are subjected to sexual harassment at school report lower psychological well-being than those who are not exposed. Yet, it is possible that the occurrence of sexual harassment in the school class is stressful also for those who are not directly targeted, with potential negative effects on well-being for all students. The aim was to examine whether sexual harassment at the student- and at the class-level was associated with students' psychological complaints. Methods Data from the Swedish Health Behaviour in School-aged Children (HBSC) of 2017/18 was used, with information from students aged 11, 13 and 15 years (n = 3,720 distributed across 209 classes). Psychological complaints were constructed as a summative index of four items capturing how often the student had felt low, felt irritable or bad tempered, felt nervous, or had difficulties to fall asleep, during the past six months (Cronbach's alpha=0.78). Sexual harassment at the student-level was measured by one item concerning bullying at school: “Other students have exposed me to sexual jokes”. Students who reported that this had happened at least “2 or 3 times a month” were classified as exposed to sexual harassment at school. Sexual harassment at the class-level was defined as the school class proportion of students exposed to sexual harassment, reported in per cent. Two-level linear regression analysis was applied. Results Students who had been exposed to sexual harassment had higher levels of psychological complaints (b = 2.74, p &lt; 0.001). The proportion of students in the school class who had been exposed to sexual harassment was also associated with higher levels of psychological complaints, even when adjusting for sexual harassment at the student-level, gender and grade (b = 0.03, p = 0.015). Conclusions Sexual harassment is harmful for those who are exposed, but may also affect other students negatively. Thus, a school climate free from sexual harassment will profit all students. Key messages Using data collected among students aged 11, 13 and 15 years, this study showed that sexual harassment at the student- and class-level was associated with higher levels of psychological complaints. Sexual harassment is harmful for those who are exposed, but may also affect other students negatively. Thus, a school climate free from sexual harassment will profit all students.

scholarly journals Association of the Chronotype Score with Circulating Trimethylamine N-Oxide (TMAO) Concentrations

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1671
Author(s):  
Luigi Barrea ◽  
Giovanna Muscogiuri ◽  
Gabriella Pugliese ◽  
Chiara Graziadio ◽  
Maria Maisto ◽  
...  
Keyword(s):  
Mediterranean Diet ◽  
Metabolic Profile ◽  
Cardiometabolic Risk ◽  
Linear Regression Analysis ◽  
Biological Rhythms ◽  
Unhealthy Lifestyle ◽  
Gut Dysbiosis ◽  
Study Population ◽  
The Mediterranean ◽  
The Individual

Individual differences in the chronotype, an attitude that best expresses the individual circadian preference in behavioral and biological rhythms, have been associated with cardiometabolic risk and gut dysbiosis. Up to now, there are no studies evaluating the association between chronotypes and circulating TMAO concentrations, a predictor of cardiometabolic risk and a useful marker of gut dysbiosis. In this study population (147 females and 100 males), subjects with the morning chronotype had the lowest BMI and waist circumference (p < 0.001), and a better metabolic profile compared to the other chronotypes. In addition, the morning chronotype had the highest adherence to the Mediterranean diet (p < 0.001) and the lowest circulating TMAO concentrations (p < 0.001). After adjusting for BMI and adherence to the Mediterranean diet, the correlation between circulating TMAO concentrations and chronotype score was still kept (r = −0.627, p < 0.001). Using a linear regression analysis, higher chronotype scores were mostly associated with lower circulating TMAO concentrations (β = −0.479, t = −12.08, and p < 0.001). Using a restricted cubic spline analysis, we found that a chronotype score ≥59 (p < 0.001, R2 = −0.824) demonstrated a more significant inverse linear relationship with circulating TMAO concentrations compared with knots <59 (neither chronotype) and <41 (evening chronotype). The current study reported the first evidence that higher circulating TMAO concentrations were associated with the evening chronotype that, in turn, is usually linked to an unhealthy lifestyle mostly characterized by low adherence to the MD.

scholarly journals 978-118 Exercise Capacity and Coronary Flow Reserve in Patients with Intermediate Coronary Stenoses

1995 ◽  
Vol 25 (2) ◽  
pp. 259A ◽  
Author(s):  
James D. Joye ◽  
Angel R. Flores ◽  
Judith E. Orie ◽  
Nathaniel Reichek ◽  
Douglas S. Schulman
Keyword(s):  
Exercise Capacity ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Flow Reserve ◽  
Coronary Stenoses

scholarly journals Is empowerment a route to improving mental health and wellbeing in an urban regeneration (UR) context?

Urban Studies ◽  
2016 ◽  
Vol 54 (7) ◽  
pp. 1619-1637 ◽  
Author(s):  
Camilla Baba ◽  
Ade Kearns ◽  
Emma McIntosh ◽  
Carol Tannahill ◽  
James Lewsey
Keyword(s):  
Mental Health ◽  
Linear Regression Analysis ◽  
Urban Regeneration ◽  
Personal Characteristics ◽  
Well Being ◽  
Community Empowerment ◽  
Health Improvement ◽  
Cross Sectional ◽  
Health And Wellbeing ◽  
Health Gains

Urban regeneration (UR) programmes are recognised as a type of Population Health Intervention (PHI), addressing social and health inequalities. Policy recommends programmes involve communities through engagement and empowerment. Whilst the literature has started to link empowerment with health improvement, this has not been within an UR context. As part of broader research on the economic evaluation of community empowerment activities, this paper examines how health gains can be generated through promoting empowerment as well as identifying whether feelings of empowerment are associated with residents personal characteristics or perceptions of their neighbourhood. Using 2011 Community Health and Wellbeing Survey (GoWell) cross-sectional data, ordinal logistic regression and simple linear regression analysis of 15 Glasgow neighbourhoods undergoing regeneration with 4302 adult householders (≥16 years old) was completed. Analyses identified strong associations ( P≥ 0.05) between empowerment and the mental health subscale of the SF12v2 and with several items of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) scale. Furthermore, residents’ who felt more empowered reported more positive attitudes towards their surroundings and housing providers. This concurs with recent evidence of the importance of residents’ psychological investments in their neighbourhood influencing their sense of place attachment. Such analyses present initial evidence of the value of investing resources within UR programmes to activities geared towards increasing residents’ empowerment as a means of producing those health gains often sought by more costly aspects of the programmes.

scholarly journals Coronary flow reserve as a link between diastolic and systolic function and exercise capacity in heart failure

2012 ◽  
Vol 14 (7) ◽  
pp. 677-683 ◽  
Author(s):  
M. Snoer ◽  
T. Monk-Hansen ◽  
R. H. Olsen ◽  
L. R. Pedersen ◽  
O. W. Nielsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Capacity ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Systolic Function ◽  
Flow Reserve

scholarly journals Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Adam S. Weinstein ◽  
Martin I. Sigurdsson ◽  
Angela M. Bader
Keyword(s):  
Cardiac Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Metabolic Equivalents ◽  
Cardiac Stress Testing ◽  
Cardiac Stress Test

Background. Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient’s functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient’s physical activity, with the goal of providing an estimate of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients’ METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test. Methods. A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those, a total of 170 charts were identified as having a preoperative evaluation note and an exercise cardiac stress test. The METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test were compared using a Bland–Altman plot and Cohen’s kappa. Results. Exercise cardiac stress test quantified METs were on average 3.3 METS higher than the METs estimated by the preoperative evaluation history. Only 9% of patients had lower METs quantified by the cardiac stress test than by history. Conclusions. The METs of a patient estimated by preoperative history often underestimates the METs measured by exercise stress testing. This demonstrates that the preoperative assessments of patients’ METs are often conservative which errs on the side of patient safety as it lowers the threshold for deciding to order further cardiac stress testing for screening for ischemia or cardiac failure.

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