Abstract 13692: Cardiorespiratory Fitness and Atrial Fibrillation Risk in African American Veterans

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Apostolos Tsimploulis ◽  
charles faselis ◽  
Eric J Rashba ◽  
Hans Moore ◽  
Pamela Karasik ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
African American ◽  
Cardiorespiratory Fitness ◽  
Washington Dc ◽  
Beneficial Effects ◽  
Metabolic Equivalents ◽  
Exercise Treadmill ◽  
The Usa ◽  
Cox Proportional Hazard Models ◽  
Cv Disease

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting >10 million in the USA. The beneficial effects of cardiorespiratory fitness (CRF) on cardiovascular (CV) diseases are well-documented. Interestingly, African American (AA) individuals are less prone to develop AF. Little is known about the association between CRF and AF in AA men. Hypothesis: CRF-AF risk association in AA men. Methods: We identified 11,216 AA Veterans with a mean age (±SD) 58±11 years who completed a symptom-limited exercise treadmill test at the VAMCs in Washington DC and Palo Alto CA. None exhibited evidence of ischemia or AF during and prior to it. We established four fitness groups based on age-specific quartiles of peak metabolic equivalents (METs) achieved: Least-Fit: 4.4 ±1.2 METs (n=2,530); Moderate-Fit: 6.6±1.3 METs (n=3,361); Fit: 8.1±1.4 METs (n=2,719) and High-Fit: 11.2±2.4 METs (n=2,606). AF was identified by a search of the medical records CPRS (database) using ICD coding and verified by 2 investigators. Cox proportional hazard models adjusted for age, CV disease, CV medications and risk factors were constructed to assess the CRF-AF association. P-values <0.05 using two sided tests were considered statistically significant. Results: During a mean follow-up period of 10.7±6.2 years, 1,423 patients developed AF; 421(16.6%) in the Least-Fit, 366 (10.9%) in Moderate-Fit, 323 (11.9%) in Fit and 313 (12%) in the High-Fit group. The CRF-AF association was inverse and graded. When compared to the patients in the Least-Fit group, the AF risk in the Moderate-Fit group was 29% lower (HR=0.71; 95% CI: 0.62-0.82, p<0.001). For Fit and High-Fit patients, the risk was 37% (HR=0.63; 95% CI: 0.54-0.73, p<0.001) and 51.0% lower (HR=0.49; 95% CI: 0.42-0.57, p<0.001), respectively. Conclusion: In this cohort, higher fitness levels reduced and delayed the risk of atrial fibrillation. The CRF-AF association was inverse, graded and independent of comorbidities.

scholarly journals SAT-LB96 Chronic Kidney Disease Incidence and Cardiorespiratory Fitness Association in Patients With Diabetes And/Or Hypertension

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Joseph Powell ◽  
Eric S Nylen ◽  
Jonathan Myers ◽  
Pamela Karasik ◽  
Hans Moore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiorespiratory Fitness ◽  
Cox Regression ◽  
Disease Incidence ◽  
Metabolic Equivalents ◽  
Patients With Diabetes ◽  
Exercise Treadmill ◽  
Traditional Risk Factors

Abstract Introduction: Type 2 diabetes mellitus (T2DM) and hypertension (HTN) are considered strong risk factors for developing chronic kidney disease (CKD). Increased cardiorespiratory fitness (CRF) is associated with lower CKD risk. However, the CRF-CKD association in patients with T2DM and/or HTN has not been assessed.Methods: We identified 9,751 patients (age 58.6 + 10.1 years) with T2DM (N=1,444) or HTN (n=5,031) or both (n=3,276) prior to a maximal standardized exercise treadmill test (ETT) and no evidence of ischemia as indicated by the ETT. We established four CRF categories based on age-adjusted peak metabolic equivalents (METs) achieved: Least-Fit (4.6±1.2 METs; n=2,231); Low-Fit Fit (6.4±1.1 METs; n=2,693); Moderate-Fit (8.0±1.0 METs; n=2,432); and High-Fit (10.8±2.1 METs; n=2,395). We performed multivariable Cox Regression analyses to access the risk of CKD according to fitness. The models were adjusted for age, body mass index (BMI), traditional risk factors and medications. Results: During the median follow-up of 12.4 years, 1,118 patients developed CKD, accounting for 9.1 events/ 1,000 person-years of observation. The association between CRF and CKD was inverse and graded. The risk of CKD was 21% lower (Hazard Ratio [HR] 0.79; 95% confidence interval [CI] 0.77-0.81). When CRF categories were considered, the CKD risk was 44% lower for Moderate-Fit patients (HR 0.56; 95% CI 0.48-0.67) and 80% lower for High-Fit (HR 0.20; 95% CI 0.15-0.25). Similar findings were noted in patients with both T2DM and HTN. Conclusions: We noted an inverse and dose-response association between CRF and CKD incidence. The risk was attenuated significantly beyond a mean peak MET level of 8.0±1.0, suggesting that moderate increases in exercise capacity confers favorable health benefits in patients at high risk of developing CKD.

Cardiorespiratory fitness and electroanatomical remodelling in patients with atrial fibrillation

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
RS Mishima ◽  
AD Elliott ◽  
JP Ariyaratnam ◽  
D Jones ◽  
O Nguyen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiorespiratory Fitness ◽  
De Novo ◽  
Low Voltage ◽  
Heart Rhythm ◽  
Funding Sources ◽  
Metabolic Equivalents ◽  
Heart Rhythm Disorders ◽  
Arrhythmogenic Substrate ◽  
Conduction Velocities

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation (AF) is the most common clinically-relevant arrhythmia. Its initiation and maintenance is linked to the presence cardiovascular risk factors such as hypertension and obesity. Higher cardiorespiratory fitness (CRF) has been associated with a better prognosis. However, specific electroanatomical features associated with baseline CRF have not been described.  Purpose Compare electroanatomical substrate across exercise capacity levels in patients with AF Methods Patients referred for de novo AF radiofrequency ablation at the Centre for Heart Rhythm Disorders from August 2017 until June 2020 were screened for inclusion and CRF was evaluated in metabolic equivalents (METs) by a symptom-limited maximal treadmill exercise test using the standard Bruce protocol prior to ablation. Predicted CRF was calculated based on established equations and patients were categorized according to the percentage of predicted CRF achieved; low (&lt;85%), adequate (85-100%) and high (&gt;100%). Total mean and regional peak-to-peak bipolar voltages, percent of low voltage areas (% LVA), conduction velocity (CV) and percent of complex fractionated electrograms (% CFE) in sinus rhythm were compared across groups.  Results There were no between-group differences in baseline characteristics, medication use or echocardiographic features. Total mean voltage was significantly lower in the low CRF group compared to both adequate and high CRF. Compared to the high CRF group, roof (3.25 ± 1.2 mV vs 1.9 ± 1.3 mV, p &lt; 0.05), posterior (3.8 ± 1.8 mV vs 1.7 ± 0.9 mV, p &lt; 0.001) and inferior mean voltages (3.4 ± 2 mV vs 1.6 ± 0.7 mV, p &lt; 0.05) were significantly lower in the low CRF group (figure 1A). Furthermore, compared with the adequate CRF group, mean voltages were significantly lower in the posterior (3.7 ± 1.5 mV vs 1.7 ± 0.9 mV, p &lt; 0.001), inferior (3.4 ± 1 mV vs 1.6 ± 0.7 mV, p &lt; 0.001) and lateral (4.2 ± 2.2 mV vs 2.1 ± 1.4 mV, p &lt; 0.05) walls of the low CRF group. Anterior and septal mean voltages were not significantly different across CRF groups (P for trend = 0.07, 0.3 and 0.15, respectively). Conduction velocities were not significantly different across groups. The inferior %LVA was significantly higher in the low CRF (5.6 ± 6%) compared to adequate CRF group (23 ± 18%) (p &lt; 0.05) (figure 1B). Total and regional % CFE was higher in the low CRF compared to adequate and high CRF. Conclusion Participants in the lower baseline CRF category showed significant reductions in regional voltages along with higher fractionation with preserved conduction velocities. Research on the effect of physical activity and CRF on left atrial arrhythmogenic substrate is required. Abstract Figure. Global and regional mV and % LVA by CRF

Association of post-diagnosis cardiorespiratory fitness with cause-specific mortality in cancer

2020 ◽  
Vol 6 (4) ◽  
pp. 315-322 ◽  
Author(s):  
John D Groarke ◽  
David L Payne ◽  
Brian Claggett ◽  
Mandeep R Mehra ◽  
Jingyi Gong ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cardiorespiratory Fitness ◽  
Cancer Mortality ◽  
Cohort Analysis ◽  
Primary Diagnosis ◽  
Adjusted Risk ◽  
Metabolic Equivalents ◽  
Specific Mortality ◽  
Exercise Treadmill ◽  
Exercise Treadmill Testing

Abstract Aims  The prognostic importance of post-diagnosis assessment of cardiorespiratory fitness (CRF) in cancer patients is not well established. We sought to examine the association between CRF and mortality in cancer patients. Methods and results  This was a single-centre cohort analysis of 1632 patients (58% male; 64 ± 12 years) with adult-onset cancer who were clinically referred for exercise treadmill testing a median of 7 [interquartile range (IQR): 3–12] years after primary diagnosis. Cardiorespiratory fitness was defined as peak metabolic equivalents (METs) achieved during standard Bruce protocol and categorized by tertiles. The association between CRF and all-cause and cause-specific mortality was assessed using multivariable Cox proportional hazard models adjusting for important covariates. Median follow-up was 4.6 (IQR: 2.6–7.0) years; a total of 411 deaths (229, 50, and 132 all-cause, cardiovascular (CV), and cancer related, respectively) occurred during this period. Compared with low CRF (range: 1.9–7.6 METs), the adjusted hazard ratio (HR) for all-cause mortality was 0.38 [95% confidence interval (CI): 0.28–0.52] for intermediate CRF (range: 7.7–10.6 METs) and 0.17 (95% CI: 0.11–0.27) for high CRF (range: 10.7–22.0 METs). The corresponding HRs were 0.40 (95% CI: 0.19–0.86) and 0.41 (95% CI: 0.16–1.05) for CV mortality and 0.40 (95% CI: 0.26–0.60) and 0.16 (95% CI: 0.09–0.28) for cancer mortality, respectively. The adjusted risk of all-cause, CV, and cancer mortality decreased by 26%, 14%, and 25%, respectively with each one MET increment in CRF. Conclusion  Cardiorespiratory fitness is a strong, independent predictor of all-cause, CV, and cancer mortality, even after adjustment for important clinical covariates in patients with certain cancers.

scholarly journals CARDIORESPIRATORY FITNESS LOWERS THE RISK FOR ATRIAL FIBRILLATION IN MEN WITH TYPE 2 DIABETES MELLITUS

2014 ◽  
Vol 63 (12) ◽  
pp. A365
Author(s):  
Andreas Pittaras ◽  
Michael E. Doumas ◽  
Charles Faselis ◽  
F. Kyritsi ◽  
JP Kokkinos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiorespiratory Fitness

scholarly journals “Subtle, vicious effects”: Lillian Steele Proctor's Pioneering Investigation of Gifted African American Children in Washington, DC

2021 ◽  
Vol 61 (3) ◽  
pp. 351-371
Author(s):  
Sevan G. Terzian
Keyword(s):  
African American ◽  
African American Youth ◽  
Black Children ◽  
Gifted Children ◽  
Washington Dc ◽  
Cultural Resources ◽  
Systemic Racism ◽  
Master's Thesis ◽  
American Children ◽  
Intellectual Potential

AbstractThis essay examines the first detailed study of gifted African American youth: Lillian Steele Proctor's master's thesis from the late 1920s on Black children in Washington, DC. Unlike formative research on gifted children by educational psychologists, Proctor's investigation emphasized children's experiences at school, home, and community in determining their abilities, opportunities, and accomplishments. Proctor's work also anticipated African American intellectuals’ critiques of racist claims about intelligence and giftedness that would flourish in the 1930s. In focusing on the nation's capital, her investigation drew from a municipality with a high proportion of African American residents that was segregated by law. Proctor pointed directly to systemic racism as both contributing to the relative invisibility of gifted African American youth and in thwarting opportunities to realize their intellectual potential. In an environment of racial subordination and segregation, these gifted children found themselves excluded from cultural resources and educational opportunities.

scholarly journals Greater cardiorespiratory fitness reduces incidence of atrial fibrillation: a meta-analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
C Verdicchio ◽  
A Elliott ◽  
R Mahajan ◽  
D Linz ◽  
D Lau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Cardiorespiratory Fitness ◽  
Meta Analysis ◽  
Exercise Stress ◽  
Inverse Association ◽  
Exercise Interventions ◽  
Increased Risk ◽  
Statistical Heterogeneity

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the global population, with the prevalence of AF increasing dramatically over the past two decades. Although low levels of cardiorespiratory fitness (CRF) and physical activity are predictive of cardiovascular disease onset and mortality, only recently has this emerged as a potential risk factor for AF. Purpose The aim of this meta-analysis was therefore to quantify the relationship between CRF, measured by a symptom limited exercise stress test, and incident AF. We hypothesised that there would be an inverse relationship between CRF and the incidence of AF. Methods The systematic literature review was conducted using PUBMED, MEDLINE and EMBASE databases, with seven studies meeting the inclusion criteria. A random-effects meta-analysis was then used to compare the multivariate risk estimates of the lowest CRF group from each cohort with the group of the highest CRF. Results Data from 206,925 individuals (55.8% males) was used for analysis with a mean age of 55 ± 2.5 years and a mean follow-up period of 10.3 ± 5 years. The total number of AF events across the studies was 19,913. The overall pooled risk of AF in the high-CRF group versus the low-CRF group showed a significant lower risk of incident AF in those with high-CRF (OR: 0.52, 95% CI, 0.44-0.605, p &lt; 0.001). There was evidence of statistical heterogeneity between the studies (I2 = 81%, p &lt; 0.001). AF incidence rates demonstrated an overall decline in rates across the CRF quartiles from low to high. The mean incidence rate for low-CRF was 21 ± 13.4 compared to 6.9 ± 0.7 per 1000 person-years for the high CRF group (p = 0.03). Conclusion There is an inverse association between a lower CRF and an increased risk of AF, with a higher level of CRF protective against AF. This study highlights that low-CRF may be an additional risk factor for AF along with already other established lifestyle-based risk factors such as obesity and hypertension. Exercise interventions should be promoted as a primary prevention strategy in those at risk of developing AF with known risk factors. Future studies are warranted to identify the mechanism(s) through which improved CRF confers a reduction in AF incidence. Abstract Figure. AF risk between high and low-CRF

scholarly journals A comparison of the effect of glitazones on serum sialic acid in patients with type 2 diabetes

2011 ◽  
Vol 9 (3) ◽  
pp. 238-240 ◽  
Author(s):  
Inayat ur Rahman ◽  
Muhammad Idrees ◽  
Mohammad Salman ◽  
Rooh Ullah Khan ◽  
MI Khan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Sialic Acid ◽  
Treated Group ◽  
Diabetes Therapy ◽  
Beneficial Effects ◽  
Hba1 C ◽  
Serum Sialic Acid ◽  
High Incidence ◽  
Cv Disease

Although management of hyperglycaemia represents one of the principal treatment goals of diabetes therapy, the high incidence of cardiovascular (CV) complications in diabetes also needs effective management. Therefore, the present study was designed to determine and compare the effect of glitazones on serum sialic acid (SSA), a known risk marker for CV disease, along with fasting plasma glucose (FPG), glycohaemoglobin (HbA1-c) and blood lipids, in overweight, previously only diet-treated patients with type 2 diabetes ( n=60). The study was conducted for a period of 12 months. Significant improvement in FPG and HbA1-c were shown by both rosiglitazone ( p<0.003 and p<0.001, respectively) and pioglitazone ( p<0.005 and p<0.001, respectively), compared with baseline, and pioglitazone showed greater beneficial effects on other parameters monitored, significantly reducing total cholesterol (TC) ( p≤0.05). Both the drugs showed a decrease in SSA and no significant differences were observed between the groups. However, the decrease was significant only in the pioglitazone-treated group at month 12 ( p≤0.05), compared with baseline. A significant decrease in SSA by pioglitazone indicates its greater cardioprotective effect compared with rosiglitazone.

scholarly journals Practical implications of naloxone knowledge among suburban people who use opioids

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Kristin E. Schneider ◽  
Glenna J. Urquhart ◽  
Saba Rouhani ◽  
Ju Nyeong Park ◽  
Miles Morris ◽  
...  
Keyword(s):  
Public Health ◽  
Health Department ◽  
Washington Dc ◽  
Multiple Sources ◽  
Public Health Response ◽  
Baltimore City ◽  
The Public ◽  
Health Response ◽  
The Usa ◽  
Practical Implications

Abstract Background Naloxone distribution programs have been a cornerstone of the public health response to the overdose crisis in the USA. Yet people who use opioids (PWUO) continue to face a number of barriers accessing naloxone, including not knowing where it is available. Methods We used data from 173 PWUO from Anne Arundel County, Maryland, which is located between Baltimore City and Washington, DC. We assessed the prevalence of recently (past 6 months) receiving naloxone and currently having naloxone, the type(s) of the naloxone kits received, and the perceived ease/difficultly of accessing naloxone. We also assessed participants knowledge of where naloxone was available in the community. Results One third (35.7%) of participants had recently received naloxone. Most who had received naloxone received two doses (72.1%), nasal naloxone (86.9%), and education about naloxone use (72.1%). Most currently had naloxone in their possession (either on their person or at home; 78.7%). One third (34.4%) believed naloxone was difficult to obtain in their community. Only half (56.7%) knew of multiple locations where they could get naloxone. The health department was the most commonly identified naloxone source (58.0%). Identifying multiple sources of naloxone was associated with being more likely to perceive that naloxone is easy to access. Discussion Our results suggest that additional public health efforts are needed to make PWUO aware of the range of sources of naloxone in their communities in order to ensure easy and continued naloxone access to PWUO.

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