The impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease

Introduction: Proton pump inhibitors (PPIs) are used by an estimated 29 million Americans. PPIs increase the levels of asymmetrical dimethylarginine, a known risk factor for cardiovascular disease (CVD). Data from a select population of patients with CVD suggest that PPI use is associated with an increased risk of stroke, heart failure, and coronary heart disease. The impact of PPI use on incident CVD is largely unknown in the general population. Hypothesis: We hypothesized that PPI users have a higher risk of incident total CVD, coronary heart disease, stroke, and heart failure compared to nonusers. To demonstrate specificity of association, we additionally hypothesized that there is not an association between use of H 2 -blockers - another commonly used class of medications with similar indications as PPIs - and CVD. Methods: We used the Rochester Epidemiology Project’s medical records-linkage system to identify all residents of Olmsted County, MN on our baseline date of January 1, 2004 (N=140217). We excluded persons who did not grant permission for their records to be used for research, were <18 years old, had a history of CVD, had missing data for any variable included in our model, or had evidence of PPI use within the previous year.We followed our final cohort (N=58175) for up to 12 years. The administrative censoring date for CVD was 1/20/2014, for coronary heart disease was 8/3/2016, for stroke was 9/9/2016, and for heart failure was 1/20/2014. Time-varying PPI ever-use was ascertained using 1) natural language processing to capture unstructured text from the electronic health record, and 2) outpatient prescriptions. An incident CVD event was defined as the first occurrence of 1) validated heart failure, 2) validated coronary heart disease, or 3) stroke, defined using diagnostic codes only. As a secondary analysis, we calculated the association between time-varying H 2 -blocker ever-use and CVD among persons not using H 2 -blockers at baseline. Results: After adjustment for age, sex, race, education, hypertension, hyperlipidemia, diabetes, and body-mass-index, PPI use was associated with an approximately 50% higher risk of CVD (hazard ratio [95% CI]: 1.51 [1.37-1.67]; 2187 CVD events), stroke (hazard ratio [95% CI]: 1.49 [1.35-1.65]; 1928 stroke events), and heart failure (hazard ratio [95% CI]: 1.56 [1.23-1.97]; 353 heart failure events) compared to nonusers. Users of PPIs had a 35% greater risk of coronary heart disease than nonusers (95% CI: 1.13-1.61; 626 coronary heart disease events). Use of H 2 -blockers was also associated with a higher risk of CVD (adjusted hazard ratio [95% CI]: 1.23 [1.08-1.41]; 2331 CVD events). Conclusions: PPI use is associated with a higher risk of CVD, coronary heart disease, stroke and heart failure. Use of a drug with no known cardiac toxicity - H 2 -blockers - was also associated with a greater risk of CVD, warranting further study.

Download Full-text

Exercise recommendations in patients with valvular heart disease

Heart ◽

10.1136/heartjnl-2018-313372 ◽

2018 ◽

Vol 105 (2) ◽

pp. 106-110 ◽

Cited By ~ 12

Author(s):

Sabiha Gati ◽

Aneil Malhotra ◽

Sanjay Sharma

Keyword(s):

Physical Activity ◽

Heart Disease ◽

Ventricular Function ◽

Functional Capacity ◽

Valvular Heart Disease ◽

Stress Test ◽

Exercise Stress ◽

Competitive Sport ◽

Increased Risk ◽

The Impact

Valvular heart disease affects 1%–2% of young individuals, many of whom aspire to partake in competitive sport or high intensity recreational exercise. There are limited reports on the impact of intensive physical activity on the progression of valvular heart disease; therefore, current recommendations are based on consensus opinion. The management of exercising individuals with valvular heart disease requires a structured approach that incorporates several key factors including symptomatic status, functional capacity, type and nature of the valvular lesion, impact on ventricular structure and function and effect on pulmonary artery pressure. Asymptomatic individuals with minor valvular abnormalities may engage in all forms of competitive sport, whereas those with lesions of moderate severity may exercise intensively if an exercise stress test tailored to the relevant physical activity reveals good functional capacity without myocardial ischaemia, haemodynamic disturbances or arrhythmia. Symptomatic athletes and those with severe valvular heart disease, impaired ventricular function, pulmonary hypertension and arrhythmias should refrain from most competitive sports. Athletes with a bicuspid aortic valve and aortic root diameter >40 mm should avoid sport with a strong isometric component even with minimal valvular dysfunction. There is an association between mitral valve prolapse and sudden cardiac death in the general population; however, there is limited evidence of increased risk with competitive sport. Athletes undergoing corrective surgery may return to exercise after 3 months if ventricular function and exercise capacity are preserved. Individuals anticoagulated for mechanical bioprosthetic valves should avoid contact or collision sport to minimise the risk of bleeding.

Download Full-text

Occupational Physical Activity and Coronary Heart Disease in Women’s Health Initiative Observational Study

The Journals of Gerontology Series A ◽

10.1093/gerona/gly288 ◽

2018 ◽

Vol 74 (12) ◽

pp. 1952-1958

Author(s):

Conglong Wang ◽

Anneclaire J De Roos ◽

Kaori Fujishiro ◽

Matthew A Allison ◽

Robert Wallace ◽

...

Keyword(s):

Physical Activity ◽

Coronary Heart Disease ◽

Heart Disease ◽

Observational Study ◽

Women’S Health ◽

Women's Health ◽

Occupational Physical Activity ◽

Health Initiative ◽

Chd Risk ◽

The Impact

Abstract Background Women comprise nearly half of the labor force in our society, but the impact of the occupational psychical activity on women’s heart health in later life was unclear. We conducted a case-cohort study to assess the association of occupational physical activity (OPA), alone and jointly with leisure-time physical activity (LTPA) and risk of coronary heart disease (CHD). Methods We included women enrolled in Women’s Health Initiative Observational Study who provided an occupational history at baseline and were followed until 2013 for the first occurrence of myocardial infarction or death from CHD (mean age ± SD = 63.4 ± 7.2). A total of 5,243 women free of CHD at baseline were randomly selected into a subcohort and 3,421 CHD events were adjudicated during follow-up. Through linkage of Standard Occupational Classification codes to the Occupational Information Network, we assessed cumulative and most recent exposure of OPA. LTPA was assessed through Women’s Health Initiative’s physical activity questionnaire. Weighted Cox proportional hazard models were used to evaluate CHD risk. Results After adjustment for demographic and socioeconomic factors, levels of OPA were not associated with CHD risk. Compared with women with low OPA and high LTPA, women with moderate to high cumulative OPA and low LTPA had relative high CHD risk (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.26, 1.88 for moderate OPA and HR: 1.46. 95% CI: 1.20, 1.78 for high OPA). Discussion Results from this study suggest no overall association between lifetime OPA and CHD risk in women, but the impact of OPA varies by LTPA levels.

Download Full-text

The impact of cigarette smoking on the pleiotropic effects of simvastatin in the coronary heart disease patients

Atherosclerosis ◽

10.1016/j.atherosclerosis.2014.05.757 ◽

2014 ◽

Vol 235 (2) ◽

pp. e253

Author(s):

T.B. Domagala ◽

K. Kotula-Horowitz ◽

M. Janczura ◽

R. Januszek ◽

J. Zagajewski ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Cigarette Smoking ◽

Pleiotropic Effects ◽

The Impact

Download Full-text

Oral health and later coronary heart disease: Cohort study of one million people

European Journal of Preventive Cardiology ◽

10.1177/2047487318759112 ◽

2018 ◽

Vol 25 (6) ◽

pp. 598-605 ◽

Cited By ~ 7

Author(s):

G David Batty ◽

Keum Ji Jung ◽

Yejin Mok ◽

Sun Ju Lee ◽

Joung Hwan Back ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Oral Health ◽

Cigarette Smoking ◽

Tooth Loss ◽

Disease Risk ◽

Positive Association ◽

Increased Risk ◽

The Relationship

Aims Systematic reviews report an association between poorer oral health and an increased risk of coronary heart disease. This contentious relationship may not be causal but existing studies have been insufficiently well powered comprehensively to examine the role of confounding, particularly by cigarette smoking. Accordingly, we sought to examine the role of smoking in generating the relationship between oral health and coronary heart disease in life-long non-smokers. Methods and results In the Korean Cancer Prevention Study, 975,685 individuals (349,579 women) aged 30–95 years had an oral examination when tooth loss, a widely used indicator of oral health, was ascertained. Linkage to national mortality and hospital registers over 21 years of follow-up gave rise to 64,784 coronary heart disease events (19,502 in women). In the whole cohort, after statistical adjustment for age, there was a moderate, positive association between tooth loss and coronary heart disease in both men (hazard ratio for seven or more missing teeth vs. none; 95% confidence interval 1.08; 1.02, 1.14; Ptrend across tooth loss groups <0.0001) and women (1.09; 1.01, 1.18; Ptrend 0.0016). Restricting analyses to a subgroup of 464,145 never smokers (25,765 coronary heart disease events), however, resulted in an elimination of this association in men (1.01; 0.85, 1.19); Ptrend 0.7506) but not women (1.08; 0.99, 1.18; Ptrend 0.0086). Conclusion In men in the present study, the relationship between poor oral health and coronary heart disease risk appeared to be explained by confounding by cigarette smoking so raising questions about a causal link.

Download Full-text

Does weight mediate the effect of smoking on coronary heart disease? Parametric mediational g-formula analysis

PLoS ONE ◽

10.1371/journal.pone.0262403 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262403

Author(s):

Yaser Mokhayeri ◽

Maryam Nazemipour ◽

Mohammad Ali Mansournia ◽

Ashley I. Naimi ◽

Jay S. Kaufman

Keyword(s):

Coronary Heart Disease ◽

Body Weight ◽

Heart Disease ◽

Cigarette Smoking ◽

Direct Effect ◽

Indirect Effect ◽

Mediating Effect ◽

Absolute Difference ◽

Time Varying ◽

Increased Risk

Background In settings in which there are time-varying confounders affected by previous exposure and a time-varying mediator, natural direct and indirect effects cannot generally be estimated unbiasedly. In the present study, we estimate interventional direct effect and interventional indirect effect of cigarette smoking as a time-varying exposure on coronary heart disease while considering body weight as a time-varying mediator. Methods To address this problem, the parametric mediational g-formula was proposed to estimate interventional direct effect and interventional indirect effect. We used data from the Multi-Ethnic Study of Atherosclerosis to estimate effect of cigarette smoking on coronary heart disease, considering body weight as time-varying mediator. Results Over a 11-years period, smoking 20 cigarettes per day compared to no smoking directly (not through weight) increased risk of coronary heart disease by an absolute difference of 1.91% (95% CI: 0.49%, 4.14%), and indirectly decreased coronary heart disease risk by -0.02% (95% CI: -0.05%, 0.04%) via change in weight. The total effect was estimated as an absolute 1.89% increase (95% CI: 0.49%, 4.13%). Conclusion The overall absolute impact of smoking to incident coronary heart disease is modest, and we did not discern any important contribution to this effect relayed through changes to bodyweight. In fact, changes in weight because of smoking have no meaningful mediating effect on CHD risk.

Download Full-text

Plasma Concentrations of Cystatin C in Patients with Coronary Heart Disease and Risk for Secondary Cardiovascular Events: More than Simply a Marker of Glomerular Filtration Rate

Clinical Chemistry ◽

10.1373/clinchem.2004.041889 ◽

2005 ◽

Vol 51 (2) ◽

pp. 321-327 ◽

Cited By ~ 205

Author(s):

Wolfgang Koenig ◽

Dorothee Twardella ◽

Hermann Brenner ◽

Dietrich Rothenbacher

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Cystatin C ◽

Filtration Rate ◽

Plasma Concentrations ◽

Outcome Variable ◽

Increased Risk ◽

The Impact

Abstract Background: Renal impairment (RI) is associated with worse prognosis. Recently, cystatin C has been shown to represent a potentially superior marker of the glomerular filtration rate compared with creatinine clearance (CrCl). We evaluated the impact of cystatin C and other markers of RI on prognosis in a large cohort of patients with coronary heart disease (CHD). Methods: Cystatin C, creatinine (Cr), and CrCl were determined at baseline in a cohort of 1033 patients (30–70 years) with CHD. Patients were followed for a mean of 33.5 months, and a combined endpoint [fatal and nonfatal cardiovascular disease (CVD) events] was used as the outcome variable. Cystatin C was measured by immunonephelometry, and CrCl was calculated. Results: During follow-up, 71 patients (6.9%) experienced a secondary CVD event. Neither Cr (P = 0.63) nor CrCl (P = 0.10) were associated with incidence of CVD events, whereas cystatin C was clearly associated with risk of secondary CVD events (P <0.0001). In multivariate analyses, patients in the top quintile of the cystatin C distribution at baseline had a statistically significantly increased risk of secondary CVD events even after adjustment for classic risk factors, severity of coronary disease, history of diabetes mellitus, treatment with angiotensin-converting enzyme inhibitors, and C-reactive protein (hazard ratio, 2.27; 95% confidence interval, 1.05–4.91) compared with patients in the bottom quintile. Conclusions: These data support the possibly important prognostic value of cystatin C among patients with known CHD and suggest that it may be a useful clinical marker providing complementary information to established risk determinants.

Download Full-text

699 INVESTIGATING THE IMPACT OF DIETARY AND PHYSICAL ACTIVITY TARGET ACHIEVEMENT ON WEIGHT AND WAIST CIRCUMFERENCE IN CORONARY HEART DISEASE PATIENTS

Atherosclerosis Supplements ◽

10.1016/s1567-5688(11)70700-0 ◽

2011 ◽

Vol 12 (1) ◽

pp. 147

Author(s):

R. Nathwan

Keyword(s):

Physical Activity ◽

Coronary Heart Disease ◽

Heart Disease ◽

Waist Circumference ◽

The Impact

Download Full-text

Effects of physical exercise on inflammatory parameters and risk for repeated acute coronary syndrome in patients with ischemic heart disease

Vojnosanitetski pregled ◽

10.2298/vsp0901044r ◽

2009 ◽

Vol 66 (1) ◽

pp. 44-48 ◽

Cited By ~ 27

Author(s):

Goran Rankovic ◽

Branislava Milicic ◽

Todorka Savic ◽

Boris Djindjic ◽

Zorica Mancev ◽

...

Keyword(s):

Physical Activity ◽

Coronary Heart Disease ◽

Heart Disease ◽

Physical Exercise ◽

Physical Training ◽

Home Setting ◽

Coronary Syndrome ◽

Markers Of Inflammation ◽

Cardiovascular Rehabilitation ◽

Increased Risk

Background/Aim. Inflammation is an important factor in the pathogenesis of atherosclerosis, and several markers of inflammation have been associated with an increased risk of cardiovascular events. Physical activity may lower the risk for coronary heart disease (CHD) by mitigating inflammation. The aim of this study was to investigate the effects of aerobic physical exercise on systemic inflammatory response in patients with stable coronary disease participating in a cardiovascular rehabilitation exercise program. Methods. Male (n = 29) and female (n = 23) patients with stable coronary heart disease were enrolled in this study. All the patients were divided into two groups: the group with regular aerobic physical training during cardiovascular rehabilitation program phase II for 3 weeks in our rehabilitation center and 3 weeks after that in their home setting, and sedentary lifestyle group. There were no significant differences in gender distribution among the analyzed groups. Student's t-test showed no significant differences in average age, waist circumference (OS) and waist/hip ratio (WHR). Results. The degree of obesity was measured by BMI and there was a significant improvement in BMI in the patients who undertook 6-week physical training compared to the controls (p < 0.05). Physical training during 6-week appeared not to have any effects on leukocite count and ICAM-1 levels compared to controls. Exercise induced reduction in plasma CRP levels by 23.72% (p < 0.001) and reduction in plasma VCAM-1 levels by 10.23%, (p < 0.05). Conclusion. Moderate aerobic exercise resulted in a significant reduction of inflammatory state by decreasing CRP and VCAM-1 levels with significant obesity reduction but without visceral obesity reduction. The obtained results indicate that regular physical activity is clinically desirable in primary and secondary prevention of coronary heart diseases.

Download Full-text