Showing papers in "European Journal of Preventive Cardiology in 2007"
TL;DR: The European Society of Cardiology Committee for Practice Guidelines for Cardiology (ESC) Committee for practice guidelines (CPG) thanked experts who contributed to parts of the guidelines, including Irene Hellemans, the CPG Review Coordinator.
Abstract: Other experts who contributed to parts of the guidelines: Edmond Walma, Schoonhoven (The Netherlands), Tony Fitzgerald, Dublin (Ireland), Marie Therese Cooney, Dublin (Ireland), Alexandra Dudina, Dublin (Ireland) European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG):, Alec Vahanian (Chairperson) (France), John Camm (UK), Raffaele De Caterina (Italy), Veronica Dean (France), Kenneth Dickstein (Norway), Christian Funck-Brentano (France), Gerasimos Filippatos (Greece), Irene Hellemans (The Netherlands), Steen Dalby Kristensen (Denmark), Keith McGregor (France), Udo Sechtem (Germany), Sigmund Silber (Germany), Michal Tendera (Poland), Petr Widimsky (Czech Republic), Jose Luis Zamorano (Spain)Document reviewers: Irene Hellemans (CPG Review Coordinator) (The Netherlands), Attila Altiner (Germany), Enzo Bonora (Italy), Paul N. Durrington (UK), Robert Fagard (Belgium), Simona Giampaoli(Italy), Harry Hemingway (UK), Jan Hakansson (Sweden), Sverre Erik Kjeldsen (Norway), Mogens Lytken Larsen ...
1,731 citations
TL;DR: In this paper, a meta-analysis of randomized controlled trials involving dynamic aerobic endurance training or resistance training was performed, showing that training induced significant net reductions in resting and daytime ambulatory blood pressure of, respectively, 3.0/2.6 and 3.3/3.5 mmHg.
Abstract: Several large epidemiological studies have reported an inverse relationship between blood pressure and physical activity. However, longitudinal intervention studies are more appropriate for assessing the effects of physical activity. We performed meta-analyses of randomized controlled trials involving dynamic aerobic endurance training or resistance training. The meta-analysis on endurance training involved 72 trials and 105 study groups. After weighting for the number of trained participants, training induced significant net reductions in resting and daytime ambulatory blood pressure of, respectively, 3.0/2.4 mmHg (P<0.001) and 3.3/3.5 mmHg (P<0.01). The reduction in resting blood pressure was more pronounced in the 30 hypertensive study groups (-6.9/-4.9) than in the others (-1.9/-1.6; P<0.001 for all). Systemic vascular resistance decreased by 7.1% (P<0.05), plasma norepinephrine by 29% (P<0.001), and plasma renin activity by 20% (P<0.05). Body weight decreased by 1.2 kg (P<0.001), waist circumference by 2.8 cm (P<0.001), percentage body fat by 1.4% (P<0.001) and the homeostasis model assessment index of insulin resistance by 0.31 units (P<0.01); high-density lipoprotein cholesterol increased by 0.032 mmol/l (P<0.05). Resistance training has been less well studied. A meta-analysis of nine randomized controlled trials (12 study groups) on mostly dynamic resistance training revealed a weighted net reduction in blood pressure of 3.2 (P=0.10)/3.5 (P<0.01) mmHg associated with exercise. Endurance training decreases blood pressure through a reduction in systemic vascular resistance, in which the sympathetic nervous system and the renin-angiotensin system appear to be involved, and favourably affects concomitant cardiovascular risk factors. The few available data suggest that resistance training can reduce blood pressure. Exercise is a cornerstone therapy for the prevention, treatment and control of hypertension.
338 citations
TL;DR: Aerobic exercise training without significant weight loss improves metabolic profile and exerts anti-inflammatory effects in patients with type 2 DM.
Abstract: BackgroundDiabetes mellitus (DM) and chronic inflammation are strongly related to increased cardiovascular risk. The purpose of this study was to evaluate whether an aerobic training programme would ameliorate inflammatory and anti-inflammatory markers in patients with type 2 DM.DesignInterventional study.MethodsA total of 60 overweight individuals with type 2 DM, but without vascular complications, were randomly assigned to either a 6-month aerobic exercise training programme (four times/week, 45-60 min/session), designated as exercise group, or to the control group. All participants were on an oral antidiabetic regimen and none was receiving lipid-lowering medications. Anthropometric parameters, cardiorespiratory fitness, glycaemic and lipid profiles, high sensitivity C-reactive protein (hs CRP), adiponectin, interleukin (IL)-10, IL-18, tumour necrosis factor (TNF)-a, insulin, reciprocal index of homoeostasis model assessment (HOMA-IR), body fat and blood pressure (BP) were measured at baseline and at t...
312 citations
TL;DR: Low cardiorespiratory fitness is strongly associated with the clustering of CVD risk factors in children independent of country, age and sex.
Abstract: Background and designFew studies have investigated the association between maximal cardiorespiratory capacity (fitness) and the clustered cardiovascular disease (CVD) risk in children and youth from culturally diverse countries. This cross-sectional study examined the association between fitness and clustered CVD risk in children and adolescents from three European countries.MethodsParticipants were 2845 randomly selected school children aged 9 or 15 years from Portugal (n = 944), Denmark (n = 849) and Estonia (n = 1052). Cardiorespiratory fitness was determined during a maximal test on a cycle ergometer. CVD risk factors selected to assess the degree of clustering were the total cholesterol/high-density lipoprotein cholesterol ratio, plasma triglycerides, insulin resistance (homeostasis model assessment), sum of four skinfolds, and systolic blood pressure.ResultsThere was a strong association between cardiorespiratory fitness and the clustering of CVD risk factors. The odds ratios for clustering in each ...
310 citations
TL;DR: In this paper, the authors discuss whether maximal treadmill running speed in a gradually increasing ramp protocol might be sufficient to control intensity without losing accuracy, and suggest that directly measured oxygen uptake should be used to assess exercise intensity and optimize endurance training.
Abstract: Valid and reliable experimental models are essential to gain insight into the cellular and molecular mechanisms underlying the beneficial effects of exercise in prevention, treatment, and rehabilitation of lifestyle-related diseases. Studies with large changes, low variation, and reproducible training outcome require individualized training intensity, controlled by direct measurements of maximal oxygen uptake or heart rate. As this approach is expensive and time consuming, we discuss whether maximal treadmill running speed in a gradually increasing ramp protocol might be sufficient to control intensity without losing accuracy. Combined data from six studies of rats and mice from our lab demonstrated a close correlation between running speed and oxygen uptake. This relationship changed towards a steeper linear slope after endurance training, indicating improved work economy, that is, less oxygen was consumed at fixed submaximal running speeds. Maximal oxygen uptake increased 40-70% after high-intensity aerobic interval training in mice and rats. The speed at which oxygen uptake reached a plateau, increased in parallel with the change in maximal oxygen uptake during the training period. Although this suggests that running speed can be used to assess training intensity throughout a training program, the problem is to determine the exact relative intensity related to maximal oxygen uptake from running speed alone. We therefore suggest that directly measured oxygen uptake should be used to assess exercise intensity and optimize endurance training in rats and mice. Running speed may serve as a supplement to ensure this intensity.
269 citations
TL;DR: The sensitivity and the positive predictive values of the Finnish hospital discharge registers and causes of death registers are fairly good, but the number of cerebral infarctions should be interpreted with caution.
Abstract: Background and purposeAdministrative registers, like hospital discharge registers and causes of death registers are used for the monitoring of disease incidences and in the follow-up studies. Obtai...
202 citations
TL;DR: In this article, the trends of cardiovascular risk factor prevalence between 1995 and 2005 in the 35-74-year-old population of Gerona, Spain were determined by a comparison of cross-sectional studies.
Abstract: BackgroundHigh prevalence of cardiovascular risk factors has been observed in Spain along with low incidence of acute myocardial infarction. Our objective was to determine the trends of cardiovascular risk factor prevalence between 1995 and 2005 in the 35-74-year-old population of Gerona, Spain.DesignComparison of cross-sectional studies were conducted in random population samples in 1995, 2000, and 2005 at Gerona, Spain.MethodsAn electrocardiogram was obtained, along with standardized measurements of body mass index, lipid profile, systolic and diastolic blood pressure, glycaemia, energy expenditure in physical activity, smoking, use of lipid-lowering and antihypertensive medications, and cardiovascular risk. Prevalence of diabetes, hypertension, and obesity was calculated and standardized for age.ResultsA total of 7571 individuals (52.0% women) were included (response rate 72%). Low-density lipoprotein cholesterol > 3.4 mmol/l (130 mg/dl) (49.7%) and hypertension (39.1%) were the most prevalent cardiova...
176 citations
TL;DR: Cardiorespiratory fitness relates more strongly to cardiovascular risk factors than components of objectively measured physical activity in children and adolescents, indicating that these modifiable lifestyle factors increase in importance with age.
Abstract: BackgroundPhysical activity and cardiorespiratory fitness are closely related to health variables in adults, especially those considered to be among risk factors for cardiovascular diseases. The possible tracking of cardiovascular disease risk factors from childhood to adulthood makes it important to increase our understanding of the complex relationships between physical activity, cardiorespiratory fitness and cardiovascular risk factors early in life.DesignA cross-sectional, school-based study on healthy children and adolescents, aged 9-10 years (295 girls, 295 boys) and 15-16 years (302 girls, 233 boys) was performed during a school year in Sweden and Estonia, as part of the European Youth Heart Study.MethodsTotal physical activity, and minutes spent in inactivity and activity of moderate or higher intensity were measured by accelerometry. A maximal ergometer bike test was used for estimation of cardiorespiratory fitness. The risk factors included blood pressure and fasting blood levels of insulin, glu...
176 citations
TL;DR: In this paper, an impaired capacity to increase heart rate during exercise testing (chronotropic incompetence) and a slowed rate of recovery following exercise (heart rate recovery) have been show.
Abstract: BackgroundBoth an impaired capacity to increase heart rate during exercise testing (chronotropic incompetence), and a slowed rate of recovery following exercise (heart rate recovery) have been show...
156 citations
TL;DR: The Asklepios Study is a longitudinal population study focusing on the interplay between ageing, cardiovascular haemodynamics and inflammation in (preclinical) cardiovascular disease, and the systematic determination of peripheral blood leukocyte telomere length as a marker for biological ageing.
Abstract: The Asklepios Study is a longitudinal population study focusing on the interplay between ageing, cardiovascular haemodynamics and inflammation in (preclinical) cardiovascular disease. The 2524 participants (1301 women) are a representative cohort of 35-55-year-old individuals, free from overt cardiovascular disease at study initiation, randomly sampled from the twinned Belgian communities of Erpe-Mere and Nieuwerkerken. Baseline examinations (all single-observer, single-device, single-site, single 2-year consecutive timeframe) include: questionnaires, conventional risk factors and biochemistry. Additional phenotypes under study include: (a) vascular structure and function: carotid and femoral atherosclerosis (intima-media thickness, plaque), arterial distension and pressure curves (brachial, carotid, femoral; wall-tracking and applanation tonometry); (b) cardiac structure and function. A novel aspect of the study is 'integrated' non-invasive biomechanical assessment of cardiac, arterial and ventriculovascular function through a combination of modeling, fundamental hydraulical measurements and system identification techniques. Integrated phenotypes result from combining at least two sets of curves (flow/pressure/distension). The value of this 'integrated' haemodynamic phenotype in the detection, prediction and prevention of clinical cardiovascular pathology (atherosclerosis progression, atherothrombosis, development of heart failure) will be tested. A second novel aspect is the systematic determination of peripheral blood leukocyte telomere length as a marker for biological ageing. During follow-up, baseline examinations will be repeated and the incidence of cardiovascular events will be monitored. Sex-specific baseline risk factor and biochemical data are provided in the current analyses. The primary aim is to build a combined dataset that will act as a tool to answer a cluster of questions about ageing, haemodynamics and the emergence of cardiovascular disease, especially the incidence of atherothrombotic events and the development of adverse haemodynamic profiles (arterial stiffening, heart failure). The study will reassess current risk factors and provide a long-term base for the detection of novel (epi)genetic and non-genetic risk factors and for more performant risk stratification modalities. Within these broader goals, a constant will be to strive towards more fundamental mechanistic-haemodynamic insights into cardiovascular disease processes.
152 citations
TL;DR: Even mild chronic kidney disease worsens the prognosis in patients with non-ST elevation acute coronary syndromes, and clopidogrel treatment significantly increased the risk of minor bleeding in all tertiles of renal function.
Abstract: IntroductionPatients with renal dysfunction are more prone to bleeding when receiving antithrombotic drugs. The aim of the study was to assess the impact of clopidogrel on safety and efficacy in patients with renal dysfunction in non-ST elevation acute coronary syndromes.Methods and resultsPatients in the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial were analysed to assess the relationship of chronic kidney disease to cardiovascular outcomes. Renal function was estimated by the glomerular filtration rate computed from the baseline serum creatinine measurements in 12253 (97.5%) patients enrolled in the trial. Patients were grouped into tertiles of glomerular filtration rate. The primary outcome (cardiovascular death, myocardial infarction, stroke combined) occurred more frequently in the lowest glomerular filtration rate tertile. The bleeding risk was also significantly increased in patients in this tertile, compared with the other two. The beneficial effect of adding clopidogrel...
TL;DR: The physical activity questionnaire has acceptable validity when compared with Vo 2 max in adult men and women and a simple question on self-rated fitness seems to reflect measured Vo 2max objectively.
Abstract: BackgroundPhysical activity level and cardiorespiratory fitness are both inversely associated with the risk of cardiovascular diseases and with all-cause mortality. Physical activity questionnaires are often validated against objectively measured maximal oxygen uptake (Vo2max).AimTo validate a self-report physical activity questionnaire against Vo2max and furthermore to establish whether a simple question on self-rated physical fitness could predict objectively measured Vo2max.MethodsA total of 102 men and women aged between 35 and 65 years were recruited from an ongoing population-based intervention study, the Inter99 Study. Participants reported their self-rated fitness and daily physical activity using a new questionnaire based on metabolic equivalents (MET). Vo2max (ml/kg per min) was determined using a graded bicycle test with increasing workload until exhaustion and with simultaneous measurement of breath-to-breath oxygen uptake in 15-s periods. Statistical analyses were performed by linear regressi...
TL;DR: Demands on coordination and aerobic dynamic endurance are suitable in counteracting age-related neuronal cellular loss, synapsis hypotrophy, and in improving neurogenesis and capillarization in ageing processes.
Abstract: Functional ageing processes are characterized by a loss of performance capabilities regarding coordination, flexibility, strength, speed, and endurance. The effects of ageing processes on the cardiovascular system and skeletal muscle are the foci of attention. After age 30, the maximum aerobic dynamic performance capacity decreases by an average of 8% per decade. The causes are mainly a reduction in the maximum cardiac output and decreases in capillarization and in the skeletal muscle mass. An improvement in the maximum oxygen uptake by 18% and in the aerobic-anaerobic threshold by 22% was achieved in untrained men aged 55-70 years, in a 12-week-long bicycle ergometer-training programme. The strength of the skeletal muscle decreases particularly after 50-60 years of age. The main cause is the reduction in the number of motor units and muscle fibres. Further, modifications of the endothelial function and the development of sarcopenia are of particular importance in ageing processes. General aerobic dynamic training can improve the endothelial function in old age and thus help prevent cardiovascular diseases. Strength training is most appropriate for the prevention of sarcopenia. Imaging techniques over the last 20 years have provided new findings on the influence and the significance of physical activity on the brain. We call this new interdisciplinary area 'Exercise Neuroscience'. Demands on coordination and aerobic dynamic endurance are suitable in counteracting age-related neuronal cellular loss, synapsis hypotrophy, and in improving neurogenesis and capillarization. Adjusted physical activity is thus capable of counteracting age-related changes and performance loss not only in the cardiovascular system but also in the brain.
TL;DR: In this article, the authors investigated the association between the time spent on physical activity as well as the average intensity of these activities and cognitive function and found that intensity of weekly physical activities is significantly positively associated with processing speed, memory, mental flexibility and overall cognitive function.
Abstract: Background: Physical activity is thought to facilitate cognitive performance and to slow down the rate of age-related cognitive decline. This study aimed to investigate the association between the time spent on physical activity as well as the average intensity of these activities and cognitive function.
Design: Cross-sectional analysis.
Methods: Our study population comprised of 1927 healthy men and women aged 45-70 years in the Netherlands, examined from 1995 until 2000. Physical activity was assessed with an extensive questionnaire, and cognitive function by a neuropsychological test battery.
Results: Multivariate linear regression analysis showed that intensity of weekly physical activities is significantly positively associated with processing speed, memory, mental flexibility and overall cognitive function. No significant associations were observed between the time spent weekly on physical activities and the various cognitive domains. At the same time, variation in activities was significantly positively associated with speed, memory, mental flexibility and overall cognitive function.
Conclusions: Average intensity of weekly physical activities and variation in activities are positively and significantly associated with cognitive performance on processing speed, memory and mental flexibility as well as performance on overall cognitive function.
Journal Article•
TL;DR: C3 and C4 show substantial correlations with cardiovascular risk factors, including blood pressure, BMI, and lipids, which accounts for the increased incidence of CVD in men with high C3 levels.
Abstract: Background Complement factor C3 and C4 have been associated with atherosclerosis and cardiovascular risk factors. This study explored whether plasma levels of C3 and C4 are risk factors for the incidence of cardiovascular disease (CVD). Design A population-based prospective study of 5850 initially healthy men, 28-61 years old at baseline. Methods Plasma levels of C3 and C4 were analysed at the baseline examination. The incidence of coronary events (i.e. fatal or non-fatal myocardial infarction), ischaemic stroke and cardiovascular events (i.e. myocardial infarction, ischaemic stroke or cardiovascular death) was studied over 18 years of follow-up. Results Adjusted for age, C3 in the fourth quartile (versus the first quartile) was associated with an increased incidence of coronary events [relative risk (RR) 1.54, 95% confidence interval (CI) 1.2-1.91, cardiovascular events (RR 1.56, 95% CI 1.3-1.9), and non-significantly with the incidence of ischaemic stroke (RR 1.31, 95% CI 0.89-1.8). However, after adjustments for smoking, body mass index (BMI), cholesterol, diabetes and systolic blood pressure, these relationships were completely attenuated and non-significant. The relationships were similar for C4 concentrations within the normal range. However, for men with C4 in the top 10% of the distribution (>0.34 g/l), a significantly increased incidence of coronary events was found, which persisted after adjustments for risk factors. Conclusion C3 and C4 show substantial correlations with cardiovascular risk factors, including blood pressure, BMI, and lipids. This relationship accounts for the increased incidence of CVD in men with high C3 levels. However, very high C4 levels may be associated with the incidence of CVD, independently of traditional cardiovascular risk factors.
TL;DR: It is suggested that bilirubin is a novel coronary heart disease risk marker in middle-aged men, with a U-shaped relationship observed between bilirUBin concentration and coronaryHeart disease risk.
Abstract: BackgroundClassic coronary heart disease risk factors fail to explain the large coronary heart disease incidence gradient between Northern Ireland and France. The Prospective Epidemiological Study of Myocardial Infarction (PRIME), a multicentre prospective study of 10 593 men, aims to investigate novel risk factors in these populations. We tested the hypothesis that higher bilirubin, a bile pigment possessing antioxidant properties, is associated with decreased coronary heart disease risk.MethodsBilirubin was measured in 216 participants who had developed coronary heart disease at 5-year follow-up and in 434 matched controls.ResultsBilirubin was significantly lower in cases (geometric mean 7.95 μmol/l; interquartile range 5.32–12.33 μmol/l) compared with controls (9.07; 6.16–12.76; P = 0.005). Conditional logistic regression, adjusted for classical and putative risk factors, showed a U-shaped pattern, with coronary heart disease risk significantly lower for bilirubin in the third and fourth fifths, compar...
TL;DR: In this article, a cross-sectional study was conducted on 2405 patients admitted to the Angiographic Ward at Tehran Hospital to investigate the effects of opium consumption on coronary artery disease.
Abstract: BackgroundThe effects of opium consumption on coronary artery disease are still unknown.MethodsA cross-sectional study was conducted on 2405 patients admitted to the Angiographic Ward at Tehran Hea...
TL;DR: Obesity in old women and diabetes in old men are the most decisive factors adversely affecting the health-related quality of life, thereby rendering them a group that calls for special study and attention.
Abstract: BackgroundThe purpose of this study was to study the cumulative effects of cardiovascular risk factors on all the health-related quality of life dimensions among the elderly in this era of epidemic obesity and diabetes.Design and methodsThe population-based study covered 3567 participants, representative of the Spanish non-institutionalized population aged 60 years and above. Data were gathered from home-based interviews and from the measurements of blood pressure and other anthropometric variables. Multiple linear regression was used to examine the relationships between health-related quality of life, on each scale of the SF-36 questionnaire, and obesity (waist circumference > 102 cm in men and >88cm in women), hypertension (blood pressure ≥ 140/90 mmHg), and known diabetes, after adjusting for sociodemographic and lifestyle factors.ResultsPatients with obesity, hypertension, and diabetes, or a combination of these factors were, in general, associated with a worse health-related quality of life, on both ...
TL;DR: An important role especially for symptoms of anxiety for long-term prognosis of patients with known coronary heart disease is suggested, and several pathogenetic links may partly explain the increased risk.
Abstract: BackgroundWe evaluated the association of symptoms of anxiety and depression with fatal and non-fatal cardiovascular disease events among patients with coronary heart disease and considered several potential underlying pathogenetic links.DesignThis was a prospective cohort study.MethodsIn this study, including coronary heart disease patients undergoing an in-patient rehabilitation program, symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal cardiovascular disease events were determined during a 3-year follow-up.ResultsOf the 1052 patients with CHD 16.1% showed a borderline and 8.3% a manifest anxiety symptoms score, whereas 11.8 and 5.9% showed a borderline and manifest depressive symptoms score, respectively. During the 3-year follow-up fatal and non-fatal cardiovascular disease events were observed in 73 (6.9%) patients. After adjustment for covariates, patients having manifest anxiety symptoms had a statistically significant hazar...
TL;DR: A large (European) trial on gender-specific coping styles, needs, and preferences of older women, and the effects of psychosocial intervention is proposed.
Abstract: Ischaemic heart disease (IHD) has changed from a disease of middle-aged men in the late 1970s to a disease of elderly women in the 2000s. Most clinical studies during the past three decades have been conducted with men. Cardiac rehabilitation programmes were also developed with special regard to improving the rate of return to work in middle-aged men. The rehabilitation needs of older patients and women in particular have been largely neglected. The aim of this review is briefly to outline our present knowledge on gender issues in cardiac rehabilitation, and to specify barriers with regard to physical activities especially in (older) women. Coping with a cardiac event, women tend to minimize or play down the impact of their health situation and avoid burdening their social contacts. After a first cardiac event, women report greater psychological distress and lower self-efficacy and self-esteem. In addition, older age, lower exercise levels and reduced functional capacity or co-morbid conditions such as os...
TL;DR: In this article, regular physical activity is associated with many health benefits in patients with cardiac disease, and Advances in treatment have resulted in an increasing population of adults with congenit...
Abstract: BackgroundRegular physical activity is associated with many health benefits in patients with cardiac disease. Advances in treatment have resulted in an increasing population of adults with congenit...
TL;DR: An overview of the rehabilitation measures provided for cardiac patients in Germany is given to outline its legal basis and outcomes and the positive effects of cardiac rehabilitation are also important economically for the improvement of secondary prevention and vocational integration.
Abstract: The purpose of this review is to give an overview of the rehabilitation measures provided for cardiac patients in Germany and to outline its legal basis and outcomes. In Germany the cardiac rehabilitation system is different from rehabilitation measures in other European countries. Cardiac rehabilitation in Germany since 1885 is based on specific laws and the regulations of insurance providers. Cardiac rehabilitation has predominantly been offered as an inpatient service, but has recently been complemented by outpatient services. A general agreement on the different indications for offering these two services has yet to be reached. Cardiac rehabilitation is mainly offered after an acute cardiac event and bypass surgery. It is also indicated in severe heart failure and special cases of percutaneous coronary intervention. Most patients are men (>65%) and the age at which events occur is increasing. The benefits obtained during the 3-4 weeks after an acute event, and confirmed in numerous studies, are often later lost under 'usual care' conditions. Many attempts have been made by rehabilitation institutions to improve this deficit by providing intensive aftercare. One instrument set up to achieve this is the nationwide institution currently comprising more than 6000 heart groups with approximately 120000 outpatients. After coronary artery bypass grafting or acute coronary syndrome cardiac rehabilitation can usually be started within 10 days. The multidisciplinary rehabilitation team consists of cardiologists, psychologists, exercise therapists, social workers, nutritionists and nurses. The positive effects of cardiac rehabilitation are also important economically, for example, for the improvement of secondary prevention and vocational integration.
TL;DR: A nurse-led systematic telephone follow-up intervention significantly improved the physical dimension of health-related quality of life in patients in the intervention group compared with usual care patients.
Abstract: BackgroundProviding information is an important part of standard care and treatment for acute myocardial infarction inpatients. Evidence exists indicating that acute myocardial infarction patients experience an information gap in the period immediately after discharge from the hospital. The aim of this study was to assess the short-term effects of a nurse-led telephone follow-up intervention to provide information and support to patients with acute myocardial infarction after their discharge from hospital.Design and methodA prospective randomized, controlled trial with a 6-month follow-up was conducted. A total of 288 patients were allocated to either an intervention group (n = 156) or a control group (n = 132). The latter received routine post-discharge care. The primary endpoint measured at 3 and 6 months after discharge was the health-related quality of life using the 36-item Short Form Health Survey. Secondary endpoints included smoking and exercise habits.ResultsIn both groups, health-related quality...
TL;DR: Shorter secondary prevention programmes, those based in general practice, and those staffed by generalists are at least as effective in reducing all cause mortality in patients with coronary heart disease as longer programmes, hospital-based programmes, and programmes staffed by specialists.
Abstract: BackgroundThe aim of this study was to determine which programme characteristics influence the effectiveness of secondary prevention programmes for Coronary Heart Disease.DesignThe study follows a meta-regression design.MethodsWe conducted a meta-regression within a systematic review of randomized trials comparing secondary prevention programmes versus usual care. The primary outcome was all-cause mortality. Studies were identified by searching multiple electronic databases, bibliographies of published studies, contact with experts, and references provided by the United States Centers for Medicare and Medicaid Services. Primary authors of all relevant trials were surveyed for detailed information on programme characteristics. Forty-six unique trials were identified (18 821 patients). The pooled all-cause mortality risk ratio (RR) for programmes was 0.87 [95% confidence interval (CI) 0.79-0.97]. Programmes containing less than 10 h of patient contact with health professionals reduced all-cause mortality (R...
TL;DR: Exercise training improves O2 kinetics in chronic heart failure patients, but continuous training results in superior improvement of the phase II O2-kinetics, an indirect index of muscle oxidative capacity.
Abstract: BackgroundProlonged oxygen uptake kinetics (O2 kinetics), following the onset of a constant workload of exercise has been associated with a poor prognosis in patients with chronic heart failure. Th...
TL;DR: In this article, the authors examined the impact of walking intensity and walking duration on all-cause mortality and found a significant inverse association between intensity and risk of death, but only a weak inverse association to walking duration.
Abstract: BackgroundCurrent recommendations prescribe that every adult should accumulate 30 min or more of moderate-intensity physical activity in leisure time, preferably all days of the week. To further support these recommendations we examined the impact of walking intensity and walking duration on all-cause mortality.DesignRelative intensity and duration of walking were recorded in 7308 healthy women and men aged 20-93 at the third examination (1991-1994) of the Copenhagen City Heart Study. During an average of 12 years of follow-up 1391 deaths were recorded.ResultsFor both sexes we found a significant inverse association between walking intensity and risk of death, but only a weak inverse association to walking duration. For women walking with average intensity, the adjusted hazard ratio (HR) of death was 0.75 [95% confidence interval (CI) 0.61–0.92; P 0.001) compared to women walking with slow intensity. For men the relative risks were 0.54 (...
TL;DR: In this paper, a 3-month endurance exercise training program augments coronary collateral supply to normal vessels, and even to previously stenotic arteries having undergone percutaneous coronary intervention before initiating the program.
Abstract: BACKGROUND: In humans, it is not known whether physical endurance exercise training promotes coronary collateral growth. The following hypotheses were tested: the expected collateral flow reduction after percutaneous coronary intervention of a stenotic lesion is prevented by endurance exercise training; collateral flow supplied to an angiographically normal coronary artery improves in response to exercise training; there is a direct relationship between the change of fitness after training and the coronary collateral flow change. METHODS AND RESULTS: Forty patients (age 61+/-8 years) underwent a 3-month endurance exercise training program with baseline and follow-up assessments of coronary collateral flow. Patients were divided into an exercise training group (n=24) and a sedentary group (n=16) according to the fact whether they adhered or not to the prescribed exercise program, and whether or not they showed increased endurance (VO2max in ml/min per kg) and performance (W/kg) during follow-up versus baseline bicycle spiroergometry. Collateral flow index (no unit) was obtained using pressure sensor guidewires positioned in the coronary artery undergoing percutaneous coronary intervention and in a normal vessel. In the vessel initially undergoing percutaneous coronary intervention, there was an increase in collateral flow index among exercising but not sedentary patients from 0.155+/-0.081 to 0.204+/-0.056 (P=0.03) and from 0.189+/-0.084 to 0.212+/-0.077 (NS), respectively. In the normal vessel, collateral flow index changes were from 0.176+/-0.075 to 0.227+/-0.070 in the exercise group (P=0.0002), and from 0.219+/-0.103 to 0.238+/-0.086 in the sedentary group (NS). A direct correlation existed between the change in collateral flow index from baseline to follow-up and the respective alteration of VO2max (P=0.007) and Watt (P=0.03). CONCLUSION: A 3-month endurance exercise training program augments coronary collateral supply to normal vessels, and even to previously stenotic arteries having undergone percutaneous coronary intervention before initiating the program. There appears to be a dose-response relation between coronary collateral flow augmentation and exercise capacity gained.
TL;DR: Results indicate that adverse changes in body shape have taken place from the late 1980s to the early 2000s, and there is an even larger group of individuals at risk of obesity-related metabolic disorders because of abdominal obesity, particularly among low-educated individuals.
Abstract: BackgroundObesity is an increasing health problem. Data on long-term obesity trends are most often based on the measurement of body mass index (BMI). Abdominal obesity, assessed by waist circumference may, however, be more closely related to health risks than overall obesity. The aim of this study was to investigate 15-year changes in general and abdominal obesity among adults in Finland, and furthermore, to assess whether obesity trends differ between educational groups.DesignFour cross-sectional population surveys conducted at 5-year intervals between 1987 and 2002.MethodsAltogether, 9025 men and 9950 women aged 25-64 years participated in these surveys. The weight, height, and waist circumferences of the participants were measured using a standardized protocol.ResultsMean waist circumference increased by 2.7 cm in men and 4.3 cm in women in 15 years. Whereas the distribution of BMI values did not change much, a remarkable shift towards higher waist circumference values was observed in 15 years. In both...
TL;DR: The results support cigarette smoking as an independent and modifiable risk factor for DM and suggest early smoking cessation could decrease the risk for developing DM to that of nonsmokers in the long term.
Abstract: BackgroundTo investigate the independent effects of smoking cessation on the risk for developing type 2 diabetes mellitus (DM) in the general population.DesignAn 8-year prospective study.MethodsThis prospective study started with baseline examinations in 1990 and 1992, and continued with follow-up examinations every 2 years up to 1998 and 2000. A total of 27635 nondiabetic men, aged 35–44 years were classified as 5701 nonsmokers, 7477 ex-smokers and 14457 sustained smokers, based on repeated self-reported questionnaires in 1992, 1994 and 1996. Baseline fasting serum glucose level and other risk factors were measured in 1990 and 1992. The outcome was newly developed DM, defined as a fasting glucose level ≥7.0mmol/l in 1998 and 2000 (averaged).ResultsOver the 8 years, 1170 men (4.2%) developed DM. When compared with nonsmokers, the fully adjusted risk ratio of ex-smokers and sustained smokers for diabetes was 1.22 [95% confidence interval (CI), 0.96–1.55] and 1.60 (95% CI, 1.29–1.97), respectively. Among th...