European Journal of Preventive Cardiology

Aerobic exercise training improves vasodilatory capacity of peripheral resistance vasculature and modifies plasma proinflammatory markers in chronic heart failure patients. It is, however, currently unknown whether aerobic exercise has a similar effect in heart transplant recipients (HTR).

Eight weeks after transplantation, 14 HTR were randomly assigned to 12 weeks of supervised aerobic exercise training (TRAINED; n = 8) or attention-time control (CONTROL; n = 6) in addition to posttransplantation medical care. Peak forearm blood flow and calf blood flow (CBF) during reactive hyperemia after 5 min of limb ischemia was used as a measure of endothelium-dependent vasodilation of limb resistance arteries. Plasma C-reactive protein, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), soluble intercellular adhesion molecule-1 (sICAM-1), and exercise capacity were measured at baseline and again after 12 weeks in both groups.

Peak CBF increased 22% in the TRAINED (25.9±5.8-31.6±7.9 ml/min/100 ml, P<0.05), but there was no change in peak CBF after 12 weeks in CONTROL. Plasma C-reactive protein, IL-6, TNF-α, sICAM-1 did not change in TRAINED, but there was a significant increase in TNF-α (1.66±1.02 vs. 3.07± 1.10 pg/ml, P < 0.05), and sICAM-1 (205.9±59.1 vs. 245.0 ± 47.9 ng/ml, P<0.01) in CONTROL after 12 weeks. Furthermore, exercise test duration improved 51.7% (P<0.01) and there was a trend toward an increase in peak VO₂ (P = 0.05) in TRAINED after 12 weeks but neither changed in CONTROL.

A program of supervised aerobic exercise improves endothelium-dependent vasodilation of the calf, but not forearm resistance arteries, and may attenuate a progressive increase in selected proinflammatory markers in HTR.

The relationship between coronary heart disease (CHD) incidence and death, and individual socio-demographic status is well established. Our aim was to examine whether neighbourhood deprivation scores predict CHD and death in older men, independently of individual sociodemographic status.

Prospective study of 5049 men, born between 1918 and 1939, recruited from 24 British towns encompassing 969 electoral wards, without documented evidence of previous major CHD when responding to a questionnaire in 1992, and followed up for incidence of major CHD and death.

Four hundred and seventy-two new major CHD events (1.08% pa), and 1021 deaths (2.28% pa) occurred over an average of 9.75 years. When men were divided into fifths according to increasing neighbourhood deprivation score, CHD incidences (% pa) were 0.92, 0.89, 0.99,1.33 and 1.29. When modelling continuous trends, the rate ratio for men in the top fifth compared with the bottom fifth was 1.55 (95% confidence interval 1.19-2.00) for CHD. This rate ratio was, however, no longer statistically significant [1.22 (95% confidence interval 0.92-1.61)] when effects of individual sociodemographic status measures (car ownership, housing, longest held occupation, marital status and social networks) were accounted for.

Little evidence of an independent relationship of neighbourhood deprivation with CHD incidence was found once individual measures of sociodemographic status had been adjusted for.

Many epidemiological studies have reported that antioxidant vitamin intake from diet or supplements are associated with a lower risk of coronary heart disease (CH D), the findings are, however, inconsistent. We undertook a meta-analysis of cohort studies to examine the relations between antioxidant vitamins (vitamins C, E, and β-carotene) and CHD risk.

We included all the relevant cohort studies if they provided a relative risk and corresponding 95% confidence interval (CI) of CHD in relation to antioxidant vitamins intake from diet or supplement. Fifteen cohort studies were identified involving a total of 7415 incident CHD cases and 374488 participants with a median follow-up of approximately 10, 8.5, and 15 years for vitamins C, E, and β-carotene, respectively. Pooled estimates across studies were obtained by random-effects model. The potential sources of heterogeneity and publication bias were also estimated. For vitamins C, E, and β-carotene, a comparison of individuals in the top third with those in the bottom third of baseline value yielded a combined relative risk of 0.84 (95% CI, 0.73-0.95), 0.76 (95% CI, 0.63-0.89), and 0.78 (95% CI, 0.53-1.04), respectively. Subgroup analyses show that dietary intake of vitamins C and E and supplement use of vitamin E have an inverse association with CHD risk, but supplement use of vitamin C has no significant association with CHD risk. In the dose-response meta-analysis, each 30 mg/day increase in vitamin C, 30IU/day increase in vitamin E, and 1 mg/day increase in β-carotene yielded the estimated overall relative risk for CHD of 1.01 (95% CI, 0.99-1.02), 0.96 (95% CI, 0.94-0.99), and 1.00 (95% CI, 0.88-1.14), respectively.

Our findings in this meta-analysis suggest that an increase in dietary intake of antioxidant vitamins has encouraging prospects for possible CHD prevention.

Down syndrome (DS) is a risk factor for metabolic syndrome and cardiovascular disease. The greater oxidative stress described in DS can increase this risk owing to its potential deleterious effects on insulin sensitivity. We hypothesized that metabolic syndrome or its markers, at rest and during exercise, are more pronounced in young adults with DS.

The study design is that of a controlled study.

Thirteen physically active young adults with DS, after overnight polysomnography, plasma-lipid profile, and insulin-resistance [Homeostasis Model Assessment Insulin Resistance (HOMA-IR)] assessments, underwent a sub-maximal progressive treadmill exercise (10 min at 30 and 50%, and 20 min at 75% of Vo_{2 max}), allowing for maximal fat-oxidation rate and blood-oxidative stress determinations. They were compared with 15 healthy control participants (C).

Vo_{2 max} of DS participants was lower than that of C (60.8 ±2.4 versus 44.4 ± 3.3 ml/kg/min; P < 0.001) but was close to the predicted value (95 ±6%). In DS participants, as expected, oxidative stress was greater than in C (+ 15%; P < 0.001) at rest and all through the exercise protocol. Although a greater fat mass (DS: 19.9 ±1.3%; C: 13.5 ±0.9%; P < 0.001), and a lower insulin sensitivity (HOMA-IR in DS: 1.09±0.16; in C: 0.64±0.13; P < 0.05) was observed for DS participants, a metabolic syndrome could not be shown. Maximal fat-oxidation rate was lower in DS participants (394.2 ±69.9 versus 486.1 ±134.8mg/min in C; P < 0.01), but it was in the normal range.

Despite greater oxidative stress and lower insulin sensitivity, the DS group involved in our study did not display clear metabolic abnormalities. The young age and lifestyle of this group might, partially, have accounted for this apparently healthy metabolic status.

Inflammation may contribute to the pathogenesis of chronic heart failure. Some reports suggesting that exercise training may have net anti-inflammatory effects in heart failure patients exists, although the results are somewhat conflicting.

Fifteen patients with mild to moderate chronic heart failure underwent an exercise training program of 20 weeks. They were examined at baseline, at the end of the training period, and 1 year after end of training.

Our main findings were as follows: (i) during the training period there was a significant increase in exercise capacity as estimated by the 6-min walk test as well as an improvement in several quality of life parameters, (ii) these changes were accompanied by a marked decrease in plasma levels of soluble CD40 ligand and P-selectin, probably reflecting an attenuated platelet-mediated inflammation, (iii) in contrast, there were no changes in plasma levels of tumor necrosis factor α, monocyte chemoattractant protein-1, or vascular cellular adhesion molecule-1 during the training period, (iv) except for an increase in systolic annular velocity there were no changes in echocardiographic variables during the training period, (v) one year after the training, in a period without systematic training, plasma levels of soluble CD40 ligand, and P-selectin had returned to baseline levels along with a nonsignificant reduction in 6-min walk test.

Our findings suggest a potent downregulatory effect of exercise training on platelet-mediated inflammation in patients with chronic heart failure. Further studies are needed to clarify the clinical significance of these findings.

The aim of this study was to investigate the relationship of the prevalence and risk of the metabolic syndrome to body mass index (BMI) in Australian Aboriginal people.

It was a cross-sectional, secondary analysis of data obtained from population-based screenings in Aboriginal communities in central and northern Australia (913 participants recruited between 1993 and 1997).

Forty-one percent of men and 48% of women conformed to the National Cholesterol Education Program definition for the metabolic syndrome (χ² = 3.72, P = 0.054). The prevalence of low high-density lipoprotein-cholesterol was high in all BMI categories (89 and 95% in men and women, respectively). The prevalence of all other metabolic abnormalities increased linearly with BMI.

The metabolic syndrome is highly prevalent in Aboriginal communities and is strongly associated with BMI. Low high-density lipoprotein-cholesterol was the predominant component of the metabolic syndrome across sex groups and BMI strata.

Moderate physical activity enhances endothelium-dependent vasorelaxation. Whether the frequency of exercise affects endothelial function is unclear. The purpose of this study was to investigate the effects of various frequencies of training on endothelium-dependent vasorelaxation.

Male Wistar rats were trained for 8 weeks on a treadmill at various frequencies [1 (Ex1), 3 (Ex3) or 5 days/week (Ex5)] and compared with age-matched sedentary animals (SED). A control group allowed us to assess endothelial function before the exercise protocol. Rings of thoracic aorta were precontracted with phenylephrine.

Endothelium-independent relaxation elicited by sodium nitroprusside was similar in all groups. The maximal response elicited by acetylcholine (ACh) was not different between groups, whereas pD₂ values (−logEC₅₀, EC₅₀ being the concentration of ACh that elicited 50% of the maximal response) significantly correlated with frequency of training, nitro-L-arginine methyl ester (L-NAME) reduced the relaxation elicited by 10⁻⁷mol/l ACh or higher in control and all trained groups, and by 10⁻⁶mol/l ACh or higher in SED group. Indomethacin inhibited the vasodilating response to 10⁻⁷mol/l ACh or higher in control, SED and Ex1 groups, and to 10⁻⁸mol/l or more in Ex3 and Ex5 animals. Tetraethylammonium attenuated the response to 10⁻⁶mol/l ACh or higher in control and SED groups and to 10⁻⁷mol/l or more in all trained animals.

This data suggest that decreased ACh-induced vasorelaxation after physical inactivity may result from impairment of endothelial nitric oxide synthase, prostacyclin and endothelium-derived hyperpolarizing factor pathways. This effect is prevented by training in a frequency-dependent manner.

The importance of patients' involvement in decision-making is because of their right to know the risks and benefits they accept in undertaking treatment and the as yet unproven hope that this will improve compliance. The aim of this study was to establish local people's willingness to receive antihypertensive treatment for primary prevention of cardiovascular disease (CVD) and to explore the role of ethnicity.

In a cross-sectional study with face-to-face interview South Asian and Caucasian men and women aged 35-74, with and without history of CVD, were interviewed. Minimal clinically important differences were measured for three different baseline CVD risks (10, 20, and 40% in 10 years) using a standard method with risks presented both graphically and numerically and expressed in positive and negative terms.

A total of 262 (110 South Asians) participants were interviewed. Overall, South Asians expressed smaller median minimal clinically important differences than Caucasians, 1 and 4%, respectively. Up to 17% of participants in both ethnic groups indicated that they would not take medication regardless of the benefits. The proportion of South Asian men unwilling to take medication regardless of benefit was higher than Caucasian men for all scenarios, 17.2 versus 10.7% for scenario 1 and 12.1 versus 5.6% for scenario 2, respectively. South Asians of both sexes who would consider therapy required less benefit for acceptance in all three scenarios compared with the Caucasians.

South Asian participants were at least likely as Caucasians to accept antihypertensive treatment as the primary prevention therapy and they should be targeted for this type of therapy.

To compare the intensity of three exercise training regimens.

During a cardiac rehabilitation program coronary artery disease (CAD) patients should be trained at an intensity as close as possible to the ventilatory threshold (VT) level. The precise way to obtain this intensity of training during the sessions, however, remains unclear.

In stable β-blocked CAD patients, heart rate (HR) and workload (WL) at the VT were determined from a cardiopulmonary exercise test. The 3 following days, each patient performed (in a randomized order) one bicycle training session per day at an intensity determined by (i) HR at VT, (ii) WL at VT, (iii) patient's feelings (14 on the Borg scale). HR, WL, systolic blood pressure, oxygen consumption (V O ₂) and the respiratory exchange ratio were monitored during each session, to compare the intensity of each regimen.

Twenty patients, 57 ± 10 years old were included. V O ₂, WL, HR and systolic blood pressure were significantly higher in the sessions driven by feelings and WL, than in the HR-driven sessions. As respiratory exchange ratio remained less than 1, we can assume that there was no important and deleterious participation of anaerobic metabolism.

Classical training HR prescription could lead to undertrain CAD patients, although a training session prescription driven by the feelings or by the WL observed at VT allows the patients to train at a higher — but still aerobic — intensity.

Little information exists regarding the effect of several obesity markers on blood pressure (BP) levels in youth.

Transverse study including 2494 boys and 2589 girls.

Height, weight and waist were measured according to the international criteria and body fat (BF) by bioimpedance. BP was measured by an automated device. Hypertension was defined using sex-specific, age-specific and height-specific observation-points.

Body mass index (BMI) and waist were positively related with systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate in both sexes, whereas the relationships with BF were less consistent. Stepwise linear regression analysis showed that BMI was positively related with SBP and DBP in both sexes, whereas BF was negatively related with SBP in both sexes and with heart rate in boys only; finally, waist was positively related with SBP in boys and heart rate in girls. Age and heart rate-adjusted values of SBP and DBP increased with BMI: for SBP, 117 ± 1, 123 ± 1 and 124 ± 1 mmHg in normal, overweight and obese boys, respectively; corresponding values for girls were 111 ± 1, 114 ± 1 and 116 ± 2 mmHg (mean ± SE, P<0.001). Overweight and obese boys had an odds ratio for being hypertensive of 2.26 (95% confidence interval: 1.79-2.86) and 3.36 (2.32-4.87), respectively; corresponding values for girls were 1.58 (confidence interval 1.25-1.99) and 2.31 (1.53-3.50).

BMI, not BF or waist, is consistently and independently related to BP levels in children; overweight and obesity considerably increase the risk of hypertension.

The proportion of elderly immigrants in Sweden is increasing. This is an important issue considering that the prevalence of cardiovascular disease (CVD) is a global health problem and that CVD is one of the main causes of morbidity among the elderly. The aim of this study is to analyze whether there is an association between migration status, that is being an elderly Iranian immigrant in Sweden, as compared with being an elderly Iranian in Iran, and the prevalence of risk factors for CVD.

Population-based cross-sectional study with face-to-face interviews.

A total of 176 Iranians in Stockholm and 300 Iranians in Tehran, aged 60-84 years.

The prevalence of general obesity, abdominal obesity, hypertension, smoking, and diabetes was determined. Unconditional logistic regression analysis was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes.

The age-adjusted risk of hypertension and smoking was higher in Iranian women and men in Sweden. OR for hypertension was 1.9 (95% CI: 1.1-3.2) for women and 3.1 (95% CI: 1.5-6.3) for men and OR for smoking was 6.9 (95% CI: 2.2-21.6) for women and 4.7 (95% CI: 2.0-11.0) for men. The higher risk for hypertension and smoking remained significant after accounting for age, socioeconomic status, and marital status. Abdominal obesity was found in nearly 80% of the women in both groups.

The findings show a strong association between migration status and the prevalence of hypertension and smoking. Major recommendation for public health is increased awareness of CVD risk factors among elderly immigrants.

Of previous studies, some have indicated an adverse development of serum lipids, blood pressure and body weight in women around the menopause. We sought to study these associations in data collected before the widespread use of lipid lowering drugs and hormone therapy.

Population-based cohort study.

We analysed data from population-based cardiovascular surveys in Norway. During 1985-1988, all women aged 40-54 years in three counties were invited, 83% participated and 24 085 nonusers of hormone therapy were studied, of whom 12 736 had attended similar surveys 5 and 10 years earlier (1974-1978 and 1977-1983). Serum lipids, blood pressure, height and weight were measured, and menopausal status was registered by interview. Analyses were made in cross-sectional data and by comparing changes in serum lipids, body weight and blood pressure between the surveys according to menopausal exposure.

Total cholesterol (TC), triglycerides and the TC/high-density lipoprotein (HDL)-cholesterol ratio increased from premenopausal to postmenopausal status. The HDL-cholesterol concentration seemed to increase slightly in the perimenopause. In women who had entered the postmenopausal phase most recently, the increases of TC and triglycerides since 5 years earlier were more than twice the levels of premenopausal women. The results were consistent in subgroups by age. Menopausal status was not associated with adverse development of blood pressure or body weight.

The menopausal transition may be associated with an accelerated increase of TC and triglyceride concentrations and of the TC/HDL-cholesterol ratio.

The objective of the study was to investigate whether depression is a predictor of postdischarge smoking relapse among patients hospitalized for myocardial infarction (MI) or unstable angina (UA), in a smoke-free hospital.

Current smokers with MI or UA were interviewed while hospitalized; patients classified with major depression (MD) or no humor disorder were reinterviewed 6 months post discharge to ascertain smoking status. Potential predictors of relapse (depression; stress; anxiety; heart disease risk perception; coffee and alcohol consumption; sociodemographic, clinical, and smoking habit characteristics) were compared between those with MD (n = 268) and no humor disorder (n = 135).

Relapsers (40.4%) were more frequently and more severely depressed, had higher anxiety and lower self-efficacy scale scores, diagnosis of UA, shorter hospitalizations, started smoking younger, made fewer attempts to quit, had a consort less often, and were more frequently at the ‘precontemplation’ stage of change. Multivariate analysis showed relapse-positive predictors to be MD [odds ratio (OR): 2.549; 95% confidence interval (CI): 1.519-4.275] (P < 0.001); ‘precontemplation’ stage of change (OR: 7.798; 95% CI: 2.442-24.898) (P < 0.001); previous coronary bypass graft surgery (OR: 4.062; 95% CI: 1.356-12.169) (P = 0.012); and previous anxiolytic use (OR: 2.365; 95% CI: 1.095-5.107) (P = 0.028). Negative predictors were diagnosis of MI (OR: 0.575; 95% CI: 0.361-0.916) (P = 0.019); duration of hospitalization (OR: 0.935; 95% CI: 0.898-0.973) (P = 0.001); smoking onset age (OR: 0.952; 95% CI: 0.910-0.994) (P = 0.028); number of attempts to quit smoking (OR: 0.808; 95% CI: 0.678-0.964) (P = 0.018); and ‘action’ stage of change (OR: 0.065; 95% CI: 0.008-0.532) (P = 0.010).

Depression, no motivation, shorter hospitalization, and severity of illness contributed to postdischarge resumption of smoking by patients with acute coronary syndrome, who underwent hospital-initiated smoking cessation.

Few have studied the association between chewing ability and longevity.

In this prospective study, we analyzed 697 80-year-old participants residing in Fukuoka Prefecture, Japan. Chewing ability was assessed on the basis of the types of food that each participant reported being able to chew.

During follow-up, 108 participants died. Patients reporting the lowest numbers of chewable foods were associated with higher risks of cardiovascular mortality than those who were able to chew all the types of food surveyed (multivariate hazard ratio: 4.60; 95% confidence interval: 1.01-21.1).

Impaired dentition status with poor masticatory ability was an independent risk factor for cardiovascular mortality in active elderly individuals.

Chronic vascular inflammation may trigger ischemic events whereas regular physical exercise training (ET) has shown to be cardioprotective in patients with coronary artery disease (CAD). We investigated the impact of 2 years regular ET versus percutaneous intervention (PCI) on chronic inflammation and cardiovascular events.

A total of 101 male patients with stable CAD and an indication for revascularization were prospectively randomized to regular ET (n = 51) or PCI with stentimplantation (n = 50). High-sensitive C-reactive protein and interleukin-6, exercise capacity and ischemic endpoints were analyzed at baseline and after 2 years. At 2 years maximal oxygen consumption (Vo₂ max) increased by 10% in the ET group (23.3 ± 0.6 to 25.7 ± 1.0 ml O₂/kg/min; P = 0.0171 versus baseline) versus 7% in the PCI group (22.3 ± 0.8 to 23.9 ± 1.2 ml O₂/kg/min; P = 0.4248). In a subgroup of patients, high-sensitive C-reactive protein levels and interleukin-6 levels were significantly reduced after ET by 41 and 18%, respectively, whereas no relevant changes were observed in the PCI group. Event-free survival rates after 24 months were 78% (ET) versus 62% (PCI) (P = 0.039).

In patients with stable coronary artery disease, regular physical exercise is associated with a reduction of inflammatory markers and ischemic events.

To investigate the effects of exercise training (ET) on left ventricular (LV) volumes, cardiopulmonary functional capacity and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in postinfarction patients with moderate LV dysfunction.

Sixty-one postinfarction patients were randomized into two groups: group T [n = 30, LV ejection fraction (EF) 41.6 ± 11.3%, mean ± SD] entered a 6-month ET programme, whereas group C (n = 31, EF 42.0 ± 7.6%, P=NS) did not. NT-proBNP assay, Doppler-echocardiography and cardiopulmonary exercise test were performed upon enrolment and at sixth months.

At sixth months, trained patients showed an improvement in workload (+26%, P<0.001), Vo_2peak (+31%, P<0.001), LV end-diastolic volume index (LVEDVI; −9%, P<0.001), a reduction in NT-proBNP (−71%, P<0.001) and a significant correlation between changes in NT-proBNP and in LVEDVI (r=0.858, P<0.001). Baseline NT-proBNP correlated with changes in LVEDVI in both trained (r=0.673, P<0.001) and untrained (r=0.623, P<0.001) patients. Group C showed unfavourable LVEDVI dilation (+8%, P<0.001; T vs. C group, P<0.001) and a smaller reduction in NT-proBNP (−40%, P<0.001; T vs. C group, P<0.001).

Six month ET induced a favourable LV remodelling and a marked fall in NT-proBNP that could predict LV remodelling in postinfarction patients with moderate LV dysfunction.