Publications by authors named "Carl J Lavie"

895 Publications

Body Composition and Pulmonary Diseases.

COPD 2022 ;19(1):262-264

UH Center for Cardiovascular Prevention and Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA), Harrington Heart and Vascular Institute. University Hospitals Cleveland Medical Center. Case Western Reserve University School of Medicine, Cleveland, OH, USA.

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http://dx.doi.org/10.1080/15412555.2022.2070465DOI Listing
January 2022

Obesity and Its Impact on Adverse In-Hospital Outcomes in Hospitalized Patients With COVID-19.

Front Endocrinol (Lausanne) 2022 2;13:876028. Epub 2022 May 2.

Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.

Background: An increasing level of evidence suggests that obesity not only is a major risk factor for cardiovascular diseases (CVDs) but also has adverse outcomes during COVID-19 infection.

Methods: We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19 diagnosis in Germany from January to December 2020 and stratified them for diagnosed obesity. Obesity was defined as body mass index ≥30 kg/m according to the WHO. The impact of obesity on in-hospital case fatality and adverse in-hospital events comprising major adverse cardiovascular and cerebrovascular events (MACCE), acute respiratory distress syndrome (ARDS), venous thromboembolism (VTE), and others was analyzed.

Results: We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19 infection; among them, 9,383 (5.3%) had an additional obesity diagnosis. Although COVID-19 patients without obesity were older (72.0 [interquartile range (IQR) 56.0/82.0] vs. 66.0 [54.0/76.0] years, p < 0.001), the CVD profile was less favorable in obese COVID-19 patients (Charlson comorbidity index 4.44 ± 3.01 vs. 4.08 ± 2.92, p < 0.001). Obesity was independently associated with increased in-hospital case fatality (OR 1.203 [95% CI 1.131-1.279], p < 0.001) and MACCE (OR 1.168 [95% CI 1.101-1.239], p < 0.001), ARDS (OR 2.605 [95% CI 2.449-2.772], p < 0.001), and VTE (OR 1.780 [95% CI 1.605-1.973], p < 0.001) and also associated with increased necessity of treatment on intensive care unit (OR 2.201 [95% CI 2.097-2.310], p < 0.001), mechanical ventilation (OR 2.277 [95% CI 2.140-2.422], p < 0.001), and extracorporeal membrane oxygenation (OR 3.485 [95% CI 3.023-4.017], p < 0.001).

Conclusions: Obesity independently affected case fatality, MACCE, ARDS development, VTE, and other adverse in-hospital events in patients with COVID-19 infection. Obesity should be taken into account regarding COVID-19 prevention strategies, risk stratification, and adequate healthcare planning. Maintaining a healthy weight is important not only to prevent cardiometabolic diseases but also for better individual outcomes during COVID-19 infection.
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http://dx.doi.org/10.3389/fendo.2022.876028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9108252PMC
May 2022

Alcohol Consumption and Cardiovascular Health.

Am J Med 2022 May 14. Epub 2022 May 14.

John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.

Introduction: Studies evaluating alcohol consumption and cardiovascular diseases have shown inconsistent results.

Methods: We performed a systematic review of peer-reviewed publications from an extensive query of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception to March 2022 for all studies that reported the association between alcohol consumption in terms of quantity (daily or weekly amounts) and type of beverage (wine, beer or spirit) and cardiovascular disease events.

Results: The study population included a total of 1,579,435 individuals based on 56 cohorts from several countries. We found that moderate wine consumption defined as 1-4 drinks per week was associated with a reduction in risk for cardiovascular mortality when compared to beer or spirits. However, higher risk for cardiovascular disease mortality was typically seen with heavier daily or weekly alcohol consumption across all types of beverages.

Conclusions: It is possible that the observational studies may overestimate the benefits of alcohol for cardiovascular disease outcomes. Although moderate wine consumption is probably associated with low cardiovascular disease events, there are many confounding factors, in particular lifestyle, genetic and socioeconomic associations with wine drinking which likely explain much of the association with wine and reduced cardiovascular disease events. Further prospective study of alcohol and all-cause mortality, including cancer, is needed.
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http://dx.doi.org/10.1016/j.amjmed.2022.04.021DOI Listing
May 2022

Making the Case to Measure and Improve Cardiorespiratory Fitness in Routine Clinical Practice.

Mayo Clin Proc 2022 May 12. Epub 2022 May 12.

Fisher Institute of Health and Well Being, Ball State University, Muncie, IN; Healthy Living for Pandemic Event Protection (HL-PIVOT).

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http://dx.doi.org/10.1016/j.mayocp.2022.04.011DOI Listing
May 2022

Association of Ramadan Participation with Psychological Parameters: A Cross-Sectional Study during the COVID-19 Pandemic in Iran.

J Clin Med 2022 Apr 22;11(9). Epub 2022 Apr 22.

Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran 1415563117, Iran.

COVID-19 restrictions are associated with poor physical-activity (PA). Less is known about the relationship between the combination of these restrictions with Ramadan intermittent fasting (RIF), PA, mental health, and sleep-quality. The present study aimed to evaluate whether COVID-19 restrictions and RIF during the fourth wave of the COVID-19 pandemic in Iran are associated with poor PA, anxiety, well-being, and sleep-quality outcomes. A total of 510 individuals participated in an online questionnaire that was disseminated to adults (≥18 years) residing in Iran from 13 May 2021 to 16 May 2021 (~3 days), just after the end of Ramadan 2021. PA behavior (Godin-Shephard Leisure-Time Exercise Questionnaire), anxiety (General Anxiety Disorder-7), well-being (Mental Health Continuum-Short Form), and sleep-quality (Pittsburgh Sleep Quality Index). Of 510 individuals included in the study (331 female (64.9%); mean ± SD, 31 ± 12 years), 172 (33.7%) reported less PA during the Ramadan 2021. PA was associated with better well-being and sleep-quality outcomes. Regardless of PA, participants who fasted for all of Ramadan had less anxiety and better well-being outcomes than those who fasted part of Ramadan or did not fast at all. However, the fasting part of Ramadan decreased the sleep-quality of active participants. The Ramadan 2021 was associated with poor PA, well-being, and sleep-quality of Iranians. However, PA was associated with better well-being and sleep-quality outcomes, and those who fasted all Ramadan had better anxiety and well-being outcomes. Therefore, PA during Ramadan might be an essential and scalable mental health resilience builder during COVID-19 restrictions which should be encouraged.
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http://dx.doi.org/10.3390/jcm11092346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103718PMC
April 2022

Strength training and cardiovascular health: A meta-analysis.

Prog Cardiovasc Dis 2022 May 5. Epub 2022 May 5.

The Michael E. DeBakey VA Medical Center, Houston, TX, USA; Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. Electronic address:

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http://dx.doi.org/10.1016/j.pcad.2022.05.001DOI Listing
May 2022

Use of preventive cardiovascular health care among Asian American individuals: A National Health Interview Survey Study.

Curr Probl Cardiol 2022 May 2:101241. Epub 2022 May 2.

Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; DeBakey Heart and Vascular Institute, Houston Methodist, Houston, TX; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA. Electronic address:

The risk of atherosclerotic cardiovascular disease (ASCVD) varies across Asian Americans. Heterogeneity in preventive health care use may have a role in health disparity across Asian American populations. We included 318,069 White, Chinese, Asian Indian, Filipino, and 'other Asian' (Japanese, Korean, and Vietnamese) participants with and without self-reported history of ASCVD or ASCVD risk factors (including hypertension, hypercholesterolemia, and diabetes) from 2006-2018 National Health Interview Survey (NHIS). We used multivariable logistic regression models adjusted for age, sex, US birth, education, insurance coverage, and a comorbidity score to assess the association between Asian American race/ethnicity and annual health care use. Adjusted odds ratios (aOR) with 95% confidence intervals were reported. Of the total, 187,093 participants did not report ASCVD or ASCVD risk factors (mean age, 40.2 ± 0.1 y; 52% women), and 130,976 participants reported ASCVD or ASCVD risk factors (mean age, 58.3 ± 0.9 y; 49.5% women). Compared with White individuals, among the group without ASCVD or ASCVD risk factors (N=187,093), 'other Asian' adults were less likely to visit general practitioner (aOR=0.80, 0.72-0.89), or check blood pressure (aOR=0.77, 0.66-0.89), blood cholesterol (aOR=0.80, 0.70-0.92), and fasting blood sugar (aOR=0.73, 0.63-0.84). Among participants with ASCVD or ASCVD risk factors (N=130,976), Asian Indian adults were more likely to visit general practitioner (aOR=1.29, 1.01-1.66), or check blood pressure (aOR=1.27, 0.83-1.96), blood cholesterol (aOR=1.46, 1.00-2.15), and fasting blood sugar (aOR=1.49, 1.11-1.99). Annual preventive health care use is heterogenous across the Asian American populations.
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http://dx.doi.org/10.1016/j.cpcardiol.2022.101241DOI Listing
May 2022

Individual sentiments on telehealth in the COVID-19 era: Insights from Twitter.

Prog Cardiovasc Dis 2022 Apr 27. Epub 2022 Apr 27.

Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.

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http://dx.doi.org/10.1016/j.pcad.2022.04.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9042425PMC
April 2022

To Anticoagulate or Not to Anticoagulate in COVID-19: Lessons after 2 Years.

Semin Thromb Hemost 2022 Apr 25. Epub 2022 Apr 25.

John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.

A hypercoagulable state associated with coronavirus disease 2019 (COVID-19) has been well documented and is believed to be strongly supported by a proinflammatory state. The hypercoagulable state in turn results in increased incidence of arterial and venous thromboembolism (VTE) seen in hospitalized COVID-19 when compared with hospitalized non-COVID-19 patient cohorts. Moreover, patients with arterial or VTE and COVID-19 have higher mortality compared with COVID-19 patients without arterial or VTE. Prevention of arterial or VTE thus remains an essential question in the management of COVID-19 patients, especially because of high rates of reported microvascular and macrovascular thrombosis. This has prompted multiple randomized control trials (RCTs) evaluating different anticoagulation strategies in COVID-19 patients at various stages of the disease. Herein, we review findings from RCTs in the past 2 years of antithrombotic therapy in critically ill hospitalized patients, noncritically ill hospitalized patients, patients postdischarge from the hospital, and outpatients. RCTs in critically ill patients demonstrated therapeutic dose anticoagulation does not improve outcomes and has more bleeding than prophylaxis dose anticoagulant in these patients. Trials in noncritically ill hospitalized patients showed a therapeutic dose anticoagulation with a heparin formulation might improve clinical outcomes. Anticoagulation with a direct oral anticoagulant posthospital discharge may improve outcomes, although there is a large RCT in progress. Nonhospitalized COVID-19 patients have an insufficient burden of events to be candidates for antithrombotic therapy. Anticoagulation in pregnant and lactating patients with COVID-19, as well as antiplatelet therapy for COVID-19, is also reviewed.
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http://dx.doi.org/10.1055/s-0042-1744302DOI Listing
April 2022

The Impact of Obesity in Heart Failure.

Cardiol Clin 2022 May;40(2):209-218

Cardiomyopathy and Heart Transplantation, Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA.

Overweight and obesity adversely impact cardiac structure and function, affecting systolic and diastolic ventricular function. Epidemiologic studies have documented an obesity paradox in large heart failure cohorts, where overweight and obese individuals with established heart failure have a better short- and medium-term prognosis compared with leaner patients; this relationship is strongly impacted by level of cardiorespiratory fitness. There are implications for therapies aimed at increasing lean mass as well as weight loss and improvements in quality of diet for the prevention and treatment of heart failure and concomitant obesity to improve cardiorespiratory fitness.
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http://dx.doi.org/10.1016/j.ccl.2021.12.009DOI Listing
May 2022

Heart Failure After ST-Elevation Myocardial Infarction: Beyond Left Ventricular Adverse Remodeling.

Curr Probl Cardiol 2022 Apr 20:101215. Epub 2022 Apr 20.

Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA. Electronic address:

ST-segment elevation myocardial infarction (STEMI) remains a significant source of morbidity and mortality worldwide. Despite advances in treatment leading to a significant reduction in the early complications and in-hospital mortality, a significant proportion of STEMI survivors develop heart failure (HF) at follow-up. The classic paradigm of HF after STEMI is one characterized by left ventricular adverse remodeling (LVAR) and encompasses the process of regional and global structural and functional changes that occur in the heart as a consequence of loss of viable myocardium, increased wall stress and neurohormonal activation, and results in HF with reduced ejection fraction (HFrEF). More recently, however, with further improvements in the treatment of STEMI the incidence and entity of LVAR appear to be largely reduced, yet the risk for HF following STEMI is not abolished and remains substantial, identifying a new paradigm by which patients with STEMI present with HF and preserved EF (HFpEF) characterized by reduction of diastolic or systolic reserve independent of LVAR.
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http://dx.doi.org/10.1016/j.cpcardiol.2022.101215DOI Listing
April 2022

Sympathovagal Balance Is a Strong Predictor of Post High-Volume Endurance Exercise Cardiac Arrhythmia.

Front Physiol 2022 21;13:848174. Epub 2022 Mar 21.

Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia.

Regular physical activity is important for cardiovascular health. However, high-volume endurance exercise has been associated with increased number of electrocardiogram (ECG) abnormalities, including disturbances in cardiac rhythm (arrhythmias) and abnormalities in ECG pattern. The aim of this study was to assess if heart rate variability (HRV) is associated with ECG abnormalities. Fifteen participants with previous cycling experience completed a 21-day high-volume endurance exercise cycle over 3,515 km. Participants wore a 5-lead Holter monitor for 24 h pre- and post-exercise, which was used to quantify ECG abnormalities and export sinus R-to-R intervals (NN) used to calculate HRV characteristics. As noise is prevalent in 24-h HRV recordings, both 24-h and heart rate collected during stable periods of time (i.e., deep sleep) were examined. Participants experienced significantly more arrhythmias post high-volume endurance exercise (median = 35) compared to pre (median = 12; = 0.041). All 24-h and deep sleep HRV outcomes were not different pre-to-post high-volume endurance exercise ( > 0.05). Strong and significant associations with arrhythmia number post-exercise were found for total arrhythmia (total arrhythmia number pre-exercise, ρ = 0.79; age, ρ = 0.73), supraventricular arrhythmia (supraventricular arrhythmia number pre-exercise: ρ = 0.74; age: ρ = 0.66), and ventricular arrhythmia (age: ρ = 0.54). As a result, age and arrhythmia number pre-exercise were controlled for in hierarchical regression, which revealed that only deep sleep derived low frequency to high frequency (LF/HF) ratio post high-volume endurance exercise predicted post total arrhythmia number ( = Δ = 34%, = 0.013) and supraventricular arrhythmia number ( = Δ = 69%, < 0.001). In this study of recreationally active people, only deep sleep derived LF/HF ratio was associated with more total and supraventricular arrhythmias after high-volume endurance exercise. This finding suggests that measurement of sympathovagal balance during deep sleep might be useful to monitor arrhythmia risk after prolonged high-volume endurance exercise performance.
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http://dx.doi.org/10.3389/fphys.2022.848174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8978599PMC
March 2022

Omega-3: The Overlooked Evidence-Based Therapy for Heart Failure.

JACC Heart Fail 2022 Apr;10(4):235-237

John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA.

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http://dx.doi.org/10.1016/j.jchf.2022.02.004DOI Listing
April 2022

Exerkines in health, resilience and disease.

Nat Rev Endocrinol 2022 May 18;18(5):273-289. Epub 2022 Mar 18.

Department of Genetics, Stanford School of Medicine, Stanford, CA, USA.

The health benefits of exercise are well-recognized and are observed across multiple organ systems. These beneficial effects enhance overall resilience, healthspan and longevity. The molecular mechanisms that underlie the beneficial effects of exercise, however, remain poorly understood. Since the discovery in 2000 that muscle contraction releases IL-6, the number of exercise-associated signalling molecules that have been identified has multiplied. Exerkines are defined as signalling moieties released in response to acute and/or chronic exercise, which exert their effects through endocrine, paracrine and/or autocrine pathways. A multitude of organs, cells and tissues release these factors, including skeletal muscle (myokines), the heart (cardiokines), liver (hepatokines), white adipose tissue (adipokines), brown adipose tissue (baptokines) and neurons (neurokines). Exerkines have potential roles in improving cardiovascular, metabolic, immune and neurological health. As such, exerkines have potential for the treatment of cardiovascular disease, type 2 diabetes mellitus and obesity, and possibly in the facilitation of healthy ageing. This Review summarizes the importance and current state of exerkine research, prevailing challenges and future directions.
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http://dx.doi.org/10.1038/s41574-022-00641-2DOI Listing
May 2022

Machine Learning for Electrocardiographic Features to Identify Left Atrial Enlargement in Young Adults: CHIEF Heart Study.

Front Cardiovasc Med 2022 1;9:840585. Epub 2022 Mar 1.

Department of Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.

Background: Left atrial enlargement (LAE) is associated with cardiovascular events. Machine learning for ECG parameters to predict LAE has been performed in middle- and old-aged individuals but has not been performed in young adults.

Methods: In a sample of 2,206 male adults aged 17-43 years, three machine learning classifiers, multilayer perceptron (MLP), logistic regression (LR), and support vector machine (SVM) for 26 ECG features with or without 6 biological features (age, body height, body weight, waist circumference, and systolic and diastolic blood pressure) were compared with the P wave duration of lead II, the traditional ECG criterion for LAE. The definition of LAE is based on an echocardiographic left atrial dimension > 4 cm in the parasternal long axis window.

Results: The greatest area under the receiver operating characteristic curve is present in machine learning of the SVM for ECG only (77.87%) and of the MLP for all biological and ECG features (81.01%), both of which are superior to the P wave duration (62.19%). If the sensitivity is fixed to 70-75%, the specificity of the SVM for ECG only is up to 72.4%, and that of the MLP for all biological and ECG features is increased to 81.1%, both of which are higher than 48.8% by the P wave duration.

Conclusions: This study suggests that machine learning is a reliable method for ECG and biological features to predict LAE in young adults. The proposed MLP, LR, and SVM methods provide early detection of LAE in young adults and are helpful to take preventive action on cardiovascular diseases.
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http://dx.doi.org/10.3389/fcvm.2022.840585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8921457PMC
March 2022

Non-Exercise Estimated Cardiorespiratory Fitness and Incident Hypertension.

Am J Med 2022 Feb 27. Epub 2022 Feb 27.

Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia. Electronic address:

Background: The purpose of the current study is to examine the association between non-exercise estimated cardiorespiratory fitness and incident hypertension by sex.

Methods: A total of 5513 participants (4403 men and 1110 women) free of hypertension from the Aerobics Center Longitudinal Study were followed for incident hypertension, which was determined as resting systolic or diastolic blood pressure at least 130/80 mm Hg or physician diagnosis. Non-exercise estimated cardiorespiratory fitness was estimated in metabolic equivalents (METs) with sex-specific algorithms. Age, body mass index, waist circumference, and resting heart rate were used as continuous variables, whereas being physically active and current smoking were dichotomous variables. Multivariable Cox regression models were used to examine the association between cardiorespiratory fitness and risk of developing hypertension. Hazard ratios and 95% confidence intervals (CIs) were reported as an index of strength of association.

Results: During an average follow-up of 5 years, 61.7% of men and 39.5% of women developed hypertension. In men, the upper and middle tertiles of cardiorespiratory fitness had 22% (95% CI, 0.71-0.86) and 10% (95% CI, 0.82-0.99) lower risk, respectively, of developing hypertension compared with those in the lower tertile. In women, the upper and middle tertiles of cardiorespiratory fitness had 30% (95% CI, 0.55-0.88) and 6% (95% CI, 0.74-1.18) lower risk, respectively, of developing hypertension. Each 1-MET increment was associated with a 10% higher risk of incident hypertension in the overall sample.

Conclusion: Cardiorespiratory fitness estimated using a non-exercise algorithm is inversely associated with risk of developing hypertension in men and women.
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http://dx.doi.org/10.1016/j.amjmed.2022.01.048DOI Listing
February 2022

Prevalence and Predictors of Premature Coronary Heart Disease Among Asians in the United States: A National Health Interview Survey Study.

Curr Probl Cardiol 2022 Feb 26:101152. Epub 2022 Feb 26.

Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX; DeBakey Heart and Vascular Institute, Houston Methodist, Houston, TX; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX. Electronic address:

Identifying Asian subgroups with higher risk of premature coronary heart disease (CHD) can help implement targeted strategies to prevent future CHD events. We conducted this National Health Interview Survey study from 2006 to 2015 among participants with history of CHD to compare the risk of premature CHD (<65 for women and <55 years old for men) across Whites, Chinese, Asian Indians, Filipinos, and "other Asians" (Japanese, Korean, and Vietnamese individuals) using univariate and multi-variable logistic regression models. A total of 17,266 participants with history of CHD (mean age, 66.0 ± 0.2; 39% women) were included. Risk of premature CHD was higher among Asian Indians (OR = 1.77, 1.05-2.97) and "other Asians" (OR = 1.68, 1.17-2.42) than Whites adults. Compared with Chinese, the risk of premature CHD was significantly higher for Asian Indians in the unadjusted models (OR = 2.72, 1.19-6.3). "Other Asians" exhibited significantly higher risk in crude (OR = 2.88, 1.32-6.27) and adjusted models (aOR = 2.29, 1.01-5.18). Among younger adults (<50 years) with CHD, Asian Indian adults (aOR = 2.43, 1.26-4.70) and other Asian adults (aOR = 1.86, 1.14-3.02) showed higher odds of premature CHD compared with White adults. The risk of premature CHD varies across Asian populations. More studies with an adequate sampling of Asian subgroups are needed to identify the risk and determinants of premature CHD.
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http://dx.doi.org/10.1016/j.cpcardiol.2022.101152DOI Listing
February 2022

Working Toward Optimal Exercise Prescription: Strength Training Should Not Be Overlooked.

J Cardiopulm Rehabil Prev 2022 03;42(2):E32-E33

Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, Indiana (Dr Kaminsky); Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois (Drs Kaminsky, Lavie, and Arena and Ms Bond); Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana (Dr Lavie); Department of Cardiology, School of Medicine, University of Colorado, Aurora (Dr Flint); and Departments of Physical Therapy (Dr Arena) and Biomedical Health Information Sciences (Ms Bond), College of Applied Sciences, University of Illinois at Chicago.

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http://dx.doi.org/10.1097/HCR.0000000000000696DOI Listing
March 2022

Association of participation in Cardiac Rehabilitation with Social Vulnerability Index: The behavioral risk factor surveillance system.

Prog Cardiovasc Dis 2022 Feb 16. Epub 2022 Feb 16.

Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. Electronic address:

Objectives: To identify whether social vulnerability is associated with low cardiac rehabilitations (CR) use, a Class I recommendation by current treatment guidelines following acute myocardial infarction (AMI).

Methods: We performed this cross-sectional study using the 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey. The Centers for Disease Control and Prevention Social Vulnerability Index (CDC SVI) was calculated using 15 social risk factors from 4 main themes including socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. A higher SVI indicates higher social vulnerability. We used multivariable logistic regression models to evaluate the association of CR use with state-level SVI adjusted for demographic, behavioral, socioeconomic, and comorbidity variables.

Results: A total 2093 participants with history of AMI were included. Out of total, 61.7% were older than 65 years, 42.5% female, 72.5% White, and 42.4% used CR. Participation in CR was lower among females (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.44-0.91), those without a primary care physician (OR, 0.45; 95% CI, 0.23-0.87), and higher with college degree education (OR, 1.95; 95% CI, 1.06-3.59). CR use decreased with increasing SVI tertiles (1st =61%, 2nd =52%, and 3rd =35%). Compared with those residing in states in the 1st tertile, CR use was lower in the 2nd (OR, 0.68; 95% CI, 0.47-0.98) and 3rd (OR, 0.33; 95% CI 0.23-0.48) SVI tertiles.

Conclusion: CR use following AMI is low and is associated with social vulnerability. Identifying social risk factors may help improve access to care among vulnerable populations.
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http://dx.doi.org/10.1016/j.pcad.2022.02.003DOI Listing
February 2022

Protecting against sedentary lifestyle, left atrial enlargement and atrial fibrillation.

Open Heart 2022 02;9(1)

John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA.

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http://dx.doi.org/10.1136/openhrt-2022-001962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8845329PMC
February 2022

Defining the importance of stress reduction in managing cardiovascular disease - the role of exercise.

Prog Cardiovasc Dis 2022 Jan-Feb;70:84-93. Epub 2022 Feb 4.

Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.

Traditional risk factors for cardiovascular disease (CVD) have long been the focus of preventive strategies. The impact of family stress, depression, anxiety, hostility, pessimism, job strain, social isolation, lack of purpose in life and social support, are well recognized risks for CVD development, however they are under-appreciated in clinical practice guidelines. The purpose of this article is to review the impact of acute and chronic stress on CVD risk, elaborate repositioning in guidelines, with emphasis to approaches for stress reduction. Regular exercise, both aerobic and resistance, leads to better adaptiveness to other types of stress, however, it remains unknown whether the total amount of stress one can receive before negative health effects is unlimited. Evidently, marked reductions in stress related disorders are shown following formal cardiac rehabilitation programs. Attendance of cardiac rehabilitation is highly recommended for the stress-related mortality risk reduction. Innovative approaches to offset the broad challenges that CVD pose, augmented by sustained exposure to stress, are desperately needed, but hindered by a lack of successful population-level interventions that promote lasting change.
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http://dx.doi.org/10.1016/j.pcad.2022.01.008DOI Listing
April 2022

Nine Years as Editor-in Chief of Progress in Cardiovascular Diseases.

Authors:
Carl J Lavie

Prog Cardiovasc Dis 2022 Jan-Feb;70:195-196. Epub 2022 Feb 1.

John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States of America. Electronic address:

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http://dx.doi.org/10.1016/j.pcad.2022.01.011DOI Listing
April 2022

Taking the Obesity Paradox to New Heights in Cerebral Atherosclerosis.

J Stroke Cerebrovasc Dis 2022 04 2;31(4):106325. Epub 2022 Feb 2.

Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States. Electronic address:

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2022.106325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8957606PMC
April 2022

In Reply-Association Between Weekly Exercise Time and Mortality.

Mayo Clin Proc 2022 02;97(2):421-422

John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA.

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http://dx.doi.org/10.1016/j.mayocp.2021.12.011DOI Listing
February 2022

Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs.

Diabetes Care 2022 02;45(2):372-380

Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX.

Objective: There is mounting evidence regarding the cardiovascular benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use.

Research Design And Methods: We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1 RA and the facility-level variation in their use. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1 RA in patients with ASCVD and T2DM.

Results: Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received an SGLT2i while 8.0% of patients received a GLP-1 RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10th-90th percentile) facility-level rates were 14.92% (9.31-22.50) for SGLT2i and 10.88% (4.44-17.07) for GLP-1 RA. There was significant facility-level variation among SGLT2i use-MRRunadjusted: 1.41 (95% CI 1.35-1.47) and MRRadjusted: 1.55 (95% CI 1.46 -1.63). Similar facility-level variation was observed for use of GLP-1 RA-MRRunadjusted: 1.34 (95% CI 1.29-1.38) and MRRadjusted: 1.78 (95% CI 1.65-1.90).

Conclusions: Overall utilization rates of SGLT2i and GLP-1 RA among eligible patients are low, with significantly higher residual facility-level variation in the use of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients.
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http://dx.doi.org/10.2337/dc21-1815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8914426PMC
February 2022

Weight loss for cardiovascular disease prevention - is semaglutide the answer?

Trends Cardiovasc Med 2022 Jan 5. Epub 2022 Jan 5.

Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.

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http://dx.doi.org/10.1016/j.tcm.2021.12.018DOI Listing
January 2022

The COVID-19 pandemic and physical activity during intermittent fasting, is it safe? A call for action.

Biol Sport 2021 Oct 12;38(4):729-732. Epub 2021 Aug 12.

Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

Intermittent fasting (IF) has recently gained popularity, and has been used for centuries in many religious practices. The Ramadan fasting is a mandatory form of IF practiced by millions of healthy adult Muslims globally for a whole lunar month every year. In Islam, the "Sunna" also encourages Muslims to practice IF all along the year (e.g.; two days a week). The 2019-Coronavirus disease (COVID-19) pandemic in the context of Ramadan has raised the question whether fasting is safe practice during the COVID-19 pandemic health crisis, and what would be the healthy lifestyle behaviors while fasting that would minimize the risk of infection. As COVID-19 lacks a specific therapy, IF and physical activity could help promote human immunity and be part of holistic preventive strategy against COVID-19. In this commentary, the authors focus on this dilemma and provide recommendations to the fasting communities for safely practicing physical activity in time of COVID-19 pandemic.
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http://dx.doi.org/10.5114/biolsport.2021.108300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8670795PMC
October 2021

Association Between Personal Activity Intelligence and Mortality: Population-Based China Kadoorie Biobank Study.

Mayo Clin Proc 2022 Apr 3;97(4):668-681. Epub 2021 Dec 3.

Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA; School of Human Movement & Nutrition Sciences, University of Queensland, Australia.

Objective: To prospectively investigate the association between personal activity intelligence (PAI) - a novel metabolic metric which translates heart rate during physical activity into a simple weekly score - and mortality in relatively healthy participants in China whose levels and patterns of physical activity in addition to other lifestyle factors are different from those in high-income countries.

Patients And Methods: From the population-based China Kadoorie Biobank study, 443,792 healthy adults were recruited between June 2004 and July 2008. Participant's weekly PAI score was estimated and divided into four groups (PAI scores of 0, ≤50, 51-99, or ≥100). Using Cox proportional hazard analyses, we calculated adjusted hazard ratios (AHRs) for cardiovascular disease (CVD) and all-cause mortality related to PAI scores.

Results: During a median follow-up of 8.2 (interquartile range, 7.3 to 9.1) years, there were 21,901 deaths, including 9466 CVD deaths. Compared with the inactive group (0 PAI score), a baseline weekly PAI score greater than or equal to 100 was associated with a lower risk of CVD mortality, an AHR of 0.87 (95% CI, 0.81 to 0.94) in men, and an AHR of 0.84 (95% CI, 0.78 to 0.92) in women, after adjusting for multiple confounders. Participants with a weekly PAI score greater than or equal to 100 also had a lower risk of all-cause mortality (AHR, 0.93; 95% CI, 0.89 to 0.97 in men, and AHR, 0.93; 95%, 0.88 to 0.98 in women). Moreover, this subgroup gained 2.7 (95% CI, 2.4 to 3.0) years of life, compared with the inactive cohort.

Conclusion: Among relatively healthy Chinese adults, the PAI metric was inversely associated with CVD and all-cause mortality, highlighting the generalizability of the score in different races, ethnicities, and socioeconomic strata.
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http://dx.doi.org/10.1016/j.mayocp.2021.10.022DOI Listing
April 2022
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