Publications by authors named "Jari Laukkanen"

278 Publications

Exercise heart rate reserve and recovery as risk factors for sudden cardiac death.

Prog Cardiovasc Dis 2021 Sep 15. Epub 2021 Sep 15.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea.

Background: Little is known if heart rate responses during and after exercise test may be associated with the risk of sudden cardiac death (SCD). Our aim was to determine if exercise heart rate reserve and recovery, providing non-invasive indices, may predict SCD risk in general male population.

Methods: We evaluated the impact of delayed heart rate reserve and slow heart rate recovery and the risk of SCD in the Kuopio Ischemic Heart Disease prospective cohort study of randomly selected 1967 men aged 42-61 years at recruitment. Heart rate reserve was calculated as the difference between the maximal attained heart rate and resting heart rate, whereas heart rate recovery was defined as maximal heart rate minus the heart rate measured at 2 min of recovery, on a symptom-limited cardiopulmonary exercise testing.

Results: During a median follow-up interval of 25 years, 209 events of SCD occurred. The age and examination adjusted relative hazards of SCD were in the lowest third of heart rate reserve 3.86 (95% confidence interval (CI) 2.56-5.80, p < 0.001) and the lowest third of heart rate recovery 2.86 (95% CI 1.95-4.20, p < 0.001) as compared to men in the highest third of heart rate reserve and heart rate recovery, respectively. After adjusting for potential confounders, the respective relative hazards were 1.96 (95% CI 1.24-3.12) and 1.75 (95% CI 1.16-2.64). Each unit increment (1 beat/min) in heart rate reserve and heart rate recovery decreased the incidence of SCD by 1-2%.

Conclusions: Delayed exercise heart rate reserve and slow heart rate recovery predicted the risk of SCD, suggesting that heart rate responses may be associated with an increased risk for SCD in general population.
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http://dx.doi.org/10.1016/j.pcad.2021.09.002DOI Listing
September 2021

Percutaneous Coronary Intervention Versus Medical Therapy in the Treatment of Stable Coronary Artery Disease: An Updated Meta-Analysis of Contemporary Randomized Controlled Trials.

J Invasive Cardiol 2021 Aug;33(8):E647-E657

Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, P.O. Box 1627, FIN-70211 Kuopio, Finland.

Background: The net clinical benefit of percutaneous coronary intervention (PCI) compared with medical therapy (MT) alone for the treatment of stable coronary artery disease (CAD) remains uncertain. We conducted an updated meta-analysis of randomized controlled trials (RCTs) to compare PCI with MT for the treatment of patients with stable CAD.

Methods: RCTs of PCI vs MT in patients with stable CAD were identified from MEDLINE, the Cochrane Library, and manual search of bibliographies to March 2020. Study-specific risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for the composite of all-cause mortality, myocardial infarction (MI), revascularizations, rehospitalizations, or stroke and its individual components.

Results: Eleven unique RCTs comprising 9629 patients were included. PCI reduced the overall risk of the composite outcome of allcause mortality, MI, revascularizations, rehospitalizations, or stroke (RR, 0.63; 95% CI, 0.46-0.87); unplanned revascularization (RR, 0.58; 95% CI, 0.44-0.77); and fatal MI (RR, 0.69; 95% CI, 0.52-0.92). There were no significant differences in overall risk of all-cause mortality and other cardiovascular events comparing PCI with MT. The composite outcome of all-cause mortality, MI, revascularizations, rehospitalizations, or stroke was reduced with PCI at 2-5 years.

Conclusions: In patients with stable CAD, overall, short-term and intermediate-term risks of all-cause mortality are not significantly different between PCI and MT. However, PCI may reduce the overall and intermediate-term risk of the combined outcome of all-cause mortality, MI, revascularizations, rehospitalizations, or stroke.
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August 2021

Circulating Serum Magnesium and the Risk of Venous Thromboembolism in Men: A Long-Term Prospective Cohort Study.

Pulse (Basel) 2021 Jun 13;8(3-4):108-113. Epub 2021 Apr 13.

Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland.

Background And Objective: Serum magnesium, an essential trace element involved in processes that regulate cardiovascular function, has been linked to the risk of atherosclerotic cardiovascular disease. However, the potential association between serum magnesium and venous thromboembolism (VTE) has not been previously investigated. We aimed to assess the prospective association of serum magnesium with the risk of VTE.

Methods: Serum magnesium was measured using atomic absorption spectrometry in 2,361 men aged 42-61 years with no history of VTE at baseline in the Kuopio Ischemic Heart Disease prospective cohort. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for VTE.

Results: A total of 159 incident VTE events were recorded during a median follow-up of 27.1 years. The risk of VTE per 1 SD increase in serum magnesium in the age-adjusted analysis was (HR 1.30; 95% CI 0.46-3.69). The association remained consistent in analyses adjusted for systolic blood pressure, body mass index, total cholesterol, triglycerides, smoking status, a history of type 2 diabetes, a history of coronary heart disease, medication for dyslipidemia, alcohol consumption, physical activity, socioeconomic status, serum active calcium, high-sensitivity C-reactive protein, and a history of cancer (HR 1.38; 95% CI 0.48-3.96). Comparing the extreme tertiles of serum magnesium, the corresponding adjusted HRs were 1.17 (95% CI 0.81-1.70) and 1.17 (95% CI 0.81-1.70), respectively.

Conclusion: In a middle-aged Caucasian male population, serum-circulating magnesium was not associated with a future risk of VTE. Further studies in women, other age groups, and other populations are required to generalize these findings.
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http://dx.doi.org/10.1159/000515409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280418PMC
June 2021

Impact of the Physical Activity and Fitness Components on the Genetic Risk of Stroke.

Mayo Clin Proc 2021 07;96(7):1703-1705

Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio; Central Finland Health Care District, Jyväskylä, Finland.

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http://dx.doi.org/10.1016/j.mayocp.2021.05.014DOI Listing
July 2021

Percentage of Age-Predicted Cardiorespiratory Fitness Is Inversely Associated with Cardiovascular Disease Mortality: A Prospective Cohort Study.

Cardiology 2021 Jul 1:1-8. Epub 2021 Jul 1.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom.

Introduction: Percentage of age-predicted cardiorespiratory fitness (% age-predicted CRF) is a potentially useful cardiopulmonary exercise testing (CPX) parameter, but there are limited data on its prognostic relevance for adverse cardiovascular disease (CVD) outcomes. We aimed to assess the association of % age-predicted CRF with CVD mortality and the extent to which % age-predicted CRF measurements could improve the prediction of CVD mortality.

Methods: Peak oxygen uptake, used as the measure of CRF, was directly assessed in 2,276 men who underwent CPX. The age-predicted CRF estimated from a regression equation for age was transformed to % age-predicted CRF with the following formula: (achieved CRF/age-predicted CRF) × 100. Hazard ratios (HRs) (95% confidence intervals [CIs]) and measures of risk discrimination for CVD mortality were calculated.

Results: During a median follow-up of 28.5 years, 643 fatal CVDs were recorded. The relationship between % age-predicted CRF and CVD mortality was dose response in nature. In analysis adjusted for conventional risk factors, one standard deviation increase in % age-predicted CRF was associated with a reduced risk of CVD mortality (HR 0.61; 95% CI: 0.56-0.67), which was minimally attenuated on further adjustment for several other confounders (HR 0.71; 95% CI: 0.64-0.78). Addition of % age-predicted CRF to a CVD mortality risk prediction model containing established risk factors significantly improved risk discrimination and reclassification.

Conclusion: Percentage of age-predicted CRF is inversely and independently associated with CVD mortality in a graded fashion and significantly improves the prediction and classification of the long-term risk for CVD mortality beyond established risk factors.
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http://dx.doi.org/10.1159/000516123DOI Listing
July 2021

Cardiorespiratory optimal point during exercise testing is related to cardiovascular and all-cause mortality.

Scand J Med Sci Sports 2021 Oct 12;31(10):1949-1961. Epub 2021 Jul 12.

Kuopio Research Institute of Exercise Medicine, Kuopio, Finland.

Cardiorespiratory optimal point (COP) during exercise may be a potentially clinically useful cardiopulmonary exercise testing (CPET) variable, but its prognostic relevance for adverse cardiovascular disease (CVD) outcomes is unknown. We aimed to assess the association of COP during exercise with fatal mortality outcomes and the extent to which COP could improve the prediction of CVD mortality. Cardiorespiratory optimal point, the minimum value of the ventilatory equivalent for oxygen (VE/VO2) in a given minute of a CPET, was defined in 2,205 men who underwent CPET. Hazard ratios (HRs) (95% confidence intervals [CIs]) for outcomes and measures of risk discrimination for CVD mortality were calculated. During a median follow-up of 28.8 years, 402 fatal CHDs, 607 fatal CVDs, and 1,348 all-cause mortality events occurred. COP was continually associated with each outcome in a dose-response manner. On adjustment for established and emerging risk factors, the HRs (95% CIs) for fatal CHD, fatal CVD, and all-cause mortality were 3.05 (1.94-4.81), 2.82 (1.91-4.18) and 2.46 (1.85-3.27), respectively, per standard deviation increase in COP. After further adjustment for high sensitivity C-reactive protein, the HRs were 2.82 (1.78-4.46), 2.57 (1.73-3.81), and 2.27 (1.70-3.02), respectively. Addition of COP to a CVD mortality risk prediction model containing established risk factors was associated with a C-index change of 0.0139 (0.0040 to 0.0238; p = 0.006) at 25 years. COP during exercise is directly associated with fatal cardiovascular and all-cause mortality events in dose-response fashions. COP during exercise may improve the prediction of the long-term risk for CVD mortality.
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http://dx.doi.org/10.1111/sms.14012DOI Listing
October 2021

Non-invasive home telemonitoring in patients with decompensated heart failure: a systematic review and meta-analysis.

ESC Heart Fail 2021 Jun 24. Epub 2021 Jun 24.

Päijät-Häme Joint Authority for Health and Well-being, Lahti, Finland.

We planned this systematic review and meta-analysis to study an estimate of the effect of non-invasive home telemonitoring (TM) in the treatment of patients with recently decompensated heart failure (HF). A systematic literature search was conducted in the Medline, Cinahl, and Scopus databases to look for randomized controlled studies comparing TM with standard care in the treatment of patients with recently decompensated HF. The main outcomes of interest were all-cause hospitalizations and mortality. Eleven original articles met our eligibility criteria. The pooled estimate of the relative risk of all-cause hospitalization in the TM group compared with standard care was 0.95 (95% CI 0.84-1.08, P = 0.43) and the relative risk of all-cause death was 0.83 (95% CI 0.63-1.09, P = 0.17). There was significant clinical heterogeneity among primary studies. HF medication could be directly altered in three study interventions, and two of these had a statistically significant effect on all-cause hospitalizations. The pooled effect estimate of TM interventions on all-cause hospitalizations and all-cause death in patients with recently decompensated heart failure was neutral.
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http://dx.doi.org/10.1002/ehf2.13475DOI Listing
June 2021

Low body mass is associated with reduced left ventricular mass in Chinese elderly with severe COPD.

Sci Rep 2021 Jun 22;11(1):13074. Epub 2021 Jun 22.

Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.

There is limited information on the association of body mass index (BMI) with left ventricular (LV) remodeling corresponding to severity of reduced lung function in patients with chronic obstructive pulmonary disease (COPD). Therefore, we investigated whether BMI is associated with cardiac atrial and ventricular dimensions according to severity of lung functional impairment in Chinese COPD elderly. A total of 563 hospitalized COPD patients with lung function impairment and 184 patients with non-COPD (aged 65-92 years) were collected retrospectively in a cross-sectional study in a university affiliated tertiary hospital in China. BMI and cardiac echocardiographic parameters were compared according to severity of lung functional impairment in COPD patients. BMI was 22.9 ± 3.9 kg/m in COPD patients, 24.0 ± 4.1 kg/m in non-COPD patients respectively. Reduced BMI, LV mass index, LV wall thickness and left atrial diameter, and dilated right ventricle (RV) existed in COPD patients with severe lung dysfunction as compared the COPD patients with mild to moderate lung functional reduction and non-COPD patients (P < 0.05), while there were no differences in BMI and echocardiographic parameters between the COPD patients with mild to moderate lung functional decline and non-COPD patients (P > 0.05). Logistic regression analysis showed that low BMI (BMI < 18.5 kg/m) was correlated with reduced LV mass and wall thickness, dilated RV and reduced lung function in the COPD patients with severe lung dysfunction. In conclusion, this study demonstrates that lower BMI is associated not only with dilated RV and impaired pulmonary function, but also it is related to reduced LV mass in Asian COPD elderly with severe lung dysfunction.
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http://dx.doi.org/10.1038/s41598-021-92212-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219796PMC
June 2021

Impact of Sauna Bathing on Risk of Pneumonia in Men With Low Socioeconomic Status: A Cohort Study.

J Cardiopulm Rehabil Prev 2021 Jul;41(4):289-291

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland.

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http://dx.doi.org/10.1097/HCR.0000000000000611DOI Listing
July 2021

Women Have Lower Mortality Than Men After Attending a Long-Term Medically Supervised Exercise Program.

J Cardiopulm Rehabil Prev 2021 Jun 10. Epub 2021 Jun 10.

Exercise Medicine Clinic (Clínica de Medicina do Exercício, CLINIMEX), Rio de Janeiro, Brazil (Drs de Souza e Silva, Castro, Franca, and Araújo); Escola de Medicina Souza Marques, Rio de Janeiro, Brazil (Dr Nishijuka); Division of Cardiology, VA Palo Alto, Palo Alto, California, and Stanford University School of Medicine, Stanford, Stanford, California (Dr Myers); and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland, and Central Finland Health Care District Hospital, Jyväskylä, Finland, and Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland (Dr Laukkanen).

Purpose: Medically supervised exercise programs (MSEPs) are equally recommended for men and women with cardiovascular disease (CVD). Aware of the lower CVD mortality in women, we hypothesized that among patients attending a MSEP, women would also have better survival.

Methods: Data from men and women, who were enrolled in a MSEP between 1994 and 2018, were retrospectively analyzed. Sessions included aerobic, resistance, flexibility and balance exercises, and cardiopulmonary exercise test was performed. Date and underlying cause of death were obtained. Kaplan-Meier methods and Cox proportional hazards regression were used for survival analysis.

Results: A total of 2236 participants (66% men, age range 33-85 yr) attended a median of 52 (18, 172) exercise sessions, and 23% died during 11 (6, 16) yr of follow-up. In both sexes, CVD was the leading cause of death (39%). Overall, women had a more favorable clinical profile and a longer survival compared to men (HR = 0.71: 95% CI, 0.58-0.85; P < .01). When considering those with coronary artery disease and similar clinical profile, although women had a lower percentage of sex- and age-predicted maximal oxygen uptake at baseline than men (58 vs 78%; P < .01), after adjusting for age, women still had a better long-term survival (HR = 0.68: 95% CI, 0.49-0.93; P = .02).

Conclusion: Survival after attendance to a long-term MSEP was better among women, despite lower baseline cardiorespiratory fitness. Future studies should address whether men and women would similarly benefit when participating in an MSEP.
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http://dx.doi.org/10.1097/HCR.0000000000000623DOI Listing
June 2021

The combined effect of blood pressure and C-reactive protein with the risk of mortality from coronary heart and cardiovascular diseases.

Nutr Metab Cardiovasc Dis 2021 06 21;31(7):2051-2057. Epub 2021 Apr 21.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Division of Cardiology, Central Finland Health Care District Jyväskylä, Finland.

Background And Aims: Both blood pressure and C-reactive protein (CRP) are individually associated with cardiovascular mortality risk. However, the combined effect of systolic blood pressure (SBP) and CRP on coronary heart disease (CHD) and cardiovascular disease (CVD) mortality risk, has not been studied.

Methods And Results: We evaluated the joint impact of SBP and CRP and the risk of mortality in the Kuopio Ischemic Heart Disease prospective cohort study of 1622 men aged 42-61 years at recruitment with no history of CVD. SBP and CRP were measured. SBP was categorized as low and high (cut-off 135 mmHg) and CRP as low and high (cut-off 1.54 mg/L) based on ROC curves. Multivariable adjusted hazard ratios (HRs) with confidence intervals (CI) were calculated. During a median follow-up of 28 years, 196 cases of CHD and 320 cases of CVD deaths occurred. Elevated SBP (>135 mmHg) combined with elevated (CRP >1.54 mg/L) were associated with CHD and CVD mortality (HR 3.41, 95% CI, 2.20-5.28, p < 0.001) and (HR 2.93, 95% CI, 2.11-4.06, p < 0.001) respectively after adjustment for age, examination year, smoking, alcohol consumption, BMI, Type 2 diabetes, energy expenditure, total cholesterol, serum HDL cholesterol, antihypertensive medication and use of aspirin.

Conclusion: The combined effect of both high systolic blood pressure and high CRP is associated with increased risk of future CHD and CVD mortality as compared with both low SBP and low CRP levels in general male Caucasian population.
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http://dx.doi.org/10.1016/j.numecd.2021.04.004DOI Listing
June 2021

Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology.

Eur J Prev Cardiol 2021 Jun 2. Epub 2021 Jun 2.

Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy.

A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
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http://dx.doi.org/10.1093/eurjpc/zwab007DOI Listing
June 2021

Longitudinal association between CRP levels and risk of psychosis: a meta-analysis of population-based cohort studies.

NPJ Schizophr 2021 May 28;7(1):31. Epub 2021 May 28.

Department of Psychiatry, University of Cambridge, Cambridge, UK.

Meta-analyses of cross-sectional studies suggest that patients with psychosis have higher circulating levels of C-reactive protein (CRP) compared with healthy controls; however, cause and effect is unclear. We examined the prospective association between CRP levels and subsequent risk of developing a psychotic disorder by conducting a systematic review and meta-analysis of population-based cohort studies. Databases were searched for prospective studies of CRP and psychosis. We obtained unpublished results, including adjustment for age, sex, body mass index, smoking, alcohol use, and socioeconomic status and suspected infection (CRP > 10 mg/L). Based on random effect meta-analysis of 89,792 participants (494 incident cases of psychosis at follow-up), the pooled odds ratio (OR) for psychosis for participants with high (>3 mg/L), as compared to low (≤3 mg/L) CRP levels at baseline was 1.50 (95% confidence interval [CI], 1.09-2.07). Evidence for this association remained after adjusting for potential confounders (adjusted OR [aOR] = 1.31; 95% CI, 1.03-1.66). After excluding participants with suspected infection, the OR for psychosis was 1.36 (95% CI, 1.06-1.74), but the association attenuated after controlling for confounders (aOR = 1.23; 95% CI, 0.95-1.60). Using CRP as a continuous variable, the pooled OR for psychosis per standard deviation increase in log(CRP) was 1.11 (95% CI, 0.93-1.34), and this association further attenuated after controlling for confounders (aOR = 1.07; 95% CI, 0.90-1.27) and excluding participants with suspected infection (aOR = 1.07; 95% CI, 0.92-1.24). There was no association using CRP as a categorical variable (low, medium or high). While we provide some evidence of a longitudinal association between high CRP (>3 mg/L) and psychosis, larger studies are required to enable definitive conclusions.
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http://dx.doi.org/10.1038/s41537-021-00161-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8163886PMC
May 2021

Nurse-led counseling for coronary artery disease patients: A 1-year follow-up study.

Nurs Health Sci 2021 Sep 3;23(3):678-687. Epub 2021 Jun 3.

Central Finland Health Care District, Jyvaskyla, Finland.

Nurse-led counseling and systematic follow-up have been shown to reduce cardiovascular risk factor levels. The study aims were to investigate if cardiovascular risk factor levels could be reduced in patients with coronary artery disease with a nurse-led intervention and to report patients' evaluations of nurse-led counseling. The study design was a real-life longitudinal follow-up counseling intervention. Data were collected from November 2017 to May 2020. The nurse-led intervention and patients' follow-up time was 1 year. Of the 78 patients recruited, 74 completed the study. The most significant findings were in the levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides at every follow-up visit compared to their baseline levels and that waist circumference decreased during the 1-year follow-up. Patients assessed the quality of nurse-led counseling to be very good, though it decreased slightly during follow-up. The results suggest the integrated care path and specialized and primary care for coronary artery disease patients need further development. More research is needed on how to strengthen patients' self-management and what kind of counseling would best promote it.
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http://dx.doi.org/10.1111/nhs.12852DOI Listing
September 2021

Fitness and reduced risk of hypertension-approaching causality.

J Hum Hypertens 2021 May 13. Epub 2021 May 13.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.

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http://dx.doi.org/10.1038/s41371-021-00545-0DOI Listing
May 2021

Impact of cardiorespiratory fitness on survival in men with low socioeconomic status.

Eur J Prev Cardiol 2021 May;28(4):450-455

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.

Aims: Although both low socioeconomic status (SES) and poor cardiorespiratory fitness (CRF) are associated with increased chronic disease and heightened mortality, it remains unclear whether moderate-to-high levels of CRF are associated with survival benefits in low SES populations. This study evaluated the hypothesis that SES and CRF predict all-cause mortality and cardiovascular disease mortality and that moderate-to-high levels of CRF may attenuate the association between low SES and increased mortality.

Methods: This study included 2368 men, who were followed in the Kuopio Ischaemic Heart Disease Study cohort. CRF was directly measured by peak oxygen uptake during progressive exercise testing. SES was characterized using self-reported questionnaires.

Results: During a 25-year median follow-up, 1116 all-cause mortality and 512 cardiovascular disease mortality events occurred. After adjusting for potential confounders, men with low SES were at increased risks for all-cause mortality (hazard ratio 1.49, 95% confidence interval: 1.30-1.71) and cardiovascular disease mortality (hazard ratio1.38, 1.13-1.69). Higher levels of CRF were associated with lower risks of all-cause mortality (hazard ratio 0.54, 0.45-0.64) and cardiovascular disease mortality (hazard ratio 0.53, 0.40-0.69). In joint associations of SES and CRF with mortality, low SES-unfit had significantly higher risks of all-cause mortality (hazard ratio 2.15, 1.78-2.59) and cardiovascular disease mortality (hazard ratio 1.95, 1.48-2.57), but low SES-fit was not associated with a heightened risk of cardiovascular disease mortality (hazard ratio 1.09, 0.80-1.48) as compared with their high SES-fit counterparts.

Conclusion: Both SES and CRF were independently associated with subsequent mortality; however, moderate-to-high levels of CRF were not associated with an excess risk of cardiovascular disease mortality in men with low SES.
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http://dx.doi.org/10.1177/2047487319901057DOI Listing
May 2021

Glomerular Filtration Dysfunction is Associated with Cardiac Adverse Remodeling in Menopausal Diabetic Chinese Women.

Clin Interv Aging 2021 14;16:603-609. Epub 2021 Apr 14.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.

Background: Previous studies have showed that nephropathy was associated with cardiac structural changes and dysfunction among diabetic adults. However, information on the association of glomerular filtration dysfunction with the cardiac adverse remodeling is still limited in menopausal diabetic women. Therefore, we investigated whether impaired glomerular filtration function is associated with the cardiac adverse remodeling in menopausal Chinese women with type 2 diabetes mellitus (DM).

Methods: A total of 1231 hospitalized menopausal Chinese women with type 2 DM were collected retrospectively. The cross-sectional data of echocardiography were compared among estimated glomerular filtration rate (eGFR) categorized groups.

Results: In menopausal diabetic women, moderate to severe glomerular filtration dysfunction (eGFR <60 mL/min per 1.73m) was found to be associated with enlarged left-side atrioventricular chambers, increased ventricular wall thickness, decreased cardiac function and dilated right ventricle (All < 0.05).

Conclusion: Glomerular filtration dysfunction is associated with cardiac adverse structural remodeling and dysfunction in menopausal Chinese women with type 2 DM.
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http://dx.doi.org/10.2147/CIA.S306342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055368PMC
June 2021

Omega-3 Benefits Remain Strong Post-STRENGTH.

Mayo Clin Proc 2021 05 8;96(5):1371-1372. Epub 2021 Apr 8.

University of Eastern Finland, Kuopio, University of Jyväskylä, Finland, Central Finland Health Care District.

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http://dx.doi.org/10.1016/j.mayocp.2021.03.004DOI Listing
May 2021

Longitudinal associations of physical activity, sedentary time, and cardiorespiratory fitness with arterial health in children - the PANIC study.

J Sports Sci 2021 Sep 8;39(17):1980-1987. Epub 2021 Apr 8.

School of Medicine, Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland.

We investigated the longitudinal associations of physical activity (PA), sedentary time (ST), and cardiorespiratory fitness (CRF) with arterial health among children. In our primary analyses, we investigated 245 children (girls 51.8%) aged 6-9 years participating in the baseline examinations who had data on arterial health at 2-year follow-up. We also utilized a subsample of 90 children who had a complete arterial health data at baseline and 2-year follow-up. ST (≤1.5 METs), light PA (>1.5-4 METs), moderate PA (>4-7 METs), vigorous PA (>7METs), and moderate-to-vigorous PA (MVPA, >4 METs) were assessed by combined movement and heart rate monitoring and CRF by maximal exercise testing on a cycle ergometer at baseline and 2-year follow-up. Stiffness index (SI) as a measure of arterial stiffness and change in reflection index during exercise test (DRI) as a measure of arterial dilation capacity were assessed by pulse contour analysis. Two-year change in vigorous PA was associated with DRI in boys but not in girls (p=0.021 for interaction). In a subsample analyses, 2-year changes in MPA, VPA, and MVPA were inversely associated with 2-year change in SI. In conclusion, promoting PA at higher intensities may confer larger benefits on arterial health than reducing ST and increasing LPA.
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http://dx.doi.org/10.1080/02640414.2021.1912450DOI Listing
September 2021

Attenuated Risk of Pneumonia Due to Inflammation by Frequent Sauna Baths: A PROSPECTIVE COHORT STUDY.

J Cardiopulm Rehabil Prev 2021 Mar 26. Epub 2021 Mar 26.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, and Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, England (Dr Kunutsor); Department of Sport Science, University of Seoul, Seoul, South Korea (Dr Jae); and Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland, and Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland, and Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland (Dr Laukkanen).

Purpose: Inflammatory pathways are involved in the pathogenesis of pneumonia. Frequent sauna sessions may reduce the risk of respiratory tract infections including pneumonia independent of inflammation. We aimed to evaluate the independent and joint associations of high-sensitivity C-reactive protein (hsCRP) and frequency of sauna bathing (FSB) with risk of pneumonia in a prospective cohort study.

Methods: Serum hsCRP as an inflammatory marker was measured using an immunometric assay and FSB was assessed by self-reported sauna bathing habits at baseline in 2264 men aged 42-61 yr. Serum hsCRP was categorized as normal and high (≤3 and >3 mg/L, respectively) and FSB as low and high (defined as ≤1 and 2-7 sessions/wk, respectively). Multivariable-adjusted HRs (CIs) were calculated for incident pneumonia.

Results: A total of 528 cases of pneumonia occurred during a median follow-up of 26.6 yr. Comparing high versus normal hsCRP, the multivariable-adjusted risk for pneumonia was HR = 1.30 (95% CI, 1.04-1.62). The corresponding risk was HR = 0.79 (95% CI, 0.66-0.95) comparing high versus low FSB. Compared with men with normal hsCRP and low FSB, high hsCRP and low FSB was associated with an increased risk of pneumonia in multivariable analysis (HR = 1.67: 95% CI, 1.21-2.29), with no evidence of an association for high hsCRP and high FSB and pneumonia (HR = 0.94: 95% CI, 0.69-1.29).

Conclusions: In a general middle-aged to older male Caucasian population, frequent sauna baths attenuated the increased risk of pneumonia due to inflammation.
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http://dx.doi.org/10.1097/HCR.0000000000000598DOI Listing
March 2021

Inverse Association of Handgrip Strength With Risk of Heart Failure.

Mayo Clin Proc 2021 06 26;96(6):1490-1499. Epub 2021 Mar 26.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, United Kingdom; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.

Objective: To evaluate the nature, magnitude, and specificity of the association between handgrip strength (HGS) and heart failure (HF) risk.

Patients And Methods: Handgrip strength was assessed at baseline from March 1, 1998, to December 31, 2001, by use of a hand dynamometer in the Finnish Kuopio Ischemic Heart Disease prospective population-based cohort of 770 men and women aged 61 to 74 years without a history of HF. Relative HGS was obtained by dividing the absolute value by body weight. Hazard ratios (HRs) with 95% CIs were estimated with Cox regression models. We used multiple imputation to account for missing data.

Results: During a median (interquartile range) follow-up of 17.1 (11.3-18.3) years, 177 HF events were recorded. Handgrip strength was continually associated with risk of HF, consistent with a curvilinear shape. On adjustment for several established risk factors and other potential confounders, the HR (95% CI) for HF was 0.73 (0.59-0.91) per 1 SD increase in relative HGS. Comparing the top vs bottom tertiles of relative HGS, the corresponding adjusted HR was 0.55 (0.38-0.81). The association remained similar across several clinical subgroups. Imputed results were broadly similar to the observed results.

Conclusion: Relative HGS is inversely and continually associated with the future risk of HF in the general population. Studies are warranted to evaluate whether HGS may be a useful prognostic tool for HF in the general population and to determine whether resistance exercise training may lower the risk of HF.
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http://dx.doi.org/10.1016/j.mayocp.2020.09.040DOI Listing
June 2021

Cardiorespiratory fitness is not associated with reduced risk of prostate cancer: A cohort study and review of the literature.

Eur J Clin Invest 2021 Aug 25;51(8):e13545. Epub 2021 Mar 25.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.

Background: Cardiorespiratory fitness (CRF) has a strong inverse relationship with several chronic disease outcomes, including some cancers. The association between CRF and prostate cancer is controversial. We aimed to assess the prospective association of CRF with prostate cancer risk using a cohort study and review of the literature.

Material And Methods: Cardiorespiratory fitness was assessed using a respiratory gas exchange analyser during exercise testing in 2204 cancer-free middle-aged men. Hazard ratios (HRs) with 95% confidence interval (CIs) were estimated. We corrected for within-person variability in CRF levels using repeat measurements.

Results: During a median follow-up of 24.9 years, 216 prostate cancer cases occurred. The age-adjusted regression dilution ratio of CRF was 0.58 (95% CI: 0.53-0.64). The HR (95% CI) of prostate cancer per 1 standard deviation increase in CRF in age-adjusted analysis was 1.10 (0.95-1.27). The association remained consistent after further adjustment for several risk factors (HR 1.13; 95% CI 0.96-1.33). The corresponding adjusted HRs were 1.24 (95% CI: 0.87-1.77) and 1.28 (95% CI: 0.87-1.88), respectively, when comparing the extreme tertiles of CRF levels. Previous studies mostly reported no evidence of an association or an increased risk of prostate cancer in relation to high CRF. Studies reporting positive associations had short-term follow-up durations (<10 years).

Conclusions: Primary data and a review of previous studies suggest that elevated CRF is not associated with reduced prostate cancer risk. Previous findings of significant evidence of associations could be attributed to increased screening and detection as well as reverse causation bias.
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http://dx.doi.org/10.1111/eci.13545DOI Listing
August 2021

Percentage of age-predicted cardiorespiratory fitness and risk of sudden cardiac death: A prospective cohort study.

Heart Rhythm 2021 Jul 6;18(7):1171-1177. Epub 2021 Mar 6.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom; Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research, Southmead Hospital, Bristol, United Kingdom.

Background: The inverse associations between cardiorespiratory fitness (CRF) and vascular outcomes have been established. However, there has been no prospective evaluation of the relationship between percentage of age-predicted cardiorespiratory fitness (%age-predicted CRF) and risk of sudden cardiac death (SCD).

Objective: The purpose of this study was to assess the association of %age-predicted CRF with SCD risk in a long-term prospective cohort study.

Methods: CRF was assessed using the gold standard respiratory gas exchange analyzer in 2276 men who underwent cardiopulmonary exercise testing. The age-predicted CRF estimated from a regression equation for age was converted to %age-predicted CRF using (Achieved CRF/Age-predicted CRF) × 100. Hazard ratios (HRs) [95% confidence intervals (CIs)] were calculated for SCD.

Results: During median follow-up of 28.2 years, 260 SCDs occurred. There was a dose-response relationship between age-predicted CRF and SCD. A 1-SD increase in %age-predicted CRF was associated with a decreased risk of SCD in analysis adjusted for established risk factors (HR 0.60; 95% CI 0.53-0.70), which remained consistent on further adjustment for several potential confounders, including alcohol consumption, physical activity, socioeconomic status, and systemic inflammation (HR 0.73; 95% CI 0.62-0.85). The corresponding adjusted HRs were 0.34 (0.23-0.50) and 0.52 (0.34-0.79), respectively, when comparing extreme quartiles of %age-predicted CRF levels. HRs for the associations of absolute CRF levels with SCD risk in the same participants were similar.

Conclusion: Percentage of age-predicted CRF is continuously, strongly, and independently associated with risk of SCD and is comparable to absolute CRF as a risk indicator for SCD.
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http://dx.doi.org/10.1016/j.hrthm.2021.03.010DOI Listing
July 2021

Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era.

Eur J Prev Cardiol 2021 05;28(5):541-557

IHF - Institut für Herzinfarktforschung, Ludwigshafen, Germany.

This Delphi consensus by 28 experts from the European Association of Preventive Cardiology (EAPC) provides initial recommendations on how cardiovascular rehabilitation (CR) facilities should modulate their activities in view of the ongoing coronavirus disease 2019 (COVID-19) pandemic. A total number of 150 statements were selected and graded by Likert scale [from -5 (strongly disagree) to +5 (strongly agree)], starting from six open-ended questions on (i) referral criteria, (ii) optimal timing and setting, (iii) core components, (iv) structure-based metrics, (v) process-based metrics, and (vi) quality indicators. Consensus was reached on 58 (39%) statements, 48 'for' and 10 'against' respectively, mainly in the field of referral, core components, and structure of CR activities, in a comprehensive way suitable for managing cardiac COVID-19 patients. Panelists oriented consensus towards maintaining usual activities on traditional patient groups referred to CR, without significant downgrading of intervention in case of COVID-19 as a comorbidity. Moreover, it has been suggested to consider COVID-19 patients as a referral group to CR per se when the viral disease is complicated by acute cardiovascular (CV) events; in these patients, the potential development of COVID-related CV sequelae, as well as of pulmonary arterial hypertension, needs to be focused. This framework might be used to orient organization and operational of CR programmes during the COVID-19 crisis.
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http://dx.doi.org/10.1093/eurjpc/zwaa080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717287PMC
May 2021

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology.

Eur J Prev Cardiol 2020 Apr 7. Epub 2020 Apr 7.

REHPA-Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark.

Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
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http://dx.doi.org/10.1177/2047487320913379DOI Listing
April 2020

Leisure-time cross-country skiing and the risk of venous thromboembolism: A prospective cohort study.

Eur J Prev Cardiol 2020 Mar 3. Epub 2020 Mar 3.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.

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http://dx.doi.org/10.1177/2047487320908978DOI Listing
March 2020

Exercise cardiac power and the risk of myocardial infarction and fatal coronary heart disease events in men.

Eur J Prev Cardiol 2020 Mar 31. Epub 2020 Mar 31.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.

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http://dx.doi.org/10.1177/2047487320914734DOI Listing
March 2020

Cardiorespiratory Fitness, Inflammation, and the Incident Risk of Pneumonia.

J Cardiopulm Rehabil Prev 2021 05;41(3):199-201

Department of Sport Science, University of Seoul, Seoul, South Korea (Dr Jae); Department of Exercise Science, Syracuse University, Syracuse, New York (Dr Heffernan); Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland (Drs Kurl and Laukkanen); National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, and Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, England (Dr Kunutsor); Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota (Drs Kim and Johnson); Preventive Cardiology and Cardiac Rehabilitation, Beaumont Health, Royal Oak, Michigan (Dr Franklin); and Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, and Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland (Dr Laukkanen).

Introduction: Both inflammation and cardiorespiratory fitness (CRF) are associated with the risk of respiratory infections. To clarify the hypothesis that CRF attenuates the incident risk of pneumonia due to inflammation, we conducted a prospective study examining the independent and joint associations of inflammation and CRF on the risk of pneumonia in a population sample of 2041 middle-aged men.

Methods: Cardiorespiratory fitness was directly measured as peak oxygen uptake (V˙o2peak) during progressive exercise testing to volitional fatigue, and categorized into tertiles. Inflammation was defined by high-sensitivity C-reactive protein (hsCRP). Pneumonia cases were identified by internal medicine physicians using the International Classification of Diseases codes in clinical practice.

Results: During a median follow-up of 27 yr, 432 pneumonia cases were recorded. High hsCRP and CRF were associated with a higher risk (HR = 1.38; 95% CI, 1.02-1.88) and a lower risk of pneumonia (HR = 0.55; CI, 0.39-0.76) after adjusting for potential confounders, respectively. Compared with normal hsCRP-Fit, moderate to high hsCRP-Unfit had an increased risk of pneumonia (HR = 1.63; CI, 1.21-2.20), but moderate to high hsCRP-Fit was not associated with an increased risk of pneumonia (HR = 1.25; CI, 0.93-1.68).

Conclusions: High CRF attenuates the increased risk of pneumonia due to inflammation. These findings have potential implications for the prevention of respiratory infection characterized by systemic inflammation, such as coronavirus disease-2019 (COVID-19).
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http://dx.doi.org/10.1097/HCR.0000000000000581DOI Listing
May 2021

In Reply-Impact of a High-Shrimp Diet on Cardiovascular Risk: An NHANES Analysis.

Mayo Clin Proc 2021 02;96(2):508

Global Organization for EPA and DHA Omega-3s (GOED), Salt Lake City, Utah.

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http://dx.doi.org/10.1016/j.mayocp.2020.10.028DOI Listing
February 2021

Cardiorespiratory Fitness Attenuates the Increased Risk of Sudden Cardiac Death Associated With Low Socioeconomic Status.

Am J Cardiol 2021 04 24;145:164-165. Epub 2021 Jan 24.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland.

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http://dx.doi.org/10.1016/j.amjcard.2021.01.012DOI Listing
April 2021
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