Background-Exercise capacity is inversely related to mortality risk in healthy individuals and those with cardiovascular diseases. This evidence is based largely on white populations, with little information available for blacks. Methods and Results-We assessed the association between exercise capacity and mortality in black (nϭ6749; age, 58Ϯ11 years) and white (nϭ8911; age, 60Ϯ11 years) male veterans with and without cardiovascular disease who successfully completed a treadmill exercise test at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, Calif. Fitness categories were based on peak metabolic equivalents (METs) achieved. Subjects were followed up for all-cause mortality for 7.5Ϯ5.3 years. Among clinical and exercise test variables, exercise capacity was the strongest predictor of risk for mortality. The adjusted risk was reduced by 13% for every 1-MET increase in exercise capacity (hazard ratio, 0.87; 95% confidence interval, 0.86 to 0.88; PϽ0.001). Compared with those who achieved Ͻ5 METs, the mortality risk was Ϸ50% lower for those with an exercise capacity of 7.1 to 10 METs (hazard ratio, 0.51; 95% confidence interval, 0.47 to 0.56; PϽ0.001) and 70% lower for those achieving Ͼ10 METs (hazard ratio, 0.31; 95% confidence interval, 0.26 to 0.36; PϽ0.001). The findings were similar for those with and without cardiovascular disease and for both races. Conclusions-Exercise capacity is a strong predictor of all-cause mortality in blacks and whites. The relationship was inverse and graded, with a similar impact on mortality outcomes for both blacks and whites. (Circulation. 2008;117: 614-622.)

Background-Epidemiological findings, based largely on middle-aged populations, support an inverse and independent association between exercise capacity and mortality risk.

Regular exercise reduced blood pressure and left ventricular hypertrophy in African-American men with severe hypertension.

Background: During the past decades, the prevalence of diabetes (DM) has increased significantly, mainly as a result of continuous rise in the incidence of type 2 DM. According to World Health Organization statistics, >422 million adults globally were suffering from DM in 2014 and a continuous rise in DM prevalence is expected. Objective: The present review considers recent epidemiological data providing worldwide estimates regarding the incidence of DM. Methods: A comprehensive literature search was conducted to identify available data from epidemiological studies evaluating the current burden of DM. Results: Over the past few decades the prevalence of DM has risen significantly in nearly all countries and may be considered as a growing epidemic. Urbanization and income status are major factors which influence current rates in the prevalence studies introducing interesting differences between several population groups. Conclusion: Having recognized the global burden of DM, we now realize the urgent need for effective interventions. In order to monitor the public-health strategies and design effective future interventions we need reliable global estimates regarding the prevalence of DM.

Background-The aim of the present study was to assess the prognostic value of novel repolarization descriptors from the 12-lead ECG in a large cohort of US veterans. Methods and Results-Male US veterans (nϭ813) with cardiovascular disease had digital 12-lead ECGs recorded at the VA Medical Center, Washington, DC, between 1984 and 1991. The patient series was retrospectively compiled in 1991; follow-up was prospectively assessed until 2000. Novel ECG variables characterizing repolarization and the T-wave loop were automatically analyzed. Of 772 patients with technically analyzable data, 252 patients (32.6%) died after a mean follow-up of 10.4Ϯ3.8 years. Direct comparison between dead and alive patients showed that the so-called T-wave residua (the absolute and relative amount of nondipolar contents within the T wave) predicted mortality (111 900Ϯ164 700 versus 85 600Ϯ144 800 between dead and alive patients, PϽ0.0002; and 0.43Ϯ0.62% versus 0.33Ϯ0.56%, PϽ0.0005 for the absolute and relative T-wave residuum, respectively). On Cox regression analysis entering age, left ventricular ejection fraction, echocardiographic left ventricular hypertrophy, and either of the T-wave residua, risk prediction was independent for the absolute (Pϭ0.022) and for the relative (Pϭ0.006) T-wave residuum, respectively, with age (PϽ0.0001), presence of left ventricular hypertrophy (Pϭ0.002), and left ventricular ejection fraction (Pϭ0.004) also being predictors of survival. Conclusions-The heterogeneity of myocardial repolarization, measured by the so-called T-wave residuum in the ECG, confers long-term independent prognostic information in US veterans with cardiovascular disease.

OBJECTIVE -The purpose of this study was to assess the association between exercise capacity and mortality in African Americans and Caucasians with type 2 diabetes and to explore racial differences regarding this relationship.RESEARCH DESIGN AND METHODS -African American (n ϭ 1,703; aged 60 Ϯ 10 years) and Caucasian (n ϭ 1,445; aged 62 Ϯ 10 years) men with type 2 diabetes completed a maximal exercise test between 1986 and 2007 at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, California. Three fitness categories were established (low-, moderate-, and high-fit) based on peak METs achieved. Subjects were followed for all-cause mortality for 7.3 Ϯ 4.7 years.RESULTS -The adjusted mortality risk was 23% higher in African Americans than in Caucasians (hazard ratio 1.23 [95% CI 1.1-1.4]). A graded reduction in mortality risk was noted with increased exercise capacity for both races. There was a significant interaction between race and METs (P Ͻ 0.001) and among race and fitness categories (P Ͻ 0.001). The association was stronger for Caucasians. Each 1-MET increase in exercise capacity yielded a 19% lower risk for Caucasians and 14% for African Americans (P Ͻ 0.001). Similarly, the risk was 43% lower (0.57 CONCLUSIONS -Exercise capacity is a strong predictor of all-cause mortality in African American and Caucasian men with type 2 diabetes. The exercise capacity-related reduction in mortality appears to be stronger and more graded for Caucasians than for African Americans. Diabetes Care 32:623-628, 2009

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Abstract-Prehypertensive individuals are at increased risk for developing hypertension and cardiovascular disease compared with those with normal blood pressure. Early compromises in left ventricular structure may explain part of the increased risk. We assessed echocardiographic and exercise parameters in prehypertensive individuals (nϭ790) to determine associations between exercise blood pressure and left ventricular structure. The exercise systolic blood pressure at 5 metabolic equivalents (METs) and the change in blood pressure from rest to 5 METs were the strongest predictors of left ventricular hypertrophy. We identified the systolic blood pressure of 150 mm Hg at the exercise levels of 5 METs as the threshold for left ventricular hypertrophy. There was a 4-fold increase in the likelihood for left ventricular hypertrophy for every 10-mm Hg increment in systolic blood pressure beyond this threshold 2,3 It is estimated that substantial reductions in hospitalizations, nursing home admissions, and deaths would be realized if prehypertension is eliminated 4 or the progression from prehypertension to hypertension is prevented.The factors involved in the increased risk are not well defined. Prehypertension may mark the beginning of a progressive remodeling of the left ventricle that may go unnoticed for years. Increased left ventricular mass (LVM) is an independent predictor of cardiovascular disease and mortality. 5-7 Naturally, reversing or retarding the rate of progression from prehypertension to hypertension and preventing target-organ injury is desirable.Daytime ambulatory systolic BP is directly associated with LVM and is a stronger predictor of it than resting BP. 8,9 This suggests that the impetus for increased LVM is an elevated hemodynamic load during routine daily activities. Because the metabolic demand of most routine daily activities is within 5 metabolic equivalents (METs), 10 the BP taken during an exercise tolerance test (ETT) at the workload of 5 METs is likely to reflect the hemodynamic load during daily activities. Thus, this exercise BP may be used as a practical and relatively inexpensive predictor of increased risk for left ventricular hypertrophy (LVH) in prehypertensive individuals.Moderate and high-fit prehypertensive individuals exhibit significantly lower ambulatory BP, 11 exercise BP, and heart rate (HR) at submaximal and absolute workloads 12 when compared with unfit. We also reported significantly lower exercise BP at the absolute submaximal workloads of 3 to 6 METs 13 and LVM 14 in hypertensive patients after 16 weeks of low-to-moderate intensity exercise training. Collectively, these findings support that moderate increases in cardiorespiratory fitness may result in lower BP, HR, and hemodynamic