New insights in preventive cardiology and cardiac rehabilitation

Franklin, Barry A.; Trivax, Justin; Vanhecke, Thomas E.

doi:10.1097/hco.0b013e32830b360b

Cited by 8 publications

(4 citation statements)

References 100 publications

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“…Thus, blood glucose, heart rate, and blood pressure are continuously monitored and promptly corrected. Furthermore, patients profit from physical activity and controlled food intake, ie, lifestyle improvement 39,40…”

Section: Discussionmentioning

confidence: 99%

Patients with insulin-dependent diabetes or coronary heart disease following rehabilitation express serum fractalkine levels similar to those in healthy control subjects

Maegdefessel

Schlitt²,

Pippig³

et al. 2009

VHRM

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The chemokine and adhesion molecule fractalkine and its receptor CX3CR1 have emerged as interesting regulators in inflammation and related atherosclerosis. The pro-inflammatory status may be counteracted by appropriate treatment, such as in rehabilitation. We compared serum fractalkine concentrations of 46 patients with coronary heart disease (CHD) and 47 insulin-dependent diabetic patients (IDDM) following rehabilitation with those of 50 control subjects. Following rehabilitation serum fractalkine levels (477 ± 225 pg/mL) in CHD patients were similar to those in control subjects (572 ± 205 pg/mL; P = 0.303), whereas fractalkine levels were lower in IDDM patients (430 ± 256 pg/mL; P = 0.042). No significant difference between CHD and IDDM patients was present (P = 0.319). Postprandial hyperlipemia may influence inflammation; thus, we investigated fractalkine levels four and eight hours after inducing postprandial hyperlipemia. However, we did not find any significant alterations in CHD and diabetic patients, whereas the fractalkine levels in controls were reduced. In vitro, lipofundin used as a hyperlipemic stimulus was added to vessel wall cells and reduced fractalkine levels. Low fractalkine levels in patients attending rehabilitation indicate a beneficial effect of the rehabilitation procedure on innate inflammatory pathways, such as the chemokine and adhesion molecule fractalkine.

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Section: Discussionmentioning

confidence: 99%

Patients with insulin-dependent diabetes or coronary heart disease following rehabilitation express serum fractalkine levels similar to those in healthy control subjects

Maegdefessel

Schlitt²,

Pippig³

et al. 2009

VHRM

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“…This is owing to an increase in obesity and diabetes mellitus as well as adverse lifestyles (including smoking and physical inactivity) even in children and young adults 1,2. Premature CAD is defined as the first manifestation of CAD in male patients under 55 years of age and in female patients under 65 years of age 3.…”

Section: Introductionmentioning

confidence: 99%

Disparity in risk factor pattern in premature versus late-onset coronary artery disease: a survey of 15,381 patients

Reibis¹,

Treszl²,

Wegscheider³

et al. 2012

VHRM

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BackgroundThere are few data available regarding the specificity and modifiability of major cardiovascular (CV) risk factors in patients with premature versus (vs) late-onset coronary artery disease (CAD). This study was designed to analyze and compare these risk factors.Patients and methodsData from 15,381 consecutive patients (mean age, 62.3 ± 11.7 years; female, 33.8%) hospitalized with CAD were collected from a large-scale registry (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management) and analyzed. The patients were divided into two groups, depending on age at inclusion: group 1 patients (n = 5725; mean age, 50.5 ± 7.2 years) were males aged < 55 years and females aged < 65 years; group 2 patients (n = 9656; mean age, 69.4 ± 7.4 years) were males aged > 55 years and females aged > 65 years and had a low-density lipoprotein cholesterol level of >100 mg/dL on admission to cardiac rehabilitation. Besides the conventional risk factors, lipoprotein(a) concentrations and glucose tolerance were measured facultatively. Univariate (chi-square test) and multivariate logistic regression models were used.ResultsCigarette smoking (group 1 at 31.5% vs group 2 at 9.4%; P < 0.001), family history of CAD (group 1 at 43.6% vs group 2 at 26.5%; P < 0.001), and dyslipidemia (group 1 at 92.7% vs group 2 at 91.8%; P < 0.001) were dominant risk factors in the younger group. Arterial hypertension (group 1 at 71.4% vs group 2 at 87.0%; P < 0.001) and diabetes (group 1 at 23.5% vs group 2 at 30.1%; P < 0.001) were dominant risk factors in the older group. Impaired glucose tolerance and diabetes were less frequent in the younger group (Ptrend = 0.038), and identical lipoprotein(a) concentration levels of >30 mg/dL were found in both groups (8.0%; P = 0.810). Modification of lipid profile and blood pressure was more effective in the younger group (low-density lipoprotein cholesterol < 100 mg/dL: group 1 at 66.3% vs group 2 at 61.1%; systolic blood pressure < 140 mmHg: group 1 at 91.7% vs group 2 at 83.0%; P < 0.001).ConclusionCV risk factors differ markedly between premature and non-premature CAD. Cardiac rehabilitation provides an opportunity to reinforce secondary prevention after acute coronary syndrome.

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“…Exercise is the most important physiological stimulus for increasing myocardial O 2 demand, and physical activity and fitness explain much of the association between obesity, metabolic syndrome, and all-cause and cardiovascular mortality (30,32,33,52). Structured exercise prescription often forms the basis of strategies to improve fitness, but the threshold intensity needed to improve V O 2max should equate to 30 -45% of the O 2 uptake reserve, corresponding to ϳ60 -70% of the highest heart rate achieved during peak exercise testing (21). Understandably, this intensity of exercise is difficult to achieve in middle-aged obese individuals at risk of type 2 diabetes, and other methods of improving V O 2max are urgently needed.…”

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confidence: 99%

Diastolic function is strongly and independently associated with cardiorespiratory fitness in central obesity

Turzyniecka

Krentz²,

Chipperfield

et al. 2010

Journal of Applied Physiology

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Cardiorespiratory fitness [maximal O2 consumption (VO2max)] is an independent risk factor for type 2 diabetes; but in individuals at risk, factors influencing VO2max are poorly understood. We tested the hypothesis that VO2max is associated with diastolic function [subendocardial variability ratio (SEVR), %], as diastolic function influences myocardial perfusion. We studied 47 men and women with central obesity without diabetes. We measured fitness (VO2max) by treadmill testing and diastolic function (SEVR%) by pulse-wave analysis. We measured other factors influencing this relationship: insulin sensitivity [whole body glucose uptake-to-insulin concentration ratio (M/I)] by hyperinsulinemic euglycemic clamp, fatness by MR imaging and dual-energy X-ray absorptiometry, physical activity energy expenditure (metabolic equivalents of tasks) by the Sensewear Pro2 device, and muscle microvascular exchange capacity (capillary filtration coefficient) by venous plethysmography. Mean age of the subjects was 51+/-9 (SD) yr. VO2max was associated with SEVR% (r=0.50, P=0.001), fatness (r=-0.39, P=0.008), and HbA1c (r=-0.35, P=0.018), but not with whole body glucose uptake-to-insulin concentration ratio, metabolic equivalents of tasks, or capillary filtration coefficient. In regression modeling with age, sex, fatness, and SEVR% as explanatory variables, only age, sex, and SEVR% were independently associated with VO2max (SEVR%--standardized B coefficient=0.37, 95% confidence interval=0.003-0.18, P=0.007). This model identified 46% of the variance in VO2max (R2=0.46, P=0.0001). There was a strong, independent association between VO2max and a measure of diastolic function in sedentary individuals with central obesity.

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New insights in preventive cardiology and cardiac rehabilitation

Abstract: Collectively, these data highlight the value of comprehensive risk factor modification in the prevention of initial and recurrent cardiovascular events.

Cited by 8 publications

References 100 publications

Patients with insulin-dependent diabetes or coronary heart disease following rehabilitation express serum fractalkine levels similar to those in healthy control subjects

Patients with insulin-dependent diabetes or coronary heart disease following rehabilitation express serum fractalkine levels similar to those in healthy control subjects

Disparity in risk factor pattern in premature versus late-onset coronary artery disease: a survey of 15,381 patients

Diastolic function is strongly and independently associated with cardiorespiratory fitness in central obesity

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