Physical activity, health benefits, and mortality risk

A plethora of epidemiologic evidence from large studies supports unequivocally an inverse, independent, and graded association between volume of physical activity, health, and cardiovascular and overall mortality. This association is evident in apparently healthy individuals, patients with hypertension, type 2 diabetes mellitus, and cardiovascular disease, regardless of body weight. Moreover, the degree of risk associated with physical inactivity is similar to, and in some cases even stronger than, the more traditional cardiovascular risk factors. The exercise-induced health benefits are in part related to favorable modulations of cardiovascular risk factors observed by increased physical activity or structured exercise programs. Although the independent contribution of the exercise components, intensity, duration, and frequency to the reduction of mortality risk is not clear, it is well accepted that an exercise volume threshold defined at caloric expenditure of approximately 1,000 Kcal per week appears to be necessary for significant reduction in mortality risk. Further reductions in risk are observed with higher volumes of energy expenditure. Physical exertion is also associated with a relatively low and transient increase in risk for cardiac events. This risk is significantly higher for older and sedentary individuals. Therefore, such individuals should consult their physician prior to engaging in exercise

Statin therapy, fitness, and mortality risk in middle-aged hypertensive male veterans

BACKGROUND Hypertension often coexists with dyslipidemia, accentuating cardiovascular risk. Statins are often prescribed in hypertensive individuals to lower cardiovascular risk. Higher fitness is associated with lower mortality, but exercise capacity may be attenuated in hypertension. The combined effects of fitness and statin therapy in hypertensive individuals have not been assessed. Thus, we assessed the combined health benefits of fitness and statin therapy in hypertensive male subjects. METHODS Peak exercise capacity was assessed in 10,202 hypertensive male subjects (mean age = 60.4±10.6 years) in 2 Veterans Affairs Medical Centers. We established 4 fitness categories based on peak metabolic equivalents (METs) achieved and 8 categories based on fitness status and statin therapy. RESULTS During the follow-up period (median = 10.2 years), there were 2,991 deaths. Mortality risk was 34% lower (hazard ratio (HR) = 0.66; 95% confidence interval (CI) = 0.59–0.74; P \u3c 0.001) among individuals treated with statins compared with those not on statins. The fitness-related mortality risk association was inverse and graded regardless of statin therapy status. Risk reduction associated with exercise capacity of 5.1–8.4 METs was similar to that observed with statin therapy. However, those achieving ≥8.5 METs had 52% lower risk (HR = 0.48; 95% CI = 0.37–0.63) when compared with the least-fit subjects (≤5 METs) on statin therapy. CONCLUSIONS The combination of statin therapy and higher fitness lowered mortality risk in hypertensive individuals more effectively than either alone. The risk reduction associated with moderate increases in fitness was similar to that achieved by statin therapy. Higher fitness was associated with 52% lower mortality risk when compared with the least fit subjects on statin therapy

Long-term survival after CABG in diabetics with aggressive risk factor management

Objectives: Diabetes is a well-established risk factor for cardiovascular disease, and diabetics have a threefold increase in risk of death from cardiovascular disease compared to non-diabetics. Following coronary artery bypass grafting, tight glycemic control improves short-term outcomes, however limited data exist for long-term outcomes. Here we examine these outcomes in diabetics using aggressive risk factor management. Methods: A retrospective review of all patients under-going coronary artery bypass between 1991 and 2000 at a single Veterans Affairs Medical Center was undertaken. 973 patients were included, 313 with diabetes and 660 without. Strict glucose control was maintained for all patients. Additional risk factor modification, including anti-platelets medications, statins, and beta blockers were also used. Survival analysis was performed. Results: The diabetic group was at higher risk, with age, BSA, and NYHA class all being greater (p \u3c 0.05). The mean follow-up time was 6.7 ± 3 years. There were 28 deaths/1000 person-years for non-diabetics, and 48 deaths/1000 person-years for diabetics. Survival rates were significantly higher for non-diabetics (72% versus 58% in the diabetic group, p \u3c 0.001). Cox proportional hazard analysis demonstrated mortality risk was 57% higher for diabetic patients (hazard ratio = 1.57; CI: 1.19 - 2.09; p = 0.002). The mortality risk in diabetics with and without prior MI was similar (HR = 0.83; CI: 0.54 - 1.28; p = 0.40). Conclusions: Diabetics undergoing coronary bypass have poorer long-term survival than non-diabetics despite perioperative glycemic control and risk factor modification. The long-term survival decrease in diabetics with history of MI is attenuated with surgical revascularization

The interaction of cardiorespiratory fitness with obesity and the obesity paradox in cardiovascular disease

Overweight and obesity are well-established risk factors for most cardiovascular diseases (CVD), including coronary heart disease (CHD), heart failure (HF), and atrial fibrillation. Despite the strong link between excess adiposity and risk of CVD, growing evidence has demonstrated an obesity paradox in patients with CVD. This phenomenon is characterized by a better prognosis in overweight and mildly obese CVD patients than their leaner counterparts. Moreover, the worst outcomes are often incurred by underweight CVD patients, followed by those of normal weight or severely obese. The obesity paradox is now a well-established phenomenon across different types of CVD, and it occurs regardless of age and ethnicity of patients, and severity of CVD. Physical inactivity and low cardiorespiratory fitness (CRF) have long been recognized as major risk factors for CVD. In contrast, high levels of physical activity (PA) and CRF largely neutralize the adverse effects of excess adiposity and other traditional CVD risk factors, including hypertension, metabolic syndrome, and type-2 diabetes. Higher CRF also results in better CVD outcomes across different BMI groups and significantly alters the obesity paradox in patients with HF and CHD. Prognostic benefits of overweight/obesity tend to be limited to unfit patients with HF and CHD, and the obesity paradox usually disappears with improved levels of CRF. Nevertheless, increased PA and exercise training, to maintain or improve CRF, are effective, safe, and proven strategies for primary and secondary prevention of CVD in all weight groups. In this review, we discuss the current concepts of individual and combined contributions of fatness and fitness to CVD risk and prognosis. We then examine the influence of fitness on the obesity paradox in individuals with CVD

Relationship of physical activity and healthy eating with mortality and incident heart failure among community-dwelling older adults with normal body mass index

Aims Normal body mass index (BMI) is associated with lower mortality and may be achieved by physical activity (PA), healthy eating (HE), or both. We examined the association of PA and HE with mortality and incident heart failure (HF) among 2040 community-dwelling older adults aged ≥ 65 years with baseline BMI 18.5 to 24.99 kg/m2 during 13 years of follow-up in the Cardiovascular Health Study. Methods and results Baseline PA was defined as ≥500 weekly metabolic equivalent task-minutes and HE as ≥5 daily servings of vegetable and fruit intake. Participants were categorized into four groups: (i) PA−/HE− (n = 384); (ii) PA−/HE+ (n = 162); (iii) PA+/HE− (n = 992); and (iv) PA+/HE+ (n = 502). Participants had a mean age of 74 (±6) years, mean BMI of 22.6 (±1.5) kg/m2, 61% were women, and 4% African American. Compared with PA−/HE−, age-sex-race-adjusted hazard ratios and 95% confidence intervals for all-cause mortality for PA−/HE+, PA+/HE−, and PA+/HE+ groups were 0.96 (0.76–1.21), 0.61 (0.52–0.71), and 0.62 (0.52–0.75), respectively. These associations remained unchanged after multivariable adjustment and were similar for cardiovascular and non-cardiovascular mortalities. Respective demographic-adjusted hazard ratios (95% confidence intervals) for incident HF among 1954 participants without baseline HF were 1.21 (0.81–1.81), 0.71 (0.54–0.94), and 0.71 (0.51–0.98). These latter associations lost significance after multivariable adjustment. Conclusion Among community-dwelling older adults with normal BMI, physical activity, regardless of healthy eating, was associated with lower risk of mortality and incident HF, but healthy eating had no similar protective association in this cohort

The impact of cardiorespiratory fitness levels on the risk of developing atherogenic dyslipidemia

Background Low cardiorespiratory fitness has been established as a risk factor for cardiovascular-related morbidity. However, research about the impact of fitness on lipid abnormalities, including atherogenic dyslipidemia, has produced mixed results. The purpose of this investigation is to examine the influence of baseline fitness and changes in fitness on the development of atherogenic dyslipidemia. Methods All participants completed at least 3 comprehensive medical examinations performed by a physician that included a maximal treadmill test between 1976 and 2006 at the Cooper Clinic in Dallas, Texas. Atherogenic dyslipidemia was defined as a triad of lipid abnormalities: low high-density-lipoprotein cholesterol ([HDL-C

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease