Heart Rate Variability Characteristics in Sedentary Postmenopausal Women Following Six Months of Exercise Training: The DREW Study

Article on heart rate variability characteristics in sedentary postmenopausal women following six months of exercise training

Racial differences in the response of cardiorespiratory fitness to aerobic exercise training in Caucasian and African American postmenopausal women

African American (AA) women have an elevated risk of cardiovascular disease and have been reported to have lower cardiorespiratory fitness CRF) compared with Caucasian American (CA) women. However, little data exist that evaluate racial differences in the change in CRF following aerobic exercise training. CA (n = 264) and AA n = 122) postmenopausal women from the Dose-Response to Exercise in Women study were randomized to 4, 8, and 12 kcal·kg body wt·wk (KKW) of aerobic training or the control group for 6 mo. CRF was evaluated using a cycle ergometer. A greater increase in relative CRF was observed in CA compared with AA women in the 4 (CA: 1.00 vs. AA: 0.35 ml O·kg·min, P = 0.034), 8 (CA: 1.59 vs. AA: 0.82 ml O·kg ·min, P = 0.041), and 12 (CA: 1.98 vs. AA: 0.50 ml O·kg·min, P = 0.001) KKW groups. Similar effects were found in absolute CRF, with the exception of the 4-KKW (CA: 0.04 vs. AA: 0.02 l O/min, P = 0.147) group. However, in categorical analyses, the percentages of women who improved in both relative (>0 ml O·kg·min and absolute (>0 l O/min) CRF were not significantly different for CA and AA women in all exercise groups (all P > 0.05). AA postmenopausal women, in general, had an attenuated increase in CRF (both relative and absolute) following exercise training, but had similar response rates compared with CA women. Future studies should investigate the physiologic mechanisms responsible for this attenuated response. Copyrigh

Secondary prevention of coronary heart disease in elderly patients following myocardial infarction - Are all HMG-CoA reductase inhibitors alike?

Cardiovascular disease remains the leading cause of mortality in elderly patients. While coronary heart disease (CHD) morbidity and mortality have decreased over the last 25 years, the percentage reduction in elderly patients is nearly 50% lower than that for the general adult population. Therefore, aggressive primary and secondary prevention of CHD is imperative for our society, and hyperlipidaemia remains the major modifiable risk factor in the elderly population. However, there appears to be a reluctance among practitioners to treat hyperlipidaemia in elderly patients, a bias that is particularly important given the absolute benefits of treating such patients. While many of the major clinical trials involving HMG-CoA reductase inhibitors (statins) in patients with CHD focused on younger individuals, subsequent subgroup analyses of elderly patients have shown consistent reductions in all-cause mortality, major CHD events and numbers of revascularization procedures. Intensive statin therapy in the setting of acute myocardial infarction (MI) has also been shown to reduce the risk of death, MI, unstable angina, revascularization and stroke in elderly patients. Furthermore, three recent articles that have evaluated intensive lipid-lowering in the elderly population have extended the known benefits of such therapy to elderly patients with acute coronary syndrome and stable CHD. Elderly patients often take multiple medications and are at significant risk of drug-drug interactions. Several available statin medications are metabolized by cytochrome P450 (CYP) 3A4 and can therefore interact with commonly used medications such as amiodarone, macrolide antibacterials, calcium channel antagonists, fibric acid derivatives and ciclosporin. These interactions can result in an increased frequency of statin-related hepatotoxicity and myopathy. There are currently six commercially available statin medications on the US market, three of which, lovastatin, simvastatin and pravastatin, are available in generic formulations, and are thus less expensive. Of the commercially available statins, rosuvastatin, atorvastatin and simvastatin have the highest potency. While rosuvastatin currently lacks clinical event data, atorvastatin has the most clinical event data for CHD and even stroke prevention. Although pravastatin has lower potency than other described statins, it also has the lowest risk of drug-drug interactions involving CYP

Initial weight loss and early intervention adherence predict long-term weight loss during the PROPEL lifestyle intervention

No abstract available

A meta-analysis of the prognostic significance of cardiopulmonary exercise testing in patients with heart failure

The objective of the study is to assess the role of cardiopulmonary exercise testing (CPX) variables, including peak oxygen consumption (VO ), which is the most recognized CPX variable, the minute ventilation/carbon dioxide production (VE/VCO) slope, the oxygen uptake efficiency slope (OUES), and exercise oscillatory ventilation (EOV) in a current meta-analysis investigating the prognostic value of a broader list of CPX-derived variables for major adverse cardiovascular events in patients with HF. A search for relevant CPX articles was performed using standard meta-analysis methods. Of the initial 890 articles found, 30 met our inclusion criteria and were included in the final analysis. The total subject populations included were as follows: peak VO (7,319), VE/VCO slope (5,044), EOV (1,617), and OUES (584). Peak VO, the VE/VCO slope and EOV were all highly significant prognostic markers (diagnostic odds ratios ≥ 4.10). The OUES also demonstrated promise as a prognostic marker (diagnostic odds ratio = 8.08) but only in a limited number of studies (n = 2). No other independent variables (including age, ejection fraction, and beta-blockade) had a significant effect on the meta-analysis results for peak VO and the VE/VCO slope. CPX is an important component in the prognostic assessment of patients with HF. The results of this meta-analysis strongly confirm this and support a multivariate approach to the application of CPX in this patient population