Kliinisen rasituskokeen käyttö sydänsairauksissa : Suomen Kardiologisen Seuran työryhmän suositus

•Klii­ni­nen ra­si­tus­koe on kes­kei­nen ja ko­ko­nais­val­tai­nen tut­ki­mus­me­ne­tel­mä mo­nien sy­dän­sai­rauk­sien ­diag­nos­tii­kas­sa, en­nus­teen ar­vioin­nis­sa, hoi­to­lin­jan va­lin­nas­sa ja seu­ran­nas­sa. Sen käyt­töä ei pi­dä vä­hen­tää, vaik­ka mui­ta sy­dä­men ku­van­ta­mis­me­ne­tel­miä on saa­ta­vil­la. •Va­kaaoi­reis­ta se­pel­val­ti­mo­tau­tia epäil­täes­sä ra­si­tus­koe on en­si­si­jai­nen tut­ki­mus taus­ta­tie­to­jen pe­rus­teel­la ar­vioi­dun en­nak­ko­to­den­nä­köi­syy­den mu­kaan oi­kein va­li­tuil­le po­ti­lail­le. •Me­ne­tel­män hy­vä saa­ta­vuus ja edul­li­suus ovat tär­keim­piä etu­ja mui­hin se­pel­val­ti­mo­tau­din tut­ki­mus­me­ne­tel­miin ver­rat­tu­na. •Ra­si­tus­ko­keen tul­kin­ta ei ra­joi­tu EKG:n ST-vä­lin muu­tos­ten mit­tauk­seen, vaan tut­ki­muk­sen ai­ka­na seu­ra­taan myös sy­dä­men sy­ke­taa­juut­ta ja ve­ren­pai­net­ta, mää­ri­te­tään po­ti­laan suo­ri­tus­ky­ky ja do­ku­men­toi­daan mah­dol­li­set ryt­mi­häi­riöt. •Klii­ni­nen ra­si­tus­koe on tär­keä tut­ki­mus ra­si­tuk­sen ai­ka­na il­me­ne­vien ryt­mi­häi­riö­tun­te­mus­ten diag­nos­tii­kas­sa, ja si­tä voi­daan käyt­tää myös las­ten sy­dän­sai­rauk­sien diag­nos­tii­kas­sa ja hoi­don suun­nit­te­lus­sa.Peer reviewe

Association Between Uric Acid, Carotid Intima-Media Thickness, and Cardiovascular Events:Prospective Results From the IMPROVE Study

Background The association between elevated serum uric acid (SUA), cardiovascular disease (CVD) risk, and carotid atherosclerosis has long been explored, and contrasting results have been reported. Therefore, the role of SUA as an independent risk factor for vascular events (VEs) and carotid atherosclerosis deserves further attention. We investigated the relationship between SUA, incident VEs, carotid intima-media thickness (cIMT), and cIMT progression in subjects at moderate-to-high CVD risk. Methods and Results In the IMPROVE (IMT-Progression as Predictors of VEs) study, 3686 participants (median age 64 years; 48% men) with >= 3 vascular risk factors, free from VEs at baseline, were grouped according to SUA quartiles (division points: 244-284-328 mu mol/L in women, 295-336-385 mu mol/L in men). Carotid-IMT and its 15-month progression, along with incident VEs, were recorded. A U-shaped association between SUA and VEs was observed in men, with 2.4-fold (P = 0.004) and 2.5-fold (P = 0.002) increased CVD risk in the first and fourth SUA quartiles as compared with the second. Adjusted hazard ratios (HRs) for cerebro-VEs in men were the highest (first and fourth quartile versus second: HR, 5.3, P = 0.010 and HR, 4.4, P = 0.023, respectively). SUA level was independently associated with cIMT progression in men (beta = 0.068, P = 0.014). No significant association between SUA levels, CVD end points, and cIMT progression were found in women. Conclusions Both low and high SUA levels are associated with an increased risk of VEs in men at moderate-to-high CVD risk but not in women. Only elevated SUA levels predict cIMT progression and at a lesser but not significant extent in women

Physical activity from adolescence to young adulthood : patterns of change, and their associations with activity domains and sedentary time

BackgroundLongitudinal studies demonstrate an average decline in physical activity (PA) from adolescence to young adulthood. However, while some subgroups of adolescents decrease activity, others increase or maintain high or low activity. Activity domains may differ between subgroups (exhibiting different PA patterns), and they offer valuable information for targeted health promotion. Hence, the aim of this study was to identify PA patterns from adolescence to young adulthood; also to explore the associations of (i) changes in PA domains and in sedentary time, (ii) sociodemographic factors, and (iii) self-rated health with diverging PA patterns.MethodsThe observational cohort study data encompassed 254 adolescents at age 15 and age 19. K-means cluster analysis for longitudinal data was performed to identify participant clusters (patterns) based on their accelerometry-measured moderate-to-vigorous PA (MVPA). Logistic regressions were applied in further analysis.ResultsFive PA patterns were identified: inactivity maintainers (n=71), activity maintainers (n=70), decreasers from moderate (to low) PA (n=61), decreasers from high (to moderate) PA (n=32), and increasers (n=20).At age 15, participation in sports clubs (SC, 41-97%) and active commuting (AC, 47-75%) was common in all the patterns. By age 19, clear dropout from these activities was prevalent (SC participation mean 32%, AC 31-63%). Inactivity maintainers reported the lowest amount of weekly school physical education.Dropout from SC - in contrast to non-participation in SC - was associated with higher odds of being a decreaser from high PA, and with lower odds of being an inactivity maintainer. Maintained SC participation was associated with higher odds of belonging to the decreasers from high PA, and to the combined group of activity maintainers and increasers; also with lower odds of being an inactivity maintainer. Maintenance/adoption of AC was associated with decreased odds of being an inactivity maintainer. Self-reported health at age 19 was associated with the patterns of maintained activity and inactivity.ConclusionsPA patterns diverge over the transition to adulthood. Changes in SC participation and AC show different associations with diverging PA patterns. Hence, tailored PA promotion is recommended.Peer reviewe

Effects of exercise on NAFLD using non-targeted metabolomics in adipose tissue, plasma, urine, and stool

The mechanisms by which exercise benefits patients with non-alcoholic fatty liver disease (NAFLD), the most common liver disease worldwide, remain poorly understood. A non-targeted liquid chromatography-mass spectrometry (LC-MS)-based metabolomics analysis was used to identify metabolic changes associated with NAFLD in humans upon exercise intervention (without diet change) across four different sample types-adipose tissue (AT), plasma, urine, and stool. Altogether, 46 subjects with NAFLD participated in this randomized controlled intervention study. The intervention group (n = 21) performed high-intensity interval training (HIIT) for 12 weeks while the control group (n = 25) kept their sedentary lifestyle. The participants' clinical parameters and metabolic profiles were compared between baseline and endpoint. HIIT significantly decreased fasting plasma glucose concentration (p = 0.027) and waist circumference (p = 0.028); and increased maximum oxygen consumption rate and maximum achieved workload (p </p

Physical Activity, Screen Time and Sleep among Youth Participating and Non-Participating in Organized Sports - The Finnish Health Promoting Sports Club (FHPSC) Study

Objectives: The aim of this Health Promoting Sport Club (HPSC) study was to compare physical activity (PA), sleep time and screen time (ST) between sports club participants (n = 1200) and non-participants (n = 913). Design: A cross-sectional survey design was employed to assess PA, sleep and ST of adolescents.Methods: Information on these was collected from 14 to 16 year old adolescents (1200 sport club participants and 913 non-participants) through a standardized questionnaire. Results: Boys were more physically active than girls and met the PA guidelines more often than girls (p Conclusions: Youth participating in organized sports met the recommendations for PA, ST and sleep more often than nonparticipants, supporting sports clubs’ contribution to health promotion. At the same time, only minor portion of sporting youth met the recommendations, therefore more attention should be focused on sport club participants’ PA, sleep and ST especially in coaching.</p