Association of Blood Pressure and Fitness With Levels of Atherosclerotic Risk Markers Pre-Exercise and Post-exercise

Background: Physical fitness may attenuate the increased atherosclerotic risk in patients with systemic hypertension. We investigated the association of screening blood pressure (BP) and cardiorespiratory fitness with baseline levels and exercise-induced changes in levels of soluble atherosclerotic risk markers. Methods: Twenty-six otherwise healthy and unmedicated subjects with elevated BP (systolic BP and/or diastolic BP ≥130/85 mm Hg) and 40 subjects with normal BP underwent 20-min treadmill exercise at 65% to 70% of predetermined peak oxygen consumption (VO2peak). Interleukin (IL)-6, soluble intercellular adhesion molecule (sICAM)-1, von Willebrand factor (VWF) antigen, and plasminogen activator inhibitor (PAI)-1 antigen were measured at baseline (ie, pre-exercise), early postexercise, and late postexercise (ie, 25 min after exercise). Results: At baseline, higher screening mean arterial BP (MAP) independently predicted higher sICAM-1 levels (P = .031), and lower VO2peak independently predicted higher IL-6 (P = .016) and PAI-1 (P < .001) levels. Early and late postexercise lower VO2peak was associated with higher mean PAI-1 (P ≤ .072) and IL-6 (P ≤ .026) levels, and higher screening MAP was associated with higher mean sICAM-1 levels (P ≤ .035). Higher VO2peak was associated with a greater PAI-1 increase from baseline to early postexercise in subjects with elevated BP (P = .045) but not in those with normal BP. Conclusions: Circulating levels of some atherosclerotic risk markers at baseline and with exercise were higher with elevated BP and lower with better fitness. Greater fitness did not particularly protect subjects with elevated BP from potentially harmful responses of atherosclerotic risk markers to acute physical exercise. Am J Hypertens 2007;20: 670-675 © 2007 American Journal of Hypertension, Lt

Depressive symptoms in asymptomatic stage B heart failure with Type II diabetic mellitus.

BackgroundThe presence of concomitant Type II diabetic mellitus (T2DM) and depressive symptoms adversely affects individuals with symptomatic heart failure (HF).HypothesisIn presymptomatic stage B HF, this study hypothesized the presence of greater inflammation and depressive symptoms in T2DM as compared to non-T2DM Stage B patients.MethodsThis cross-sectional study examined clinical parameters, inflammatory biomarkers, and depressive symptoms in 349 T2DM and non-T2DM men with asymptomatic stage B HF (mean age 66.4 years ±10.1; range 30-91).ResultsFewer diabetic HF patients had left ventricular (LV) systolic dysfunction (P &lt; .05) although more had LV diastolic dysfunction (P &lt; .001). A higher percentage of T2DM HF patients were taking ACE-inhibitors, beta-blockers, calcium channel blockers, statins, and diuretics (P values &lt; .05). T2DM HF patients had higher circulating levels of interleukin-6 (IL-6) (P &lt; .01), tumor necrosis factor-alpha (P &lt; .01), and soluble ST2 (sST2) (P &lt; .01) and reported more somatic/affective depressive symptoms (Beck Depression Inventory II) (P &lt; .05) but not cognitive/affective depressive symptoms (P = .20). Among all patients, in a multiple regression analysis predicting presence of somatic/affective depressive symptoms, sST2 (P = .026), IL-6 (P = .010), B-type natriuretic peptide (P = .016), and sleep (Pittsburgh Sleep Quality Index [P &lt; .001]) were significant predictors (overall model F = 15.39, P &lt; .001, adjusted R2 = .207).ConclusionsSomatic/affective but not cognitive/affective depressive symptoms are elevated in asymptomatic HF patients with T2DM patients. Linkages with elevated inflammatory and cardiac relevant biomarkers suggest shared pathophysiological mechanisms among T2DM HF patients with somatic depression, and these conditions are responsive to routine interventions, including behavioral. Copyright © 2019 John Wiley &amp; Sons, Ltd

Neighborhood problems and nocturnal blood pressure dipping.

ObjectiveLiving in adverse neighborhood conditions has been linked with greater prevalence of cardiovascular disease (CVD). We aimed to learn whether perceived neighborhood problems are related to attenuated nocturnal blood pressure (BP) dipping, a risk factor for CVD morbidity.MethodA sample of 133 adults (71 male, 62 female; 80 White, 53 Black) underwent 24-hr ambulatory blood pressure monitoring. The neighborhood problem scale (NPS) was used to assess neighborhood environmental stressors.ResultsNocturnal dipping in systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure was reduced in individuals with higher NPS scores (p &lt; .05). Hierarchical regression analyses revealed that neighborhood problems explained 4%-6% of the variance in SBP, DBP, and MAP dipping (p &lt; .05) even after adjusting for several theoretical confounders such as social status, age, gender, race, body mass index (BMI), smoking, exercise, depression and discrimination.ConclusionNeighborhood problems may contribute to attenuated BP dipping beyond the effect of known risk factors

Neighborhood problems and nocturnal blood pressure dipping.

ObjectiveLiving in adverse neighborhood conditions has been linked with greater prevalence of cardiovascular disease (CVD). We aimed to learn whether perceived neighborhood problems are related to attenuated nocturnal blood pressure (BP) dipping, a risk factor for CVD morbidity.MethodA sample of 133 adults (71 male, 62 female; 80 White, 53 Black) underwent 24-hr ambulatory blood pressure monitoring. The neighborhood problem scale (NPS) was used to assess neighborhood environmental stressors.ResultsNocturnal dipping in systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure was reduced in individuals with higher NPS scores (p &lt; .05). Hierarchical regression analyses revealed that neighborhood problems explained 4%-6% of the variance in SBP, DBP, and MAP dipping (p &lt; .05) even after adjusting for several theoretical confounders such as social status, age, gender, race, body mass index (BMI), smoking, exercise, depression and discrimination.ConclusionNeighborhood problems may contribute to attenuated BP dipping beyond the effect of known risk factors

An exploratory randomized sub-study of light-to-moderate intensity exercise on cognitive function, depression symptoms and inflammation in older adults with heart failure

ObjectiveAlmost half of patients with heart failure (HF) have cognitive impairment. While exercise relates to better cognitive health, a hallmark of HF is exercise intolerance. The study objective was to explore whether light-to-moderate exercise improves cognitive function in patients with HF.MethodsThis was an exploratory parallel design study of 69 patients with symptomatic HF (mean age&nbsp;=&nbsp;65, SD&nbsp;=&nbsp;10), recruited from VA and University of California, San Diego Healthcare Systems. Participants were randomized to Tai Chi (TC) (n&nbsp;=&nbsp;24), resistance band (RB) exercise (n&nbsp;=&nbsp;22) or treatment as usual (TAU) (n&nbsp;=&nbsp;23). The primary outcome was change in Montreal Cognitive Assessment (MoCA) scores. We further explored if changes in Beck Depression Inventory - IA (BDI-IA) scores or inflammation biomarkers, CRP, TNFα and IL-6 related to altered cognitive function.ResultsThere was a fixed effect of group for MoCA scores changes (F&nbsp;=&nbsp;8.07, p&nbsp;=&nbsp;.001). TC and RB groups had greater MoCA score increases versus TAU, but no differences were found between TC and RB. Depression symptom changes predicted altered MoCA scores (ΔR2&nbsp;=&nbsp;0.15, Β&nbsp;=&nbsp;-0.413, p&nbsp;=&nbsp;.001). However, group did not interact with depression symptom levels for MoCA alterations (p&nbsp;=&nbsp;.392). Changes in CRP levels predicted MoCA scores (ΔR2&nbsp;=&nbsp;0.078, Β&nbsp;=&nbsp;-0.283, p&nbsp;=&nbsp;.01), but group did not interact with CRP levels for MoCA alterations (p&nbsp;=&nbsp;.689).ConclusionsLight-to-moderate exercises, TC and RB may improve cognitive function. However, the mechanisms remain unclear. ClinicalTrials.gov: NCT01625819

Acute exercise enhancement of pneumococcal vaccination response:a randomised controlled trial of weaker and stronger immune response

Acute exercise at the time of vaccination can enhance subsequent immune responses. However, the potential benefit of this effect will be its efficacy in boosting poor responses, and thus protection in at-risk populations. The current study tested the effect of exercise on the response to either a full- or half-dose Pneumococcal (Pn) vaccination to elicit stronger and weaker responses. Subjects were 133 young healthy adults, randomized to one of four groups: Exercise or control task, receiving a full- or half-dose Pn vaccination. Prior to vaccination, exercise groups completed a 15min arm and shoulder exercise task, control groups rested quietly. Antibody levels to 11 Pn strains were evaluated at baseline and 1- month. Across all participants, exercise groups showed significantly greater increase in antibody levels than control groups. When doses were compared, it emerged that those who exercised had significantly larger responses than those who rested in the half-dose group, but in the full-dose groups responses were similar. This data indicates the effectiveness of exercise as a vaccine adjuvant, particularly in weaker responses. Thus, given the potential public health benefits of no-cost behavioural intervention to enhance response to vaccination, testing in at-risk populations should be pursued

Depressive symptoms in asymptomatic stage B heart failure with Type II diabetic mellitus.

BackgroundThe presence of concomitant Type II diabetic mellitus (T2DM) and depressive symptoms adversely affects individuals with symptomatic heart failure (HF).HypothesisIn presymptomatic stage B HF, this study hypothesized the presence of greater inflammation and depressive symptoms in T2DM as compared to non-T2DM Stage B patients.MethodsThis cross-sectional study examined clinical parameters, inflammatory biomarkers, and depressive symptoms in 349 T2DM and non-T2DM men with asymptomatic stage B HF (mean age 66.4 years ±10.1; range 30-91).ResultsFewer diabetic HF patients had left ventricular (LV) systolic dysfunction (P &lt; .05) although more had LV diastolic dysfunction (P &lt; .001). A higher percentage of T2DM HF patients were taking ACE-inhibitors, beta-blockers, calcium channel blockers, statins, and diuretics (P values &lt; .05). T2DM HF patients had higher circulating levels of interleukin-6 (IL-6) (P &lt; .01), tumor necrosis factor-alpha (P &lt; .01), and soluble ST2 (sST2) (P &lt; .01) and reported more somatic/affective depressive symptoms (Beck Depression Inventory II) (P &lt; .05) but not cognitive/affective depressive symptoms (P = .20). Among all patients, in a multiple regression analysis predicting presence of somatic/affective depressive symptoms, sST2 (P = .026), IL-6 (P = .010), B-type natriuretic peptide (P = .016), and sleep (Pittsburgh Sleep Quality Index [P &lt; .001]) were significant predictors (overall model F = 15.39, P &lt; .001, adjusted R2 = .207).ConclusionsSomatic/affective but not cognitive/affective depressive symptoms are elevated in asymptomatic HF patients with T2DM patients. Linkages with elevated inflammatory and cardiac relevant biomarkers suggest shared pathophysiological mechanisms among T2DM HF patients with somatic depression, and these conditions are responsive to routine interventions, including behavioral. Copyright © 2019 John Wiley &amp; Sons, Ltd

Is Belonging to a Religious Organization Enough? Differences in Religious Affiliation Versus Self-ratings of Spirituality on Behavioral and Psychological Variables in Individuals with Heart Failure.

In the United States, heart failure (HF) affects approximately 6.5 million adults. While studies show that individuals with HF often suffer from adverse symptoms such as depression and anxiety, studies also show that these symptoms can be at least partially offset by the presence of spiritual wellbeing. In a sample of 327 men and women with AHA/ACC classification Stage B HF, we found that more spirituality in patients was associated with better clinically-related symptoms such as depressed mood and anxiety, emotional variables (affect, anger), well-being (optimism, satisfaction with life), and physical health-related outcomes (fatigue, sleep quality). These patients also showed better self-efficacy to maintain cardiac function. Simply belonging to a religious organization independent of spiritualty, however, was not a reliable predictor of health-related benefits. In fact, we observed instances of belonging to a religious organization unaccompanied by parallel spiritual ratings, which appeared counterproductive