Journal Wrap

Lower Risk of Death For Weekend Warriors

“Weekend warriors” who perform all of their exercise in one or two sessions per week may be sufficiently reducing all-cause, cardiovascular disease and cancer mortality risks according to findings published Jan. 9 in JAMA: Internal Medicine.

The World Health Organization recommends that people aged 18 to 64 years should perform at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week, but the frequency of activity is not specified. Read More >>>

Gary O’Donovan, PhD, et al. collected data from 1994 to 2008 from household-based surveillance studies, which included respondents to the Health Survey for England and Scottish Health Survey. The 63,591 respondents included in this analysis were 40 years or older. Of these, 39,947 (62.8 percent) were classified as inactive at baseline; 14,224 (22.4 percent) as insufficiently active; 2,341 (3.7 percent) as weekend warriors; and 7,079 (11.1 percent) as regularly active. The inactive participants were generally older, more likely to smoke, to be in unskilled occupations and to report a long-standing illness. Weekend warriors were more likely to be men. Mean body mass index was similar in each group.

Of the weekend warriors, 1,053 (45.0 percent) reported taking part in one session and 1,288 (55.0 percent) reported taking part in two sessions of exercise per week. The mean time spent in moderate- or vigorous-intensity physical activity was approximately 300 minutes per week for weekend warriors and approximately 450 minutes per week in the regularly active participants. The proportion of vigorous-intensity physical activity, however, was higher in weekend warriors than the regularly active participants.

There were 8,802 deaths from all causes during the study period, with 2,780 deaths from cardiovascular disease. Compared with the inactive participants, the fully adjusted hazard ratio for cardiovascular disease mortality was 0.63 (95 percent confidence interval [CI], 0.55-0.72) in the insufficiently active participants, 0.60 (95 percent CI, 0.45-0.82) in the weekend warrior participants, and 0.59 (95 percent CI, 0.48-0.73) in the regularly active participants. The fully adjusted hazard ratios for all-cause mortality were similar between men and women.

[T]hese findings are good news for people with busy schedules, suggesting that less frequent sessions of physical activity offer considerable health benefits.

The authors explain that these findings are good news for people with busy schedules, suggesting that less frequent sessions of physical activity offer considerable health benefits. “We found that the insufficiently active, weekend warrior, and regularly active patterns were associated with reduced risks for all-cause, cardiovascular disease, and cancer mortality,” the authors write. “One of the most striking findings in the present study was that one or two sessions per week of moderate or vigorous-intensity leisure time physical activity was sufficient to reduce all-cause, cardiovascular disease, and cancer mortality risks regardless of adherence to prevailing physical activity guidelines.”

“The findings will be of great interest to those millions of people who find no time in their busy schedule for the three to five days a week of exercise regimen,” said Melvyn Rubenfire, MD, FACC, in an ACC.org Journal Scan. “While baseline measures were obtained, this type of observational study cannot discern to what degree compliance with other lifestyle measures over the eight years of follow-up reduced the risk of heart disease and cancer in persons willing to commit time to exercise.”

Cardiology

O’Donovan G, Lee I, Hamer M, et al. JAMA Intern Med 2017;Jan 9:[Epub ahead of print].

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High Activity in the Amygdala May Predict CV Events

Amygdalar activity may be an important predictor of cardiac events, according to a study published Jan. 11 in The Lancet.

Ahmed Tawakol, MD, et al., looked at 293 patients who were given a combined PET/CT scan to record their brain, bone marrow and spleen activity and inflammation of their arteries. The patients were then tracked for an average of 3.7 years to see if they developed cardiovascular disease. In this time, 22 patients had cardiovascular events, including heart attack, angina, heart failure, stroke and peripheral arterial disease. Those with higher amygdalar activity had a greater risk of subsequent cardiovascular disease and developed problems sooner than those with lower activity. Read More >>>

In a smaller cross-sectional study, 13 patients who had a history of post-traumatic stress disorder (PTSD) also had their stress levels assessed by a psychologist, underwent a PET scan and had their levels of C-reactive protein measured. Those who reported the highest levels of stress had the highest levels of amygdalar activity along with more signs of inflammation in their blood and the walls of their arteries.

Other research has also shown that the amygdala is more active in people with PTSD, anxiety and depression, but this is the first study to link regional brain activity to subsequent cardiovascular disease.

“Our results provide a unique insight into how stress may lead to cardiovascular disease. This raises the possibility that reducing stress could produce benefits that extend beyond an improved sense of psychological wellbeing,” said Tawakol. “Eventually, chronic stress could be treated as an important risk factor for cardiovascular disease, which is routinely screened for and effectively managed like other major cardiovascular disease risk factors.”

In an editorial, Ilze Bot, PhD, and Johan Kuiper, PhD, explain that “…more individuals experience psychosocial stress on a daily basis. Heavy workloads, job insecurity, or living in poverty… can result in chronically increased stress, which in turn can lead to chronic psychological disorders such as depression.” They conclude that moving forward, more research is needed to confirm the mechanism.


Tawakol A, Ishai A, Takx RA, et al. Lancet 2017;Jan 11:[Epub ahead of print].

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NCDR Study Looks at Safety of Vascular-Closure Device

Among patients who undergo a PCI procedure with femoral access, the risk of a vascular complication may be higher with the Mynx vascular-closure device compared with other vascular-closure devices, according to a study published Jan. 25 in the New England Journal of Medicine.

The study, led by Frederic S. Resnic, MD, FACC, was designed to assess the postmarketing safety of the Mynx device, and looked at data from 73,124 patients enrolled in ACC’s CathPCI Registry who received the device from Jan. 1, 2011 to Sept. 30, 2013. Read More >>>

Results showed that the Mynx device was associated with a “significantly greater risk” of the primary outcome of any vascular complication – a composite of access-site bleeding, access-site hematoma, retroperitoneal bleeding, or any vascular complication requiring intervention – as compared with other devices (absolute risk, 1.2 percent vs. 0.8 percent; relative risk, 1.59; 95 percent confidence interval, 1.4-1.78; p < 0.001). There was also a “significantly greater risk” of the secondary safety endpoints: access-site bleeding requiring treatment and postprocedural blood transfusion. However, the authors note that the absolute risk differences were small.

[T]he Mynx device was associated with a “significantly greater risk” of the primary outcome of any vascular complication [...] as compared with other devices.

The authors add that alerts for the Mynx device were “triggered early, persisted throughout the duration of surveillance, and were present in all subgroups of patients.” In addition, “the primary results were confirmed in an independent, more contemporary cohort of patients.”

In a related editorial, Jon Resar, MD, FACC, and Myron L. Weisfeldt, MD, FACC, explain that there may be mitigating factors associated with the use of the Mynx device. “There may have been selective use of this device for arteries that pose a subjectively greater challenge for closure without complications...,” they note. Further, there is a learning curve for using these devices.

They conclude that the study “highlights the value of professional society registries for postmarketing evaluation of device performance in clinical practice and emphasizes the need for the establishment of a National Evaluation System for Health Technology.”

Cardiology

Resnic FS, Majithia A, Marinac-Dabic D, et al. N Engl J Med; 2017;Jan 25:[Epub ahead of print].

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Hypertension Treatment and Control Varies by Race

Black and Hispanic patients, especially those who are younger or uninsured, may have poorer hypertension control compared with white patients, according to a study published Jan. 17 in Circulation: Cardiovascular Quality and Outcomes.

Anna Gu, MD, and colleagues identified 8,796 adults with hypertension using the National Health and Nutrition Examination Survey. The overall treatment rates were 73.9 percent, 70.8 percent and 60.7 percent for whites, blacks and Hispanics, respectively. Using the Joint National Committee (JNC) 7 recommendations, the researchers found that rates of hypertension control were highest among whites (42.9 percent), followed by blacks (36.9 percent) and Hispanics (31.2 percent). These differences were similar when recommendations from some of the JNC 8 panelists were applied.. Read More >>>

The percentage of hypertensive adults who reported taking an antihypertensive drug increased from 65.6 percent in 2003 to 2004, to 77.3 percent in 2010 to 2012, while overall hypertension control increased from 33.0 percent in 2003 to 2004 to 44.9 percent in 2010 to 2012. All groups experienced “substantial improvement” in hypertension control.

Diuretics were the most commonly used antihypertensive drugs, with about one-third of patients taking them. Black patients were most likely to receive combination therapy and they also had the highest average number of antihypertensive medications, even though they were less likely to achieve hypertension control. According to the researchers, this is consistent with previous findings that black patients have more aggressive forms of hypertension.

Racial disparities in hypertension treatment and control were more prominent among those without health insurance. Compared with white patients, the odds of achieving hypertension control were reduced by more than 40 percent in uninsured black and Hispanic patients. Racial differences in hypertension control were also wider among patients younger than 60 years old. Younger black and Hispanic patients were about 40 percent less likely than white patients to achieve hypertension control.

The authors conclude that “despite major improvements in hypertension treatment and control during the 10-year study period, the racial differences in these measures persist. Future efforts should focus on systematically exploring and addressing these differences.”

Cardiology

Gu A, Yue Y, Desai RP, Arquilian E. Circ Cardiovasc Qual Outcomes 2017;Jan 17:[Epub ahead of print].

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Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Hypertension, Stress

Keywords: ACC Publications, Cardiology Magazine, Amygdala, Angina Pectoris, Antihypertensive Agents, Arteries, Biomedical Technology, Blood Transfusion, Body Mass Index, C-Reactive Protein, Confidence Intervals, Cross-Sectional Studies, Diuretics, Follow-Up Studies, Heart Failure, Hematoma, Hypertension, Inflammation, Medically Uninsured, Myocardial Infarction, Neoplasms, Hematologic Neoplasms, Nutrition Surveys, Peripheral Arterial Disease, Registries, Risk Factors, Stress Disorders, Post-Traumatic, Stress, Psychological, Workload


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