Results showed the overall mean total physical activity was 21.5 MET-h/d, mostly from occupational activity and among men. The association of cardiovascular disease with each 4 MET-h/d higher total activity (approximately one hour of brisk walking per day) was associated with a 6 percent lower risk of major vascular events, and a 9 percent, 5 percent, 6 percent and 12 percent lower risk of major coronary events, ischemic stroke, intracerebral hemorrhage and cardiovascular death, respectively.

The strength of the association was similar for occupational and nonoccupational physical activity and cardiovascular disease. However, the association was significantly attenuated for the association between occupational physical activity above 20 MET-h/d and cardiovascular disease subtypes, especially intracerebral hemorrhage.

The authors note the associations of total physical activity with major vascular events were similar among men and women and across different levels of sedentary leisure time activity, but weaker among individuals with high blood pressure. In an accompanying editorial comment, Scott A. Lear, PhD, and Salim Yusuf, MD, DPhil, FACC, state a unique finding of the study is “the lower risk that was associated with higher physical activity levels was observed with both occupational and nonoccupational activities, suggesting that any form of physical activity is beneficial.” They add, “If the entire population met the World Health Organization physical activity guidelines, whether through recreational, occupational, household, or other obligatory activities, this would prevent around 1 in 12 (or approximately 3.0 million) premature deaths in adults worldwide.”

Bennett DA, Du H, Clarke R, et al. JAMA Cardiol 2017;2:1349-58.

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Of the total patient group, 2,296 (52 percent) were women, with a mean age of 60.5 years and a median ACC/American Heart Association atherosclerotic cardiovascular disease (ASCVD) risk score of 11; their rate of MACE was 3 percent (131 events). A total of 676 patients (15.3 percent) had high-risk plaques, and 276 (6.3 percent) had significant stenosis.

The presence of high-risk plaque was associated with a significantly higher MACE rate (6.4 percent vs. 2.4 percent; hazard ratio [HR], 2.73). This association persisted after adjustment for ASCVD risk score and significant stenosis (adjusted HR, 1.72). Adding high-risk plaque to the ASCVD risk score and significant stenosis assessment led to a significant continuous net reclassification improvement (0.34; 95 percent confidence interval, 0.02-0.51).

"High-risk plaque may be an additional risk stratification tool, especially in patients with nonobstructive coronary artery disease, young patients, and women." — Maros Ferencik, MD, PhD, et al.

Among patients with nonobstructive coronary artery disease (CAD), presence of high-risk plaque increased MACE risk relative to patients without high-risk plaque (adjusted HR, 4.31 vs. 2.64).

There were no significant differences in MACE in patients with significant stenosis and high-risk plaque vs. those with significant stenosis but no high-risk plaque. High-risk plaque was a stronger predictor of MACE in women than in men (adjusted HR, 2.41 vs. 1.40, respectively) and in younger than in older patients (adjusted HR, 2.33 vs. 1.36).

“High-risk plaque may be an additional risk stratification tool, especially in patients with nonobstructive coronary artery disease, younger patients, and women,” the authors write. “The importance of the findings is limited by low absolute MACE rates and low positive predictive value of high-risk plaque.”

Ferencik M, Mayrhofer T, Bittner DO, et al. JAMA Cardiol 2018;Jan 10:[Epub ahead of print].

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The majority of patients had a less than 5 percent five-year risk of a cardiovascular event. Compared with the sustained smokers, the risk of MI and stroke was significantly reduced in both quitters with BMI gain (HR, 0.33; 95 percent CI, 0.16-0.70 for MI and HR, 0.75; 95 percent CI, 0.57-1.00 for stroke) and without BMI change (HR, 0.55; 95 percent CI, 0.37-0.83 for MI and HR, 0.75; 95 percent CI, 0.62-0.92 for stroke), but no significant association was found in quitters with BMI loss (HR, 0.91; 95 percent CI, 0.43-1.91 for MI and HR, 0.86; 95 percent CI, 0.57-1.31 for stroke), respectively. Nonsmokers had a lower risk of MI (HR, 0.37; 95 percent CI, 0.32-0.43) and stroke (HR, 0.68; 95 percent CI, 0.64-0.73) compared with sustained smokers.

“Clinicians should recommend quitting smoking to reduce the disease burden of MI and stroke despite the concern raised about the possible post-cessation weight change among current smokers,” the authors write. “Based on our data, we conclude that the post-cessation weight change is not a serious health concern for MI and stroke events in the middle-aged Korean men. Additional studies in the multi-ethnic cohorts are warranted to test the generalizability of these finding in other ethnic groups.”

Kim K, Park SM, Lee K. Eur Heart J 2018;Jan 6:[Epub ahead of print].

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There was variability in knowledge among the groups, with the patient having a higher level than the caregiver (4.9 percent; p < 0.001). Patient-caregiver dyads with the highest level of knowledge of self-care had better adherence to both a low-sodium diet and medication. Patient-caregiver dyads with the lowest level of self-care knowledge had lower adherence to a low-sodium diet, but medication adherence was not affected. The group with the highest knowledge was predominately white and had a higher education level. In that group, the patient had a higher left ventricular ejection fraction, fewer depressive symptoms and better autonomy support, and the caregiver had better quality of life.

The level of knowledge that patients and caregivers have about the pathology of HF, the definition of a low-sodium diet and the role of medications can affect patient outcomes. The complexity of the patient-caregiver dyad has not been previously studied, but this study recognizes that the interaction can have an impact. Education sessions need to address the education of the caregiver and recognize its impact on patient outcomes.

Bidwell JT, Higgins MK, Reilly CM, et al. Heart Lung 2018;47:32-9.

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