CME/CE: Cholesterol & Cardiorespiratory Fitness

CME/CE: Cholesterol & Cardiorespiratory Fitness

Published research suggests that cholesterol levels commonly rise as people age and then decrease later in life. “Abnormal lipids are important risk factors that play a critical role in the development of cardiovascular disease (CVD),” says Xuemei Sui, MD, MPH, PhD. “Therefore, identifying modifiable risk factors that can affect lipid profiles might help reduce the burden of CVD.” Some previous analyses have explored the effect of cardiorespiratory fitness (CRF) on changes in blood glucose and blood pressure and have shown beneficial changes with higher CRF levels. However, few studies have looked at the effect of CRF on age-related longitudinal changes of lipids and lipoproteins. “With the high percentage of sedentary people living in the United States, it is particularly important to understand the specific benefits of exercise and fitness and the roles they play in health,” says Dr. Sui. New Data In a study published in the Journal of the American College of Cardiology, Dr. Sui and colleagues used data from health exams performed during the Aerobics Center Longitudinal Study. The long-term study ran from 1970 to 2006 and included more than 11,400 men between the ages of 20 and 90. Patients did not have known high cholesterol, high triglycerides, CVD, and cancer at baseline. Each participant took a treadmill exercise test to determine their baseline CRF level and had their total cholesterol, LDL cholesterol, triglycerides, HDL cholesterol, and non-HDL cholesterol levels recorded. Important Findings Men with lower CRF levels had a greater risk of developing high cholesterol in their early 30s, according to the results. Men with higher levels of CRF did not develop high cholesterol until their...
Assessing Aspirin Use for CVD Prevention

Assessing Aspirin Use for CVD Prevention

Aspirin has been shown to help reduce the risk of major cardiovascular events and is recommended by the United States Preventive Services Task Force to prevent heart attacks and ischemic strokes. The drug is used as a primary strategy to help prevent a first occurrence of cardiovascular disease (CVD). It can also be used as secondary prevention for survivors of heart attacks and strokes to prevent additional cardiovascular events. The American Heart Association recommends daily low‐dose aspirin for people at high risk of heart attacks and regular use of low‐dose aspirin for heart attack survivors. “Preventing CVD events is particularly important,” says Arch G. Mainous, PhD. “Understanding physician recommendations for aspirin therapy is critical to the delivery of quality care.” Few studies, however, have evaluated patient use of aspirin and reported physician recommendations of aspirin therapy for CVD prevention.   Suboptimal Use In a study published in the Journal of the American Heart Association, Dr. Mainous and colleagues analyzed data from the National Health and Nutrition Examination Survey, 2011–2012 and examined aspirin use for preventing CVD. The study showed that only about 41% of high-risk individuals reported being told by their physician to take aspirin, and just 79% of these patients actually complied with the recommendation. Among low-risk patients, 26% were told by their physician to take aspirin, with nearly 77% complying. Several factors were identified as significant predictors of patients reporting that their physician recommended aspirin use for primary prevention. These included age, access to a regular source of care, education, and insurance status. Among high‐risk patients, significant predictors were age, race, and insurance status. Age, education, obesity,...
Systolic Hypertension & Cardiovascular Mortality

Systolic Hypertension & Cardiovascular Mortality

Studies have shown that isolated systolic hypertension (ISH)—defined as having a systolic blood pressure (BP) of 140 mm Hg or higher with a diastolic BP less than 90 mm Hg—is associated with elevated risks for cardiovascular disease (CVD) in older adults. “There has been a sense among clinicians that ISH is a benign condition in younger people,” explains Donald M. Lloyd-Jones, MD, ScM. “This had led some experts to label ISH as pseudo-hypertension, but the data to support this belief are limited.”   A Look at Younger Patients Few studies have looked at ISH in younger patients, despite research suggesting that its prevalence has increased in younger and middle-aged adults in recent years. For a study published in the Journal of the American College of Cardiology, Dr. Lloyd-Jones and colleagues assessed the risk for CVD in 27,000 patients aged 18 to 49 who did not have diagnosed coronary heart disease and were not taking antihypertensive therapy when they were assessed at baseline. Participants in the study were classified into one of the following groups: Optimal-normal BP (systolic BP <130 mm Hg, diastolic BP <85 mm Hg). High-normal BP (systolic BP 130 to 139, diastolic BP 85 to 89 mm Hg). ISH. Isolated diastolic hypertension (systolic BP <140 mm Hg, diastolic BP ≥90 mm Hg). Systolic and diastolic hypertension (systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg). With access to the Chicago Heart Association Study database and linkage to the National Death Index, the study team was able to assess follow-up data on the cause of death among participants as well as 35-year outcomes, with an average follow-up...
CME: Pneumonia & CVD: Making the Link

CME: Pneumonia & CVD: Making the Link

Studies have shown that patients with respiratory tract infections (RTIs) often have higher risk for cardiovascular events than those without RTIs. However, these studies have mostly assessed risk within the first few months after an RTI. Investigations that have assessed long-term risk have had conflicting results. By better characterizing the short- and long-term risks of CVD after an RTI, clinicians may be able to clarify whether these infections are risk factors for CVD and help explain the short- and long-term morbidity and mortality among patients with RTIs. Assessing Risk For a study published in JAMA, Sachin Yende, MD, MS, and colleagues examined community-based cohorts from the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities study (ARIC). “CHS enrolled patients older than 65 from 1989 to 1994, and we have follow-up data for about 15 years,” explains Dr. Yende. “The ARIC study enrolled patients aged 45 to 65 from 1987 to 1989, and has similar follow-up data.” To determine if the risk of CVD varied over 10 years following hospitalization for pneumonia, the authors identified pneumonia hospitalizations in the CHS and ARIC cohorts. These individuals were then matched with patients without pneumonia and monitored for the development of CVD. Risk was assessed within the 30 days of hospitalization, from 30 to 90 days, from 90 days to 1 year, and then annually thereafter. The researchers also sought to determine if any associations between pneumonia and CVD risk persisted after adjusting for traditional and cardiovascular risk factors. Persistent CVD Risk “Our study confirmed that the risk of CVD events is indeed higher among patients who have had pneumonia when...
Pneumonia & CVD: Making the Link

Pneumonia & CVD: Making the Link

Studies have shown that patients with respiratory tract infections (RTIs) often have higher risk for cardiovascular events than those without RTIs. However, these studies have mostly assessed risk within the first few months after an RTI. Investigations that have assessed long-term risk have had conflicting results. By better characterizing the short- and long-term risks of CVD after an RTI, clinicians may be able to clarify whether these infections are risk factors for CVD and help explain the short- and long-term morbidity and mortality among patients with RTIs. Assessing Risk For a study published in JAMA, Sachin Yende, MD, MS, and colleagues examined community-based cohorts from the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities study (ARIC). “CHS enrolled patients older than 65 from 1989 to 1994, and we have follow-up data for about 15 years,” explains Dr. Yende. “The ARIC study enrolled patients aged 45 to 65 from 1987 to 1989, and has similar follow-up data.” To determine if the risk of CVD varied over 10 years following hospitalization for pneumonia, the authors identified pneumonia hospitalizations in the CHS and ARIC cohorts. These individuals were then matched with patients without pneumonia and monitored for the development of CVD. Risk was assessed within the 30 days of hospitalization, from 30 to 90 days, from 90 days to 1 year, and then annually thereafter. The researchers also sought to determine if any associations between pneumonia and CVD risk persisted after adjusting for traditional and cardiovascular risk factors. Persistent CVD Risk “Our study confirmed that the risk of CVD events is indeed higher among patients who have had pneumonia when...
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