Cardio Fitness In Early Adulthood Tied To Lower Risk Of CVD, Premature Death
Introducing and maintaining increased cardiorespiratory fitness during early adulthood may reduce the risk of premature death and cardiovascular disease (CVD) events, findings from the ongoing CARDIA study showed.
Every 1-minute increment of cardiorespiratory fitness (via a maximal graded exercise test) at baseline was associated with a lower risk of all-cause mortality (HR 0.82, 95% CI 0.76-0.88) and fatal or nonfatal CVD events (HR 0.89, 95% CI 0.82-0.96), reported Kelley Pettee Gabriel, PhD, of the University of Alabama at Birmingham, and colleagues.
The effect size was larger for women (HR 0.73, 95% CI 0.64-0.82) than for men (HR 0.87, 95% CI 0.80-0.96).
In addition, every 5% increment in cardiorespiratory fitness retained through year 20 of follow-up was associated with a lower risk of all-cause mortality (HR 0.89, 95% CI 0.79-0.99), "with no evidence of effect modification by race or sex," according to the findings in JAMA Network Open.
"Together, these findings provide novel evidence that the early-adulthood-to-midlife transition is a critical window for optimizing cardiorespiratory fitness to reduce risk of premature death and nonfatal or fatal CVD," wrote Pettee Gabriel and co-authors.
The research was aimed at addressing a gap in the understanding of cardiorespiratory fitness and its relationship to aging, the investigators explained.
"Across studies, the timing of the cardiorespiratory fitness assessment spanning the adult life course has varied, with midlife being the most common period, likely because of its proximity to chronic disease outcomes and mortality," the team wrote. "While this period has led to consistency in findings, it does not determine whether there are critical windows prior to midlife that are associated with risk of premature death and CVD events."
Furthermore, "relying solely on evidence established in midlife and older adult populations can lead to spurious conclusions that place a higher emphasis on cardiorespiratory fitness during later life stages simply because cardiorespiratory fitness during earlier periods of life was unknown," the group wrote. "In addition to the starting point, the current study also showed the importance of how much early-adulthood cardiorespiratory fitness was retained through midlife in association with subsequent risk of premature death."
Writing in an invited commentary, Hermes Florez, MD, PhD, of the Medical University of South Carolina and the Ralph H. Johnson Department of Veterans Administration Medical Center in Charleston, and colleagues said the results support previous studies showing an inverse association of fitness with all-cause mortality and CVD events, but "adds the value of assessing cardiorespiratory fitness in early adulthood."
In addition, the commentators said, the results "may offer a perspective for studies targeting cardiorespiratory fitness, CVD, and overall mortality. The CARDIA study provides evidence that when an individual starts efforts at cardiorespiratory fitness matters and that maintaining higher levels of cardiorespiratory fitness may have a protective association against and reduce risk of CVD."
Improved cardiorespiratory fitness may also help explain the so-called "fat but fit paradox," Florez and co-authors added, that all-cause and CVD mortality risk were not different between individuals with obesity and those with normal weight if they were both in the top 20% for cardiorespiratory fitness based on age and gender.
CARDIA (Coronary Artery Risk Development in Young Adults) is an ongoing prospective cohort study conducted at clinics in Birmingham, Alabama; Chicago, Minneapolis; and Oakland, California. Participants were adults ages 18 to 30 years who completed a maximal graded exercise test at baseline (1985 to 1986) and have regularly undergone follow-up examinations ever since. The exercise test was conducted at baseline, year 7, and year 20 to assess cardiorespiratory fitness.
The current analysis included 4,808 adults (average age 24.8, mean body mass index 24.4) who did not use beta-blockers at the time of any exercise test and who were alive and did not have CVD at year 20. A majority (56%) were women, 51% were Black, and the rest were white. Over the course of 68,751 person-years of follow-up analyzed, 6.3% of the participants died and 5.7% experienced a CVD event sometime after the 20-year follow-up assessment.
Study limitations, the researchers said, included the observational nature of the CARDIA study, the particular tests used to determine cardiorespiratory health, and that the specific age range studied could have affected the findings.
Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow
Disclosures
The CARDIA study was supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham, Northwestern University, the University of Minnesota, and the Kaiser Foundation Research Institute; additional support came from the CARDIA Fitness Study and the CARDIA Activity and Heart Failure Study.
Pettee Gabriel and co-authors reported no conflicts of interest.
Florez and co-authors reported no conflicts of interest.
Primary Source
JAMA Network Open
Source Reference: Pettee Gabriel K, et al "Analysis of cardiorespiratory fitness in early adulthood and midlife with all-cause mortality and fatal or nonfatal cardiovascular disease" JAMA Netw Open 2023; DOI: 10.1001/jamanetworkopen.2023.0842.
Secondary Source
JAMA Network Open
Source Reference: Florez H, et al "Importance of optimizing cardiorespiratory fitness in early adulthood and through midlife" JAMA Netw Open 2023; DOI: 10.1001/jamanetworkopen.2023.3637.
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10 Best Cardiologists Of India Advices On How To Prevent Heart Attack
New Delhi (India), March 29: In our daily lives, there are many factors that contribute towards unhealthy lifestyle and stressful days. They may lead you to the early risk of having heart attack. However, prevention of heart failure or heart attack can help you lead a long life. Here are some top cardiologists sharing their experiences and knowledge in suggestions on how you can predict the heart attack and prevent it from occurring.
Dr. Manoj Bansal, MBBS, MD, DM Cardiology (Gold Medalist), FCSI, Lead Cardiologist, Kokilaben Dhirubhai Ambani Hospital, Indore & Secretary, Cardiological Society of India, Indore
Heart diseases, together with high blood pressure and diabetes mellitus, are lifestyle diseases. We need to change our lifestyle and follow 10 golden rules: – Say no to the 6 S: salt, smoking, sedentary lifestyle, sugar, saturated fats, and stress. Walk for at least 45 minutes daily. Eat a well-balanced diet that includes fresh fruits, vegetables, beans, nuts, lentils, whole grains, and pulses. Remember to exercise daily. Do yoga and pranayama. Maintain a healthy weight. Get good-quality sleep. Get regular health screenings done, especially for blood sugar, blood pressure, and cholesterol levels. Manage stress and drink a lot of water.
Healthy habits have to be started early. Families with a history of heart disease need to be very careful.
Dr. G V P Rao, MBBS, DNB (Med), FICC(Card), PhD(Card), DSc (Card), MCSI, MACC, PhD ( Heart Failure), Sr. Consultant Cardiologist & Philanthropist, Specialist in Interventional Heart Failure, & Rehabilitation, Founder & CEO – Hridhayam Heart Clinic & Medi Heart Care Foundation, Nashik, Maharashtra
Heart attacks are one of the major causes of death worldwide, irrespective of age and gender. It is always better to know how to predict heart attacks for every individual and these are the few simple predictors for Heart attacks are characterized by sudden, profuse sweating associated with nausea and vomiting. Pain in the arms and chest are the most common indicators. Diseases like high blood pressure, diabetes, tobacco use, excessive body fat, and the size of the waist measurement play an important role. High LDL cholesterol (Bad cholesterol) or very Low HDL cholesterol (Good cholesterol) are the best predictors of the risk of heart attack. Some of the major A-typical predictors are shortness of breath with exertion and better with rest, sudden throat pain, back chest pain, right hand radiating pain, A blood test for high-sensitivity Troponin T indicates damage to the heart muscle.
Dr. Lal Daga, MBBS, DNB (Med.), DNB (Card) MNAMS, FESC (International), FEAC, Advanced Cardiology Training Programme (Seoul), Senior Consultant Interventional Cardiologist, Apollo Hospital, Ahmedabad
Early predictor of heart diseases and the most common symptoms include chest pain or discomfort, which can be excruciating or cause choking sensations. It can be breathlessness, sweating, palpitations, or early fatigue. 10% of patients can have upper abdominal discomfort or a burning sensation in the low chest as well. If these symptoms or signs are caught at a young age, many lives can be saved with earlier cardiac workup. These symptoms should work as an alarm to seek cardiologist assistance.
The patient with particularly in a high-risk group like diabetes, hypertension, family disease, kidney disease, or smokers, one should be highly cautious.
Some patients, e.G., the elderly, diabetics, cancer patients, and those with chronic diseases, may have mild or silent symptoms. These all patients can be benefited by early cardiac risk evaluation at onset by LpA,HsCRP, a lipid profile, homocysteine, and cardiac markers with an ECG, 2D ECHO, TMT, AND ANGIOGRAPHY. As patient-tailored management by a cardiologist. The earlier you start, the better your chances are of avoiding complications.
Dr. S. S. Murthy, MBBS, DNB, MNAMS, Director & HOD – Ayushman Hospital, Dwarka, New Delhi
Heart disease is still the leading cause of death worldwide. Typical symptoms like tightness in the chest are more obvious. Identifying the signs of a heart attack and seeking early medical help can make a lot of difference. Here are some symptoms to look out for: Heaviness in the center of the chest, which can radiate to the left arm or to both arms, Excessive sweating, shortness of breath, or ghabrahat, or palpitations, can indicate complications of a heart attack, which can be dangerous to life. Pain in the upper half of the body, a choking sensation in the throat, or dizziness or lightheadedness may be a sign of an impending heart attack.
It may also occur due to other conditions like cervical spondylosis, ear problems, dehydration,low BP, or a gastric problem. If it doesn't subside, medical help with an ECG should be sought immediately as it may indicate an impending heart attack.
Dr. Puneet K Verma, Interventional Cardiologist & Structural Heart Specialist, ACE HEART AND VASCULAR INSTITUTE, Mohali, Punjab
The common risk factors are absent in the majority of these patients, while sedentary lifestyles, substance abuse, faulty diets, and abnormal body fat distribution abound in them. Atypical symptoms like dizziness, lightheadedness, breathlessness, and fatigue can be some of the leading symptoms that may precede a heart attack. Early on, getting a blood sample tested for high-sensitivity troponin protein may help us diagnose and prevent a major heart attack. Recently, doctors have been out to validate the utility of troponin watches. Such a watch worn around the wrist can pick up the earliest trace of troponin in the bloodstream well before detection by conventional blood tests.Premature heart attacks can also occur in those with elevated blood levels of lipoprotein (a), high-sensitivity CRP (hs-CRP), and homocysteine. A simple CT scan assessment of the coronary arteries, either by the calcium score or by CT angiography, can also help us pick up the blockages early on and can help in the prediction and prevention of heart attacks.
Dr. Upendra Bhalerao, MS, MCh, DNB FIACS Consultant Cardiothoracic and Transplant Surgeon Jaslok hospital and Research centre, Mumbai
Coronary artery disease in the Indian population occurs at a much younger age than its prevalent age in the western world. Presentation in younger individuals can be chest pain, acute myocardial infarction, or severe cardiovascular collapse leading to sudden death. With awareness, lifestyle modification, and adequate care, coronary artery disease is preventable, predictable, and curable. Some major risk factors that lead to heart attacks include smoking, unhealthy food, stress, diabetes, obesity, high blood pressure, cholesterol, and a lack of physical activity.
Do proper health check-ups—at least once a year. Consume a diet rich in fruits and vegetables, whole grains, high-fiber foods, lean meats, and fat-free or low-fat dairy products. Minimize beverages and foods with added sugars. Regular exercise helps to lower blood pressure and combat other cardiovascular disease risk factors. Mindful meditation and deep breathing can help manage stress.
Dr. Abhinit Gupta, MD, DM (AIIMS, Delhi) Gold Medalist, FIACM, FSCAI Senior Consultant Interventional Cardiologist, Regency Health, Kanpur
A heart attack is a medical emergency when a blood clot blocks blood flow to the heart. Symptoms include tightness or pain in the chest, neck, back, or arms, as well as fatigue, an abnormal heartbeat, and anxiety. Women are more likely to have atypical symptoms than men. A heart attack is best suspected on clinical grounds in the presence of typical symptoms against the background of risk factors for CAD. Usually, serial ECGs and cardiac enzymes on blood samples, known as troponin tests, are sufficient in most cases to diagnose a heart attack.
Dr. Abhinit Gupta said that if you can treat someone much earlier, before they have symptoms, you will be far more effective in preventing cardiac events. Treatment ranges from lifestyle changes and cardiac rehabilitation to medication, stents, and bypass surgery.
Dr. Salve Jaysing, MD Med. (Mumbai) Director & Physician, Cardiologist, Dietologist, Mumbai
The Heart Attack is a leading cause of deaths all over the world. It's very common in the population who has modifiable RISK Factors such as smoking, diabetes, hypertension high cholesterol, obesity and a sedentary life style. HEART ATTACK ARE CAUSE BY THE OCCULUSION OF CORONARY ARTERIES because of sudden rupture of inner layers of arteries and formation of blood clot within it. Modifiable risk factors account for 90% heart attack in men and 94% in females.
Patients with pain in the center of chest with profuse sweating must rush to the doctor or hospital for an urgent ECG and if require, cardiac ENYMES investigation. After the with confirmation of diagnosis patient must chew and consume 300 mg of aspirin and rush to an ICCU Hospital Preferably with CATH LAB without any exertion where he either goes directly for coronary angiography and primary angioplasty within n9 minutes of chest pain or second option is to dissolve the clot by THROMBOLYTIC drugs.
Dr. Mohit M Bhagwati, DrNB Cardiology, Interventional Cardiologist and Incharge – Acute Cardiac Care, Holy Family Hospital, New Delhi
While predicting a heart attack may not be foolproof, taking proactive steps to reduce risk factors and monitor one's health can greatly improve the chances of preventing a heart attack. There are several factors that can increase the risk of a heart attack, including high blood pressure, high cholesterol levels, smoking, diabetes, obesity and a family history of heart disease. To predict the likelihood of a heart attack, we often use a combination of investigations. These may include an electrocardiogram (ECG), a stress test (Treadmill Test or Stress Echocardiogram), and few blood tests. Additionally, there are several warning signs that may indicate a heart attack is imminent like chest pain or discomfort, shortness of breath, nausea, lightheadedness, and cold sweats. If you or someone you know experiences any of these symptoms, it is important to seek medical attention immediately.
Dr. Kshitij R. Dadhe, MBBS, MD General Medicine, D.M. Cardiology (Gold Medalist), Consultant & Interventional Cardiologist – Asha Hospital, Nagpur
Cardiovascular disease accounts for approximately one-third of all deaths worldwide. Prevention of CVD requires timely identification of people at increased risk. Several prediction models have been developed, like QRISK, ASCVD Risk Score, etc., which calculate an individual's 10-year risk of having a heart attack, stroke, or heart failure. They consider various modifiable risk factors like high BP, high cholesterol, smoking, diabetes mellitus, obesity, physical inactivity (and other factors like stress, excess alcohol, lack of sleep, and a lack of a balanced diet) and non-modifiable risk factors like old age, male gender, and family history of premature CAD, race, postmenopausal status, and preeclampsia.
Those who are at increased risk should aggressively target control of modifiable risk factors through effective dietary, lifestyle, or drug interventions. Various AI tools are under development to further refine risk predictions.
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What Is Coronary Artery Disease?
Coronary artery disease (CAD) is the most common form of heart disease that results from damage to the large arteries, called the coronary arteries, that supply blood to the heart. Coronary artery damage occurs when plaque builds up within the walls of the arteries (atherosclerosis), leading to narrowing and weakening of the artery walls.
Over time, plaque buildup (deposits of cholesterol, a waxy, fatty substance) can get worse and restrict the amount of blood that is delivered to the heart, which can lead to a heart attack. Sometimes, symptoms are present before this occurs. This article will review symptoms, causes, and treatment of CAD as well as tips for managing the condition.
Coronary Artery Disease SymptomsThe most common symptom of CAD is angina, or chest pain. Clogged coronary arteries block blood flow to the muscle of the heart. This causes the heart to have to pump harder, especially during increased activity, to send blood throughout the body. This increased workload can result in pain, pressure, and a squeezing sensation in the chest, which is often the only early sign of CAD.
If angina is not present, having a heart attack can sometimes be the first sign of having CAD. A heart attack occurs when lack of blood and oxygen to the heart causes damage to the heart muscle, which can interfere with its ability to beat properly.
Other symptoms of coronary artery disease may include:
Symptoms of CAD can affect adults of any age over 20. While CAD is believed to progress slowly over time, it can progress more quickly over several months in patients with worsening atherosclerosis.
Over time, lack of proper blood supply to the heart from coronary artery disease can weaken the ability of the heart to pump blood throughout the body and can lead to heart failure.
What Causes Coronary Artery Disease?CAD is caused by the formation of plaque that builds up within the large arteries of the heart called the coronary arteries. Plaque builds up within arteries when excess cholesterol in the blood gets deposited within the walls of arteries. This plaque buildup narrows arteries, leading to atherosclerosis.
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Risk factors, many of which you can control, increase the risk of plaque buildup within the coronary arteries. These include several conditions including:
High blood pressure
High cholesterol
Diabetes
Obesity
Other risk factors for CAD include lifestyle habits that increase inflammation throughout the body and weaken the health of your heart and blood vessels. These include lack of physical activity, unhealthy eating, drinking too much alcohol, and smoking tobacco.
Testing to Diagnose CADCertain tests that examine your heart function can help diagnose CAD. These include:
Electrocardiogram (ECG or EKG): A test that measures the electrical activity of your heart to assess your heart rate and regularity of your heartbeat
Echocardiogram (echo): A test that uses ultrasound waves to examine the structure of your heart
Exercise stress test: A test that measures your heart rate while walking on a treadmill to examine how your heart is working when it has to pump more blood throughout your body
Chest X-ray: An X-ray image produced by radiation to examine the structure of your heart and lungs
Cardiac catheterization: A test in which a thin tube called a catheter is inserted into your arteries to check for blockage
Coronary angiogram: A test that examines the flow of blood through the coronary arteries
Coronary artery calcium scan: A computed tomography (CT) scan that examines the coronary arteries for plaque and calcium buildup
Treatment for CAD aims to prevent worsening of clogged arteries (atherosclerosis), reduce symptoms like angina, and improve blood flow and heart function. Treatment methods include healthy lifestyle habits like regular exercise and medical treatments like medication and surgery.
ExerciseExercise and regular physical activity can help improve heart function and blood flow throughout the body. It is important for both the treatment and prevention of CAD. The American Heart Association recommends at least a total of 150 minutes of moderate intensity exercise per week or 75 minutes of vigorous intensity exercise over tree to five days.
MedicationMedication is one of the most important treatments for CAD. Depending on condition severity and any other conditions you have, your healthcare provider may prescribe one or more of the following medications:
SurgeryFor severe CAD that continues to negatively impact heart function even with medication, surgery may be needed to improve the function of the coronary arteries. Surgery can include:
Cardiac catheterization: A procedure in which a small tube is inserted into a clogged, narrowed artery to expand it in size and improve blood flow to the heart
Coronary artery bypass graft (CABG): A procedure in which an artery or vein is removed from one part of the body, often the leg, and inserted near the heart to allow an alternate pathway around a narrowed artery to improve blood flow to the heart
CAD causes permanent damage to the heart and its blood vessels, so it cannot be reversed. That's why prevention is especially important to prevent the development of the condition and lifelong side effects.
Daily Life With CADLiving with CAD can affect your daily activities. Maintaining good overall health and making sure certain health markers stay within good ranges can help control your condition. This includes maintaining low cholesterol, low blood sugar, and low blood pressure.
High blood pressure can increase pressure within already damaged coronary arteries, which can further cause more damage. High cholesterol can worsen plaque buildup through greater levels of cholesterol in the blood. High blood sugar worsens inflammation throughout the body, which can accelerate damage to the coronary arteries.
Statin medication has been associated with a 13% decrease in mortality (death) while aspirin has been associated with a 10% reduced risk of heart attack and stroke among patients with underlying cardiovascular disease.
Outlook for CADHeart disease is the number one killer of both men and women, so early diagnosis and treatment of CAD is important for lifelong management. Without treatment, CAD can progressively get worse and further restrict blood flow to the heart, which can lead to a dangerous heart attack.
Taking your medication as prescribed and practicing healthy lifestyle habits, including getting regular exercise, eating a healthy diet, and stopping smoking, can help decrease symptoms and prevent coronary artery disease from worsening.
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