Canadian Journal of Cardiology最新文献

{"title":"Absolute and Relative Risk of Exercise: When in Doubt, Let Them Play","authors":"Paul Dorian MD, MSc, FRCPC , Noah D.H. Lewis MD, FRCPC, ABIM , Paul Angaran MD, MSc, FRCPC , Kim A. Connelly PhD, MBBS","doi":"10.1016/j.cjca.2024.10.006","DOIUrl":"10.1016/j.cjca.2024.10.006","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 545-548"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Activity and Sedentary Behaviour Thresholds for Secondary Prevention of Coronary Heart Disease: Morbidity Survival Tree Analysis","authors":"Amanda Lönn PhD ,&nbsp;Theo Niyonsenga PhD ,&nbsp;Suzanne J. Carroll PhD ,&nbsp;Adrian Bauman PhD ,&nbsp;Rachel Davey PhD ,&nbsp;Robyn Gallagher PhD ,&nbsp;Nicole Freene PhD","doi":"10.1016/j.cjca.2024.11.025","DOIUrl":"10.1016/j.cjca.2024.11.025","url":null,"abstract":"<div><h3>Background</h3><div>There are no diagnosis-specific guidelines for moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) for coronary heart disease (CHD). This study aimed to identify thresholds of MVPA and SB associated with cardiovascular events.</div></div><div><h3>Methods</h3><div>This cohort study included individuals with CHD. MVPA and SB were self-reported, and health registries identified cardiovascular events in the years 2006-2022. Survival tree analyses identified thresholds of time associated with the risk of cardiovascular events. Thresholds were explored with the use of Cox regression models.</div></div><div><h3>Results</h3><div>There were 40,156 Australians, mean age 70 years, 62% men. Over a median 8.3 years, 3260 nonfatal cardiac events, 5161 total cardiac events, and 14,383 major adverse cardiovascular events (MACE) occurred. Thresholds for MVPA were 122 min/wk for nonfatal cardiac events and 94 min/wk for total cardiac events and MACE. Meeting MVPA thresholds was associated with an 18% lower risk for nonfatal cardiac events, 29% lower risk of total cardiac events, and 23% lower risk of MACE than not reaching the thresholds. Thresholds for SB were 4 and 10 h/d, respectively, for risk of total cardiac events and MACE. SB below thresholds was associated with a 14% lower risk of total cardiac events and an 18% lower risk of MACE. There were sex-specific thresholds for MVPA and SB.</div></div><div><h3>Conclusions</h3><div>To lower cardiovascular event risk, identified MVPA thresholds were lower (94-122 min/wk) than the public health guidelines (150 min/wk) in individuals with CHD. The SB thresholds associated with a lower risk of total cardiac events and MACE varied from 4 to 10 h/d.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 494-503"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Is Assessment and Optimization of Physical Activity and Sedentary Behaviour the Missing Link in Prevention of 21st Century Cardiovascular Disease?","authors":"Paul Poirier MD, PhD, FRCPC, FCCS, FACC, FAHA","doi":"10.1016/j.cjca.2025.01.002","DOIUrl":"10.1016/j.cjca.2025.01.002","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 519-521"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetics, Fitness, and Left Ventricular Remodelling: The Current State of Play","authors":"Stephanie J. Rowe BBiomed, MD, FRACP ,&nbsp;Youri Bekhuis MD ,&nbsp;Amy Mitchell BBiomedSc, BExSportSc ,&nbsp;Kristel Janssens BNurs ,&nbsp;Paolo D’Ambrosio MBBS, FRACP ,&nbsp;Luke W. Spencer BBiomed(Hons) ,&nbsp;Elizabeth D. Paratz MBBS, PhD, FRACP ,&nbsp;Guido Claessen MD, PhD ,&nbsp;Diane Fatkin MD ,&nbsp;Andre La Gerche MBBS, PhD","doi":"10.1016/j.cjca.2024.12.017","DOIUrl":"10.1016/j.cjca.2024.12.017","url":null,"abstract":"<div><div>Cardiorespiratory fitness (CRF) exists on a spectrum and is driven by a constellation of factors, including genetic and environmental differences. This results in wide interindividual variation in baseline CRF and the ability to improve CRF with regular endurance exercise training. As opposed to monogenic conditions, CRF is described as a complex genetic trait as it is believed to be influenced by multiple common genetic variants in addition to exogenous factors. Importantly, CRF is an independent predictor of morbidity and mortality, and so understanding the impact of genetic variation on CRF may provide insights into both human athletic performance and personalized risk assessment and prevention. Despite rapidly advancing technology, progress in this field has been restricted by small sample sizes and the limited number of genetic studies using the “gold standard” objective measure of peak oxygen consumption (VO₂peak) for CRF assessment. In recent years, there has been increasing interest in the heritability of numerous parameters of cardiac structure and function and how this may relate to both normal cardiac physiology and disease pathology. Regular endurance training can result in exercise-induced cardiac remodelling, which manifests as balanced dilation of cardiac chambers and is associated with superior CRF. This results in a complex relationship between CRF, cardiac size, and exercise, and whether shared genetic pathways may influence this remains unknown. In this review we highlight recent and relevant studies into the genomic predictors of CRF with a unique emphasis on how this may relate to cardiac remodelling and human adaptation to endurance exercise.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 364-374"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise and Fitness Quantification in Clinical Practice: Why and How; and Where Are We Going?","authors":"Julie Riopel-Meunier RD, MSc ,&nbsp;Marie-Eve Piché MD, PhD ,&nbsp;Paul Poirier MD, PhD","doi":"10.1016/j.cjca.2024.11.032","DOIUrl":"10.1016/j.cjca.2024.11.032","url":null,"abstract":"<div><div>Exercise and fitness quantification is increasingly recognized as a critical component in clinical practice, particularly within preventive cardiology. In this article we explore the multifaceted importance of exercise quantification in clinical settings, addressing preventive care, cost-effectiveness, psychosocial benefits, treatment planning, and monitoring progress. Quantifying exercise habits allows clinicians to evaluate risk profiles, prescribe tailored interventions, and monitor patient progress. The methodologies for exercise quantification are discussed. In preventive cardiology, adherence to guidelines from organizations such as the American Heart Association, the European Society of Cardiology, and the Canadian Cardiovascular Society is emphasized, with particular focus on high-intensity interval training and the central role of physical therapists/kinesiologists. Special populations, such as weekend warriors, those reflecting the \"fat and fit\" concept, athletes, and those at risk of overtraining syndrome, are considered in prescribing exercise. Future directions in exercise and fitness quantification include the integration of advanced wearable technology, personalized medicine, telemedicine, and promotion of active, walkable communities. The incorporation of behavioral science is highlighted as a missing component that can enhance long-term adherence to exercise regimens through motivation, behavior change techniques, patient-centered approaches, and continuous monitoring and feedback. This comprehensive approach aims to optimize cardiovascular health and overall well-being through individualized, evidence-based exercise interventions that are both effective and sustainable.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 427-442"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Remote Work Promote Exercise and Cardiovascular Health? Current Evidence and Future Directions","authors":"Aviroop Biswas PhD ,&nbsp;Stephanie A. Prince MSc, PhD","doi":"10.1016/j.cjca.2024.09.029","DOIUrl":"10.1016/j.cjca.2024.09.029","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 333-336"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Subjective Reports of Exercise Intensity Accurate in Recreational Athletes?","authors":"Jennifer Lewis MSc ,&nbsp;Robert F. Bentley PhD ,&nbsp;Kim A. Connelly MD, PhD ,&nbsp;Paul Dorian MD, MSc ,&nbsp;Jack M. Goodman PhD","doi":"10.1016/j.cjca.2024.11.008","DOIUrl":"10.1016/j.cjca.2024.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Quantifying exercise intensity accurately is crucial for understanding links between cumulative exercise and cardiovascular outcomes. Exercise burden, the integral of intensity and duration is often estimated from subjective self-reports which have uncertain accuracy.</div></div><div><h3>Methods</h3><div>We studied 40 endurance athletes (EAs) 41 to 69 years of age with &gt; 10 years of training history during a scripted outdoor 42-km cycling training session. Heart rate and power output (watts) were continuously measured. Reports of perceived exertion (RPE) using a word (RPE_Word) and numerical Borg scale (RPE_Borg) were obtained during and 30 minutes postride and were related to cardiac (heart rate) and metabolic (metabolic equivalent [MET] per minute) exercise endpoints.</div></div><div><h3>Results</h3><div>RPEs were highly variable, underestimating objective metrics of exercise intensity. Poor agreement was observed between either scale reported 30 minutes after exercise relative to heart rate: exercise RPE_Borg vs mean exercise heart rate and % heart rate_peak (both <em>r</em>_<em>s</em> = 0.29; <em>P</em> = 0.07), with no agreement between either scale vs other objective endpoints. Agreement between RPE_Borg and RPE_Word was good during exercise (<em>r</em>_<em>s</em> = 0.86; 95% confidence interval (CI), 0.75- 0.92; <em>P</em> = 0.001), but diminished postride (<em>r</em>_<em>s</em> = 0.54; 95% CI, 0.28-0.73; <em>P</em> = 0.001). Different cardiac and metabolic profiles during exercise and a contrast between metabolic and cardiac burden was greater in less fit individuals as they accrued greater cardiac (14,039 ± 2649 vs 11,784 ± 1132 heart rate per minute; <em>P</em> &lt; 0.01) but lower metabolic (808 ± 59 vs 858 ± 61 MET per minute; <em>P</em> &lt; 0.05) burden vs fitter EA.</div></div><div><h3>Conclusions</h3><div>Caution is advised in interpreting MET per minute and heart rate burden estimated from self-reports. Objective measurements of exercise intensity are required for detailed assessment of the risks and benefits of long-term exercise.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 531-541"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Prevention of Exercise-Related Sudden Cardiac Arrest or Death","authors":"Nathaniel Moulson MD, MHA, FRCPC ,&nbsp;Julien Wiese BSc ,&nbsp;Bradley J. Petek MD ,&nbsp;Reid Mitchell MSc ,&nbsp;Saul Isserow MBBCh, FRCPC ,&nbsp;James McKinney MSc, MD, FRCPC","doi":"10.1016/j.cjca.2024.11.014","DOIUrl":"10.1016/j.cjca.2024.11.014","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 549-552"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Cardiovascular Adaptations Following Aerobic Exercise Training Programs: A Systematic Review and Meta-analysis","authors":"Lisa M. Cotie PhD, RKin ,&nbsp;Isabela R. Marçal MSc ,&nbsp;Kimberley L. Way PhD ,&nbsp;Leanna S. Lee PhD ,&nbsp;Megan Patterson BHSc ,&nbsp;Mitchell Pearson ,&nbsp;Emilia Main MI ,&nbsp;Jane S. Thornton MD, PhD, CCFP ,&nbsp;Jennifer L. Reed PhD, RKin ,&nbsp;Laura Banks PhD, RKin","doi":"10.1016/j.cjca.2024.12.005","DOIUrl":"10.1016/j.cjca.2024.12.005","url":null,"abstract":"<div><h3>Background</h3><div>The influence of aerobic exercise training on cardiovascular adaptations in healthy males vs. females is unclear. This systematic review and meta-analysis summarized sex-based differences in cardiac adaptations following aerobic exercise training interventions in healthy adults.</div></div><div><h3>Methods</h3><div>Five electronic databases were searched from inception to June 2024. Cardiac adaptation data included peak oxygen uptake, heart rate, arteriovenous oxygen difference, systolic and diastolic blood pressure, stroke volume, cardiac output, left ventricular (LV) mass, LV end diastolic volume (LVEDV), LV end systolic volume (LVESV), and LV ejection fraction (LVEF). Meta-analyses were conducted in RevMan 5.4.</div></div><div><h3>Results</h3><div>Meta-analyses were conducted on 4 outcomes: LV mass, LVEDV, LVESV, and LVEF. The meta-analysis revealed no sex differences in LV mass (standardized mean difference = –0.01, 95% confidence interval [CI]: –0.29, 0.27, <em>P</em> = 0.97), LVESV (mean difference [MD] = 1.85, 95% CI: –3.45, 7.10, <em>P</em> = 0.5), or LVEF (MD = –0.9, 95% CI: –3.26, 1.46, <em>P</em> = 0.45) following aerobic exercise interventions. Meta-analyses revealed a sex difference in LVEDV: males show a greater improvement in LVEDV (MD = 7.67, 95% CI: 2.75, 12.59, <em>P</em> = 0.002) than females after aerobic exercise training. No other sex differences were observed in any of the other outcomes. The overall risk of bias was low, and the quality of evidence was moderate.</div></div><div><h3>Conclusions</h3><div>Aerobic exercise interventions were associated with a larger increase in LVEDV in men relative to women, yet no sex differences were found in cardiac morphology (LV mass) or functional indices (LVEF).</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 337-353"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sports-Related Sudden Cardiac Arrest in Canada: Incidence and Survival","authors":"Mika’il Visanji BHSc ,&nbsp;Katherine S. Allan MASc, PhD ,&nbsp;Manya Charette MSc ,&nbsp;Brian Grunau MD, MHSc ,&nbsp;Carla Roy BAHSc, ACP ,&nbsp;Judah Goldstein PhD ,&nbsp;Thérésa Choisi MSc ,&nbsp;Luc de Montigny PhD ,&nbsp;Steve Lin MD, MSc ,&nbsp;Jessyca Brissaw MD ,&nbsp;Lindsey Cameron-Dermann MSc ,&nbsp;Madison Donoghue BHSc ,&nbsp;Morgan Haines MD ,&nbsp;Jacob Hutton BA ,&nbsp;Armin Nowroozpoor MD ,&nbsp;Paul Olszynski MD, MEd ,&nbsp;Ryan Quinn MD ,&nbsp;Christian Vaillancourt MD, MSc ,&nbsp;Alix Carter MD, MPH ,&nbsp;Khadija Abawajy BSc ,&nbsp;Paul Dorian MD, MSc","doi":"10.1016/j.cjca.2024.11.017","DOIUrl":"10.1016/j.cjca.2024.11.017","url":null,"abstract":"<div><h3>Background</h3><div>Sports-related (Sr-) sudden cardiac arrest (SCA) is widely recognized in young competitive athletes, yet occurs more frequently in middle-aged, recreational athletes. Our objective was to describe the epidemiology and characteristics of Sr-SCA in 5 Canadian Provinces (population: 10.9 million).</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using emergency medical services records from consecutive out of hospital SCAs, for patients aged 18-85 years, who were treated, and whose SCA was from a presumed cardiac cause, during or ≤ 1 hour after sports activity.</div></div><div><h3>Results</h3><div>A total of 18,769 SCAs occurred between January 1, 2016 and December 31, 2020, of which 339 (1.8%) were sport-related. Most patients were male (93.8%; 318/339), with an average age of 58.1 ± 14.3 years old. The incidence of Sr-SCA was 1.2 per 100,000 person-years (95% confidence interval [CI], 1.1-1.4). Men had an almost 16-fold greater incidence than women (2.3 [95% CI, 2.1-2.6] vs 0.2 [95% CI, 0.1-0.2] per 100,000 person-years). Sr-SCAs occurred during 52 unique sports. Almost two-thirds occurred in recreational facilities (60.2%; 204/339), with high rates of bystander witnessed (75.6%; 256/339) and bystander cardiopulmonary resuscitation (73.6%; 248/337). Bystanders delivered automated external defibrillator shocks in 121 of 335 (36.1%) cases. Median emergency medical services response time was 6.2 (interquartile range, 4.8-8.9) minutes, with an initial shockable rhythm reported in 76.9% (249/324). More than half of those with known final vital status (52.0%; 167/321) survived to hospital discharge, which varied on the basis of sport.</div></div><div><h3>Conclusions</h3><div>Sr-SCA occurs infrequently, attracts high rates of bystander intervention, and has high survivability.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 3","pages":"Pages 522-530"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}