Prospective early adulthood risk factors for vasomotor symptoms in the Coronary Artery Risk Development in Young Adults study.

OBJECTIVE: Previous studies have assessed potential risk factors for vasomotor symptoms (VMS) beginning in midlife. We examined whether early adulthood risk factors predict VMS trajectories over time. METHODS: We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort. We included women who answered questions about VMS at three or more examinations (n = 1,966). We examined whether risk factors at baseline (when participants were aged 18-30 y; average age, 25 y) and the year 15 (Y15) exam (at ages 33-45 y; average age, 40 y) were associated with VMS trajectories from Y15 through Y35. Logistic regression models were used to evaluate the associations with VMS trajectories. RESULTS: We identified three trajectories of VMS presence: minimal (40%), increasing over time (27%), and persistent (33%). Baseline factors associated with persistent VMS over time included Black race, less than a high school education, depressive symptoms, migraines, cigarette use, and at Y15 hysterectomy. Baseline factors associated with increasing VMS over time included Black race and lower body mass index. Risk factors for bothersome VMS were similar and also included thyroid disease, although thyroid disease was not associated with persistence of VMS over time. Associations were similar among women who had not undergone hysterectomy and in Black and White women. CONCLUSIONS: Risk factors for VMS may be identified in early adulthood. Further examination of risk factors such as migraines and depressive symptoms in early adulthood may be helpful in identifying therapies for VMS.

A novel technique to estimate intravillous fetal vasculature on routine placenta histologic sections.

Placental histopathologic lesions are dichotomized into "present" or "absent" and have limited inter-rater reliability. Continuous metrics are needed to characterize placental health and function. Tissue sections (N = 64) of human placenta were stained with CD34 antibody and hematoxylin. Proportion of the villous space occupied by fetal vascular endothelium (%FVE; pixels positive for CD34/total pixels) was evaluated for effect sizes associated with pregnancy outcomes, smoking status, and subtypes of lesions (n = 30). Time to fixation>60 min significantly increased the quantification. Large effect sizes were found between %FVE and both preterm birth and intrauterine growth restriction. These results demonstrate proof-of-concept for this vascular estimation.

Adverse pregnancy outcomes and renal-vascular function in the early years after delivery.

Adverse pregnancy outcomes (APOs: hypertensive disorders, gestational diabetes, preterm birth, and placental disorders) are associated with cardiovascular disease risk or blood volume abnormalities. Traditional risk factors might not identify highest risk people in the early years after APO deliveries. Test the hypothesis that vascular function is worse, and plasma volume-regulating renal hormones are lower after delivery in people who did versus did not have an APO. Adult participants 6 mo-3 years postdelivery of a singleton infant participated in this cross-sectional study. Exclusion criteria included current smoking, current use of certain medications, and diabetes outside of pregnancy. Differences in measurements between participants with versus without APOs were determined with t tests or Wilcoxon tests. Associations of renal hormones with APO history were assessed with linear regression, adjusted for age, race, body mass index (BMI), and sodium consumption. Of 86 participants, 38 (44%) had an APO history. Those with APOs were more likely to identify as Black and had a higher BMI, 34.0 kg/m2 [interquartile range (IQR), 24.6, 39.3] versus 24.2 kg/m2 [IQR, 21.2, 31.3], P < 0.05. Most brachial and all aortic blood pressures were higher in those with APOs: median aortic blood pressure was 102/74 versus 96/68 mmHg, P ≤ 0.05. There were no differences in arterial stiffness or endothelial function between groups. Aldosterone was lower (54 [IQR, 28-84] vs. 80 [IQR, 39-150] pmol/L) in participants with past APOs. Blood pressures were higher, and aldosterone was lower in participants with past APOs. Associations of aldosterone with APO history persisted after adjustment. Neither renin nor aldosterone were related to vascular function.NEW & NOTEWORTHY Adverse pregnancy outcomes (APOs) are associated with cardiovascular disease (CVD) risk. Traditional CVD risk factors may not fully capture excess CVD risk soon after APOs. Vascular dysfunction and plasma volume irregularities may be detectable. We found people with APOs had worse blood pressures, higher BMI, and lower aldosterone levels versus those without APOs in the early years after delivery. Vascular function was similar between groups. Future research should assess vascular function and renal hormones at multiple timepoints during the perinatal period.

Associations of Physical Activity and Lactation Duration With Cardiometabolic Risk Factors: The CARDIA Study.

BACKGROUND: Physical activity (PA) and lactation benefit cardiometabolic health. OBJECTIVES: The purpose of this study was to describe the joint associations of PA and lactation with cardiometabolic risk. METHODS: We averaged PA across exams and summed lifetime lactation in Black and White parous women in the Coronary Artery Risk Development in Young Adults Study. Categories were created for PA (-PA:

Association of a Lifestyle Intervention with Blood Pressure Trajectories During Pregnancy and Postpartum in Women with Pre-pregnancy Overweight and Obesity.

OBJECTIVES: Healthy lifestyle, including healthy diet and physical activity, has been associated with lower blood pressure (BP). We hypothesized that overweight/obese women randomized to a lifestyle intervention beginning in early pregnancy would be less likely to have a higher BP trajectory. METHODS: The Health in Pregnancy and Postpartum study promoted a healthy lifestyle in pregnant and postpartum women with pre-pregnancy overweight or obesity. BP was measured at study visits at ≤ 16 and 32 weeks of pregnancy and 6 and 12 months postpartum. Latent class trajectories were constructed to identify groups of participants with similar BP patterns throughout the study period. Odds of being assigned to the higher BP trajectories between the intervention and control group were determined with logistic regression, adjusted for age, race, pre-pregnancy BMI, gestational weight gain, smoking during the study period, and household income. RESULTS: Of the 219 participants enrolled (44.3% Black participants, 55.7% White participants, mean age = 29.7 ± 0.3 years), 112 (51.1%) were randomized to the intervention. Two systolic and diastolic BP trajectory groups were identified (Low-Stable, Moderate-Increasing). Randomization to the lifestyle intervention was not associated with odds of Moderate-Increasing systolic (OR 0.83, 95%CI 0.4, 1.6) or diastolic (OR 0.67, 95%CI 0.3, 1.3) BP trajectory assignment. Those in the Moderate-Increasing BP groups had higher BMI and were more likely to have an adverse pregnancy outcome. CONCLUSIONS: A lifestyle intervention initiated in early pregnancy to help prevent excessive gestational weight gain was not associated with odds of specific BP patterns through pregnancy and postpartum.

Thirteen-Year Associations of Occupational and Leisure-Time Physical Activity with Cardiorespiratory Fitness in CARDIA.

PURPOSE: Differential effects on fitness are hypothesized to contribute to the opposing health effects of leisure-time physical activity (LTPA) and occupational physical activity (OPA). As such, this study examined cross-sectional and longitudinal associations of fitness with LTPA and OPA. METHODS: This study examined fitness associations with LTPA and OPA across 13 yr in the Coronary Artery Risk Development in Young Adults study (years 7 (baseline), 10, 15, and 20 (follow-up) examinations). Fitness was measured at baseline and follow-up via symptom-limited maximal graded exercise test (GXT) duration (in seconds), whereas LTPA and OPA were self-reported during each examination. Baseline and follow-up cross-sectional associations of LTPA (low, medium, high) and OPA (0, 1-6, and ≥6 months with OPA) with fitness were examined using linear regression. Longitudinal linear regression examined associations between 13-yr LTPA (low, medium, or high) and OPA (no, decreasing, or increasing) trajectories with fitness at follow-up, adjusted for baseline values. All models adjusted for center, sex, race, age, education, smoking history, alcohol intake, resting blood pressure, diabetes status, and body mass index. Stratified analyses examined associations by sex (female/male), race (Black/White), and LTPA groups. RESULTS: Compared with low, medium, and high LTPA were positively associated with fitness in all analyses ( P < 0.001). Reporting 1-6 or ≥6 months with OPA was negatively associated with fitness in cross-sectional follow-up models ( ß = -15.6 and -15.4, respectively; P ≤ 0.01). Longitudinally, those with increasing OPA had lower follow-up fitness compared with no OPA ( ß = -16.41, P < 0.01). Negative associations of OPA with fitness were not meaningfully different across sex and race groups. Significant LTPA-OPA interactions were observed ( P < 001). CONCLUSIONS: Physical activity research and public health promotion should consider domain-specific associations on cardiovascular health.

Effect of acute aerobic exercise on vaccine efficacy in older adults.

UNLABELLED: The most effective way of avoiding influenza is through influenza vaccination. However, the vaccine is ineffective in about 25% of the older population. Immunosenescence with advancing age results in inadequate protection from disease because of ineffective responses to vaccination. Recently, a number of strategies have been tested to improve the efficacy of a vaccine in older adults. An acute bout of moderate aerobic exercise may increase the efficacy of the vaccine in young individuals, but there are limited efficacy data in older adults who would benefit most. PURPOSE: This study sought to evaluate whether acute moderate-intensity endurance exercise immediately before influenza vaccination would increase the efficacy of the vaccine. METHODS: Fifty-nine healthy volunteers between 55 and 75 yr of age were randomly allocated to an exercise or control group. Antibody titers were measured at baseline before exercise and 4 wk after vaccination. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured at 24 and 48 h after vaccination. RESULTS: Delta CRP and IL-6 at 24 and 48 h were significantly higher after vaccination as compared to the sham injection. There were no differences in the levels of antibody titers against the H3N2 influenza strain between groups. However, women in the exercise group had a significantly higher antibody response against the H1N1 influenza strain as compared to the men, probably because of lower prevaccine titers. There were no significant differences in seroprotection between groups. CONCLUSIONS: Acute moderate aerobic exercise was not immunostimulatory in healthy older men but may serve as a vaccine adjuvant in older women.