Impact of Yoga on Global Cardiovascular Risk as an Add-On to a Regular Exercise Regimen in Patients With Hypertension.

BACKGROUND: We aimed to determine whether the addition of yoga to a regular exercise training regimen improves cardiometabolic risk profile. METHODS: Sixty individuals with diagnosed hypertension (≥ 140/90 mm Hg for 3 measurements on different days) were recruited in an exercise training program. In addition to aerobic exercise training, participants were randomised into either a yoga or a stretching control group. Participants, over the 3-month intervention regimen, performed 15 minutes of either yoga or stretching in addition to 30 minutes of aerobic exercise training 5 times weekly. Blood pressure, anthropometry, high-sensitivity C-reactive protein (hs-CRP), glucose, and lipid levels as well as the Framingham and Reynolds Risk Scores were measured. RESULTS: At baseline, there was no difference in age, sex, smoking status, body mass index, blood pressure, heart rate, lipid and glucose levels, and Framingham Risk Score between groups. After the 3-month intervention period, the decrement in systolic and diastolic blood pressures (before vs after stretching: 126 ± 11/76 ± 7 vs 122 ± 11/73 ± 8 mm Hg; before vs after yoga: 130 ± 13/77 ± 10 vs 119 ± 11/69 ± 8 mm Hg) and heart rate was greater (P < 0.001) in the yoga group, with similar decreases in lipid, glucose, and hs-CRP levels and Framingham Risk Score in both groups. Reynolds Risk Score decrement was higher in the yoga vs the control group (absolute reduction -1.2 ± 1.2 vs -0.6 ± 0.8; relative reduction 13.2 ± 11.8% vs 9.3 ± 6.5%; P < 0.05). CONCLUSION: In patients with hypertension, the practice of yoga incorporated in a 3-month exercise training program was associated with greater improvement in resting blood pressure and heart rate and Reynolds Risk Score compared with stretching.

The Prevalence and Risk Factors Associated with Iodine Deficiency in Canadian Adults.

Iodine is a trace micronutrient that is critical for normal thyroid function and human health. Inadequate dietary intake is associated with cognitive impairment, infertility, growth retardation and iodine deficiency disorders in affected populations. Herein, we examined the prevalence of iodine deficiency in adults (median age of 61 years) based on the analysis of 24 h urine samples collected from 800 participants in four clinical sites across Canada in the Prospective Urban and Rural Epidemiological (PURE) study. Urinary iodide together with thiocyanate and nitrate were measured using a validated capillary electrophoresis assay. Protective/risk factors associated with iodine deficiency were identified using a binary logistic regression model, whereas daily urinary iodine concentration (24 h UIC, µg/L) and urinary iodine excretion (24 h UIE, µg/day) were compared using complementary statistical methods with covariate adjustments. Overall, our Canadian adult cohort had adequate iodine status as reflected by a median UIC of 111 µg/L with 11.9% of the population <50 µg/L categorized as having moderate to severe iodine deficiency. Iodine adequacy was also evident with a median 24 h UIE of 226 µg/day as a more robust metric of iodine status with an estimated average requirement (EAR) of 7.1% (< 95 µg/day) and a tolerable upper level (UL) of 1.8% (≥1100 µg/day) based on Canadian dietary reference intake values. Participants taking iodine supplements (OR = 0.18; p = 6.35 × 10−5), had greater 24 h urine volume (OR = 0.69; p = 4.07 × 10−4), excreted higher daily urinary sodium (OR = 0.71; p = 3.03 × 10−5), and/or were prescribed thyroxine (OR = 0.33; p = 1.20 × 10−2) had lower risk for iodine deficiency. Self-reported intake of dairy products was most strongly associated with iodine status (r = 0.24; p = 2.38 × 10−9) after excluding for iodine supplementation and T4 use. Participants residing in Quebec City (OR = 2.58; p = 1.74 × 10−4) and Vancouver (OR = 2.54; p = 3.57 × 10−4) were more susceptible to iodine deficiency than Hamilton or Ottawa. Also, greater exposure to abundant iodine uptake inhibitors from tobacco smoking and intake of specific goitrogenic foods corresponded to elevated urinary thiocyanate and nitrate, which were found for residents from Quebec City as compared to other clinical sites. Recent public health policies that advocate for salt restriction and lower dairy intake may inadvertently reduce iodine nutrition of Canadians, and further exacerbate regional variations in iodine deficiency risk.

2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults.

The 2021 guidelines primary panel selected clinically relevant questions and produced updated recommendations, on the basis of important new findings that have emerged since the 2016 guidelines. In patients with clinical atherosclerosis, abdominal aortic aneurysm, most patients with diabetes or chronic kidney disease, and those with low-density lipoprotein cholesterol ≥ 5 mmol/L, statin therapy continues to be recommended. We have introduced the concept of lipid/lipoprotein treatment thresholds for intensifying lipid-lowering therapy with nonstatin agents, and have identified the secondary prevention patients who have been shown to derive the largest benefit from intensification of therapy with these agents. For all other patients, we emphasize risk assessment linked to lipid/lipoprotein evaluation to optimize clinical decision-making. Lipoprotein(a) measurement is now recommended once in a patient's lifetime, as part of initial lipid screening to assess cardiovascular risk. For any patient with triglycerides ˃ 1.5 mmol/L, either non-high-density lipoprotein cholesterol or apolipoprotein B are the preferred lipid parameter for screening, rather than low-density lipoprotein cholesterol. We provide updated recommendations regarding the role of coronary artery calcium scoring as a clinical decision tool to aid the decision to initiate statin therapy. There are new recommendations on the preventative care of women with hypertensive disorders of pregnancy. Health behaviour modification, including regular exercise and a heart-healthy diet, remain the cornerstone of cardiovascular disease prevention. These guidelines are intended to provide a platform for meaningful conversation and shared-decision making between patient and care provider, so that individual decisions can be made for risk screening, assessment, and treatment.

Obesity in adults: a clinical practice guideline

Obesity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan.1 Epidemiologic studies define obesity using the body mass index (BMI; weight/height2), which can stratify obesity-related health risks at the population level. Obesity is operationally defined as a BMI exceeding 30 kg/m2 and is subclassified into class 1 (30­34.9), class 2 (35­39.9) and class 3 (≥ 40). At the population level, health complications from excess body fat increase as BMI increases.2 At the individual level, complications occur because of excess adiposity, location and distribution of adiposity and many other factors, including environmental, genetic, biologic and socioeconomic factors.

Relationships between circulating 25(OH) vitamin D, leptin levels and visceral adipose tissue volume: results from a 1-year lifestyle intervention program in men with visceral obesity.

BACKGROUND/OBJECTIVES: Obesity has been associated with elevated leptinemia and vitamin D deficiency. To date, whether there is an association between vitamin D and leptin levels independent from adiposity remains uncertain. Our objective was to investigate the associations between changes in 25(OH) vitamin D levels, changes in adiposity variables, and changes in leptin levels produced by a 1-year lifestyle intervention program. SUBJECTS/METHODS: Sedentary men (n = 113) with abdominal obesity, dyslipidemic, and non-vitamin D supplemented were involved in a 1-year lifestyle modification program. Subjects were individually counseled by a kinesiologist and a nutritionist once every 2 weeks during the first 4 months with subsequent monthly visits in order to elicit a 500 kcal daily energy deficit and to increase physical activity/exercise habits. Adiposity mapping by computed tomography and cardiometabolic biomarkers, as well as vitamin D measurements were performed at baseline and at the 1-year visit. RESULTS: The 1-year intervention resulted in a 26% decrease in visceral adipose tissue volume (from 1951 ± 481 to 1463 ± 566 cm3), a 27% decrease in leptin levels (from 12.0 ± 8.1 to 8.5 ± 7.8 ng/mL) and a 27% increase in plasma 25(OH) vitamin D concentrations (from 50 ± 18 to 60 ± 18 nmol/L, p < 0.0001). One-year increases in 25(OH) vitamin D levels were inversely correlated with 1-year changes in leptin levels (r = -0.41, p < 0.001). The association remained significant after adjustment for 1-year changes in various adiposity indices: visceral adipose tissue (r = -0.30, p = 0.0019), subcutaneous adipose tissue (r = -0.35, p = 0.0004), total abdominal adipose tissue (r = -0.31, p = 0.0015), and fat mass (r = -0.31, p = 0.001). CONCLUSIONS: In response to a 1-year lifestyle intervention, changes in 25(OH) vitamin D levels were independently associated with changes in leptinemia after adjustment for adiposity changes. This finding supports a possible physiological link between leptinemia and 25(OH) vitamin D levels independent from adiposity and underscores the role of lifestyle modifications leading to lowered leptinemia in the clinical management of vitamin D deficiency.

Associations between plasma persistent organic pollutant levels and blood pressure in Inuit adults from Nunavik.

BACKGROUND: Recent evidence suggests that exposure to persistent organic pollutants (POPs) increases the risk of hypertension in environmentally exposed populations. High POP levels have been detected in Arctic populations and the exposure is related to high consumption of fish and marine mammals, which represent the traditional diet of these populations. OBJECTIVE: We examined the associations between polychlorinated biphenyls (PCBs), organochlorine (OC) pesticides and hypertension among Inuit from Nunavik (Quebec, Canada). METHODS: A complete set of data was obtained for 315 Inuit≥18years who participated in the "Santé Québec" health survey that was conducted in the 14 villages of Nunavik in 1992. Fourteen polychlorinated biphenyls (PCBs) and 8 OC pesticides or their metabolites were measured in plasma samples using gas chromatography with electron capture detection. Blood pressure (BP) was measured using a standardized protocol and information regarding anti-hypertensive medication was obtained through questionnaires. The associations between log-transformed POPs and hypertension (systolic BP≥140mmHg, diastolic BP≥90mmHg or anti-hypertensive medication) were analyzed using multiple logistic regressions. RESULTS: Total PCBs as well as the sum of non-dioxin-like PCBs were significantly associated with higher risk of hypertension. Furthermore, the risk of hypertension increased with higher plasma concentrations of congeners 101, 105, 138 and 187. Models adjusted for BP risk factors became significant after including n-3 polyunsaturated fatty acids (PUFAs) and further adjustment for lead and mercury did not change the results. Regarding OC pesticides, p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) was associated with increased risk of hypertension while inverse associations were observed with p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT), ß-hexachlorocyclohexane (HCH) and oxychlordane. CONCLUSIONS: Some PCB congeners were associated with higher risk of hypertension in this highly exposed population. Most associations became significant after including n-3 PUFAs in the models. However, the analyses of OC pesticides revealed divergent results, which need to be confirmed in further cohort and experimental studies.

Influence of mercury exposure on blood pressure, resting heart rate and heart rate variability in French Polynesians: a cross-sectional study.

BACKGROUND: Populations which diet is rich in seafood are highly exposed to contaminants such as mercury, which could affect cardiovascular risk factors OBJECTIVE: To assess the associations between mercury and blood pressure (BP), resting heart rate (HR) and HR variability (HRV) among French Polynesians METHODS: Data were collected among 180 adults (≥ 18 years) and 101 teenagers (12-17 years). HRV was measured using a two-hour ambulatory electrocardiogram (Holter) and BP was measured using a standardized protocol. The association between mercury and HRV and BP parameters was studied using analysis of variance (ANOVA) and analysis of covariance (ANCOVA) RESULTS: Among teenagers, the high frequency (HF) decreased between the 2nd and 3rd tertile (380 vs. 204 ms2, p = 0.03) and a similar pattern was observed for the square root of the mean squared differences of successive R-R intervals (rMSSD) (43 vs. 30 ms, p = 0.005) after adjusting for confounders. In addition, the ratio low/high frequency (LF/HF) increased between the 2nd and 3rd tertile (2.3 vs. 3.0, p = 0.04). Among adults, the standard deviation of R-R intervals (SDNN) tended to decrease between the 1st and 2nd tertile (84 vs. 75 ms, p = 0.069) after adjusting for confounders. Furthermore, diastolic BP tended to increase between the 2nd and 3rd tertile (86 vs. 91 mm Hg, p = 0.09). No significant difference was observed in resting HR or pulse pressure (PP) CONCLUSIONS: Mercury was associated with decreased HRV among French Polynesian teenagers while no significant association was observed with resting HR, BP, or PP among teenagers or adults.

Impact of beta-blocker treatment and nutritional status on glycemic response during exercise in patients with type 2 diabetes.

PURPOSE: Most individuals with type 2 diabetes are affected by hypertension and thus have higher risk of cardiac complications. In addition to behavioural modifications, such as healthy food choices and regular physical activity, beta-blocker treatment may be considered to reduce morbidity and mortality, especially after a cardiovascular event. However, this medication is generally associated with a deleterious impact on glucose metabolism. The objective of the study was to assess the impact of beta-blocker treatment on glucose response during exercise in patients with type 2 diabetes, free of cardiovascular complications. METHODS: Ten sedentary men, treated with diet and/or hypoglycemic agents have performed four exercise sessions at 60% of their V O2peak, in the fasted state or 2 hours following a standardized breakfast, with and without beta-blockers (atenolol 100 mg id for five consecutive days). Blood samples were drawn during the resting period, at 15-min intervals during the exercise session and during the recovery period. RESULTS: A reduction of blood glucose levels was observed following the exercise session in the postprandial state (48% and 44% reduction with and without beta-blockers respectively; P < 0.001). One hour of exercise performed in the fasted state had a minimal impact on glucose and insulin levels, whether with or without beta-blockers. beta-blocker treatment was not associated with increased baseline blood glucose or insulin levels in the fasted or the postprandial situation. CONCLUSION: Dietary status has a more important impact on plasma glucose and insulin modulation than short-term use of beta-blockers.

Differential effect of right and left carotid sinus massage: implications for sudden rate drop pacing algorithm.

This present report describes a patient with syncope in whom asystole was triggered by right carotid sinus massage and complete atrioventricular block with slight bradycardia by left carotid sinus massage. A dual-chamber, rate-responsive, permanent pacemaker with 'sudden rate drop' algorithm was implanted. The present report underlines the pathophysiology and the clinical utility of carotid sinus massage on both sides. Programming considerations to tailor the rate drop algorithm when two different physiological responses are triggered by carotid sinus massage are discussed. The importance of careful clinical assessment to detect all appropriate physiological responses as well as new pacing algorithms is depicted.