© 2022 American Medical Association. All Rights Reserved. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1001/jamacardio.2022.1572
Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by irregular atrial activity. AF is related to increased risk of thromboembolic events, heart failure, and premature mortality. Recent advances in our understanding of its pathophysiology include a potentially central role for inflammation and presence of cardiovascular risk factors. The role of physical activity and exercise in the development and progression of AF, however, are not yet fully understood. Physical activity is protective for modifiable cardiovascular risk factors, including those associated with AF. Indeed, emerging research has demonstrated beneficial effects of exercise on AF-specific outcomes, including AF recurrence postablation. Counterintuitively, the prevalence of AF in veteran endurance athletes seems higher compared with the general population. In this review, we discuss the novel evidence and underlying mechanisms underpinning the role of exercise as medicine in the development and management of AF but also the counterintuitive detrimental role of excessive endurance exercise. Finally, we advocate regular (but not long-term high-intensity endurance) exercise training as a safe and effective strategy to reduce the risk of incident AF and to minimize the associated risk of secondary cardiovascular events.
Abstract Background The occurrence of acute ischemic stroke and intra-cranial hemorrhage (ICH) would result in severe stress for patients which may trigger cardiovascular (CV) events. In the present study, we aimed to report and compare the risks of CV events of patients who experienced ischemic stroke and ICH. Also, we analyzed the associations between the severities of stroke/ICH and risks of CV events. Methods A total of 413,000 and 131,313 patients who experienced acute ischemic stroke and ICH and did not have past history of acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF) and ventricular arrhythmia (VA) were identified from the Taiwan National Health Insurance Research Database, respectively. Risks of CV events within 90 days after stroke and ICH were analyzed and compared. Results There were 2.77% and 1.75% of patients who suffered from CV events after ischemic stroke and ICH, respectively. The risks of AMI (odds ratio [OR] 0.702, 95%CI 0.618-0.798), HF (OR 0.708, 95%CI 0.661-0.759), AF (OR 0.534, 95%CI 0.502-0.569) and any events (OR 0.626, 95%CI 0.598-0.655) were lower for patients with ICH compared to those with ischemic stroke (Figure 1). For patients with acute ICH, the risks of CV events expect for AF significantly increased from mild to severe ICH (Figure 2). For patients with acute ischemic stroke, all the risks of CV events were higher among patients with severe stroke. Conclusions When managing patients with acute ischemic stroke and ICH, the risks of acute CV events should also be kept in mind. The impacts of acute CV events on the long-term prognosis of these patients deserve a further study.
Letters18 June 2019β-Blocker Use in Pregnancy and the Risk for Congenital MalformationsAlena Shantsila, PhD, D. Gareth Beevers, MD, and Gregory Y.H. Lip, MDAlena Shantsila, PhDUniversity of Liverpool, Liverpool, United Kingdom (A.S., G.Y.L.)Search for more papers by this author, D. Gareth Beevers, MDUniversity of Birmingham, Birmingham, United Kingdom (D.G.B.)Search for more papers by this author, and Gregory Y.H. Lip, MDUniversity of Liverpool, Liverpool, United Kingdom (A.S., G.Y.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0156 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read Bateman and colleagues' article (1) with interest. Hypertension during pregnancy is common and is a major cause of maternal and perinatal mortality. It includes cases of high blood pressure that require pharmacologic treatment in the first trimester. Use of medicines during this part of pregnancy is particularly concerning, because it may affect organogenesis and thus cause severe fetal abnormalities.Bateman and colleagues report that treating hypertension with β-blockers in the first trimester has not been associated with an increased risk for overall or cardiac congenital malformations (1). Their findings were confirmed after adjustment for many ...References1. Bateman BT, Heide-Jørgensen U, Einarsdóttir K, et al. ß-Blocker use in pregnancy and the risk for congenital malformations: an international cohort study. Ann Intern Med. 2018;169:665-73. [PMID: 30326014]. doi:10.7326/M18-0338 LinkGoogle Scholar2. Lip GY, Beevers M, Churchill D, et al. Effect of atenolol on birth weight. Am J Cardiol. 1997;79:1436-8. [PMID: 9165181] CrossrefMedlineGoogle Scholar3. Lydakis C, Lip GY, Beevers M, et al. Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens. 1999;12:541-7. [PMID: 10371362] CrossrefMedlineGoogle Scholar4. Xie RH, Guo Y, Krewski D, et al. Association between labetalol use for hypertension in pregnancy and adverse infant outcomes. Eur J Obstet Gynecol Reprod Biol. 2014;175:124-8. [PMID: 24502872] doi:10.1016/j.ejogrb.2014.01.019 CrossrefMedlineGoogle Scholar5. Fitton CA, Steiner MFC, Aucott L, et al. In-utero exposure to antihypertensive medication and neonatal and child health outcomes: a systematic review. J Hypertens. 2017;35:2123-37. [PMID: 28661961] doi:10.1097/HJH.0000000000001456 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Liverpool, Liverpool, United Kingdom (A.S., G.Y.L.)University of Birmingham, Birmingham, United Kingdom (D.G.B.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0156. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee Alsoβ-Blocker Use in Pregnancy and the Risk for Congenital Malformations Brian T. Bateman , Uffe Heide-Jørgensen , Kristjana Einarsdóttir , Anders Engeland , Kari Furu , Mika Gissler , Sonia Hernandez-Diaz , Helle Kieler , Anna-Maria Lahesmaa-Korpinen , Helen Mogun , Mette Nørgaard , Johan Reutfors , Randi Selmer , Krista F. Huybrechts , and Helga Zoega β-Blocker Use in Pregnancy and the Risk for Congenital Malformations Brian T. Bateman , Krista F. Huybrechts , Sonia Hernandez-Diaz , Helle Kieler , and Helga Zoega Metrics 18 June 2019Volume 170, Issue 12Page: 909KeywordsDisclosureHypertensionPharmacokineticsPregnancyPrimary hypertensionRespiratory distress syndromeRisk managementSepsisStable coronary artery diseaseSystematic reviews ePublished: 18 June 2019 Issue Published: 18 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of major adverse cardiovascular events (MACE). Patients with AF typically have other concomitant cardiovascular risk factors—hypertension being one of the commonly associated conditions with a prevalence of up to 90% in major clinical trials of AF. The association of BP control and reduction in MACE in patients with AF does not come as a surprise as hypertension has been linked not only with adverse cardiovascular outcomes but also with an increased risk of AF. The importance of BP control has previously been shown in a large meta-analysis of 61 prospective observational studies involving 12.7 million person-years, i.e., that there is a linear relation between BP and vascular (and overall) mortality, starting from values of 115/75 mmHg. This IPD meta-analysis by the BPLTTC has shown that the presence of AF does not alter the treatment effects of antihypertensives.
