Sandra Weiss

Exercise Blood Pressure and Future Cardiovascular Death in Asymptomatic Individuals

Background— Individuals with exaggerated exercise blood pressure (BP) tend to develop future hypertension. It is controversial whether they have higher risk of death from cardiovascular disease (CVD). Methods and Results— A total of 6578 asymptomatic Lipid Research Clinics Prevalence Study participants (45% women; mean age, 46 years; 74% with untreated baseline BP <140/90 mm Hg [nonhypertensive]) performing submaximal Bruce treadmill tests were followed for 20 years (385 CVD deaths occurred). Systolic and diastolic BP at rest, Bruce stage 2, and maximal BP during exercise were significantly associated with CVD death. When we compared multivariate hazard ratios and 95% confidence intervals per 10/5-mm Hg BP increments, the association was strongest for rest BP (systolic, 1.21 [1.14 to 1.27]; diastolic, 1.20 [1.14 to 1.26]), then Bruce stage 2 BP (systolic, 1.09 [1.04 to 1.14]; diastolic, 1.09 [1.05 to 1.13]), then maximal exercise BP (systolic, 1.06 [1.01 to 1.10]; diastolic, 1.04 [1.01 to 1.08]). Overall, exercise BP was not significant after adjustment for rest BP. However, hypertension status modified the risk associated with exercise BP (Pinteraction=0.03). Among nonhypertensives, whether they had normal BP (<120/80 mm Hg) or prehypertension, Bruce stage 2 BP >180/90 versus ≤180/90 mm Hg carried increased risk independent of rest BP and risk factors (adjusted hazard ratio for systolic, 1.96 [1.40 to 2.74], P<0.001; diastolic, 1.48 [1.06 to 2.06], P=0.02) and added predictive value (net reclassification improvement, systolic, 12.0% [−0.1% to 24.2%]; diastolic, 9.9% [−0.3% to 20.0%]; relative integrated discrimination improvement, 14.3% and 12.0%, respectively). Conclusions— In asymptomatic individuals, elevated exercise BP carried higher risk of CVD death but became nonsignificant after accounting for rest BP. However, Bruce stage 2 BP >180/90 mm Hg identified nonhypertensive individuals at higher risk of CVD death.

Postoperative Pericardial Calcification Causing Diastolic Coronary Compression

Diastolic compression of the coronary arteries is a rare and likely acquired finding. Previous reports hypothesized that the artery becomes compressed against epicardial and pericardial scarring during ventricular filling, which leads to reduced coronary blood flow and clinical ischemia. We present two cases of isolated diastolic coronary artery compression resulting from contact against postoperative pericardial reflections that became calcified during the course of 10 to 20 years.

Value of Primordial and Primary Prevention for Cardiovascular Diseases: A Global Perspective

Worldwide, cardiovascular disease (CVD) is estimated to be the leading cause of death and loss of disability-adjusted life years. Although age-adjusted cardiovascular death rates have declined in several developed countries in past decades, rates of cardiovascular disease have risen greatly in low-income and middle-income countries [1]. CVD is now the leading cause of death in all developing regions, with the exception of sub-Saharan Africa [1]. It causes twice as many deaths as HIV, malaria, and tuberculosis combined. Furthermore, due to the increasing prevalence of risk factors and lack of appropriate preventive measures, a relatively younger population is affected by CVD in these countries [2]. This leads to the loss of many potential years of productive life and places a huge economic burden on these countries. Hence, efforts to produce even modest reductions in age-specific disease rates could have a very large economic impact.