Physical activity as a risk factor for arrhythmogenic right ventricular cardiomyopathy caused by a pS358L mutation in TMEM43 in Newfoundland, Canada

The many benefits of regular physical activity (PA) have been well documented in the literature. PA has been shown to improve cardiovascular health and reduce the risk of cardiovascular disease. However, much less is known about the serious and sometimes fatal effects PA can have in individuals with certain rare cardiovascular diseases, such as arrhythmogenic right ventricular cardiomyopathy (ARVC). This cross sectional study sought to examine the association between PA and the onset and progression of ARVC caused by a p.S358L mutation in TMEM43. The sample consisted of 82 patients in who were diagnosed with ARVC caused by a p.S358L mutation in TMEM43 and had received an implantable cardioverter defibrillator (ICD) as primary prophylactic (PP) treatment. Survival analyses were done on several clinical cardiac symptoms, cardiac test abnormalities, and demographic variables from prior to ICD implant using the Kaplan-Meier product limit method to determine their association with time to appropriate firing of the ICD. Relative risk (RR) was calculated using the Cox regression model. Having an abnormal 24 hour Holter monitor test result prior to receiving the ICD and reporting high levels of moderate to vigorous PA were found to be associated with appropriate discharge of the ICD with RR’s of 4.1 (CI 1.2-13.7) and 12.8 (CI 3.7-45.2) respectively. A multivariate Cox regression model showed high levels of moderate to vigorous PA and having an abnormal 24 hour Holter monitor result prior to ICD implant to be strongly associated with appropriate firing of the ICD with RR’s of 28.1 (CI 6.9-114.2) and 16.4 (CI 3.8-71.5). These results suggest that high levels of moderate to vigorous PA could play an important role in the phenotypic expression of ARVC caused by a p.S358L mutation in TMEM43

Farming, foreign holidays, and vitamin D in Orkney

Orkney, north of mainland Scotland, has the world's highest prevalence of multiple sclerosis (MS); vitamin D deficiency, a marker of low UV exposure, is also common in Scotland. Strong associations have been identified between vitamin D deficiency and MS, and between UV exposure and MS independent of vitamin D, although causal relationships remain to be confirmed. We aimed to compare plasma 25-hydroxyvitamin D levels in Orkney and mainland Scotland, and establish the determinants of vitamin D status in Orkney. We compared mean vitamin D and prevalence of deficiency in cross-sectional study data from participants in the Orkney Complex Disease Study (ORCADES) and controls in the Scottish Colorectal Cancer Study (SOCCS). We used multivariable regression to identify factors associated with vitamin D levels in Orkney. Mean (standard deviation) vitamin D was significantly higher among ORCADES than SOCCS participants (35.3 (18.0) and 31.7 (21.2), respectively). Prevalence of severe vitamin D deficiency was lower in ORCADES than SOCCS participants (6.6% to 16.2% p = 1.1 x 10(-15)). Older age, farming occupations and foreign holidays were significantly associated with higher vitamin D in Orkney. Although mean vitamin D levels are higher in Orkney than mainland Scotland, this masks variation within the Orkney population which may influence MS risk

A first update on mapping the human genetic architecture of COVID-19

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Preventing and Managing Falls in Adults With Cardiovascular Disease: A Scientific Statement From the American Heart Association

Falls and fear of falling are a major health issue and associated with high injury rates, high medical care costs, and significant negative impact on quality of life. Adults with cardiovascular disease are at high risk of falling. However, the prevalence and specific risks for falls among adults with cardiovascular disease are not well understood, and falls are likely underestimated in clinical practice. Data from surveys of patient-reported and medical record–based analyses identify falls or risks for falling in 40% to 60% of adults with cardiovascular disease. Increased fall risk is associated with medications, structural heart disease, orthostatic hypotension, and arrhythmias, as well as with abnormal gait and balance, physical frailty, sensory impairment, and environmental hazards. These risks are particularly important among the growing population of older adults with cardiovascular disease. All clinicians who care for patients with cardiovascular disease have the opportunity to recognize falls and to mitigate risks for falling. This scientific statement provides consensus on the interdisciplinary evaluation, prevention, and management of falls among adults with cardiac disease and the management of cardiovascular care when patients are at risk of falling. We outline research that is needed to clarify prevalence and factors associated with falls and to identify interventions that will prevent falls among adults with cardiovascular disease.</jats:p

Effects of exercise dose on endogenous estrogens in postmenopausal women: A randomized trial

Exercise dose comparison trials with biomarker outcomes can identify the amount of exercise required to reduce breast cancer risk and also strengthen the causal inference between physical activity and breast cancer. The Breast Cancer and Exercise Trial in Alberta (BETA) tested whether or not greater changes in estradiol (E2), estrone, and sex hormone-binding globulin (SHBG) concentrations can be achieved in postmenopausal women randomized to 12 months of HIGH (300 min/week) vs MODERATE (150 min/week) volumes of aerobic exercise. BETA included 400 inactive postmenopausal women aged 50-74 years with BMI of 22-40 kg/m2. Blood was drawn at baseline and 6 and 12 months. Adiposity, physical fitness, diet, and total physical activity were assessed at baseline and 12 months. Intention-to-treat analyses were performed using linear mixed models. At full prescription, women exercised more in the HIGH vs MODERATE group (median min/week (quartiles 1,3): 253 (157 289) vs 137 (111 150); P smaller than 0.0001). Twelve-month changes in estrogens and SHBG were smaller than 10% on average for both groups. No group differences were found for E2, estrone, SHBG or free E2 changes (treatment effect ratios (95% CI) from linear mixed models: 1.00 (0.96–1.06), 1.02 (0.98–1.05), 0.99 (0.96–1.02), 1.01 (0.95, 1.06), respectively, representing the HIGH:MODERATE ratio of geometric mean biomarker levels over 12 months; n=382). In per-protocol analyses, borderline significantly greater decreases in total and free E2 occurred in the HIGH group. Overall, no dose effect was observed for women randomized to 300 vs 150 min/week of moderate to vigorous intensity exercise who actually performed a median of 253 vs 137 min/week. For total and free E2, the lack of differential effect may be due to modest adherence in the higher dose group