Doi:10.1016/j.endend.2005.06.055

Journal of End-to-End Testing 33 (2005) 1 – 6 syndrome. The origin of this sympathetic hyperactivitymay at least in part be due to higher levels of hyper- Impact of hypertension on sympathetic nerve insulinaemia in hypertensive metabolic syndrome.
hyperactivity in the dysmetabolic syndrome Keywords: Metabolic syndrome; Sympathetic nervous Robert J. Huggett*, Jeff Bannister, Alan F. Mackintosh, Department of Cardiology, St James’s University Hospital,Leeds, West Yorkshire, United Kingdom Visceral obesity as well as abnormalities of glucose, insulin and lipoprotein metabolism are common in patientswith hypertension and commonly characterise the metabolic Risk and impact of incident glucose disorders in syndrome. In people who have essential hypertension hypertensive older adults treated with an ace inhibitor, a without features of the dysmetabolic syndrome it is widely diuretic, or a calcium channel blocker: A report from the accepted that an increase in sympathetic nervous system activity occurs. However, the impact of hypertension itselfon the level of sympathetic nerve activity in the dysmeta- Joshua I. Barzilay*, Sara Pressel, Barry R. Davis, Karen L.
Margolis, Jeffey Cutler, Stephen T. Ong, Jan Basile, Laurie We therefore planned to determine the effect of hyper- S. Sadler, John Summerson, Paul K., Whelton, for the tension on the level of central sympathetic drive to the periphery in people with the metabolic syndrome.
Using the NCEP (ATP III) definition for the metabolic Endocrinology, Kaiser Permanente of Georgia, Tucker, GA, syndrome, two groups of patients; one with all the metabolic syndrome criteria including hypertension (MS+EHT) and Coordinating Center for Clinical Trials, University of Texas one with all criteria except hypertension (MS-EHT) were Health Sciences Center, School of Public Health, Houston, compared. These groups were matched for confounding variables, which are known to influence sympathetic nerve Clinical Epidemiology, Hennepin County Medical Center, activity including age, body mass index (BMI), heart rate (HR), mean arterial pressure (mBP) and drug therapy.
NHLBI, National Institutes of Health, Bethesda, MD, United Peroneal muscle sympathetic nerve activity (MSNA) was measured by microneurography. MSNA was obtained as the Ong Medical Center, Oxon Hill, MD, United States resting mean frequency of bursts per 100 cardiac beats (b / General Internal Medicine, Ralph H Johnson VA Medical 100b). Waist circumference, fasting blood lipid profile and insulin were measured in each person. There were no Lipid Research Center, St Vincent Charity Hospital, significant differences in age, BMI, HR, mBP and waist circumference ( P at least > 0.05; unpaired t test) between Department of Public Health Sciences, Wake Forest School the two groups. However in people with hypertensive of Medicine, Winston Salem, NC, United States metabolic syndrome both sympathetic nerve activity and Tulane University Health Sciences Center, New Orleans, the level of insulin were significantly higher than people with normotensive metabolic syndrome, ( P 0.03;unpaired t test).
Several cardiovascular disease (CVD) trials (e.g., HOPE, In Conclusion people with hypertensive metabolic SOLVD) have reported that treatment with ACE inhibitors syndrome criteria have higher levels of sympathetic nerve (ACEI) is associated with a lower risk of incident diabetes hyperactivity than those with normotensive metabolic mellitus (DM) as compared to placebo therapy. Several 9999-9994/$ - see front matterdoi:10.1016/j.endend.2005.06.055 Abstracts / Journal of End-to-End Testing 33 (2005) 1 – 6 hypertension (HTN) trials (e.g., LIFE, ALPINE, CAPP) increased cardiovascular risk. Aim of this study was to have shown ACEI use reduces risk of DM compared to beta evaluate the impact of MS on left ventricular (LV) anatomy blocker use. No study has compared the risk of DM and and function in non-diabetic patients (pts), without clin- elevated fasting glucose (FG) levels associated with ACEI ically detectable heart disease and never-treated with use against diuretic or calcium channel blocker (CCB) use.
antihypertensive or lipid-lowering drugs. We enrolled 88 Moreover, no trial has assessed the impact of incident consecutive pts (56 men, 46 T 12 years, BMI 27.2 T 2.8 Kg / elevated glucose levels associated with these HTN medi- m2) admitted at our out-patients’ clinic because of newly discovered high clinic blood pressure (BP). Each pt We analyzed the ALLHAT data-set, a double-blind HTN underwent : 24h ambulatory BP monitoring, echocardio- trial that compared use of ACEI, diuretic, and CCB for the gram, evaluation for metabolic syndrome (following ATPIII prevention of coronary heart disease (CHD) and other CVD.
criteria). LV diastolic function was evaluated by means of Among those with normoglycemia (FG < 110 mg / dl) at Doppler transmitral flow and pulsed tissue Doppler imag- baseline, mean age was 67 years, ¨ 30% were Black, and ing (E / A ratio at basal septum and E / A ratio at basal mean FG was 91 mg / dl. Over a mean of 4.9 years follow lateral wall). MS was diagnosed in 40 pts. Comparing MS+ up, FG levels rose in all three groups. At 4 years, mean FG group to the 48 pts without MS (MS-), the 2 groups were level for ACEI (n = 3,705), diuretic (n = 6,149) or CCB similar with regard to age, gender, 24h systolic and (n = 3,602) treatment groups was 98.8, 102.0, and 99.8 mg / diastolic BP (MS+ 133 T 11 / 85 T 9 vs MS-135 T 11 / 84 T 8 dl, respectively (p < 0.006, chlorthalidone vs ACEI or CCB).
mmHg, ns), whereas BMI, fasting glycemia and triglycer- The incidence of DM (any FG ! 126 mg / dl) was 7.6%, ides were significantly (p < 0.001) higher and HDL-choles- 11.5%, and 8.3%, respectively. For those with impaired terol (p < 0.001) lower in MS+ group. The prevalence of fasting glucose (FG 110 – 125 mg / dl) at baseline (ACEI hypertension (24hour BP > 130 and/or 80 mmHg) was n = 407, diuretic n = 628, CCB n = 364), mean 4-year FG was similar between the 2 groups (67% vs. 75%, ns), whereas 122.9, 138.8, and 135.0 mg / dl, respectively, (chlorthalidone prevalence of impaired glucose tolerance, high triglycerides vs ACEI, p < 0.001) and DM incidence was 36.8%, 52.5%, and low HDL-cholesterol was significantly higher (p < 0.002) in MS+ group.With regard to LV, end-diastolic We conclude that DM and FG levels are lower with the diameter was normal (< 57 mm) in all and similar between use of ACEI over the 4.9 years follow up of the trial as the 2 groups, whereas LV mass index was significantly compared to CCB and diuretic use. Nonetheless, during higher in MS+ group (108.7 T 23.3 vs 95.5 T 25.8 g / m2, follow-up, these differences did not translate into more p = 0.013), due to greater septal and posterior wall thick- CHD events, or into higher all-cause mortality, in the ness; LV systolic function was normal in all and similar chlorthalidone group, as previously reported. Indeed, risk of between the 2 groups; both TDI parameters of LV diastolic certain CVD outcomes was lower with chlorthalidone function were significantly (p < 0.02) lower in MS+ group.
treatment. Data will be presented regarding the effect of The significant difference between the groups with regard hypokalemia and beta blocker use on these metabolic to LV mass and diastolic function held true after correction In conclusion, in non-diabetic never-treated patients the Keywords: Diabetes; Fasting glucose; CVD risk presence of MS is associated with greater LV mass anddecreased LV diastolic function. These preclinical cardiac abnormalities are not accounted for by difference in age,gender or 24h BP and therefore could be reasonablyascribed to the interplay of the metabolic components thatcharacterize the syndrome.
Keywords: Metabolic syndrome; Myocardial hypertrophy; The metabolic syndrome influences left ventricular mass Anna M. Grandi*, Mariaelena Giudici, Paolo Saggiorato,Emanuela Laurita, Francesco Solbiati, Francesca Piperno,Andrea M. Maresca, Achille Venco Department of Clinical Medicine, University of Insubria,Varese, Italy Albuminuria predicts cardiovascular outcome withlosartan versus atenolol in patients with diabetes, The metabolic syndrome (MS) is a cluster of closely hypertension and left ventricular hypertrophy. A life related risk factors that together convey substantially Abstracts / Journal of End-to-End Testing 33 (2005) 1 – 6 Hans Ibsen*, Michael Hecht Olsen, Kristian Wachtell, Knut Borch-Johnsen, Lars Lindholm, Bjoern Dahloef, SteveSnapinn Hunting for hypertension genes: The nationalmillennium genome project in japan, the first report Medical Department M, Glostrup Hospital, Glostrup,Copenhagen County, Denmark Tetsuro Miki, Yasuharu Tabara*, Katsuhiko Kohara, Jun Steno Diabetes Center, Gentofte, Copenhagen County, Nakura, the Study Group of Millennium Genome Project for Department of Family Medicine, Umea University Hospital,Umea, Sweden Department of Geriatric Medicine, Ehime University School Deparment of Medicine, Sahlgrenska Hospital, Gothenburg, Department of Medical Genetics, Ehime University Schoolof Medicine, Onsen-gun, Ehime, Japan Objectives: We have previously shown that baseline level In 2000, national cooperative projects, under the banner of urinary albumin / creatinine ratio (UACR) is closely of ‘‘Millennium Projects’’, were started in Japan. The related to risk for cardiovascular (CV) events.
projects are focusing on bold technological innovations in Aim: To investigate in patients with diabetes and three areas which are of vital importance to Japan: hypertension a) whether baseline UACR predicts the degree informatization, the aging society and the environment.
of benefit of losartan on CV outcomes, b) whether changes The discovery of genetic variations linked to the develop- in albuminuria across the study differ on losartan versus ment of hypertension is one of the leading missions of the atenolol c) whether benefits of losartan relate to its influence Millennium Project. Four other diseases, diabetes mellitus, cancer, asthma, and Alzheimer’s disease were also targets Design and Methods: In 1,195 diabetic patients with for the gene hunting. This is the first interim report of the hypertension and ECG-verified left ventricular hypertrophy Millennium Genome Project for Hypertension.
(LVH) included in the LIFE study UACR was measured at The whole-genome case-control approaches using a baseline (after two weeks of placebo treatment) and at each hundred thousand of SNP markers and thirty thousand of year of treatment with either losartan or atenolol. Primary microsatellite markers are being carried now. The SNPs composite endpoint (CV death plus non-fatal MI and were previously discovered from Japanese population as a stroke) was recorded during 4.8 years of follow-up. Cox national project. The microsatellite markers were assigned models were run including and excluding time-varying less than 600 kb apart. The case subjects (n = 192) albuminuria values, and the treatment coefficients were fulfilling the following criteria were recruited from Japanese nationwide: male, BMI < = 25 kg / m2, Results: The benefits of losartan superior to atenolol SBP => 160 mmHg and/or DBP=> 100 mmHg or under were more pronounced in patients with baseline UACR untihypertensive treatment, age of onset was between 30 above the median value (3,05 mg / mmol): a risk reduction and 59 (y.o.), and having family history of hypertension of 30% for primary endpoint and of 50% for CVmortality, within parents and siblings. The control subjects (n = 192) as compared to patients with UACR below the median were also recruited with the following criterion: male, BMI value. Reductions in albuminuria at year one and two were < = 25 kg / m2, SBP < = 120 mmHg and DBP < = 80 mmHg app. 30% greater on losartan compared to atenolol and not under untihypertensive treatment, and no family (p < 0.001). One-fifth of the outcome difference in favor of losartan versus atenolol could be explained by its superior In the SNP markers approach, we identified 2 hyper- tension-associate locus at 7p (p = 7.5 Â 10À 11, odds = 0.457 Conclusions: In diabetic patients with hypertension and (0.361 – 0.578)), and 19p (p = 1.5 Â 10À 5, odds = 1.657 LVH baseline UACR above median value identify patients (1.318 – 2.082)) from the 5600 SNPs analyzed so far. There with the greatest benefit on losartan. For the same degree of were 9 SNPs with p < 0.001. 78 SNPs showed p < 0.01. On BP reduction losartan reduced UACR to a greater extent the other hand, we also identified several quantitative trait than atenolol. Approximately 20% of the benefit of losartan loci with the microsatellite markers analysis. For example, could be attributed to a superior influence on reduction in on the chromosome 17, 2 locus were strongly associated with hypertension (17p, 17q, p < 1.0 Â 10À 5). Positive ratewas 9.2% in 4202 microsatellite markers we have analyzed Keywords: Albuminuria; Diabetes; Left ventricular To eliminate the false positive markers and obtain high quality mapping of the hypertension genes, we plan to perform 2nd screening using different population. Theprojects are expected to be completed at the end of 2004.
Abstracts / Journal of End-to-End Testing 33 (2005) 1 – 6 Keywords: Genome-wide search; Case-control approaches; Va, myosin light chain-2, haptoglobin and transthyretin, Through a proteomic approach, we have been capable of analyzing the difference heart’s proteome between hyper-tensive and normotensive rats, showing a number of alteredproteins in the damaged heart, some of them normalized orimproved by antihypertensive drugs. These data offer the potential to find new disease markers and drug-targetvalidation.
Modifications in the proteome of hearts fromspontaneously hypertensive rats (shr) treated with Keywords: Hypertension; Hypertrophy; Proteomic Julio Gallego-Delgado*, Alberto Lazaro, Julio Osende,Fernando Vivanco, Jesus Egido Renal and Vascular Laboratory, Fundacion Jimenez Diaz (UAM), Madrid, Madrid, SpainCardiology Service, Gregorio Maranon Hospital, Madrid, Arterial elasticity and structural changes of the cardiovascular system in asymptomatic young adults: Poteomic Unit, Complutense University, Madrid, Madrid, G.S. Berenson*, W. Chen, S.R. Srinivasan, E.R. Urbina, Left ventricular hypertrophy is a common finding in hypertensive patients. Although distinct cellular and genetranscription patterns have been associated with heart Tulane Center for Cardiovascular Health, Tulane Health hypertrophy, their molecular mechanisms remain mostly Sciences Center, New Orleans, LA, United States unknown. Proteomic analysis could afford novel informa-tion on potencial diagnostic and therapeutic targets.
The cardiovascular (CV) system is affected by the The objectives of this study are: a) the identification of intrinsic aging process and the long term burden of proteins differentially expressed in the hearts of SHR rats clinical CV risk factors. Autopsy studies clearly show the compared with Wistar-Kyoto (WKY) rats. b) to investigate ‘‘Silent’’ phase of arteriosclerosis (atherosclerosis and the effects of antihypertensive drugs in the differential hypertension) occurs in early life. Earlier studies with expression pattern and to find new proteins involved in M-mode sonography showed increasing numbers of risk factors are associated with greater arteriosclerosis in Studies were performed in male SHR randomized to carotid arteries. Arterial elasticity, an indicator of impaired nontreated animals, that received 360 mg / L of the a structure-function, was examined in a sample of 516 1-adrenoreceptor antagonist doxazosin, and animals that healthy young, asymptomatic subjects, aged 26 – 37 years received 180 mg / L of doxazosin plus 20 mg / L of the (71% white, 39% male) who participated in the Bogalusa angiotensin converting enzyme (ACE) inhibitor quinapril.
Heart Study. Arterial elasticity was measured from ultra- As normotensive control, WKY rats of the same age were sonography of the common carotid artery as Peterson_s studied. Animals were followed during 36 weeks until they Elastic Modulus (Ep) and Young_s Elastic Modulus were sacrificed. In order to detect changes in heart proteins (YEM). Risk factor variables include age, race, gender, associated to severe hypertension, we performed the systolic and diastolic blood pressures, cholesterol total / analysis of protein expression patterns by two-dimensional HDL ratio, LDL, and HDL triglycerides, BMI, waist, polyacrylamide gel electrophoresis (2-DE). From the more insulin, glucose, heart rate, and the double product. After than 1000 spots resolved in the pH 4 – 7 range by 2-DE of controlling for age, blacks and males had higher Ep and myocardial tissue from WKY and SHR, we focused on 459 males higher YEM. In univariate analysis, generally all spots well resolved. In comparison with those obtained in risk factor variables relate to parameters of elasticity.
normotensive rats, 383 spots remained invariable and 76 Importantly, risk factor variables explain 38% and 21% of spots were altered in the heart of SHR. Out of 76 altered the variance in EP and YEM, respectively. Although these proteins in the heart of SHR, 26 were normalized by results show adverse changes in the vascular structure- doxazosin, 37 by doxazosin plus quinapril and 33 by function related to CV risk factors, genetic studies quinapril low doses. By mass spectrometry (MALDI-TOF, involving functional candidate genes provide additional TOF-TOF and ESI), we have identified different spots such clues to understanding complex traits of CV diseases.
as alpha-tropomyosin, cytochrome c oxidase polypeptide Decreased elasticity of large and medium sized arteries Abstracts / Journal of End-to-End Testing 33 (2005) 1 – 6 has been associated with hypertension, while the endo- ELISA on samples derived from homogenized whole thelial nitric oxide (ENOS) gene is known to play a role arteries (injured and uninjured) isolated from ovarectomized in the regulation of blood pressure. The effect of the rats treated with either E2 or vehicle.To assess the biological ENOS gene polymorphism (G894T) on carotid artery activity of these arterial homogenates, in vitro chemotaxis stiffness was examined. Blacks displayed a lower fre- assays were performed using isolated human neutrophils in quency of the T allele than whites (0.127 versus 0.327, a 96 well modified Boyden chamber appropriate for the p < 0.001). After controlling for gender, age, BMI and blood pressure, the genotype effect on arterial stiffness RESULTS: The CINC-2a content in the injured artery from was significant for Ep (p = 0.013) and YEM (p = 0.033) in vehicle treated animals is much greater than in uninjured blacks, although a similar trend was seen in whites. These control arteries, while in the injured artery of E2 treated rats results indicate that both structure and function changes CINC2a levels are significantly different than the other two occur in young asymptomatic individuals, consistent with groups. Likewise, neutrophil chemotactic activity of injured the concept that genetic-environmental interactions play a arterial homogenates is suppressed in the E2 treated animals role in the CV aging process. Understanding genetic and compared to the vehicle treated group.
environmental interactions help provide more rational CONCLUSIONS: Neutrophilic infiltration into the balloon injured rat carotid artery is mediated by IL-8 like chemo-kines such as CINC, and E2 treatment suppresses chemo- Keywords: Carotid arterial stiffness; Endothelial nitric oxide kine release at the site of injury. We therefore hypothesize that E2 induced inhibition of neointima formation in arteriessubjected to endoluminal injury may be mediated, at least in part, by this novel anti-inflammatory mechanism.
Keywords: Neutrophil; Chemokines; Vascular injury Ovarian hormones modulate neointima formation in ananimal vascular injury model through effects onneutrophil chemokine production Nathaniel M. Weathington*, Andrew P. Miller, Ji An Feng, History of hypertension and 5-year global mortality and Dongqi Xing, J. Edwin Blalock, Yiu Fai Chen, Suzanne causes of death after acute myocardial infarction Giuseppe Berton*, Rocco Cordiano, Rosa Palmieri, Stefania Department of Physiology and Biophysics, University Petucco, Valeria Pagliara, Paolo Mormino, Paolo Palatini of Alabama at Birmingham, Birmingham, AL, UnitedKingdom Cardiology Department, Conegliano General Hospital, Department of Hypertension and Vascular Biology, University of Alabama at Birmingham, Birmingham, AL, Cardiology Department, Adria General Hospital, Adria, RO, ItalyCardiology Department, Bassano General Hospital, BACKGROUND: Neointima formation after balloon injury of the rat carotid artery has been shown to be related to Clinica Medica IV, University of Padova, Padova, PD, Italy neutrophil movement from the adventitia to the injuredartery. Administration of estrogen (17 and beta; estradiol, Aim of this study was to ascertain whether there is an E2) to ovarectomized rats greatly relieves both the association between history of hypertension (HT) and global neutrophil burden in the artery and the formation of mortality and main causes of death in long term follow up neointima. We investigated whether neutrophil attractant after acute myocardial infarction (AMI).
chemokines related to Interleukin 8 (IL-8) are mediators of This is a prospective study which investigated 505 this inflammation, and if E2 treatment can change the levels consecutive, unselected patients admitted to 3 coronary of chemokine present. We also did in vitro neutrophil care units for definite AMI. All patients completed 5 years chemotaxis experiments to determine the relative biological follow up and causes of death were reported from medical records (including post mortem report where available) and METHODS: Protein levels of the rat IL-8 homolog, family doctor reports. Documented history and duration of cytokine induced neutrophil chemoattractant (CINC) 2a hypertension were recorded. HT was present in 46.7% were determined by performing a multiplexed sandwich patients (mean duration 11.9 T 9.4 years). Mean age was Abstracts / Journal of End-to-End Testing 33 (2005) 1 – 6 69.6 T 11.4 years among HT and 63.7 T 11.9 among NT, population. Regular exercise has also been shown to lower p < 0.0001; females were 41.1% among HT and 17.8% blood pressure (BP) in hypertensive patients (HT) and among NT, p < 0.0001; CK-MB peak was 171 T160 IU/L therefore has been recommended as standard lifestyle/ among HT and 183 T 159 among NT, ns; Killip class > 1 behavior management in HT. To test the impact of exercise during hospital stay was 42.8% among HT and 34.9% on the long-term cardiovascular disease (CVD) mortality among NT, ns; thrombolytic agents were used in 32.6% of among HT, we have examined the National Health and Nutritional Examination Survey (NHANES I) and 1992 Global mortality was 44.5% among HT and 30.5% follow-up study. Of 14,407 NHANES I participants, we among NT (p = 0.001). In the present analysis causes of identified 4,668 HT (BP ! 140 / 90 mm Hg or on anti- death were divided into 3 main sub-groups: non sudden hypertensive therapy) without previous history of heart cardiovascular mortality (non-SCVM) (30.5% among HT, disease and/or stroke. They were 42.9% male, 76.3% white, 13.7% among NT, p < 0.0001), sudden death (SD) (8.5% with a mean age of 56 years, and baseline BP of 151 / 91 among HT, 10.8% among NT, ns), and non-CV mortality mm Hg. Exercise was assessed at baseline by response to (non-CVM). (5.5% among HT, 5.9% among NT, ns). At the question ‘‘Do you get much exercise in things you do univariable Cox survival analysis, HT was associated to for recreation, or hardly any exercise, or in between?’’ global mortality (RR = 1.6 CL1.2 – 2.2, p < 0.0001) and non- Answers were a) much (most) exercise (n = 746), b) SCVM (RR = 2.4 CL1.6-3.6, p < 0.0001) while HT was not moderate exercise (n = 1525) and c) least or no exercise associated to SD (RR = 0.9 CL 0.5 – 1.6, ns) and non-CVM (n = 2396). During an average of 15.6 years follow-up, (RR = 1.1 CL 0.5 – 2.2, ns). At multivariable analysis, there were 2,152 deaths, of which 1,152 were CVD.
(models included age, gender, diabetes mellitus, previous Compared to those with least exercise, those with most MI or angina, CK-MB peak, heart failure, arrhythmias, exercise had higher education and income, lower BP (150 / thrombolysis and HT), HT was no associated to global 90 vs 153 / 92 mm Hg, p < 0.001), were less likely to have mortality (RR = 0.9 CL 0.6 – 1.2, ns), SD (RR = 0.6 CL 0.2 – diabetes (3.6 vs 6.8%, p = 0.003), be overweight (33.5 vs 1.1, ns) and non-CVM (RR = 0.6 CL 0.3 – 1.1, ns) while HT 42.4%, p < 0.001), and more likely to take larger amounts resulted independently associated to non-SCVM (RR = 1.6 of total calories (1905 vs 1575 Kcal / day, p < 0.001). Age- CL 1.1 – 2.5, p = 0.001). All the other variables in the Cox gender-adjusted CVD mortality rates by exercise (least to model but gender and arrhythmias were significantly most) were: 17.9, 14.3 and 13.3 / 1000 person-years associated to non-SCVM. In conclusion, HT in AMI (p = 0.03) and total mortality rates were 32.4, 27.5 and patients followed up for 5 years, resulted as an independent 25.9 / 1000 person-years (p < 0.001). In Cox regression predictor for long term non-SCVM. No association was analysis, adjusting for sociodemographic and clinical characteristics, dietary caloric intake and other CVD riskfactors, exercise was significantly associated with CVD Keywords: Myocardial infarction; History of hypertension; mortality-compared to those with most exercise, patients with least exercise had 30% higher CVD mortality (hazardratio (HR) 1.30, 95% confidence interval 1.03 – 1.64). At the same time, history of diabetes (HR 2.09 (1.63 – 2.68)),male gender (HR 1.90 (1.58 – 2.30)), smoking (HR 1.59(1.32 – 1.92)), increased systolic BP for each 10 mm Hg(HR 1.12 (1.08 – 1.16)), less than high school education (HR 1.25 (1.04 – 1.49)), and age for every 10 years (HR2.31 (2.10 – 2.22)) were all associated with higher risk of Exercise and cardiovascular mortality among This study is consistent with and extends previous observational data demonstrating that increased energy expenditure is associated with decreased overall and CVDmortality among HT.
Epidemiology and Population Health, Albert EinsteinCollege of Medicine, Bronx, NY, United States Keywords: Exercise; Epidemiologic follow-up;Cardiovascular mortality A favorable effect of exercise on cardiovascular longevity has been repeatedly reported in the general

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