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The future of cardiology: research trends to watch

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Credit: Yuichiro Chino/Getty Images

Medical research is revolutionizing the evaluation and management of disorders of the heart’s valves, walls and chambers, collectively known as structural heart disease (SHD). But there is still more to learn. Home to one of the top US cardiology programmes, Atlantic Health System conducts dozens of clinical trials every year into diagnostic tools, therapeutic devices and medications for the millions of people suffering from SHD and other complex cardiac conditions. Cardiologist Linda Gillam outlines where the next research breakthroughs may come from.

Linda Gillam, Medical Director of Atlantic Health System’s Cardiovascular Service Line. Credit: Atlantic Health System

SHD is an extremely important and rapidly growing branch of cardiology. These conditions are very common and carry a heavy burden. Because SHD makes the heart work harder to pump blood, or restricts flow through the body, it can lead to many complications — including heart failure, heart attack, stroke, or even sudden death.

What treatments and technologies are you investigating?

Our research portfolio is heavily weighted toward advanced cardiovascular imaging and minimally invasive, catheter-based therapies for forms of SHD that have traditionally been treated with open-heart surgery. We see many opportunities for expansion in these areas, not only in our volume of clinical trials, but also as principal investigators in high-impact work that challenges the status quo.

Since SHD can lead to many serious complications, we are also investigating new approaches to supporting patients who have associated disorders. Our Heart Success Program is for patients with heart failure, and our Cardiovascular Rescue and Recovery Program for those with severe and complicated cardiac issues.

Where will this research have the greatest impact?

With Philippe Géneréux as the principal investigator, we are conducting a clinical trial called PROGRESS that could change treatment protocols for the 2.5 million Americans with aortic stenosis — narrowing of the valve that prevents it from opening fully. Current guidelines recommend valve replacement only if the disease is severe; patients with moderate aortic stenosis are closely monitored by their cardiologists. However, people with moderate aortic stenosis can suffer irreversible heart damage, go into heart failure or die before the guidelines call for treatment. In our study, older adults with moderate aortic stenosis and signs of heart damage or dysfunction receive either standard care or transcatheter aortic valve replacement (TAVR), a minimally invasive FDA-approved procedure.

We have a second study, Early TAVR — also led by Géneréux, to evaluate TAVR in asymptomatic severe aortic stenosis. If TAVR proves to be the way to go in either study, that will result in new guidelines, allowing treatment sooner.

TAVR is a dynamic field. This past September, Géneréux’s Morristown Medical Center team was the first in the United States to use the new FDA-approved SavvyWire — the first sensor-guided TAVR that delivers the valve while also monitoring haemodynamic status.

Which SHD is a high priority for further investigation?

Mitral regurgitation — blood flowing the wrong way through the left heart chambers due to a leaky mitral valve — is top of the list. A few years ago, we did a first-in-human trial of a transcatheter mitral valve replacement device. Now there are more than 20 mitral valve replacement devices in clinical trials, but none has emerged as the clear winner.

There are two broad categories of mitral regurgitation: primary, when the valve itself is the problem; and secondary, when the valves can’t close because of another issue. These groups of patients are treated differently. I served as a principal investigator, our imaging team provided study review, and our structural heart team was one of the highest enrollers in CLASP IID , the first randomized clinical trial to directly compare two transcatheter edge-to-edge repair approaches for primary mitral regurgitation. Results from the trial were published in September and the FDA has approved a new device.

What role is imaging playing in the diagnosis and treatment of SHD?

Until very recently, imaging tools for right-sided heart diseases, such as tricuspid valve regurgitation, were not as well developed as those for left-side diseases. What’s more, imaging was mostly two-dimensional and exclusively with echocardiography. Now we have 3-D approaches with echo, cardiac CT and MRI to illuminate the structure and function of all four valves.

We are also actively exploring the use of AI, for example to help interpret cardiac images and spot areas of concern for cardiologists to review. We expect exponential growth in using AI and machine learning for faster, more accurate and earlier detection of dangerous heart conditions.

What’s ahead for Atlantic Health?

In April 2022, we began offering the first fellowship in the United States for hypertrophic cardiomyopathy (HCM) and sports cardiology, led by Matthew Martinez. HCM is a genetic condition that causes the heart walls to become abnormally thick, and is the leading cause of sudden death in athletes. It’s estimated to affect one in 500 people worldwide, 85% of whom are undiagnosed. There is only one FDA-approved drug to treat certain types of HCM, which must be administered in a tightly controlled environment. We are the only site in New Jersey authorized to administer it. We are also involved in several studies into new drugs for this disease. We see an increasingly important role for subspecialists trained in HCM and sports cardiology to assess the health of athletes. And, of course, we will continue our work in SHD, advanced heart failure and rhythm disorders.

Click here to learn more about the cardiology research and clinical trials at Atlantic Health System

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Associations of Physical Activity and Heart Rate Variability from a Two-Week ECG Monitor with Cognitive Function and Dementia: The ARIC Neurocognitive Study

Affiliations.

• 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
• 2 Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
• 3 Courant Institute of Mathematical Sciences, New York University, New York, NY 10012, USA.
• 4 Welch Center for Prevention, Epidemiologic, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
• 5 Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC 27109, USA.
• 6 Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
• 7 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
• 8 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
• 9 Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 20205, USA.
• 10 Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
• PMID: 39000839
• PMCID: PMC11244549
• DOI: 10.3390/s24134060

Low physical activity (PA) measured by accelerometers and low heart rate variability (HRV) measured from short-term ECG recordings are associated with worse cognitive function. Wearable long-term ECG monitors are now widely used, and some devices also include an accelerometer. The objective of this study was to evaluate whether PA or HRV measured from long-term ECG monitors was associated with cognitive function among older adults. A total of 1590 ARIC participants had free-living PA and HRV measured over 14 days using the Zio ® XT Patch [aged 72-94 years, 58% female, 32% Black]. Cognitive function was measured by cognitive factor scores and adjudicated dementia or mild cognitive impairment (MCI) status. Adjusted linear or multinomial regression models examined whether higher PA or higher HRV was cross-sectionally associated with higher factor scores or lower odds of MCI/dementia. Each 1-unit increase in the total amount of PA was associated with higher global cognition (β = 0.30, 95% CI: 0.16-0.44) and executive function scores (β = 0.38, 95% CI: 0.22-0.53) and lower odds of MCI (OR = 0.38, 95% CI: 0.22-0.67) or dementia (OR = 0.25, 95% CI: 0.08-0.74). HRV (i.e., SDNN and rMSSD) was not associated with cognitive function. More research is needed to define the role of wearable ECG monitors as a tool for digital phenotyping of dementia.

Keywords: ECG; accelerometry; dementia; digital health; heart rate variability; physical activity; remote monitoring.

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Conflict of interest statement

Adam Spira received payment for serving as a consultant for Merck, received honoraria from Springer Nature Switzerland AG for guest editing special issues of Current Sleep Medicine Reports, and is a paid consultant to Sequoia Neurovitality, BellSant, Inc., and Amissa, Inc. There are no other conflicts of interest to disclose.

Flowchart of sample selection. Note:…

Flowchart of sample selection. Note: PA = physical activity, AF = atrial fibrillation,…

Diurnal patterns of MAD by…

Diurnal patterns of MAD by dementia, mild cognitive impairment, or cognitively unimpaired status.

• Zhang X., Li Q., Cong W., Mu S., Zhan R., Zhong S., Zhao M., Zhao C., Kang K., Zhou Z. Effect of physical activity on risk of Alzheimer’s disease: A systematic review and meta-analysis of twenty-nine prospective cohort studies. Ageing Res. Rev. 2023;92:102127. doi: 10.1016/j.arr.2023.102127. - DOI - PubMed
• Vítor J., Melita C., Rodrigues M., de Sousa D.A., Costa J., Ferro J.M., Verdelho A. Physical activity in vascular cognitive impairment: Systematic review with meta-analysis. J. Stroke Cerebrovasc. Dis. 2023;32:107133. doi: 10.1016/j.jstrokecerebrovasdis.2023.107133. - DOI - PubMed
• Livingston G., Huntley J., Sommerlad A., Ames D., Ballard C., Banerjee S., Brayne C., Burns A., Cohen-Mansfield J., Cooper C., et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396:413–446. doi: 10.1016/S0140-6736(20)30367-6. - DOI - PMC - PubMed
• Liu F., Wanigatunga A.A., Schrack J.A. Assessment of Physical Activity in Adults Using Wrist Accelerometers. Epidemiol. Rev. 2022;43:65–93. doi: 10.1093/epirev/mxab004. - DOI - PMC - PubMed
• Maher C., Szeto K., Arnold J. The use of accelerometer-based wearable activity monitors in clinical settings: Current practice, barriers, enablers, and future opportunities. BMC Health Serv. Res. 2021;21:1064. doi: 10.1186/s12913-021-07096-7. - DOI - PMC - PubMed
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Article Contents

Introduction, conclusions, acknowledgements.

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Hot topics and trends in cardiovascular research

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Diane Gal, Bart Thijs, Wolfgang Glänzel, Karin R Sipido, Hot topics and trends in cardiovascular research, European Heart Journal , Volume 40, Issue 28, 21 July 2019, Pages 2363–2374, https://doi.org/10.1093/eurheartj/ehz282

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Comprehensive data on research undertaken in cardiovascular medicine can inform the scientific community and can support policy building. We used the publication output from 2004 to 2013 and the 2014 references to these documents, to identify research topics and trends in the field of cardiovascular disease.

Text fragments were extracted from the titles and abstracts of 478 000 publications using natural language processing. Through machine-learning algorithms, these text fragments combined to identify specific topics across all publications. A second method, which included cross-references, assigned each publication document to a specific cluster. Experts named the topics and document clusters based on various outputs from these semi-automatic methods. We identified and labelled 175 cardiovascular topics and 20 large document clusters, with concordance between the approaches. Overarching, strongly growing topics in clinical and population sciences are evidence-based guidance for treatment, research on outcomes, prognosis, and risk factors. ‘Hot’ topics include novel treatments in valve disease and in coronary artery disease, and imaging. Basic research decreases its share over time but sees substantial growth of research on stem cells and tissue engineering, as well as in translational research. Inflammation, biomarkers, metabolic syndrome, obesity, and lipids are hot topics across population, clinical and basic research, supporting integration across the cardiovascular field.

Growth in clinical and population research emphasizes improving patient outcomes through novel treatments, risk stratification, and prevention. Translation and innovation redefine basic research in cardiovascular disease. Medical need, funding and publishing policies, and scientific opportunities are potential drivers for these evolutions.

Current policies for public funding of health research increasingly focus on innovation, with a final goal to improve health outcomes. 1 To support policies, roadmaps are established, for example for diabetes 2 and respiratory 3 diseases. In the USA, the joint Academies developed a document to guide national policy in health 4 with a dedicated document for cardiovascular medicine 5 that includes general directions for research. In Europe, building a roadmap for cardiovascular research is one of the tasks of the ERA-CVD network. 6 Expert opinion guides the exercise but a macro and global-level overview of past cardiovascular research can enrich the debate and strengthen the basis for recommendations. The breadth of cardiovascular research is astounding, 7 with research undertaken across a variety of institutions and with each piece of research having its own scope/focus or topic. It is thus challenging to review and summarize all the research that has been undertaken.

Identifying all the relevant research is the first hurdle to overcome, then classifying or identifying topics of research is the next significant hurdle. Journal classification systems offer little assistance, as they are not granular enough to identify more specific topics within broader fields. Thesauri or medical dictionaries, such as PubMed or the International Classification of Diseases (ICD), do not offer an overview of time-dependent changes in topics or changing concepts.

Identifying key topics using semi-automatic approaches based on text analysis is an alternative solution that takes advantage of recent developments in high-level informatics. As this is not reliant on a predefined classification, it may result in different outcomes. Various methods use natural language processing (NLP) to extract topics or clusters from text. For example, the bibliometric community has compared the results when varying methods are applied to a set of astronomy publications, focusing on the importance having topic expert input throughout the process. 8 The recent CardioScape project analysed abstracts of 2476 research projects awarded 2010–12 as published by funding bodies. The authors assigned research project to topics, based on the abstract text, using a semi-automatic process that tested and trained the data to more quickly allocate abstracts to a topic than depending solely on expert review. They produced a detailed taxonomy or classification of cardiovascular research based on the list of topics of the European Society of Cardiology, creating a hierarchical list of over 600 topics. 9

Here, we aim to identify topics in published cardiovascular research and their evolution between 2004 and 2013, assessing whether they have appeared, disappeared, or changed over time. In a comprehensive approach, we use a combination of existing methods for text mining, network analysis, and clustering, and further develop these tools to handle a large dataset of >400 000 publications.

In our study, we use two different and complementary approaches. A first one detects topics across the collection of publications, counting number of documents, and relations between topics. A second one maps document networks into clusters with an identifiable subject of research. These approaches are described here in brief, with more detail provided in the Supplementary material online .

Data sources

The dataset includes the reference, abstract, address, and citation data for 478 006 cardiovascular publications from 2004 to 2013, including 2014 references to these documents, using an expert informed search strategy and references to core cardiovascular journals, as previously published. 7 The documents span across >5000 journals, and include cardiovascular publications in leading general journals in medical and life sciences ( Supplementary material online , Table S1 ). We obtained the data from Clarivate Analytics Web of Science Core Collection (WoS) through a custom data license held by ECOOM, KU Leuven.

Text pre-processing

We took all titles and abstracts of the above publications, and extracted the noun phrases (text fragments of various lengths) using the NLP framework developed at Stanford. 10   Supplementary material online , Figure S1 illustrates the subsequent data flow for the analysis.

Topic modelling

For this approach, we applied latent Dirichlet allocation (LDA) 11 to the above-mentioned text fragments from the titles and abstracts of all publications. This LDA approach groups the text fragments to identify topics and allocates documents to topics. In this approach, a document contributes to several topics. Of note, general terms or terms that are used frequently across the majority of documents are filtered out as part of the methodology, resulting in groups of highly specific text fragments and, consequently, topics, as illustrated in Supplementary material online , Figure S2 .

At least three cardiovascular experts (listed in the Acknowledgements section) named each topic based on a set of the top 40 text fragments representing a topic. Further rounds of cross-review validated and consolidated the naming process. A final review of all topics ensured naming consistency across the topics and allowed for additional expert-based classification as clinical, basic, or population research.

We then calculated the number of documents that contributed to a topic, using probability analysis in LDA. Furthermore, we calculated the co-occurrence of topics in the publications, and visualized the outcome of this network analysis using VOSViewer ( www.vosviewer.com ). 12

Document clustering

For this second approach, the dataset was reduced to two periods, and we analysed the cardiovascular publications from 2006 to 2008 and those from 2011 to 2013, separately. For each time period, we then calculated the similarities between documents based on the noun phrase text fragments from the titles and abstracts of all publications and based on the references in these publications, using adapted cosine calculations and a hybrid document clustering algorithm, as previously described. 13 We then applied the Louvain 14 community detection algorithm to identify clusters of similar documents. For this method, each document is only located in one cluster. Subsequently, we applied the DrL/OpenOrd algorithm 15 to map and visualize the documents and clusters. We used R 16 in a high-powered cloud-based parallelized computing environment for all operations.

We identified and described the core documents, 13 the most common text fragments, as well as, the most highly cited documents and the most productive authors in each cluster, to name the clusters. For each document cluster, we identified the most highly representative topics from the LDA topic model.

Evolution of cardiovascular topics—trends and ‘hot’ topics

We identified 175 topics, listed alphabetically in Supplementary material online , Table S2 . This list groups specific topics within areas such as atherosclerosis, coronary artery disease, arrhythmias, heart failure, and their evolution over time.

For a visual and comprehensive overview, we prepared a map of the topics and their interrelation, based on co-occurrence within publications using a network analysis ( Figure 1 A ). This map identifies different categories of research: population (at the top, blue), clinical (left, green/yellow), and basic research (right, red). Large topics in each category define overarching interests such as Evidence-guided-treatment and Outcomes and prognosis in clinical research, and Epidemiology of CVD and risk factors in population research, topics that have seen large growth in numbers of publications since 2004 ( Figure 1 B ). Cell signalling and gene transcription is a central topic for basic research, with modest growth ( Figure 1 B ).

Main areas and organization of research focus. ( A ) Visual presentation of the topics in 2013 and how they relate to each other, based on how often the topics are included in the same publication. Each circle represents one topic and each group of topics is highlighted in a separate colour; the most similar documents and clusters are located closer to each other based on VOSviewer mapping. ( B ) Evolution of overarching topics.

More focused ‘hot’ topics that experienced a large growth in number of publications are presented in Figure  2 .

Topics with large growth. For population research, the eight topics that increased more than two-fold in volume are shown; for clinical research, 27 topics increased more than two-fold and 10 of these are presented; for basic research only two topics had more than a two-fold increase, and the top 8 growers are presented. Overarching topics are shown in Figure 1 B .

In population research, risk factors with research on metabolic syndrome, lipids, diabetes, physical activity, and mental health are prominent. In clinical research, patient management after myocardial infarction (MI) and outside the hospital are leading topics, but the true ‘hot’ topic was aortic valve disease that saw a surge of interest, related to transaortic valve repair, starting 2008. Though still small in numbers, heart failure research and stem cells saw substantial growth. This last clinical topic complements the major hot topics in basic research, on stem cells and cardiac repair and tissue engineering. In basic research, increasing translational output in metabolic syndrome and diabetes use mostly mouse models. Focused topics are organelle studies on mitochondria and endoplasmic reticulum.

Table  1 complements the fast growing topics of Figure  2 with additional leading 2013 topics. Most of these also have grown since 2004, but two topics, even if large, seem to have lost momentum, i.e. longitudinal studies on blood pressure, and basic research in cardiac electrophysiology.

Large topics in 2013

PCOS, polycystic ovary syndrome.

Only four topics in clinical, and none in population research, saw a decrease, whereas seven topics in basic research saw a decline in output ( Figure 3 A ). Across all topics, the growth in publication output, measured as the number of documents in 2013 divided by the number of documents in 2004, was significantly larger in clinical and population research topics than in basic research topics ( Figure 3 B ).

Unequal growth of research output across categories. ( A ) Topics that saw a decrease of >5%, i.e. 4/102 clinical and 7/50 basic research topics. ( B ) Average growth in each category. Each dot presents a topic; the values are the fractional growth, i.e. the number of documents in 2013 divided by the number of documents in 2004. Kruskal–Wallis followed by Dunn’s test for multiple comparisons; *** P < 0.0001 basic vs. clinical and vs. population.

When considering the overall output and growth of publications across the categories of population, clinical and basic research, the data suggest that the share of basic research publications is declining.

Document clusters define large research areas and trends

The size of topics represents the activity within each of these—documents contribute to more than one topic. In a complementary approach, we examined how documents group together based on the similarity of their text and of their references, whereby each document can belong to one cluster only, effectively dividing the total publication output into different areas. The hybrid clustering algorithm was applied to two datasets, i.e. the publications from 2006 to 2008 and 2011 to 2013.

In each period, 10 large clusters emerged, accounting for >90% of all documents.

To identify trends, we compare the two periods and examine the evolution over time ( Figure  4 ). In the graph legends, emerging areas are marked by green triangle, decreasing ones with a red triangle. Risk scoring in the population and related patient management are the leading areas, growing over time (top position). In 2011–13, a large cluster emerges that relates to gene and stem-cell therapy, including research on inducible pluripotent stem cells. Documents within this cluster include research on ischaemic heart disease and arrhythmias. Haemodynamics and biomechanics are another emerging area that includes documents on atherosclerosis and vascular diseases such as aneurysms, but also heart failure and assist devices. Aortic valve disease is a newly defined area in 2011–13. Imaging also becomes very prominent as an area in its own right. Whereas in 2006–08, hypertension was a defined area, this is no longer identifiable in 2011–13.

Distribution of document clusters in 2006–08 and in 2011–13. ( A ) In 2006–08, the 10 largest clusters represent 93% of the total publication output in this period. ( B ) In 2011–13, the 10 largest clusters represent 92% of the total publication output in this period. The colour codes for similar clusters are maintained across the periods. However, some clusters are present in only one period. The clusters are arranged by size, reading clockwise from the top, and the legends arranged accordingly. Red triangles mark clusters that disappeared and green triangles emerging clusters.

For the last period, we also examined the structure and interrelation of clusters, using a graphical rendering, giving insight in the size, composition, and presence of subclusters ( Figure  5 ).

Document clusters’ map 2011–13. A visual presentation of documents in clusters and subclusters: the most similar documents and clusters are located closer to each other, based on the DrL two-dimensional mapping layout technique.

In this force-directed DrL graph layout, the documents and clusters are mapped to minimize the distance between the most similar documents and maximize the distance between non-linked documents. This produces a two-dimensional co-ordinate layout where the documents closest to each other share the most similarities since they share common text fragments and references. Conversely, documents and clusters on the edges of the graph have the least similarity to other documents or clusters.

Cluster 2 on gene and stem cells is dense and separate, yet touches and interacts with Cluster 5 [acute coronary syndrome (ACS) and MI]. Cluster 9 on imaging is spread out in subclusters at different locations, including one near Cluster 5 (ACS and MI), and one near Cluster 4 (heart failure). Cluster 8 (arrhythmias) is also split with one part closer to heart failure, another to anticoagulation and atrial fibrillation.

Further naming the subclusters is presently beyond reach, as it would require a lot of expert input and resources. However, linking the clusters and the topics adds granularity to the larger research areas and provides internal methodological validation of the cluster naming.

Table  2 presents the most highly associated topics in the ten largest document clusters in each period. Overall, agreement with the LDA topics is high and provides more detail on the research contained in the clusters. E.g., the cluster ‘Haemodynamics’ is now showing different areas of focus, i.e. in congenital disease, aortic, and valvular diseases; the topic ‘Arrhythmias’ is more populated with device research in the second time period compared to the first.

Cluster names and topics present within clusters

AF, atrial fibrillation; ANS, autonomic nervous system; BP, blood pressure; CABG, coronary artery bypass grafting; CRT, cardiac resynchronization therapy; CT, computed tomography; CV, cardiovascular; DES, drug-eluting stent; ECG, electrocardiogram; HF, heart failure; LV, left ventricular; NOAC, new oral anticoagulant; PTCI, percutaneous transluminal coronary intervention; RV, right ventricle; STEMI, ST elevated myocardial infarction.

The method for identification of topics in cardiovascular publication output allowed the visualization and evaluation of trends in cardiovascular research. Over a 10-year period significant shifts occur.

Identification of cardiovascular research topics through natural language processing

In cardiovascular research, topics are generally predefined in a taxonomy that can be hierarchical and/or matrix structured. The CardioScape project approach (see Introduction section) was well suited to its purpose of the analysis of 2476 project abstracts in a single time period and using an existing taxonomy has the advantage of recognizable areas of research. The bottom-up approach used here lent itself well to analysis of much larger numbers of documents and generated a topic list that represents the interests from the community during the period under study.

A recent study by the WHO working to identify cardiovascular disease research output from random sets of publications from PubMed required a significant amount of expert-based review of only a small proportion of the published articles. 17 The current approach was more comprehensive in coverage of the field, but despite reliance on advanced automated analysis, experts still had an important role in interpreting and linking concepts to validate the results.

In the current naming of topics and clusters, experts frequently used terms that connect to a classic hierarchical list in the field, including major diseases, and recognizing clinical, population, and basic discovery research. Nevertheless, the approach uncovered specific emerging areas of research such as transcatheter aortic valve implantation (TAVI), topics consistent with broad trends, such as risk stratification and evidence-based guidance, and innovation (gene and stem cell research). Some of these terms would not appear in a classic taxonomy and thus the NLP approach offers novel insights.

The present study was not attempting to classify all research but to capture and identify the most common and evolving topics over time in the cardiovascular field by using a comprehensive set of cardiovascular publications across some 5000 journals.

Emphasis on improving clinical care and risk assessment

The most represented and fast growing topics across the documents are evidence-based guidance for treatment and research on outcomes and prognosis. These result underscore the attention given to guidelines and evidence based medicine (EBM). 18–23 Part of this research is likely to represent the large number of clinical trials taking place in the cardiovascular field, 24 which over time have had a significant effect on the reduction of mortality from CVD due to establishing the effectiveness and safety of a number of drugs and medical interventions in cardiovascular disease. 25 The presence of policy related topics, such as the topics on quality of care and health economics likewise supports the focus on implementation research and a shift of focus from reducing acute mortality to care in chronic disease.

Growth of research on risk factors emphasizes the importance of preventative medicine, evident in both the topics analysis and the document cluster analysis. However, some specific blood pressure studies declined over time, perhaps reflecting the change in focus on the single risk factor of ‘blood pressure’ to a multivariable spectrum and newly identified risk factors. We have also previously shown that hypertension has moved more closely to clinical cardiovascular research over time. 26

Smaller topics illustrate crosstalk with non-cardiovascular diseases, because of shared risk factors or common methods used in research or occurrence of cardiovascular complications. The latter is particularly evident in two topics that focus on cardiovascular complications in pregnancy and in cancer.

Innovation and translation in clinical and basic science

Major diseases such as ischaemic heart disease and arrhythmias, remain present over time but shifts can be seen. There is for example, a larger focus on atrial fibrillation, in particular embolic risk, on novel treatments, such as stem cells in heart failure, and transcatheter aortic valve interventions as a dominant element within the topic of valvular heart disease. 19 Imaging is present in several topics but emerges as a cluster in its own right in the document analysis. Many of these changes are driven by technological innovation and translation.

Basic research as a whole saw its share decline, but with interesting shifts in content. Although the topic analysis and mapping identifies basic research topics as a category, there are complementarities across categories. Stem cell research, tissue engineering, and biomechanical factors saw rapid growth and are also present in clinical topics. This also applies to inflammation and diabetes. Animal models for disease are rapidly growing topics consistent with growth of translational research.

An analysis of the countries of authorship of the publications in the emerging clusters of discovery research shows that the USA leads in the number and share of publications (30%+), followed mostly by Germany, or the UK or Italy. However, for the large document cluster on genes and stem cells in 2011–13, the second most productive country is China, contributing 17.5% of the publications in this cluster (Supplementary material online, Figure S3 ).

Interestingly, inflammation, biomarkers, metabolic syndrome, obesity, and lipids are hot topics with growing research output in population, clinical and basic research, indicating integration and crosstalk across the spectrum of cardiovascular research.

Drivers of change

Technology and opportunity-driven scientific interest, but also strategic choices and funding policies are likely to influence trends in research. CardioScape studied public and charity funding in the years 2010–12 and describes major investments in clinical research. Yet the share of publication output globally for clinical research appears to be substantially larger than the share of funding for clinical research reported in CardioScape. This could be explained by clinical research funded by other sources, such as industry or local funding, which are not included in the CardioScape analysis. Also, the present data represent global output. Major research investments in China, and the emphasis on clinical research in the USA, can contribute to some of the global trends.

The slower growth in basic science could reflect a slower growth in investment. This can be absolute or relative towards the increasing costs of advanced research methodology. Another reason could be editorial pressure for more comprehensive papers that may reduce quantity to the benefit of rich content in individual papers.

Finally, growing translational research may blur the boundaries between basic and clinical research and lead to an apparent slower growth in discovery research.

Policy perspectives

Policy development is a forward looking exercise. In health research, medical needs identified by health data and expert opinion, are an important consideration. 27 Past research output helps to identify areas that may need more investment. Research funders also use input from society. 28 When assessing current priorities in cardiovascular research for the Dutch 28 and British 29 Heart Foundations we can see that research into heart failure and arrhythmias are common across their top priorities. Focus on healthy lifestyles is a top priority in the Dutch Heart Foundation as well as in the US vision and strategic agenda. 4   ,   5 At the macro-level, the data presented here indicate that some of the main issues presented in these research agendas are actively pursued but others less so.

Study limitations

Limitations of studying research topics have been addressed in the bibliometric field. 8 The reliance of expert input is a limitation and potential source of bias that we tried to minimize by using mixed panels.

The current approach was not sufficiently granular to extract recent emerging topics that contain a limited number of documents. In addition, publication output is somewhat delayed vs. actual research and experts may be aware of ongoing research with still limited output. In this case, the method and dataset can be used to interrogate about specific developments (see Supplementary material online , Table S3 for data on micro-RNA and personalized medicine).

As the data set ends in 2013, very recent developments are not covered. This relates to the methodological complexity. Web of Science data including 2014 references were available mid-2015, the cardiovascular publications dataset was complete in 2016 and algorithms for analysis including re-iterative expert review required another 18 months. A similar time lag is seen in other studies that rely on data mining and processing. 9 Congress abstracts could be considered as a source to identify emerging topics but have several limitations. They are of a different nature than papers and the scope of a congress shapes content of selected abstracts. We provide a complementary survey of 3000 abstracts from the 2018 congress of the European Society of Cardiology, illustrating the strong presence of clinical research at this event, within the topics of Clusters 1 and 3–7 of Table  2 ( Supplementary material online , Figure S4 ). Two emerging topics were cardio-oncology and digital health, each representing however <25 abstracts.

In the present analysis, quality and impact of studies in a particular domain were not evaluated, though highly cited papers were part of the cluster identification. In their analysis of poorly cited papers covering 165 000 papers in 1997–2008, Ranasinghe et al . 30 noted the highest percentage of poorly cited papers in the clinical and population research category. Nevertheless, as they and others 31 have noted, citations are not the only parameter to assess impact, in particular in clinical medicine.

Identification of leading research topics and trends illustrates the emphasis on improving clinical medicine, and the growing interest in risk stratification and preventive medicine. Translation and innovation redefine cardiovascular research. Linking the present data with the insights of the professional community and of funders and society, may contribute to the building of a future research roadmap.

The authors thank to the following experts for their review of the text fragments and input into the names of the topics: Dr Matthew Amoni, Dr Peter Haemers, Prof Sian Harding, Dr Frederik Helsen, Prof Gerd Heusch, Prof Tatiana Kuznetsova, Prof Tobias Op‘t Hof, Prof Frank Rademakers, Dr Sander Trenson, Dr Bert Vandenberk, and Dr Maarten Vanhaverbeke.

D.G. had a PhD Fellowship through KU Leuven.

Conflict of interest: K.R.S. is Past Editor-in-Chief of Cardiovascular Research (2013–17). W.G. is Editor-in-Chief of Scientometrics .

Directorate-General for Research and Innovation. Europe’s future: open innovation, open science, open to the world. Reflections of the Research, Innovation and Science Policy Experts (RISE) High Level Group . Brussels : European Commission ; 2017 . p. 228 .

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UNLV Research Uncovers Heart-Protective Eating Patterns for Type 1 Diabetes

Six-year study reveals that closely following Mediterranean and DASH diets is linked with lower cardiovascular disease risk.

(Josh Hawkins/UNLV)

• July 9, 2024
• By UNLV News Center
• Steven Slivka: (702) 895-3259; [email protected]

Eating patterns that align with the Mediterranean or DASH diets could help lower cardiovascular disease risk in adults with Type 1 diabetes, according to results from a six-year study led by researchers at UNLV and the University of Colorado.

Both diets are considered heart-healthy and emphasize plant-based foods, healthy fats, lean proteins, and low intake of processed foods and sugars.

The study included 1,255 adults — 563 with Type 1 diabetes and 692 without diabetes. The researchers assessed diet using a food frequency questionnaire, which obtained dietary information on different food groups. The information was used to calculate nutrient intake over the course of the six years and to determine how well dietary patterns conformed to three diets commonly used in cardiovascular disease management: the Mediterranean diet, the dietary approaches to stop hypertension (DASH) diet, and the alternative healthy eating index (AHEI).

“Type 1 diabetes increases the risk of developing cardiovascular disease, which raises the likelihood of heart attacks, strokes and other serious health complications,” said Arpita Basu, associate professor in the department of Kinesiology and Nutrition Sciences within UNLV’s School of Integrated Health Sciences. “We wanted to find out how people’s regular eating habits affected blood inflammatory markers that predict cardiovascular disease risk in adults with Type 1 diabetes.” 

The study, which was presented last week during the American Society for Nutrition's annual conference in Chicago, builds on earlier work from the team which showed that dietary patterns were associated with less fat accumulation surrounding heart tissue in adults with and without Type 1 diabetes. These dietary patterns also revealed lower odds of coronary artery calcification, an advanced form of cardiovascular disease in adults without diabetes. 

“This new study reports the protective associations of these diets with selected blood cardiovascular disease markers that may explain our previous findings and provide new data on how diet affects inflammation in Type 1 diabetes,” Basu said. 

In the current study, researchers also analyzed a variety of blood biomarkers frequently used in clinical settings to determine cardiovascular disease risk and inflammation. 

Overall, those who consumed diets more closely conforming to DASH and Mediterranean patterns had lower levels of the biomarkers after accounting for other demographic and lifestyle factors such as body mass index, age, total caloric intake, blood lipids, blood pressure, smoking and physical activity. No associations were observed between AHEI scores and any of the biomarkers studied.

The analysis also revealed that adults with Type 1 diabetes generally consume a high-fat diet, mostly as a consequence of decreasing carbohydrates and increasing animal protein foods that are high in saturated fats and cholesterol. 

“There is an urgent need to address dietary quality in adults with Type 1 diabetes,” Basu said. “In a clinical setting, assessing dietary intakes using the DASH and Mediterranean dietary checklists could be an effective way to identify gaps and improve intakes. Specific foods that are part of these dietary patterns, such as olives and nuts in the Mediterranean diet, could be added to the diet even if the entire diet cannot be altered.” 

Basu recommends that individuals considering the DASH or Mediterranean diets first consult with their primary care physician or dietitian. 

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Normal Resting Heart Rate By Age (Chart)

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Table of Contents

What is a resting heart rate, normal resting heart rate chart by age, how to check your heart rate at home, what if i can’t locate my pulse, what causes a high resting heart rate, how to lower your resting heart rate, when to see a doctor.

One of the vital signs a nurse checks when you visit the doctor is your heart rate, along with temperature, blood pressure and respiratory rate . Your heart rate, which is measured by your pulse, is an important indicator of your overall health and fitness level. It can signal certain medical conditions or a need to adjust lifestyle habits that elevate your heart rate above the normal range determined by your age.

The normal resting heart rate (when not exercising) for people age 15 and up is 60 to 100 beats per minute (bpm). 

However, your heart rate may vary slightly from the norm due to several factors, including regular exercise, a medical condition, stress and use of some over-the-counter medications.

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Resting heart rate refers to when your heart pumps the lowest amount of blood your body needs when you’re not exercising. Your resting heart rate is measured by your pulse when you’re calm, relaxed, sitting or lying down and not ill.

Why Does Your Resting Heart Rate Matter?

A heart rate that’s too high or low—especially a rate that’s higher or lower than your usual resting heart rate—could be a sign of medical issues or other health conditions.

A high resting heart rate could signal an abnormal hormone level, an overactive thyroid , anemia or another potential health issue, such as a heart rhythm abnormality, says Hailu Tilahun, M.D., a cardiologist at Virginia Mason Franciscan Health in Seattle, Washington. Meanwhile, a resting heart rate that’s too low could cause dizziness, lightheadedness, fatigue or even fainting, which is dangerous and should not be ignored.

“Different levels of heart rate might reflect certain medical conditions,” says Dr. Tilahun. “However, it doesn’t always necessarily mean there’s something going on. And that’s why heart rate is important—because it can be a hint to at least consider exploring those possibilities.”

It’s also important to know the normal “maximum” heart rate during vigorous activity and the “target” heart rate for your age.

To find your normal maximum heart rate, subtract your age from 220.

Meanwhile, your target heart rate should be about 50% to 70% of your maximum heart rate during moderate-intensity activity like walking. During more intense activity, such as exercising, running or working out with weights, your target heart rate should be about 70% to 85% of your maximum heart rate.

As a general guide, below are the average maximum heart rates and target heart rate zones by age for adults, according to the American Heart Association.

You can monitor your heart rate easily by using smartwatches and other fitness-tracking wearables, but it’s also simple to check your heart rate manually.

To find your heart rate, place your index and middle fingers gently against the underside of your wrist on the side just below the base of your thumb until you can feel the pulse. You can also measure heart rate by placing two fingers on one of the carotid arteries located on each side of your neck.

Other places where you can check your heart rate include:

• Back of the knees
• Top or inside of the foot

After you locate your pulse, count the number of beats you feel for 15 seconds, then multiply that number by four. Alternatively, count the beats for 30 seconds, then multiply by two. If checking your resting heart rate, count the beats when you haven’t been exercising or physically active for at least 10 minutes.

There’s no best time of day to check your resting heart rate. “You can do it in the morning or in the evening, but you really can check the heart rate at any time,” says Dr. Tilahun. “After activity, the heart rate might still be high. Also, you don’t want to check your heart rate after resting or meditating for a very long time since that’s also not going to be truly reflective.”

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If you can’t locate your pulse in your wrist, try finding your pulse on your carotid artery or the other parts of your body where the pulse may be stronger. Be careful checking on your neck, though.

“When checking the pulse on the carotid, we have to be a little bit cautious because if it’s pressed too hard, it can cause a reflex that leads to lightheadedness and dizziness or may even cause fainting,” says Dr. Tilahun.

Research indicates that a higher resting heart rate is linked with higher blood pressure and body weight, along with lower physical fitness [1] Target Heart Rates Chart . American Heart Association. Accessed 4/7/2022. . In addition to medical conditions, such as anemia, high thyroid or hormone levels and blood clots, certain lifestyle factors can cause an elevated resting heart rate, says Dr. Tilahun.

Additional possible causes of a high heart rate include:

• Infection (including bacterial, viral and rarely fungal infections)
• Dehydration
• Poor or disrupted sleep
• Caffeine, alcohol or nicotine intake or withdrawal
• Stress and anxiety
• Use of over-the-counter decongestants
• Poor physical condition

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When your resting heart rate is in the normal heart rate range for your age, your heart muscle doesn’t have to work as hard to pump enough blood to keep a steady beat.

If someone notices an increase in their heart rate within a certain period—after not being physically active for a year or two, for example—but other things haven’t changed much with their health, the elevated heart rate could indicate they may need to be more active to lower the heart rate, says Dr. Tilahun.

If your resting heart rate is higher than the normal adult heart rate of 60 to 100 beats per minute, regular activity is key to bringing the heart rate down. “That activity could be exercise, but it doesn’t have to be dedicated exercise. It could be walking, gardening, mowing the lawn or other regular activities,” says Tilahun.

“When you’re doing the activity, the heart rate is going to be higher, and people sometimes get worried. But that’s not an issue—it’s what’s supposed to happen. Over time, regular activity will lower the heart rate for most people,” he adds.

If a higher heart rate is a result of being under stress or consuming a lot of alcohol or caffeine, that’s not typically a cause for alarm. However, these situations still warrant a discussion with your clinician, as they can discuss with you how to best address any necessary lifestyle changes.

Meanwhile, adults without an acute condition that might cause an elevated heart rate may also want to contact their doctor if their resting heart rate remains above 100 beats per minute for a few days, says Dr. Tilahun.

“If the heart rate is persistently elevated for more than a few days and there is absence of a clear thing that can explain it, that should be a time to talk to your doctor,” he says.

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On Oxiline's Website

• Target Heart Rates Chart. American Heart Association. Accessed 4/7/2022.
• Vital Signs. Medline Plus. National Library of Medicine. Accessed 4/8/2022.
• All About Heart Rate (Pulse). American Heart Association. Accessed 4/7/2022.
• Pulse. Medline Plus. National Library of Medicine. Accessed 4/7/2022.
• Duplex ultrasound. Medline Plus. National Library of Medicine. Accessed 4/7/2022.
• Should I Worry About My Fast Pulse?. Harvard Health Publishing. Accessed 4/7/2022.
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Deb Hipp is a freelance health and medical writer and editor who lives in Kansas City, Missouri. She is a former investigative reporter with more than 25 years of experience as a journalist and writer. She specializes in health and wellness, medical aging, long-term care, caregiving, retirement and a variety of other health and retirement topics.

Dr. Ardeshir Hashmi is a board-certified geriatrician who currently serves as the section chief of the Center for Geriatric Medicine and endowed chair for Geriatric Innovation at Cleveland Clinic. He also serves on Cleveland Clinic’s National Consultation Service. Dr. Hashmi completed his postgraduate research at Yale University, internal medicine training at the Yale Saint Mary’s Hospital in Connecticut, and Geriatric Medicine fellowship at Massachusetts General Hospital in Boston. Dr. Hashmi’s primary clinical interests are providing individualized, patient-centered care focused on each patient’s priorities and, serving as their Successful Aging specialist, providing guidance that helps them thrive in the “4 Ms” of mentation, mobility, medication de-prescribing and what matters most to them.

• Research & Discovery

Getting Sleepy? Check Your Heart Health

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Virend Somers, M.D., Ph.D. , thinks you should probably be sleeping in later.

“Using an alarm clock, by definition, means that you haven’t had enough sleep,” says Dr. Somers, Alice Sheets Marriott Professor at Mayo Clinic. “When you wake up artificially, your body has not yet decided to wake up. The best way to sleep is to be able to wake up in the morning refreshed, without an alarm clock.”

While that may be aspirational, it does speak to the cardiologist and sleep expert’s conviction regarding the benefits of sleep.

Sleep and Heart Health

At Mayo Clinic, Dr. Somers leads a team studying the relationship between sleep disorders and cardiovascular disease, including the impacts of conditions such as sleep apnea and excessive daytime sleepiness (EDS). Thanks to support from Sleep Number , his research has uncovered a strong relationship between how sleepy someone is during the daytime and their risk of heart problems.

In a study published in 2021, Dr. Somers and his team found that nearly 1 in 5 people out of 10,000 participants reported experiencing EDS. In addition, people who said they felt “overly sleepy” often or always during the daytime were at 2 ½ times greater risk of dying due to heart issues when compared to those who did not feel so sleepy. This was completely independent of any other sleep issues or disorders.

“We have only recently begun to really understand how important daytime sleepiness is,” Dr. Somers says. “Usually the focus is on problems that affect nighttime sleep, but EDS is its own issue with its own implications.”

Uncovering the Link

Dr. Somers has been in the sleep game for long enough to see how far the research has come. “I became interested in sleep because of some interesting nighttime blood pressure findings during my Ph.D. studies. At that time, there was very little being done in this area,” he says. “Sleep occupies a third of our lives, but the research was limited to just a few centers and was focused on neurology and pulmonology. I wanted to understand how sleep might be affecting heart health, and that was the road less traveled.”

A year after his initial study, Dr. Somers examined the relationship between nervous system activity in people with obstructive sleep apnea, excessive daytime sleepiness, and heart health, finding that patients with sleep apnea who had clinically observed EDS had higher diastolic blood pressure and increased sympathetic nervous system activity compared to those who did not have EDS, which may be linked with greater cardiovascular morbidity.

“Our research is finding this risk is independent of whether someone is experiencing other sleep problems,” says Dr. Somers. “How sleepy someone feels during times when they are supposed to be awake seems to be associated with significant health risks.”

His research continues to dissect the relationship between sleep and cardiovascular disease, seeking to better understand who is most at risk. In a 2023 study, his team examined a cohort of nearly 15,000 patients with obstructive sleep apnea and found that women who had the condition and experienced excessive daytime sleepiness were at higher risk of dying prematurely compared to others. In men, EDS did not increase their mortality risk, though both men and women with sleep apnea and EDS were at higher risk of developing diabetes.  

“This means that when dealing with sleep disorders, sleep apnea or even just heart disease, it’s important for clinicians to ask their patients — especially their female patients — not only about their sleep habits, but also about how sleepy they feel during the day,” says Dr. Somers.

How sleepy someone feels during times when they are supposed to be awake seems to be associated with significant health risks. — Virend Somers, M.D., Ph.D.

Seeking Clarity for Future Treatments

Even as he assesses his patients for their sleepiness and heart health risk, Dr. Somers says there are still many unanswered questions about this relationship: Do daytime sleepiness and heart disease develop in parallel? Does one cause the other? Are the mechanisms of sleepiness causing damage to our blood vessels, resulting in cardiovascular disease?  

Going forward, his team plans to dig into the physiological and biochemical underpinnings of this relationship in the hope of better understanding what factors are at play in excessive sleepiness and heart disease. Understanding these interactions will be the key to addressing heart health risk for these patients and ultimately identifying treatment targets.  

“This is the beauty of mechanistic research,” he says. “We’re focused not just on the phenomenon, but also understanding the underlying mechanism, because once we know the mechanism, we’ll have some ideas on how we might intervene to treat it.”

This research has been conducted in collaboration with Sleep Number . Through a corporate partnership, Sleep Number and Mayo Clinic are working together to deepen knowledge on the relationship between sleep, sleep disorders and cardiovascular health. Sleep Number also supports Mayo Clinic research in other areas of sleep research, including studies on the prevalence of disordered sleep among Somali patients and the relationship between disrupted sleep and markers of aging.

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NHLBI’s MACS/WIHS study targets chronic health conditions in people living with HIV

Longest running study of HIV survivors is marking its 40th anniversary this year.

In the 1980s, infection with HIV, the virus that causes AIDS, was often viewed as a death sentence. With no treatments available and little understanding of the virus or the disease, hundreds of thousands of people in the United States ultimately lost their lives and millions more died worldwide.

Much has changed in the past four decades. Thanks to the availability of powerful antiretroviral drugs, new infections have decreased significantly, the virus is held at low levels in the body, and the HIV death rate has plummeted. People living with HIV are now more likely to die of a chronic illness, such as cardiovascular disease, than from AIDS. Meanwhile, researchers continue to make inroads in finding an effective vaccine or even a cure.

Now, this year, another milestone: the nation’s largest and longest running study of HIV survivors is marking its 40th anniversary.

The Multicenter AIDS Cohort Study (MACS) launched in 1984 to help shed light on how AIDS was affecting gay and bisexual men living with or at risk for HIV. Over the years it enrolled some 7,300 men and eventually merged with the Women’s Interagency HIV Study (WIHS). That study has focused on the health impact of HIV on nearly 5,000 women living with or at risk for the virus.

Since then, the combined research effort – the so-called MACS/WIHS Combined Cohort Study – has been pursuing an ambitious goal: to understand and reduce the impact of chronic health conditions, including heart, lung, blood, and sleep disorders, that affect people living with HIV. That’s an estimated 1.1 million people ages 13 and older in the United States and the nearly 37 million people worldwide.

The study – coordinated by the NHLBI and conducted in collaboration with the NIH Office of AIDS Research and several co-funding institutes – not only has produced a host of findings; it also has provided a way to take stock of what its research has meant for real people.

“It’s amazing today to see that people with HIV are surviving into old age,” said Beth Pathak, Ph.D., NHLBI’s program director of the MACS/WIHS study and an epidemiologist. “On the other hand, HIV/AIDS is still a big public health problem around the world. We still have a lot more to learn.”

Pathak says that the program will honor the legacy of the participants with a specially designed panel on the National AIDS Memorial quilt . That panel will be unveiled on December 5 during a special ceremony in Washington, D.C.

David C. Goff, M.D., Ph.D., director of the NHLBI’s Division of Cardiovascular Sciences, said the MACS/WIHS study is often called the “jewel in the crown” of NIH HIV/AIDS research for good reason. To date, MACS/WIHS investigators have published over 2,000 articles on HIV-related topics. Those studies show that people living with HIV tend to carry a higher disease burden. Nearly half of HIV survivors over 50 develop one or more chronic conditions not directly associated with HIV itself – cardiovascular disease, lung diseases such as pulmonary hypertension and COPD, anemias and other blood-related disorders, sleep disorders, cognitive dysfunction, osteoporosis, and certain cancers. While common in older people generally, these conditions tend to show up at higher rates in younger people with HIV.

Some of the more important findings to emerge from the MACS/WIHS research program have direct relevance to NHLBI’s research focus areas:

• Men and women living with HIV have a higher burden of heart disease than those without HIV.
• Men and women living with HIV are more likely to have abnormal lung function than those without HIV.
• Women living with HIV have a higher comorbidity burden (health problems) than men with HIV.
• Untreated HIV lowers levels of ‘good’ cholesterol (high-density lipoprotein (HDL) cholesterol).
• High-risk coronary artery plaque is more common in men with HIV than their HIV-negative counterparts.
• At the DNA level, men living with HIV appear to age faster than men without .
• Men with HIV are more likely to have sleep-disordered breathing.
• People living with HIV have lower antibodies and greater inflammation from the COVID-19 vaccines.
• Smoking is strongly linked to atherosclerosis in men with HIV.

NHLBI’s Goff said findings like these are critical to research that could lead to better treatments for those with the disease. It’s why it is so important, he said, to “keep the study going.”

After all, he noted, “it’s one of the world’s most important sources of rigorous scientific knowledge about the evolving impact of HIV infection and its comorbidities on human health.”

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Related news & features.

All patients who have received pig organs have now died

All four patients who have received pig organs in place of their own have now died. but research continues..

All four patients who received pig organs to replace their diseased organs have now died, though researchers involved in these transplants say they will keep trying to improve this alternative source of organs.

Lisa Pisano, the fourth xenotransplantation patient and second to receive a pig kidney, died Sunday. The other three patients died within two months of transplantation.

Pisano received the kidney on April 12 . It had to be removed on May 29, after it failed because of medications that supported Pisano's blood pressure, Dr. Robert Montgomery, who helped lead her care team at NYU Langone Health, said in a statement. She was on dialysis until she died.

Pisano, 54, of New Jersey, had also received an LVAD heart pump to support her weakened organ and was very ill when she agreed to the experimental double surgeries in April.

Researchers have been trying for years to gene-edit animals to make them suitable for organ transplants.

More than 100,000 Americans are waiting for an organ to become available. Organs typically become available following a tragedy to another family. Many others, like Pisano, will never qualify for a transplant waitlist because they have been deemed too ill or otherwise not a good candidate for a transplant.

The hope is that pigs that have been gene-edited to make their organs less likely to be rejected by the human immune system can supplement human organs. For decades, though, animal research has faced repeated problems, advancing at a painfully slow pace.

The first trials using pig organs in people, two heart transplants at the University of Maryland in 2022 and 2023 , followed by a kidney transplant at Massachusetts General Hospital at Pisano at NYU in April, were supposed to turbocharge the field. However, none of the patients survived more than two months with their pig organs.

Still, researchers are committed to continuing .

"Lisa's contributions to medicine, surgery, and xenotransplantation cannot be overstated," said Montgomery, director of the NYU Langone Transplant Institute. "Her bravery gave hope to thousands of people living with end-stage kidney or heart failure who could soon benefit from an alternative supply of organs."

Karen Weintraub can be reached at [email protected].

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Heart rate recovery as an assessment of cardiorespiratory fitness in young adults

J. matthew thomas.

1 Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA

2 Center for Clinical and Translational Science, University of Kentucky, Lexington, Kentucky, USA

W. Scott Black

3 Department of Clinical Sciences, University of Kentucky, Lexington, Kentucky, USA

Philip A. Kern

4 The Department of Internal Medicine, Division of Endocrinology, University of Kentucky, Lexington, Kentucky, USA

5 Barnstable Brown Diabetes and Obesity Center, University of Kentucky, Lexington, Kentucky, USA

Julie S. Pendergast

6 Saha Cardiovascular Center, University of Kentucky, Lexington, Kentucky, USA

7 Department of Biology, University of Kentucky, Lexington, Kentucky, USA

Jody L. Clasey

Associated data, background:.

Cardiorespiratory fitness, typically measured as peak oxygen uptake (VO 2peak ) during maximal graded exercise testing (GXT max ), is a predictor of morbidity, mortality, and cardiovascular disease. However, measuring VO 2peak is costly and inconvenient and thus not widely used in clinical settings. Alternatively, postexercise heart rate recovery (HRRec), which is an index of vagal reactivation, is a valuable assessment of VO 2peak in older adults and athletes. However, the validity of HRRec as a clinical indicator of cardiorespiratory fitness in young, sedentary adults, who are a rapidly growing population at risk for developing obesity and cardiovascular disease, has not been fully elucidated.

We investigated the association between cardiorespiratory fitness, measured by VO 2peak (mL·kg −1 ·min −1 ), and HRRec measures after a GXT max in 61 young (25.2 ± 6.1 years), sedentary adults (40 females) using 3 methods. We examined the relationship between VO 2peak and absolute (b·min −1 ) and relative (%) HRRec measures at 1, 2, and 3 min post GXT max , as well as a measure of the slow component HRRec (HRRec 1 min minus HRR 2 min), using Pearson’s correlation analysis.

VO 2peak (36.5 ± 7.9 mL·kg −1 ·min −1 ) was not significantly correlated with absolute HRRec at 1 min ( r = 0.18), 2 min ( r = 0.04) or 3 min ( r = 0.01). We also found no significant correlations between VO 2peak and relative HRRec at 1 min ( r = 0.09), 2 min ( r = −0.06) or 3 min ( r = −0.10). Lastly, we found no correlation between the measure of the slow component HRRec and VO 2peak ( r = −0.14).

Conclusions:

Our results indicate that HRRec measures are not a valid indicator of cardiorespiratory fitness in young, sedentary adults.

INTRODUCTION

Accurate assessments of cardiovascular health and fitness are important for predicting at-risk individuals and for developing interventional therapeutic strategies ( 1 ). Accumulating evidence has established that clinical assessments of cardiorespiratory fitness improve risk stratification for adverse health outcomes and are a powerful tool for patient management ( 2 – 4 ). The American Heart Association released a statement indicating that cardiorespiratory fitness should be considered a clinical vital sign and should be assessed regularly in the clinic along with other preventative assessments ( 4 ). However, direct measures of cardiorespiratory fitness rely on determining peak oxygen uptake (VO 2peak ) during a graded exercise test conducted in a laboratory setting. Because measuring VO 2peak during a graded exercise test can be costly and inconvenient, it is often more practical to estimate cardiorespiratory fitness using simple, non-invasive measures that are easily collected during exercise. One such measure is heart rate recovery (HRRec) following exercise testing, which is an index of vagal reactivation and is a strong predictor of morbidity and mortality in older adults ( 5 – 9 ).

HRRec is used in some clinical settings as a measure of autonomic dysfunction to identify high risk cardiovascular disease patients. However, it is not typically used as a marker of cardiorespiratory fitness. For example, HRRec is predictive of long-term outcomes and survival in patients with coronary artery disease and congestive heart failure, which have known autonomic nervous system dysfunction ( 7 , 8 ). The HRRec is also an independent risk factor for development of metabolic diseases, suggesting it is an informative marker for at-risk individuals ( 10 , 11 ). Evidence suggests that HRRec is a valid method to assess cardiorespiratory fitness. Cross sectional studies show that physically active individuals have improved HRRec compared to their sedentary counterparts ( 12 – 15 ). Likewise, both VO 2peak and HRRec improve following an exercise regimen in longitudinal studies ( 16 – 18 ). In addition, HRRec and VO 2peak are highly associated in studies that include older adults, athletes, and physically active individuals ( 19 – 23 ). Together authors of these studies suggest that HRRec is a valid marker of cardiorespiratory fitness. However, authors of one study examined the association between cardiorespiratory fitness and HRRec in young, healthy, sedentary females and found no association between VO 2peak and submaximal HRRec ( 24 ). Therefore, despite evidence in other populations, the use of HRRec as an accurate assessment of cardiorespiratory fitness in young and sedentary, but otherwise healthy (non-smoking, non-hypertensive, non-diabetic), adults is unclear.

The purpose of this study was to investigate the validity of using HRRec as an estimate of cardiorespiratory fitness in young, sedentary adults by determining a significant association exists between HRRec and VO 2peak during a maximal graded exercise test (GXT max ). It is well-known that sedentary behavior is associated with cardiovascular disease risk factors ( 25 ). In the U.S., the amount of time young adults spent in sedentary behaviors increased 12% from 2007 to 2016 ( 26 ). Thus, young adults are an emerging at-risk population and valid clinical measures of cardiorespiratory fitness in this group are necessary.

The study was reviewed and approved by the University of Kentucky Office of Research Integrity Medical Institutional Review Board (16-0789-F6A), and participants provided written informed consent before inclusion in the study. Participants between the ages of 18 and 45 years were recruited for a previously reported intervention study ( 27 ). Each participant completed a Physical Activity Readiness-Questionnaire and Health History Form and were excluded if they had existing contraindications to the GXT max as specified in the American College of Sports Medicine Guidelines for Exercise Testing and Prescription ( 28 ).

Anthropometric and body composition measures, including standing height, body mass, circumference measurements, and a total-body dual-energy X-ray absorptiometry (DXA) scan were performed. Participants were measured in lightweight clothing containing no metal and without shoes. Standing height was determined to the nearest 0.1 cm from a wall-fixed meter stick (Pittsburgh ® ; Pittsburg, PA) with the participants’ hands positioned on the hips during a maximal inhalation. Body mass was determined to the nearest 0.1 kg using a calibrated electric scale (Escali Corp., Burnsville, MN). Circumference measurements (waist, abdominal, and hip) were taken in triplicate using a fiberglass anthropometric tape (Creative Health Products BMS-8) in accordance with the guidelines established by the Airlie Conference Proceedings ( 29 ). The mean of the 3 measures was used for analysis. Body composition was measured using total body DXA scans performed using a GE Lunar iDXA bone densitometer (Lunar Inc., Madison, WI). All female participants had negative urine pregnancy tests, which were taken immediately before DXA scanning. A single trained investigator completed and analyzed all scans using the Lunar software Version 14.10. Total body DXA absolute fat-free mass (kg) and mineral-free lean mass (kg), and absolute (kg) and relative (% of body mass) fat masses were determined for each participant.

GXT max tests were completed using an indirect calorimetry testing system (Vmax Encore, Vyaire Medical, Yorba Linda, CA) with an integrated ECG (60 Hz sampling rate; Cardiosoft v6.51, GE Healthcare, Chicago, IL) and a treadmill ergometer. Before the exercise test, baseline heart rate and blood pressure were measured while the participant stood on the treadmill. During the test and recovery period continuous cardiovascular measurements (heart rate and ECG) were monitored. During the continuous, progressive (speed and grade) tests, oxygen consumption (VO 2 ) was measured breath by breath and averaged over 1-minute intervals. The GXT max tests were performed using an incremental treadmill protocol, with 2-min workload stages, developed for a previous study ( 30 ). Since prior studies have shown that similar VO2 peak and HR max are achieved regardless of treadmill protocol (ramp vs incremental), we chose to use the incremental protocol that is regularly used in our lab ( 31 , 32 ). The initial stage of the test began with a walking speed of 5.1 km·h −1 and 0% grade. The test progressed with a 0.6- km·h −1 increase in speed and 2% increase in grade with each subsequent stage. During the final minute of each stage, blood pressure (by manual auscultation) and ratings of perceived exertion (RPE; using the original 6–20 Borg Scale ( 33 )) were recorded. Heart rate was recorded in the last 10 seconds of each stage. The test was terminated in all participants in this study at volitional fatigue (3–4.5 seconds for treadmill to fully stop), and no participants presented contraindications to continuing according to the American College of Sports Medicine guidelines ( 28 ). Verbal encouragement was given throughout the test. After completing the GXT max , five minutes of passive recovery data (heart rate and blood pressure) were taken while the participants’ remained standing on the treadmill. Achievement of VO 2peak (ml·kg −1 ·min −1 ) was defined as a participant’s ability to obtain a minimum of two of the following criteria: respiratory exchange ratio ≥1.1 (determined by 1-minute averaging), RPE ≥ 17, and/or age-predicted maximal heart rate achieved or exceeded ( 34 ). The highest VO 2 value observed during GXT was used for analysis. Eleven participants were not included in the analytic data set due to failure to achieve VO 2peak .

Our primary analysis included heart rate recovery data at 1-, 2-, and 3-minutes post-exercise. Absolute HRRec (bpm) was defined as the heart rate at 1-min, 2-min and 3-minutes post-exercise subtracted from the maximal heart rate achieved during the graded exercise test. Relative HRRec was defined as absolute HRRec divided by maximal heart rate, multiplied by 100. Also, the difference between 1- and 2-min HRRec was calculated as an index of the slow component of the post-exercise HRRec ( 35 ).

Data were analyzed using Statistical Package for Social Sciences (SPSS, Version 26, IBM, Armonk, NY). Descriptive data are presented as means ± standard deviations. Independent sample t -tests were conducted to assess differences in measured variables between males and females. Pearson’s correlation coefficients were used to assess associations between VO 2peak and relative and absolute HRRec as well as measures of body composition. Correlation analyses were stratified by sex to assess potential sex differences. Since we recognize that obesity could influence the analysis, we ran a secondary sensitivity analysis to determine if adiposity influenced our findings. Partial Pearson’s correlation coefficients were used to assess associations between VO 2peak and relative and absolute HRRec in participants while controlling for body fat %. A one-way repeated measures analysis of variance (ANOVA) was performed to determine if relative and absolute HRRec differed between 1-, 2-, and 3-minutes post-exercise. Significance was ascribed at p <0.05.

All participants reported good health, including no known cardiovascular disease or hypertension, were medication-free (except contraceptives), and did not participate in a structured exercise regimen at the time of the study or participate in greater than 2 hours moderate-vigorous physical activity each week. Eleven of the 72 participants were excluded because they did not achieve VO 2peak (details below). The remaining 61 participants included in the analytic data set (40 females) had varying adiposities (BMI: 16.6–37.0; Body fat percentage 12.4–51.7). Males had significantly greater height, body mass, and waist circumference than females ( Table 1 ).

Participant characteristics and anthropometric measures

During the GXT, all participants in the analytic data set, except 3 females, were above an absolute HRRec of 18 bpm, a cutoff value for abnormal 1-minute HRRec observed in a previous study ( Supplemental Table 1 ; DOI: 10.6084/m9.figshare.14691099 ) ( 36 ). VO 2peak was not associated with absolute HRRec at 1-, 2-, or 3-minutes when males and females were examined separately, or when the entire cohort of participants were combined ( Table 2 ; Figure 1 ). Absolute HRRec was also not significantly associated with VO 2peak at 1-, 2-, or 3-minutes when controlling for body fat %. Increased absolute HRRec at 3-minutes was associated with an increased waist circumference for the total study group only. However, absolute HRRec at 1-, 2-, and 3-minutes were not significantly associated with age, BMI, or other anthropometric measures for males, females, or the total study group ( Table 2 ). Males had a significantly greater VO 2peak than females ( Table 3 ). The difference between absolute HRRec at 1-min and 2-min was also not associated with VO 2peak in males, females, or the total study group.

Representative exercise recovery HR data from male (A) and female (B) participants. Pearson correlations were used to compare VO 2peak from the GXT max to measures of absolute (C,E,G) and relative (D,F,H) heart rate recovery at 1, 2, and 3 minutes following exercise termination. HRRec = heart rate recovery

Pearson correlation coefficients among absolute HRRec, VO 2peak , and anthropometric and body composition measures.

Circum = Circumference; HRRec = heart rate recovery; VO 2peak = peak oxygen uptake

VO 2peak , HR, and BP responses to maximal graded exercise test

BP = blood pressure; HR = heart rate; HRRec = heart rate recovery;

Increased age (r = −0.28; p = 0.03), BMI (r = −0.47; p < 0.01) and waist (r = −0.27; p = 0.04), abdominal (r = −0.43; p < 0.01), and hip circumferences (r = −0.46; p < 0.01) were associated with a lower VO 2peak for the total study group. Males, compared to females, had higher HR at peak exercise as well as higher systolic and diastolic blood pressure at baseline, peak exercise, and during recovery ( Table 3 ).

Total body DXA scans were used to determine body composition measures for all participants. Body composition varied in our cohort (%fat range:12.4–51.7%). Increased absolute HRRec at 1-minute was associated with increased fat-free mass in the total study group only. However, fat mass, %fat, and mineral-free lean mass were not associated with absolute HRRec in males, females, or total study group ( Table 2 ). Increased %fat and fat mass were associated with a reduced VO 2peak in males and females separately, as well as the total study group. Also increased mineral-free lean mass and fat-free mass was associated with an increased VO 2peak for the total study group only ( Figure 2 ). Males had greater fat-free mass and mineral-free lean mass compared to females ( Table 1 ). Additionally, females had greater body fat percentage compared to males ( Table 1 ).

Pearson correlation was used to compare VO 2peak from the GXT max to body fat percentage (A), fat mass (B), mineral-free lean mass (C), and fat-free mass (D).

Since peak HR varied within our cohort (range: 157–210), we also examined the relationship between VO 2peak and relative HRRec, which accounts for variability in peak HR. Relative HRRec at 1, 2, or 3 minutes were not significantly associated with measures of VO 2peak when males and females were examined separately, or when the entire cohort of participants were combined ( Figure 1 , Table 4 ). Relative HRRec was also not significantly associated with VO 2peak at 1-, 2-, or 3-mintues when controlling for body fat %. Greater relative HRRec at 3 minutes was associated with increasing age and increasing fat mass for the total study group only. However, relative HRRec measures were not significantly associated with BMI, or any other anthropometric and body composition measure for males, females, or the total study group ( Table 4 ).

Pearson correlation coefficients among relative HRRec, VO 2peak , and anthropometric and body composition measures.

BMI = body mass index; Circum = Circumference; HRRec = heart rate recovery; VO 2peak = peak oxygen uptake

HRRec is recognized as a powerful prognostic measure and predictor of mortality in older adults ( 5 , 6 , 9 ). HRRec and VO 2peak are both used to inform clinical practices in older adults because they are associated with health and longevity ( 2 , 3 , 9 ). Furthermore, numerous studies have shown that HRRec and VO 2peak are increased in physically active compared to sedentary participants, and after completing various exercise regimens, suggesting an important physiological relationship between HRRec and cardiorespiratory fitness ( 14 , 16 , 17 , 37 ). However, the utility of HRRec as an indicator of cardiorespiratory fitness may vary by population and has not been well-studied in young sedentary adults.

Consistent with this study, Tonello et al. also examined the association between cardiorespiratory fitness and HRRec in young (mean age: 34.5yrs) adults not participating in structured exercise and found no association between VO 2peak and 1-, 2-, 3- and 5-minute HRRec ( 24 ). While our study and Tonello et al. both studied young sedentary adults, the 2 studies used somewhat different methods. Our study included both sexes and determined VO 2peak and HRRec from treadmill exercise testing, while Tonello et al. studied only females and used a cycle ergometer. Maximal oxygen uptake measured by cycle ergometer has been shown to be lower than treadmill protocols ( 38 , 39 ). Also, Tonello et al. utilized a submaximal test to measure HRRec (that induced a HR at 86% age-predicted max), while our participants performed a GXT max to volitional fatigue for determination of HRRec. Thus, despite distinct methodological differences, the fact that our 2 studies had similar results is strong evidence that HRRec may not be a valid indicator of cardiorespiratory fitness in young, sedentary adults.

Our study examined HRRec at 1-, 2-, and 3-minutes as these are the measures that have been associated with cardiorespiratory fitness in other populations ( 19 , 23 , 40 ). HRRec after exercise is orchestrated by both the parasympathetic and sympathetic branches of the autonomic nervous system ( 41 ). Parasympathetic reactivation is predominately responsible for the decrease in heart rate immediately following exercise, while sympathetic withdrawal occurs more gradually ( 41 , 42 ). For this reason, previous studies have considered HRRec at 1- and 2-minutes an indicator of vagal reactivation ( 5 , 6 ). In our study of young sedentary adults, HRRec at 1-, 2-, and 3-min was not significantly associated with cardiorespiratory fitness in our total analytic data set or when stratified by sex. Thus, vagal reactivation may not be a reliable indicator of cardiorespiratory fitness in this population.

Our study cohort spanned a large range of adiposities, and 47% of participants were overweight or obese (BMI≥25). Previous studies found that increased obesity is associated with reduced 1-minute HRRec ( 43 , 44 ). In contrast, our data revealed that an increased waist circumference was associated with a greater absolute 3-min HRRec and increased fat mass was associated with a greater relative 3-min HRRec. However, this unexpected finding may be due to the difference in physiological significance of the 3-minute HRRec measure compared to the 1-minute (i.e., sympathetic withdrawal vs. parasympathetic reactivation). Also, our previous data showed that HRRec following a GXT max was similar in healthy-weight and obese children, indicating that young individuals with poor body composition can have normal vagal reactivation following exercise ( 45 ).

Physical activity status may be another factor influencing the relationship between VO 2peak and HRRec. Studies in young adults, which included both physically active and sedentary participants, reported a significant association between VO 2peak and HRRec ( 22 , 23 , 40 ). Studies have also found that subjectively- and objectively-measured physical activity were associated with HRRec ( 23 , 24 ). Although our subjects did not participate in structured exercise, incidental activity may have influenced HRRec, as shown by Tonello et al ( 24 ). In fact, fat-free mass, which is affected by sedentary behavior ( 46 ), was associated with 1-min HRRec in our cohort. Age may also be an important factor since a significant association between VO 2peak and HRRec following a maximal treadmill test was observed in older adults with congestive heart failure ( 19 ). Thus, sedentary behavior and young age appear to be important contributing factors when determining if HRRec is a valid indicator of cardiorespiratory fitness.

We also found that VO 2peak was associated with body fat and fat-free body composition measures. Although VO 2peak is expressed relative to body mass, the composition of body mass varies. In agreement with our findings, previous research reported that greater %fat was associated with reduced VO 2peak and greater fat free mass was associated with increased VO 2peak ( 47 , 48 ).

There were some limitations of our study. First, our HRRec measures were collected during passive recovery while participants remained standing. Other studies collected either active recovery measures or passive recovery measures while participants were seated or lying down ( 6 , 23 , 36 ). However, immediately moving participants to a seated or supine position following a maximal exercise test can be difficult in practice. Since our goal was to inform clinical utility, we collected measures while participants remained standing. Second, our sample size was small with varying adiposities. However, since we designed this study to inform on clinical utility of HRRec in the general population, our inclusion criteria included young, relatively healthy, and sedentary individuals, and no exclusion criteria regarding obesity status were implemented. Third, we did not control for dietary supplements that may have been consumed during the study. Fourth, we did not control for the phase of the menstrual cycle when the GXT max was performed for female participants. It is possible that phase of the menstrual cycle may influence maximal oxygen uptake ( 49 ).

Since the clinical utility of HRRec was first introduced in the late 1990s, many studies have investigated HRRec as a measure of cardiovascular health and fitness in a variety of populations ( 5 , 20 , 23 , 24 ). HRRec has been shown to be a useful diagnostic and prognostic tool for coronary artery disease, heart failure and mortality in older adults, including cardiovascularly healthy participants and heart failure patients ( 5 – 7 ). However, few studies have been performed in young, sedentary adults, which is a rapidly expanding and at-risk population. Valid, non-invasive measures of cardiorespiratory fitness are needed to identify at-risk individuals at a young age and develop interventional therapeutic strategies.

The prevalence of cardiovascular disease among U.S. adults is a staggering 49% of the population ( 50 ). We found that HRRec measures were not significantly associated with VO 2peak in a sample of young, sedentary, adults. While HRRec measures have been used as a clinical indicator of health and morbidity in other populations, they are not a reliable indicator of cardiorespiratory fitness in sedentary young adults.

Supplementary Material

Funding source:.

This study was supported by a Barnstable Brown Diabetes and Obesity Center Pilot Award, a National Institutes of Health (UL1TR001998) Center for Clinical and Translational Science Pilot Award, the National Center for Advancing Translational Sciences (NIH TL1TR001997), the University of Kentucky Pediatric Exercise Physiology Laboratory Endowment, and the University of Kentucky Arvle & Ellen Turner Thacker Research Fund.

No conflicts of interest

Mediterranean diet found to improve children's heart health, study finds

By taylor nicioli, cnn | posted - july 15, 2024 at 10:22 a.m., the mediterranean diet could be beneficial to children's heart health, according to a new study. (vaaseenaa, istockphoto/getty images).

Estimated read time: 4-5 minutes

ATLANTA — The Mediterranean diet has been linked to many health benefits for adults. Now, a new study suggests it could be beneficial to children's heart health as well.

An analysis of nine earlier studies including 577 participants from the ages of 3 to 18 has found incorporating the Mediterranean diet for at least eight weeks had a significant association with lowering blood pressure and total cholesterol, according to the study published Friday in the journal JAMA Network Open .

The research further supports that incorporating healthy dietary habits early in life can help prevent cardiovascular diseases and metabolic disorders, such as high blood pressure and diabetes, which often originate in childhood, researchers say.

"Early dietary habits significantly influence long-term health outcomes," said lead study author Dr. José Francisco López-Gil, a senior researcher with One Health Research Group at the University of the Americas in Quito, Ecuador, in an email.

"The key takeaway for parents is the importance of promoting a diet rich in whole foods and healthy fats to optimize their children's health and reduce the risk of developing chronic diseases."

Knowing the benefits the Mediterranean diet has for adults' cardiometabolic health, the findings are not surprising but provide further emphasis on the importance of having a diet of unprocessed foods such as fruits, vegetables, lean meats and fish for all stages of life, said Dr. Stuart Berger, division head of pediatric cardiology at the Ann & Robert H. Lurie Children's Hospital of Chicago. Berger was not involved with the study.

Here's how parents and guardians could help their children benefit from the Mediterranean eating plan, according to experts.

Should kids eat the Mediterranean diet?

The Mediterranean diet is a way of eating that includes plant-based cooking with an emphasis on healthy fats. Fruits, vegetables, beans, seeds, nuts, whole grains, lean meats and fish are all contributors to the dietary plan.

Not every child needs to adopt a Mediterranean diet, but it is important to increase "real foods" in children's diets and decrease highly processed foods that have added sugars and sodium, said Dr. Natalie Muth, a spokesperson for the American Academy of Pediatrics, who was not involved with the research.

"We know that calories from ultraprocessed foods make up about 70% of a typical teenager's intake. Any change that can lower intake of things like chips, cookies, and sodas and increase intake of fruits and vegetables is a big win," said Muth, a pediatrician and registered dietitian at the WELL Clinic at Children's Primary Care Medical Group in San Diego.

It is always important to keep in mind a child's preferences and to incorporate cultural traditions into any guidance around food choices, Muth added. For those looking to shift to the Mediterranean eating plan, following age-appropriate dietary plans and exercise recommended by a child's pediatrician is also key, said Berger, who is a professor of pediatrics at Northwestern University's Feinberg School of Medicine in Chicago.

Gathering together as a family over a meal as a way to connect also plays a major role in the Mediterranean diet, said Dr. Tamara Hannon, director of the clinical pediatric diabetes program at Riley Hospital for Children at Indiana University Health in Indianapolis.

"Parents need to lead by example by eating using this pattern, offering structured meals and snacks (scheduled), and exercising daily," she added in an email. Hannon, who is also a professor of pediatrics at Indiana University School of Medicine, was not involved with the research.

Hannon also recommends parents and guardians limit their children's eating between structured meals and snacks as well as eliminating sugary beverages and juices to improve blood glucose and weight management.

Future research on improving children's heart health

The authors of the new report found a variation in results across the earlier studies analyzed, which can be attributed to the differing factors of diet and physical activity each study displayed. Despite the variations, the Mediterranean diet consistently improved blood pressure levels and lipid profiles, López-Gil said, which can lower the risk of cardiometabolic problems later in life such as heart attacks, strokes and diabetes.

The researchers were surprised they didn't find evidence of any effects on glucose and insulin levels, López-Gil said. The impact the Mediterranean diet has on these health factors could be less pronounced, or could require a longer time frame to have an effect, he added. The study looked at the results of kids adopting the dietary plan from eight to 40 weeks.

"We'll need to do more studies on kids in particular," Berger said, "but reviewing these studies suggest the … beneficial effects of the so-called Mediterranean diet and everything associated with it."

Further research should include larger sample sizes and more diverse populations as well as longitudinal studies to assess the long-term effects of the Mediterranean diet on kids' cardiometabolic health, López-Gil said.

"The growing research shows the value (in the Mediterranean diet) to be the same for children and adolescents (as in adults)," Muth said. "One of the most impactful steps a parent can take to help improve kids' nutrition is to commit to regular family meals and try to prepare foods at home, as often as possible. The more kids are exposed to fruits, vegetables, and fish, the more likely they will try them and like them eventually."

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