#GetFit: Cardiorespiratory Fitness and Long-Term Survival in “Low-Risk” Adults

You are young and healthy, meaning that you must be “low-risk,” right? But what does this mean in terms of long-term survival?

In a 2012 study in the Journal of the American Heart Association, a group of authors, including our own Jarret Barry, sought to answer this question. They sought to establish whether cardiorespiratory fitness had important implications for long-term cardiovascular risk among individuals classified as low risk by the Framingham Risk Score (10-year coronary heart disease risk <10%).

The study population was composed of men and women, 30 to 50 years of age in our own city of Dallas, Texas. Eligible individuals were defined as being at low risk for coronary heart disease by Framingham Risk Score at the time of study entry and had no history of diabetes (n=11 190). Cardiorespiratory fitness was determined by maximum graded exercise treadmill tests. Over an average 27±2-year period, 15% of low-fit (quintile 1) compared to 6% of high-fit (quintile 5) individuals died (P<0.001).

The study noted that a 1–metabolic equivalent level increase in baseline fitness was associated with an 11% reduction in all-cause deaths and an 18% reduction in deaths due to cardiovascular disease (CVD) after adjustment for age, sex, body mass index, systolic blood pressure, total cholesterol, blood glucose levels, smoking, and early family history of coronary disease. There was an incremental decrease in CVD risk with increasing fitness quintile, such that the high fit had the lowest adjusted 30-year CVD mortality rate compared to the low fit.

Cardiorespiratory fitness is associated with a significant reduction in long-term CVD among individuals identified as low risk by Framingham Risk Score. These data suggest that preventive lifestyle interventions geared to optimize cardiorespiratory fitness, even among a “low-risk” subset, should be considered to improve CVD-free survival.

See you on the Katy Trail!

Continue reading #GetFit: Cardiorespiratory Fitness and Long-Term Survival in “Low-Risk” Adults

Extended-Spectrum Beta Lactamases

ESBLs
  • Family of heterogeneous enzymes, 100s of different types
  • Mostly seen in E. coli, Klebsiella spp. but other GNR may produce
  • Causes resistance to PCN, cephalosporins and aztreonam
  • Do not inactivate carbapenems
  • Do not affect non-beta lactams abx, but co-resistance common
Rx Options
  • Cystitis: Fosfomycin, Nitrofurantoin, Bactrim, FQ if sensitive
  • Serious infections: Carbapenems preferred
  • Rx failures seen with Cefepime (? inoculum effect) but may be able to overcome with higher doses and continuous infusion based on MIC

Case Challenge #19

History of Present Illness

A 57 year old with HCV, GERD, and chronic anemia presents with years of recurrent epistaxis. He has nosebleeds several times per week that last 10 mins and resolve spontaneously. He also notes generalized weakness, DOE, and chest pressure with exertion. In the past, he complained of dark colored stool. He denies using any nasal medications or drugs. He is not on blood thinners, aspirin or NSAIDs. He otherwise denies cough, SOB at rest, hemoptysis.

PMH: HCV , GERD

PSH: None

SHx: occ ETOH, 30 pack year smoking hx

FHx: Father had recurrent nosebleeds due to an underlying illness but he is unaware of the diagnosis

Meds: Ranitidine and prn tylenol

Allergies: None

 

Physical Exam

Vitals: 96.7F, 104 bpm, 111/68,  RR 18, 100% RA

HEENT: EOMI, PERRLA, pale conjunctiva and mucous membranes, Nasal cavity with dried blood, no active bleeding seen, no nasal polyps

CV: 2/6 systolic murmur without radiation. Regular tachycardia.

Pulm: CTAB, normal effort, no wheezes/rales/rhonchi

GI: Normal bowel sounds, soft, tender to palpation of lower abdomen and mid-epigastric region, no masses

Labs

LabsCC19

GI Endoscopy

Tel

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