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Metabolic Syndrome, Hostility, and Cardiac Rehabilitation
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shaped, is formed at the bases of the nail beds (arrow in diagram A of Fig. 1). The earliest sign of clubbing is obliteration of this “window” (diagram B of Fig. 1) ѧ In my case, the “window” reappeared 2 months after the infection had been controlled ѧ .
Although Schamroth eventually recovered from his devastating infective endocarditis, he required emergency surgery to both his aortic and mitral valves. He died in 1988 of immunoblastic lymphoma (D. Blumsohn, personal communication, January 27, 2005). Eponymous signs are usually named after the physicians who first described them. Of the 12 eponymous signs of aortic regurgitation I reported in 2004,3 11 were named after the physicians who described them. However, 1, the headbobbing sign of de Musset was named after the patient, whose name was Alfred de Musset.3 More recently, I reported another eponymous sign of aortic regurgitation that was named after a famous patient, instead of the physician—the Lincoln sign.4 Seldom has there been a sign named not only after the physician who described it but also after the patient who happened to be the physician himself. The Schamroth sign of finger clubbing is such a unique example. Tsung O. Cheng, MD Washington, DC 6 July 2005
1. Neu HC. Infective endocarditis. In: Cheng TO, ed. The International Textbook of Cardiology. New York: Pergamon Press, 1987:788 – 810. 2. Schamroth L. Personal experience. S Afr Med J 1976;50:297–300. 3. Cheng TO. Twelve eponymous signs of aortic regurgitation, one of which was named after a patient instead of a physician. Am J Cardiol 2004;93:1332–1333. 4. Cheng TO. Lincoln sign: second eponymous sign of aortic regurgitation named after a pa-
tient instead of a physician. Int J Cardiol, 2005;103:224. doi:10.1016/j.amjcard.2005.07.036
Metabolic Syndrome, Hostility, and Cardiac Rehabilitation The recent report from Todaro et al1 from the Normative Aging Study demonstrates the negative impact of the metabolic syndrome (MS) and hostility symptoms, particularly in combination, on the risk of myocardial infarction. This may be particularly applicable to young patients with coronary heart disease (CHD), because the earlier report by Boyle et al2 demonstrated the increased mortality risk associated with hostility, especially in younger patients. We have demonstrated that nearly 75% of our patients with CHD ⬍60 years have MS (compared with a 20% prevalence of similar-age patients without known CHD).3 Also, younger patients with CHD (⬍50 years old) have a 28% prevalence of hostility symptoms (compared with an only 8% prevalence in elderly patients ⬎65 years of age).4,5 Although most patients with CHD benefit from formal cardiac rehabilitation and exercise training (CRET) programs, including benefits in exercise capacity, obesity indexes, lipids, depression, autonomic function, and major CHD morbidity and mortality,6 we have also demonstrated the benefits of this therapy in improving MS and hostility symptoms.3– 6 In patients with MS, the number of metabolic factors decreased by 15% (p ⬍0.001), and the prevalence of MS decreased by 37% after formal, phase II CRET programs. Patients with MS generally had 2 times higher levels of C-reactive protein than patients without MS, and these levels decreased by nearly 40% after CRET.3 In patients
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with hostility symptoms, their hostility scores decreased by nearly 50%, and the prevalence of hostility symptoms was also reduced by nearly 50% (from 8% to 4% in the elderly and from 28% to 15% in younger patients) after CRET.4,5 We agree with Todaro et al1 regarding the importance of MS and hostility in the CHD risk, as well as with Boyle et al2 regarding the particular importance of hostility as a risk factor for younger patients. Because nonpharmacologic therapy using CRET improves both of these disorders, this therapy should be emphasized in the primary, and particularly, the secondary prevention of CHD. Carl J. Lavie, MD Richard V. Milani, MD New Orleans, Louisiana 8 August 2005
1. Todaro JF, Andrea C, Niaura R, Spio A III, Ward KD, Roytberg A. Combined effect of the metabolic syndrome and hostility on the incidence of myocardial infarction (the Normative Aging Study). Am J Cardiol 2005;96:221–226. 2. Boyle SH, Williams RB, Mark DB, Brummett BH, Siegler IC, Barefoot JC. Hostility, age, and mortality in a sample of cardiac patients. Am J Cardiol 2005;96:64 – 66. 3. Milani RV, Lavie CJ. Prevalence and profile of metabolic syndrome in patients following acute coronary events and effects of therapeutic lifestyle change with cardiac rehabilitation. Am J Cardiol 2003;92:50 –54. 4. Lavie CJ, Milani RV. Prevalence of hostility in young coronary artery disease patients and effects of cardiac rehabilitation and exercise training. Mayo Clin Proc 2005;80:335–342. 5. Lavie CJ, Milani RV. Impact of aging on hostility in coronary patients and effects of cardiac rehabilitation and exercise training in elderly persons. Am J Geriatr Cardiol 2004;13:125– 130. 6. Lavie CJ, Milani RV. Cardiac rehabilitation and exercise training programs in metabolic syndrome and diabetes. J Cardiopulm Rehabil 2005;25:59 – 66. doi:10.1016/j.amjcard.2005.08.001
shaped, is formed at the bases of the nail beds (arrow in diagram A of Fig. 1). The earliest sign of clubbing is obliteration of this “window” (diagram B of Fig. 1) ѧ In my case, the “window” reappeared 2 months after the infection had been controlled ѧ .
Although Schamroth eventually recovered from his devastating infective endocarditis, he required emergency surgery to both his aortic and mitral valves. He died in 1988 of immunoblastic lymphoma (D. Blumsohn, personal communication, January 27, 2005). Eponymous signs are usually named after the physicians who first described them. Of the 12 eponymous signs of aortic regurgitation I reported in 2004,3 11 were named after the physicians who described them. However, 1, the headbobbing sign of de Musset was named after the patient, whose name was Alfred de Musset.3 More recently, I reported another eponymous sign of aortic regurgitation that was named after a famous patient, instead of the physician—the Lincoln sign.4 Seldom has there been a sign named not only after the physician who described it but also after the patient who happened to be the physician himself. The Schamroth sign of finger clubbing is such a unique example. Tsung O. Cheng, MD Washington, DC 6 July 2005
1. Neu HC. Infective endocarditis. In: Cheng TO, ed. The International Textbook of Cardiology. New York: Pergamon Press, 1987:788 – 810. 2. Schamroth L. Personal experience. S Afr Med J 1976;50:297–300. 3. Cheng TO. Twelve eponymous signs of aortic regurgitation, one of which was named after a patient instead of a physician. Am J Cardiol 2004;93:1332–1333. 4. Cheng TO. Lincoln sign: second eponymous sign of aortic regurgitation named after a pa-
tient instead of a physician. Int J Cardiol, 2005;103:224. doi:10.1016/j.amjcard.2005.07.036
Metabolic Syndrome, Hostility, and Cardiac Rehabilitation The recent report from Todaro et al1 from the Normative Aging Study demonstrates the negative impact of the metabolic syndrome (MS) and hostility symptoms, particularly in combination, on the risk of myocardial infarction. This may be particularly applicable to young patients with coronary heart disease (CHD), because the earlier report by Boyle et al2 demonstrated the increased mortality risk associated with hostility, especially in younger patients. We have demonstrated that nearly 75% of our patients with CHD ⬍60 years have MS (compared with a 20% prevalence of similar-age patients without known CHD).3 Also, younger patients with CHD (⬍50 years old) have a 28% prevalence of hostility symptoms (compared with an only 8% prevalence in elderly patients ⬎65 years of age).4,5 Although most patients with CHD benefit from formal cardiac rehabilitation and exercise training (CRET) programs, including benefits in exercise capacity, obesity indexes, lipids, depression, autonomic function, and major CHD morbidity and mortality,6 we have also demonstrated the benefits of this therapy in improving MS and hostility symptoms.3– 6 In patients with MS, the number of metabolic factors decreased by 15% (p ⬍0.001), and the prevalence of MS decreased by 37% after formal, phase II CRET programs. Patients with MS generally had 2 times higher levels of C-reactive protein than patients without MS, and these levels decreased by nearly 40% after CRET.3 In patients
1615
with hostility symptoms, their hostility scores decreased by nearly 50%, and the prevalence of hostility symptoms was also reduced by nearly 50% (from 8% to 4% in the elderly and from 28% to 15% in younger patients) after CRET.4,5 We agree with Todaro et al1 regarding the importance of MS and hostility in the CHD risk, as well as with Boyle et al2 regarding the particular importance of hostility as a risk factor for younger patients. Because nonpharmacologic therapy using CRET improves both of these disorders, this therapy should be emphasized in the primary, and particularly, the secondary prevention of CHD. Carl J. Lavie, MD Richard V. Milani, MD New Orleans, Louisiana 8 August 2005
1. Todaro JF, Andrea C, Niaura R, Spio A III, Ward KD, Roytberg A. Combined effect of the metabolic syndrome and hostility on the incidence of myocardial infarction (the Normative Aging Study). Am J Cardiol 2005;96:221–226. 2. Boyle SH, Williams RB, Mark DB, Brummett BH, Siegler IC, Barefoot JC. Hostility, age, and mortality in a sample of cardiac patients. Am J Cardiol 2005;96:64 – 66. 3. Milani RV, Lavie CJ. Prevalence and profile of metabolic syndrome in patients following acute coronary events and effects of therapeutic lifestyle change with cardiac rehabilitation. Am J Cardiol 2003;92:50 –54. 4. Lavie CJ, Milani RV. Prevalence of hostility in young coronary artery disease patients and effects of cardiac rehabilitation and exercise training. Mayo Clin Proc 2005;80:335–342. 5. Lavie CJ, Milani RV. Impact of aging on hostility in coronary patients and effects of cardiac rehabilitation and exercise training in elderly persons. Am J Geriatr Cardiol 2004;13:125– 130. 6. Lavie CJ, Milani RV. Cardiac rehabilitation and exercise training programs in metabolic syndrome and diabetes. J Cardiopulm Rehabil 2005;25:59 – 66. doi:10.1016/j.amjcard.2005.08.001