Letters to the Editor
- Eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, the 2 main omega-3 long-chain polyunsaturated fatty acids of marine origin, have shown promise for the prevention of cardiovascular disease (CVD) outcomes in animal studies and epidemiologic studies.1 Although several recent trials have shown benefits, as summarized in Mayo Clinic Proceedings in 2019,2 2 randomized control trials published in late 2020 showed neutral results. The situation is summarized thoughtfully in a recent editorial by Farukhi et al, published in Mayo Clinic Proceedings,3 which cited our recent meta-analysis6 on the subject.
- We greatly appreciate the interest by Narasimhan and colleagues in the recent major meta-analysis by Bernasconi et al.1 In this article, we analyzed 40 studies, including more than 135,000 participants, and demonstrated that omega-3 therapy was associated with major reductions in fatal myocardial infarction (MI); (–35%), total MI (–13%), coronary heart disease (CHD) events (–10%), and CHD mortality (–9%). We further demonstrated a strong dosage effect in which higher doses of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were associated with fewer cardiovascular disease (CVD) outcomes.
- Sudden cardiac death (SCD) affects approximately 1 in every 7 adults in the United States.1 A similarly high burden is reported globally, with estimates of 4 to 5 million cases of SCD per year.2 Hypertension increases the risk of SCD, suggesting that blood pressure (BP) is an important risk factor for SCD.3 With advancing age, there are increases in systolic BP and slight decreases in diastolic BP, resulting in a widening of pulse pressure (PP) concomitant with negligible changes in mean arterial pressure (MAP).
- The protective effect of cardiorespiratory fitness on vascular outcomes including sudden cardiac death (SCD) is well established.1-3 Emerging evidence suggests that handgrip strength (HGS), a typical measure of muscular strength, is prospectively and inversely associated with mortality and vascular outcomes such as cardiovascular disease (CVD), coronary heart disease (CHD), and heart failure.4-6 Given the relationship between HGS and vascular outcomes, we hypothesized that HGS would be linked to the risk of SCD.
- The debate exists on whether the dose-response relationship between physical activity (PA) and mortality benefits is, in fact, a curvilinear, U-shaped, or J-shaped curve.1,2 Cardiorespiratory fitness (fitness), highly reflective of habitual PA, is a strong protector against various adverse health outcomes including cardiovascular disease (CVD)3,4 and is also associated with lower health care costs.5 It has been suggested that high levels of fitness may be at least as important as lower body mass index in the prevention of CVD.
- Although high cardiorespiratory fitness (fitness) is associated with a lower risk of atherosclerotic cardiovascular disease (CVD), few studies have examined the relationship between fitness and coronary artery calcium (CAC). Because the Agatston and volume scores for CAC are positively associated with an increased risk of CVD, whereas the CAC density score, representing stabilized plaques, is negatively associated with CVD risk,1 further clarification of the relationship between fitness and CAC appears warranted.