TBD Meeting (5445-23)

Older women with high levels of physical activity showed twice the risk of atrial fibrillation (AFib) over 10 years as they did for cardiac disease or stroke, based on data from 46 cross-country skiers.

Although previous research suggests that women derive greater health benefits from endurance sports, compared with men, women are generally underrepresented in sports cardiology research, and most previous studies have focused on younger women, Marius Myrstad, MD, of Baerum Hospital, Gjettum, Norway, said in a presentation at the annual congress of the European Association of Preventive Cardiology.

Previous research also has shown an increased risk of AFib in male endurance athletes, but similar data on women are lacking, Dr. Myrstad said.

The researchers reviewed data from the Birkebeiner Ageing Study, a study of Norwegian cross-country skiers aged 65 years and older who were followed for 10 years. The participants were competitors in the 2009/2010 Birkebeiner race, a 54-km cross country ski race in Norway.

Participants responded to a questionnaire addressing cardiovascular disease risk factors, exercise habits, and other health issues. The mean age at baseline was 67.5 year. A total of 34 participants (76%) were available for follow-up visits in 2014, and 36 attended a follow-up visit in 2020. Cumulative exposure to exercise was 26 years.

A total of 86% of the women reported moderate to vigorous exercise in the past year at baseline; 61% did so at the 2020 follow-up visit. One of the participants died during the study period.

“The baseline prevalence of cardiovascular conditions was very low,” Dr. Myrstad noted.

However, despite a low prevalence of cardiovascular risk factors, the risk of AFib in the study population was twice as high as for other cardiac diseases and stroke (15.6%, 7.1%, and 7.1%, respectively).

The mechanism of action for the increased AFib remains unclear, but the current study highlights the need for large, prospective studies of female athletes to address not only AFib, but also exercise-induced cardiac remodeling and cardiovascular health in general, said Dr. Myrstad.

The findings were limited by the small sample size and use of self-reports, Dr. Myrstad said, and more research is needed to clarify the association between increased AFib and high-level athletic activity in women.

“We should strive to close the gap between female and male athletes in sports cardiology research,” he added.

Consider the big picture of AFib risk

This study is important because of the growing recognition that atrial fibrillation may be a preventable disease, said Gregory Marcus, MD, a cardiologist at the University of California, San Francisco, said in an interview.

American Heart Association

“Various behaviors or exposures that are under the control of the individual patient may reveal especially powerful means to help reduce risk,” he added.

Dr. Marcus said he was not surprised by the current study findings, as they reflect those of other studies suggesting a heightened risk for atrial fibrillation associated with very excessive exercise. However, the study was limited by the relatively small size and lack of a comparison group, he said. In addition, “The study was observational, and therefore the possibility that factors other than the predictor of interest, in this case intensive endurance exercise, were truly causal of atrial fibrillation could not be excluded,” he noted.

“It is very important to place this specialized analysis in the greater context of the full weight of evidence related to physical activity and atrial fibrillation,” said Dr. Marcus. “Specifically, when it comes to the general public and the great majority of patients we see in clinical practice, encouraging more physical activity is generally the best approach to reduce risks of atrial fibrillation,” he said. “It appears to be only in extraordinarily rigorous and prolonged endurance exercise that higher risks of atrial fibrillation may result,” he noted.

However, “Exercise also has many other benefits, related to overall cardiovascular health, brain health, bone health, and even cancer risk reduction, such that, even among the highly trained endurance athletes, the net benefit versus risk remains unknown,” he said. 

“While the risk of atrial fibrillation in these highly trained endurance athletes was higher than expected, it still occurred in the minority,” Dr. Marcus said. “Therefore, there are certainly other factors yet to be identified that influence this heightened atrial fibrillation risk, and future research aimed at elucidating these other factors may help identify individuals more or less prone to atrial fibrillation or other behaviors that can help mitigate that risk.”

Dr. Myrstad disclosed lecture fees from Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, MSD, and Pfizer unrelated to the current study. Dr. Marcus disclosed serving as a consultant for Johnson and Johnson and InCarda, and holding equity as a cofounder of InCarda.

Older women with high levels of physical activity showed twice the risk of atrial fibrillation (AFib) over 10 years as they did for cardiac disease or stroke, based on data from 46 cross-country skiers.

Although previous research suggests that women derive greater health benefits from endurance sports, compared with men, women are generally underrepresented in sports cardiology research, and most previous studies have focused on younger women, Marius Myrstad, MD, of Baerum Hospital, Gjettum, Norway, said in a presentation at the annual congress of the European Association of Preventive Cardiology.

Previous research also has shown an increased risk of AFib in male endurance athletes, but similar data on women are lacking, Dr. Myrstad said.

The researchers reviewed data from the Birkebeiner Ageing Study, a study of Norwegian cross-country skiers aged 65 years and older who were followed for 10 years. The participants were competitors in the 2009/2010 Birkebeiner race, a 54-km cross country ski race in Norway.

Participants responded to a questionnaire addressing cardiovascular disease risk factors, exercise habits, and other health issues. The mean age at baseline was 67.5 year. A total of 34 participants (76%) were available for follow-up visits in 2014, and 36 attended a follow-up visit in 2020. Cumulative exposure to exercise was 26 years.

A total of 86% of the women reported moderate to vigorous exercise in the past year at baseline; 61% did so at the 2020 follow-up visit. One of the participants died during the study period.

“The baseline prevalence of cardiovascular conditions was very low,” Dr. Myrstad noted.

However, despite a low prevalence of cardiovascular risk factors, the risk of AFib in the study population was twice as high as for other cardiac diseases and stroke (15.6%, 7.1%, and 7.1%, respectively).

The mechanism of action for the increased AFib remains unclear, but the current study highlights the need for large, prospective studies of female athletes to address not only AFib, but also exercise-induced cardiac remodeling and cardiovascular health in general, said Dr. Myrstad.

The findings were limited by the small sample size and use of self-reports, Dr. Myrstad said, and more research is needed to clarify the association between increased AFib and high-level athletic activity in women.

“We should strive to close the gap between female and male athletes in sports cardiology research,” he added.

Consider the big picture of AFib risk

This study is important because of the growing recognition that atrial fibrillation may be a preventable disease, said Gregory Marcus, MD, a cardiologist at the University of California, San Francisco, said in an interview.

American Heart Association

“Various behaviors or exposures that are under the control of the individual patient may reveal especially powerful means to help reduce risk,” he added.

Dr. Marcus said he was not surprised by the current study findings, as they reflect those of other studies suggesting a heightened risk for atrial fibrillation associated with very excessive exercise. However, the study was limited by the relatively small size and lack of a comparison group, he said. In addition, “The study was observational, and therefore the possibility that factors other than the predictor of interest, in this case intensive endurance exercise, were truly causal of atrial fibrillation could not be excluded,” he noted.

“It is very important to place this specialized analysis in the greater context of the full weight of evidence related to physical activity and atrial fibrillation,” said Dr. Marcus. “Specifically, when it comes to the general public and the great majority of patients we see in clinical practice, encouraging more physical activity is generally the best approach to reduce risks of atrial fibrillation,” he said. “It appears to be only in extraordinarily rigorous and prolonged endurance exercise that higher risks of atrial fibrillation may result,” he noted.

However, “Exercise also has many other benefits, related to overall cardiovascular health, brain health, bone health, and even cancer risk reduction, such that, even among the highly trained endurance athletes, the net benefit versus risk remains unknown,” he said. 

“While the risk of atrial fibrillation in these highly trained endurance athletes was higher than expected, it still occurred in the minority,” Dr. Marcus said. “Therefore, there are certainly other factors yet to be identified that influence this heightened atrial fibrillation risk, and future research aimed at elucidating these other factors may help identify individuals more or less prone to atrial fibrillation or other behaviors that can help mitigate that risk.”

Dr. Myrstad disclosed lecture fees from Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, MSD, and Pfizer unrelated to the current study. Dr. Marcus disclosed serving as a consultant for Johnson and Johnson and InCarda, and holding equity as a cofounder of InCarda.

Older women with high levels of physical activity showed twice the risk of atrial fibrillation (AFib) over 10 years as they did for cardiac disease or stroke, based on data from 46 cross-country skiers.

Although previous research suggests that women derive greater health benefits from endurance sports, compared with men, women are generally underrepresented in sports cardiology research, and most previous studies have focused on younger women, Marius Myrstad, MD, of Baerum Hospital, Gjettum, Norway, said in a presentation at the annual congress of the European Association of Preventive Cardiology.

Previous research also has shown an increased risk of AFib in male endurance athletes, but similar data on women are lacking, Dr. Myrstad said.

The researchers reviewed data from the Birkebeiner Ageing Study, a study of Norwegian cross-country skiers aged 65 years and older who were followed for 10 years. The participants were competitors in the 2009/2010 Birkebeiner race, a 54-km cross country ski race in Norway.

Participants responded to a questionnaire addressing cardiovascular disease risk factors, exercise habits, and other health issues. The mean age at baseline was 67.5 year. A total of 34 participants (76%) were available for follow-up visits in 2014, and 36 attended a follow-up visit in 2020. Cumulative exposure to exercise was 26 years.

A total of 86% of the women reported moderate to vigorous exercise in the past year at baseline; 61% did so at the 2020 follow-up visit. One of the participants died during the study period.

“The baseline prevalence of cardiovascular conditions was very low,” Dr. Myrstad noted.

However, despite a low prevalence of cardiovascular risk factors, the risk of AFib in the study population was twice as high as for other cardiac diseases and stroke (15.6%, 7.1%, and 7.1%, respectively).

The mechanism of action for the increased AFib remains unclear, but the current study highlights the need for large, prospective studies of female athletes to address not only AFib, but also exercise-induced cardiac remodeling and cardiovascular health in general, said Dr. Myrstad.

The findings were limited by the small sample size and use of self-reports, Dr. Myrstad said, and more research is needed to clarify the association between increased AFib and high-level athletic activity in women.

“We should strive to close the gap between female and male athletes in sports cardiology research,” he added.

Consider the big picture of AFib risk

This study is important because of the growing recognition that atrial fibrillation may be a preventable disease, said Gregory Marcus, MD, a cardiologist at the University of California, San Francisco, said in an interview.

American Heart Association

“Various behaviors or exposures that are under the control of the individual patient may reveal especially powerful means to help reduce risk,” he added.

Dr. Marcus said he was not surprised by the current study findings, as they reflect those of other studies suggesting a heightened risk for atrial fibrillation associated with very excessive exercise. However, the study was limited by the relatively small size and lack of a comparison group, he said. In addition, “The study was observational, and therefore the possibility that factors other than the predictor of interest, in this case intensive endurance exercise, were truly causal of atrial fibrillation could not be excluded,” he noted.

“It is very important to place this specialized analysis in the greater context of the full weight of evidence related to physical activity and atrial fibrillation,” said Dr. Marcus. “Specifically, when it comes to the general public and the great majority of patients we see in clinical practice, encouraging more physical activity is generally the best approach to reduce risks of atrial fibrillation,” he said. “It appears to be only in extraordinarily rigorous and prolonged endurance exercise that higher risks of atrial fibrillation may result,” he noted.

However, “Exercise also has many other benefits, related to overall cardiovascular health, brain health, bone health, and even cancer risk reduction, such that, even among the highly trained endurance athletes, the net benefit versus risk remains unknown,” he said. 

“While the risk of atrial fibrillation in these highly trained endurance athletes was higher than expected, it still occurred in the minority,” Dr. Marcus said. “Therefore, there are certainly other factors yet to be identified that influence this heightened atrial fibrillation risk, and future research aimed at elucidating these other factors may help identify individuals more or less prone to atrial fibrillation or other behaviors that can help mitigate that risk.”

Dr. Myrstad disclosed lecture fees from Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, MSD, and Pfizer unrelated to the current study. Dr. Marcus disclosed serving as a consultant for Johnson and Johnson and InCarda, and holding equity as a cofounder of InCarda.

Regular meditation reduced depression by roughly 44% in adults with coronary artery disease who were involved in a cardiovascular rehabilitation program.

An increasing body of research supports the impact of psychological risk factors including stress, personality type, anger, and hostility on conditions such as depression and anxiety, but also social isolation and low socioeconomic status, Ana Luisa Vitorino Monteiro, MD, of the University of Lisbon said in a presentation at the annual congress of the European Association of Preventive Cardiology. In addition, “stress, anxiety, and depression deteriorate the cardiovascular (CV) system through psycho-neuro-immunoendocrinology system and behavioral pathways.”

Meditation as a tool for stress management has been gaining popularity, but its use as part of a CV rehabilitation program as a complementary therapy has not been well studied, she added.

Dr. Monteiro and colleagues recruited 80 adults with CAD who were undergoing CV rehabilitation to join a meditation program. Of these, 48 accepted (60%) and 40% declined. Those who accepted were part of an exercise-based CV rehabilitation program that met three times a week for at least 6 months. The mean age of the participants was 65 years, and 80% were male.

Participants were randomized to an intervention group with a weekly 90-minute session that included breathing and meditation for 1 month in addition to usual care, or to usual care in the rehabilitation program. Over the next 3 months, the intervention patients were encouraged to practice daily meditation for 20 minutes alone or using video support material, with a weekly follow-up phone call. Assessments of stress, anxiety, and depression took place at baseline and after 4 months using the Perceived Stress Scale, Beck Anxiety Inventory, Beck Depression Inventory, and HeartQoL questionnaire.

At 4 months, individuals in the meditation group had reduced depression levels significantly, by 44%, compared with controls (P < .001). Anxiety and stress decreased significantly, by 30% (P = .04) and 31% (P = .05), respectively. After 4 months, individuals in the control group were offered the opportunity to follow the meditation protocol.

In addition, “the emotional dimension of quality of life increased by 60% in the intervention group,” Dr. Monteiro noted. However, physical QoL did not change between groups.

The study was limited by the small sample size, and more research is needed in larger and more diverse populations, Dr. Monteiro said. However, the results support the value of meditation as an adjunct component of care for CAD patients in a long-term rehabilitation program.
 

Motivation makes a difference

The current study is important as an exploration of “a straightforward, simple, low-risk approach that could be an adjunct to benefit patients with serious cardiovascular disease,” Brian Olshansky, MD, a cardiologist at the University of Iowa, Iowa City, said in an interview.

“We have moved into a time of polypharmacy and multiple interventions for patients with underlying cardiovascular disease which, in many cases, have proven benefit but also potential adverse effects,” he said. “Engaging patients to participate in their health care, when there is serious underlying cardiovascular disease, has potential beneficial impact in many ways. Meditation is a low-risk, low-cost, potentially beneficial adjunct to standard medical therapy that may enhance psychological outcomes as shown here in this small study.”

However, “patients often rely on high-cost, potentially high-risk therapeutic interventions, expecting complete control of their problems without their own collaborative intervention,” he noted.

Dr. Olshansky said he was not surprised by any of the findings, and would have been surprised if meditation had failed to show any benefit for the study population.

“I am very pleased to see these results and would encourage meditation practice to be part of cardiovascular rehabilitation for motivated individuals,” he said. “What did surprise me was the adherence to the meditation protocol for those who participated. This represents a highly motivated group and it may be difficult to expect the same results in less motivated individuals.”

The current study has several strengths, including the use of controls and high rates of adherence to the protocol, said Dr. Olshansky. Other strengths include the standardized approach and the reasonable quality of the outcome measures, which showed a substantial benefit.

However, “this is a small study of motivated individuals of whom 80% were male,” and generalizability to other populations is unclear, Dr. Olshansky said. In addition, the racial mix was not described, and the severity of the underlying coronary artery disease and the therapies provided to these individuals is not detailed. A sicker population may not fare as well.”

The reasons for the benefits of meditation remain uncertain, Dr. Olshansky said. “It could be, specifically, that the meditation itself has physiological effects that ultimately translate into psychosocial benefit. However, those who enrolled and were interested may have derived a placebo effect. In any case, benefit was achieved, but the crossover benefit to the control group is unclear.

“In other words, the statistical approach to benefit is uncertain as to when it was measured, but presumably before the control group was allowed to engage in a meditation practice,” and the follow-up was short term, said Dr. Olshansky.
 

Data support patient engagement

The message to clinicians and patients: “Patients should be engaged in their own health care when it comes to rehabilitation for cardiovascular disease,” said Dr. Olshansky. “Motivated individuals who are educated about a meditative practice performed in a standardized way will have improvement most likely in their quality of life, and when it comes to measurements of depression, stress and anxiety.”

Although the mechanisms behind the benefits remain unclear, “having a standardized credible prescription for which patients can become intimately engaged is beneficial,” he added.

The study received no outside funding. Neither Dr. Monteiro nor Dr. Olshansky had any financial conflicts to disclose.


 

Regular meditation reduced depression by roughly 44% in adults with coronary artery disease who were involved in a cardiovascular rehabilitation program.

An increasing body of research supports the impact of psychological risk factors including stress, personality type, anger, and hostility on conditions such as depression and anxiety, but also social isolation and low socioeconomic status, Ana Luisa Vitorino Monteiro, MD, of the University of Lisbon said in a presentation at the annual congress of the European Association of Preventive Cardiology. In addition, “stress, anxiety, and depression deteriorate the cardiovascular (CV) system through psycho-neuro-immunoendocrinology system and behavioral pathways.”

Meditation as a tool for stress management has been gaining popularity, but its use as part of a CV rehabilitation program as a complementary therapy has not been well studied, she added.

Dr. Monteiro and colleagues recruited 80 adults with CAD who were undergoing CV rehabilitation to join a meditation program. Of these, 48 accepted (60%) and 40% declined. Those who accepted were part of an exercise-based CV rehabilitation program that met three times a week for at least 6 months. The mean age of the participants was 65 years, and 80% were male.

Participants were randomized to an intervention group with a weekly 90-minute session that included breathing and meditation for 1 month in addition to usual care, or to usual care in the rehabilitation program. Over the next 3 months, the intervention patients were encouraged to practice daily meditation for 20 minutes alone or using video support material, with a weekly follow-up phone call. Assessments of stress, anxiety, and depression took place at baseline and after 4 months using the Perceived Stress Scale, Beck Anxiety Inventory, Beck Depression Inventory, and HeartQoL questionnaire.

At 4 months, individuals in the meditation group had reduced depression levels significantly, by 44%, compared with controls (P < .001). Anxiety and stress decreased significantly, by 30% (P = .04) and 31% (P = .05), respectively. After 4 months, individuals in the control group were offered the opportunity to follow the meditation protocol.

In addition, “the emotional dimension of quality of life increased by 60% in the intervention group,” Dr. Monteiro noted. However, physical QoL did not change between groups.

The study was limited by the small sample size, and more research is needed in larger and more diverse populations, Dr. Monteiro said. However, the results support the value of meditation as an adjunct component of care for CAD patients in a long-term rehabilitation program.
 

Motivation makes a difference

The current study is important as an exploration of “a straightforward, simple, low-risk approach that could be an adjunct to benefit patients with serious cardiovascular disease,” Brian Olshansky, MD, a cardiologist at the University of Iowa, Iowa City, said in an interview.

“We have moved into a time of polypharmacy and multiple interventions for patients with underlying cardiovascular disease which, in many cases, have proven benefit but also potential adverse effects,” he said. “Engaging patients to participate in their health care, when there is serious underlying cardiovascular disease, has potential beneficial impact in many ways. Meditation is a low-risk, low-cost, potentially beneficial adjunct to standard medical therapy that may enhance psychological outcomes as shown here in this small study.”

However, “patients often rely on high-cost, potentially high-risk therapeutic interventions, expecting complete control of their problems without their own collaborative intervention,” he noted.

Dr. Olshansky said he was not surprised by any of the findings, and would have been surprised if meditation had failed to show any benefit for the study population.

“I am very pleased to see these results and would encourage meditation practice to be part of cardiovascular rehabilitation for motivated individuals,” he said. “What did surprise me was the adherence to the meditation protocol for those who participated. This represents a highly motivated group and it may be difficult to expect the same results in less motivated individuals.”

The current study has several strengths, including the use of controls and high rates of adherence to the protocol, said Dr. Olshansky. Other strengths include the standardized approach and the reasonable quality of the outcome measures, which showed a substantial benefit.

However, “this is a small study of motivated individuals of whom 80% were male,” and generalizability to other populations is unclear, Dr. Olshansky said. In addition, the racial mix was not described, and the severity of the underlying coronary artery disease and the therapies provided to these individuals is not detailed. A sicker population may not fare as well.”

The reasons for the benefits of meditation remain uncertain, Dr. Olshansky said. “It could be, specifically, that the meditation itself has physiological effects that ultimately translate into psychosocial benefit. However, those who enrolled and were interested may have derived a placebo effect. In any case, benefit was achieved, but the crossover benefit to the control group is unclear.

“In other words, the statistical approach to benefit is uncertain as to when it was measured, but presumably before the control group was allowed to engage in a meditation practice,” and the follow-up was short term, said Dr. Olshansky.
 

Data support patient engagement

The message to clinicians and patients: “Patients should be engaged in their own health care when it comes to rehabilitation for cardiovascular disease,” said Dr. Olshansky. “Motivated individuals who are educated about a meditative practice performed in a standardized way will have improvement most likely in their quality of life, and when it comes to measurements of depression, stress and anxiety.”

Although the mechanisms behind the benefits remain unclear, “having a standardized credible prescription for which patients can become intimately engaged is beneficial,” he added.

The study received no outside funding. Neither Dr. Monteiro nor Dr. Olshansky had any financial conflicts to disclose.


 

Regular meditation reduced depression by roughly 44% in adults with coronary artery disease who were involved in a cardiovascular rehabilitation program.

An increasing body of research supports the impact of psychological risk factors including stress, personality type, anger, and hostility on conditions such as depression and anxiety, but also social isolation and low socioeconomic status, Ana Luisa Vitorino Monteiro, MD, of the University of Lisbon said in a presentation at the annual congress of the European Association of Preventive Cardiology. In addition, “stress, anxiety, and depression deteriorate the cardiovascular (CV) system through psycho-neuro-immunoendocrinology system and behavioral pathways.”

Meditation as a tool for stress management has been gaining popularity, but its use as part of a CV rehabilitation program as a complementary therapy has not been well studied, she added.

Dr. Monteiro and colleagues recruited 80 adults with CAD who were undergoing CV rehabilitation to join a meditation program. Of these, 48 accepted (60%) and 40% declined. Those who accepted were part of an exercise-based CV rehabilitation program that met three times a week for at least 6 months. The mean age of the participants was 65 years, and 80% were male.

Participants were randomized to an intervention group with a weekly 90-minute session that included breathing and meditation for 1 month in addition to usual care, or to usual care in the rehabilitation program. Over the next 3 months, the intervention patients were encouraged to practice daily meditation for 20 minutes alone or using video support material, with a weekly follow-up phone call. Assessments of stress, anxiety, and depression took place at baseline and after 4 months using the Perceived Stress Scale, Beck Anxiety Inventory, Beck Depression Inventory, and HeartQoL questionnaire.

At 4 months, individuals in the meditation group had reduced depression levels significantly, by 44%, compared with controls (P < .001). Anxiety and stress decreased significantly, by 30% (P = .04) and 31% (P = .05), respectively. After 4 months, individuals in the control group were offered the opportunity to follow the meditation protocol.

In addition, “the emotional dimension of quality of life increased by 60% in the intervention group,” Dr. Monteiro noted. However, physical QoL did not change between groups.

The study was limited by the small sample size, and more research is needed in larger and more diverse populations, Dr. Monteiro said. However, the results support the value of meditation as an adjunct component of care for CAD patients in a long-term rehabilitation program.
 

Motivation makes a difference

The current study is important as an exploration of “a straightforward, simple, low-risk approach that could be an adjunct to benefit patients with serious cardiovascular disease,” Brian Olshansky, MD, a cardiologist at the University of Iowa, Iowa City, said in an interview.

“We have moved into a time of polypharmacy and multiple interventions for patients with underlying cardiovascular disease which, in many cases, have proven benefit but also potential adverse effects,” he said. “Engaging patients to participate in their health care, when there is serious underlying cardiovascular disease, has potential beneficial impact in many ways. Meditation is a low-risk, low-cost, potentially beneficial adjunct to standard medical therapy that may enhance psychological outcomes as shown here in this small study.”

However, “patients often rely on high-cost, potentially high-risk therapeutic interventions, expecting complete control of their problems without their own collaborative intervention,” he noted.

Dr. Olshansky said he was not surprised by any of the findings, and would have been surprised if meditation had failed to show any benefit for the study population.

“I am very pleased to see these results and would encourage meditation practice to be part of cardiovascular rehabilitation for motivated individuals,” he said. “What did surprise me was the adherence to the meditation protocol for those who participated. This represents a highly motivated group and it may be difficult to expect the same results in less motivated individuals.”

The current study has several strengths, including the use of controls and high rates of adherence to the protocol, said Dr. Olshansky. Other strengths include the standardized approach and the reasonable quality of the outcome measures, which showed a substantial benefit.

However, “this is a small study of motivated individuals of whom 80% were male,” and generalizability to other populations is unclear, Dr. Olshansky said. In addition, the racial mix was not described, and the severity of the underlying coronary artery disease and the therapies provided to these individuals is not detailed. A sicker population may not fare as well.”

The reasons for the benefits of meditation remain uncertain, Dr. Olshansky said. “It could be, specifically, that the meditation itself has physiological effects that ultimately translate into psychosocial benefit. However, those who enrolled and were interested may have derived a placebo effect. In any case, benefit was achieved, but the crossover benefit to the control group is unclear.

“In other words, the statistical approach to benefit is uncertain as to when it was measured, but presumably before the control group was allowed to engage in a meditation practice,” and the follow-up was short term, said Dr. Olshansky.
 

Data support patient engagement

The message to clinicians and patients: “Patients should be engaged in their own health care when it comes to rehabilitation for cardiovascular disease,” said Dr. Olshansky. “Motivated individuals who are educated about a meditative practice performed in a standardized way will have improvement most likely in their quality of life, and when it comes to measurements of depression, stress and anxiety.”

Although the mechanisms behind the benefits remain unclear, “having a standardized credible prescription for which patients can become intimately engaged is beneficial,” he added.

The study received no outside funding. Neither Dr. Monteiro nor Dr. Olshansky had any financial conflicts to disclose.


 

Napping for more than half an hour during the day was associated with a 90% increased risk of atrial fibrillation (AFib), but shorter naps were linked to a reduced risk, based on data from more than 20,000 individuals.

“Short daytime napping is a common, healthy habit, especially in Mediterranean countries,” Jesus Diaz-Gutierrez, MD, of Juan Ramon Jimenez University Hospital, Huelva, Spain, said in a presentation at the annual congress of the European Association of Preventive Cardiology (EAPC).

Judith Shidlowsky/Pixabay

Previous studies have shown a potential link between sleep patterns and AFib risk, but the association between specific duration of daytime naps and AFib risk has not been explored, he said.

Dr. Diaz-Gutierrez and colleagues used data from the University of Navarra Follow-up (SUN) Project, a prospective cohort of Spanish university graduates, to explore the possible link between naps and AFib. The study population included 20,348 individuals without AFib at baseline who were followed for a median of 13.8 years. The average age of participants at baseline was 38 years; 61% were women.

Daytime napping patterns were assessed at baseline, and participants were divided into nap groups of short nappers (defined as less than 30 minutes per day), and longer nappers (30 minutes or more per day), and those who reported no napping.

The researchers identified 131 incident cases of AFib during the follow-up period. Overall, the relative risk of incident AFib was significantly higher for the long nappers (adjusted hazard ratio 1.90) compared with short nappers in a multivariate analysis, while no significant risk appeared among non-nappers compared to short nappers (aHR 1.26).

The researchers then excluded the non-nappers in a secondary analysis to explore the impact of more specific daily nap duration on AFib risk. In a multivariate analysis, they found a 42% reduced risk of AF among those who napped for less than 15 minutes, and a 56% reduced risk for those who napped for 15-30 minutes, compared with those who napped for more than 30 minutes (aHR 0.56 and 0.42, respectively).

Potential explanations for the associations include the role of circadian rhythms, Dr. Diaz-Gutierrez said in a press release accompanying the presentation at the meeting. “Long daytime naps may disrupt the body’s internal clock (circadian rhythm), leading to shorter nighttime sleep, more nocturnal awakening, and reduced physical activity. In contrast, short daytime napping may improve circadian rhythm, lower blood pressure levels, and reduce stress.” More research is needed to validate the findings and the optimum nap duration, and whether a short nap is more advantageous than not napping in terms of AFib risk reduction, he said.

The study results suggest that naps of 15-30 minutes represent “a potential novel healthy lifestyle habit in the primary prevention of AFib,” Dr. Diaz-Gutierrez said in his presentation. However, the results also suggest that daily naps be limited to less than 30 minutes, he concluded.
 

Sleep habits may serve as red flag

“As we age, most if not all of us will develop sleep disturbances, such as insomnia, obstructive sleep apnea (OSA), and other sleep issues,” Lawrence S. Rosenthal, MD, of the University of Massachusetts, Worcester, said in an interview.

Therefore, “this study is near and dear to most people, and most would agree that poor sleeping habits affect our health.” In particular, OSA has been linked to AFib, although that was not measured in the current study, he added.

Dr. Rosenthal said he was not surprised by the current study findings. “It seems that a quick recharge of your ‘battery’ during the day is healthier than a long, deep sleep daytime nap,” he said. In addition, “Longer naps may be a marker of OSA,” he noted.

For clinicians, the take-home message of the current study is the need to consider underlying medical conditions in patients who regularly take long afternoon naps, and to consider these longer naps as a potential marker for AFib, said Dr. Rosenthal.

Looking ahead, a “deeper dive into the makeup of the populations studied” would be useful as a foundation for additional research, he said.

The SUN Project disclosed funding from the Spanish Government-Instituto de Salud Carlos III and the European Regional Development Fund (FEDER), the Navarra Regional Government, Plan Nacional Sobre Drogas, the University of Navarra, and the European Research Council. The researchers, and Dr. Rosenthal, had no financial conflicts to disclose.

Napping for more than half an hour during the day was associated with a 90% increased risk of atrial fibrillation (AFib), but shorter naps were linked to a reduced risk, based on data from more than 20,000 individuals.

“Short daytime napping is a common, healthy habit, especially in Mediterranean countries,” Jesus Diaz-Gutierrez, MD, of Juan Ramon Jimenez University Hospital, Huelva, Spain, said in a presentation at the annual congress of the European Association of Preventive Cardiology (EAPC).

Judith Shidlowsky/Pixabay

Previous studies have shown a potential link between sleep patterns and AFib risk, but the association between specific duration of daytime naps and AFib risk has not been explored, he said.

Dr. Diaz-Gutierrez and colleagues used data from the University of Navarra Follow-up (SUN) Project, a prospective cohort of Spanish university graduates, to explore the possible link between naps and AFib. The study population included 20,348 individuals without AFib at baseline who were followed for a median of 13.8 years. The average age of participants at baseline was 38 years; 61% were women.

Daytime napping patterns were assessed at baseline, and participants were divided into nap groups of short nappers (defined as less than 30 minutes per day), and longer nappers (30 minutes or more per day), and those who reported no napping.

The researchers identified 131 incident cases of AFib during the follow-up period. Overall, the relative risk of incident AFib was significantly higher for the long nappers (adjusted hazard ratio 1.90) compared with short nappers in a multivariate analysis, while no significant risk appeared among non-nappers compared to short nappers (aHR 1.26).

The researchers then excluded the non-nappers in a secondary analysis to explore the impact of more specific daily nap duration on AFib risk. In a multivariate analysis, they found a 42% reduced risk of AF among those who napped for less than 15 minutes, and a 56% reduced risk for those who napped for 15-30 minutes, compared with those who napped for more than 30 minutes (aHR 0.56 and 0.42, respectively).

Potential explanations for the associations include the role of circadian rhythms, Dr. Diaz-Gutierrez said in a press release accompanying the presentation at the meeting. “Long daytime naps may disrupt the body’s internal clock (circadian rhythm), leading to shorter nighttime sleep, more nocturnal awakening, and reduced physical activity. In contrast, short daytime napping may improve circadian rhythm, lower blood pressure levels, and reduce stress.” More research is needed to validate the findings and the optimum nap duration, and whether a short nap is more advantageous than not napping in terms of AFib risk reduction, he said.

The study results suggest that naps of 15-30 minutes represent “a potential novel healthy lifestyle habit in the primary prevention of AFib,” Dr. Diaz-Gutierrez said in his presentation. However, the results also suggest that daily naps be limited to less than 30 minutes, he concluded.
 

Sleep habits may serve as red flag

“As we age, most if not all of us will develop sleep disturbances, such as insomnia, obstructive sleep apnea (OSA), and other sleep issues,” Lawrence S. Rosenthal, MD, of the University of Massachusetts, Worcester, said in an interview.

Therefore, “this study is near and dear to most people, and most would agree that poor sleeping habits affect our health.” In particular, OSA has been linked to AFib, although that was not measured in the current study, he added.

Dr. Rosenthal said he was not surprised by the current study findings. “It seems that a quick recharge of your ‘battery’ during the day is healthier than a long, deep sleep daytime nap,” he said. In addition, “Longer naps may be a marker of OSA,” he noted.

For clinicians, the take-home message of the current study is the need to consider underlying medical conditions in patients who regularly take long afternoon naps, and to consider these longer naps as a potential marker for AFib, said Dr. Rosenthal.

Looking ahead, a “deeper dive into the makeup of the populations studied” would be useful as a foundation for additional research, he said.

The SUN Project disclosed funding from the Spanish Government-Instituto de Salud Carlos III and the European Regional Development Fund (FEDER), the Navarra Regional Government, Plan Nacional Sobre Drogas, the University of Navarra, and the European Research Council. The researchers, and Dr. Rosenthal, had no financial conflicts to disclose.

Napping for more than half an hour during the day was associated with a 90% increased risk of atrial fibrillation (AFib), but shorter naps were linked to a reduced risk, based on data from more than 20,000 individuals.

“Short daytime napping is a common, healthy habit, especially in Mediterranean countries,” Jesus Diaz-Gutierrez, MD, of Juan Ramon Jimenez University Hospital, Huelva, Spain, said in a presentation at the annual congress of the European Association of Preventive Cardiology (EAPC).

Judith Shidlowsky/Pixabay

Previous studies have shown a potential link between sleep patterns and AFib risk, but the association between specific duration of daytime naps and AFib risk has not been explored, he said.

Dr. Diaz-Gutierrez and colleagues used data from the University of Navarra Follow-up (SUN) Project, a prospective cohort of Spanish university graduates, to explore the possible link between naps and AFib. The study population included 20,348 individuals without AFib at baseline who were followed for a median of 13.8 years. The average age of participants at baseline was 38 years; 61% were women.

Daytime napping patterns were assessed at baseline, and participants were divided into nap groups of short nappers (defined as less than 30 minutes per day), and longer nappers (30 minutes or more per day), and those who reported no napping.

The researchers identified 131 incident cases of AFib during the follow-up period. Overall, the relative risk of incident AFib was significantly higher for the long nappers (adjusted hazard ratio 1.90) compared with short nappers in a multivariate analysis, while no significant risk appeared among non-nappers compared to short nappers (aHR 1.26).

The researchers then excluded the non-nappers in a secondary analysis to explore the impact of more specific daily nap duration on AFib risk. In a multivariate analysis, they found a 42% reduced risk of AF among those who napped for less than 15 minutes, and a 56% reduced risk for those who napped for 15-30 minutes, compared with those who napped for more than 30 minutes (aHR 0.56 and 0.42, respectively).

Potential explanations for the associations include the role of circadian rhythms, Dr. Diaz-Gutierrez said in a press release accompanying the presentation at the meeting. “Long daytime naps may disrupt the body’s internal clock (circadian rhythm), leading to shorter nighttime sleep, more nocturnal awakening, and reduced physical activity. In contrast, short daytime napping may improve circadian rhythm, lower blood pressure levels, and reduce stress.” More research is needed to validate the findings and the optimum nap duration, and whether a short nap is more advantageous than not napping in terms of AFib risk reduction, he said.

The study results suggest that naps of 15-30 minutes represent “a potential novel healthy lifestyle habit in the primary prevention of AFib,” Dr. Diaz-Gutierrez said in his presentation. However, the results also suggest that daily naps be limited to less than 30 minutes, he concluded.
 

Sleep habits may serve as red flag

“As we age, most if not all of us will develop sleep disturbances, such as insomnia, obstructive sleep apnea (OSA), and other sleep issues,” Lawrence S. Rosenthal, MD, of the University of Massachusetts, Worcester, said in an interview.

Therefore, “this study is near and dear to most people, and most would agree that poor sleeping habits affect our health.” In particular, OSA has been linked to AFib, although that was not measured in the current study, he added.

Dr. Rosenthal said he was not surprised by the current study findings. “It seems that a quick recharge of your ‘battery’ during the day is healthier than a long, deep sleep daytime nap,” he said. In addition, “Longer naps may be a marker of OSA,” he noted.

For clinicians, the take-home message of the current study is the need to consider underlying medical conditions in patients who regularly take long afternoon naps, and to consider these longer naps as a potential marker for AFib, said Dr. Rosenthal.

Looking ahead, a “deeper dive into the makeup of the populations studied” would be useful as a foundation for additional research, he said.

The SUN Project disclosed funding from the Spanish Government-Instituto de Salud Carlos III and the European Regional Development Fund (FEDER), the Navarra Regional Government, Plan Nacional Sobre Drogas, the University of Navarra, and the European Research Council. The researchers, and Dr. Rosenthal, had no financial conflicts to disclose.