Search

BACKGROUND: Asymptomatic atrial fibrillation (AF) is associated with an increased risk of stroke. The yield of serial electrocardiographic (ECG) screening for AF is unknown. OBJECTIVES: The aim of this study was to determine the frequency of AF detected by serial, 7-day ECG patch screenings in older women identified as having an elevated risk of AF according to the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology)-AF clinical prediction score. METHODS: Postmenopausal women with a 5-year predicted risk of new-onset AF ≥5% according to CHARGE-AF were recruited from the ongoing WHISH (Women’s Health Initiative Strong and Healthy) randomized trial of a physical activity intervention. Participants with AF at baseline by self-report or medical records review were excluded. Screening with 7-day ECG patch monitors was performed at baseline, 6 months, and 12 months from study enrollment. RESULTS: On baseline monitoring, 2.5% of the cohort had AF detected, increasing to 3.7% by 6 months and 4.9% cumulatively by 12 months. Yield of patch screening was higher among participants with a higher (≥10%) CHARGE-AF score: 4.2% had AF detected at baseline, 5.9% at 6 months, and 7.2% at 12 months. Most participants with patch-identified AF never had a clinical diagnosis of AF (36 of 46 [78%]). CONCLUSIONS: Older women with an elevated CHARGE-AF score had a high prevalence of AF on 7-day ECG patch screening. Serial screening over 12 months substantially increased the detection of AF. These data can be useful in helping identify high-risk participants for enrollment in future studies of the management of asymptomatic AF.(Women’s Health Initiative Silent Atrial Fibrillation Recording Study [WHISH STAR]; NCT05366803.)

Objectives The Women's Health Initiative (WHI) randomized trial of calcium/vitamin D supplementation found reduced bone loss with active treatment compared to placebo. Now we examine whether the treatment affected self-reported physical functioning and objective measures of physical functioning. Design A randomized, double-blind, placebo-controlled trial of 1,000 mg calcium carbonate plus 400 IU vitamin D 3 per day or matching placebo pills. Subjects/setting The study included 33,067 women (50 to 79 years old) at 40 US study centers. Main outcome measures Physical functioning was assessed by questionnaire at enrollment in WHI, 1 year prior to calcium/vitamin D trial randomization and at study close-out (average follow-up 7.1 years). Objective physical performance and self-reported exercise measures were collected at WHI baseline (1 year prior to calcium/vitamin D enrollment) and 2 years and 4 years after calcium/vitamin D trial enrollment in a subsample (n=3,137). Statistical analyses performed Calcium/vitamin D effects were tested in unadjusted and interaction linear models for each of the physical function measures. Covariates were baseline total calcium intake, fracture risk score, treatment arm in the hormone therapy and dietary modification trials (ie, active drug or placebo, low-fat diet intervention or usual diet, respectively) and age. Results Neither intention to treat nor high adherence analyses produced substantial effects of calcium/vitamin D compared to placebo on physical functioning or performance. The interaction analyses also did not result in differences because of calcium/vitamin D. Conclusions As the first long-term randomized trial to examine the effectiveness of calcium and vitamin D in protecting against decline of physical functioning in older women, the results did not support benefit.

found a higher incidence of mitral chordae attachments to the interventricular septum in patients with subaortic stenosis, they did not comment on mitral valve function. Our report differs from this previous study by including only surgical patients so that direct observations of the membrane attachments were available. In this study 11 , no patient had accessory mitral valve attachments to the interventricular septum. In addition, our report design focused on evaluating MR. To avoid confusion with physiologic MR (common in this age group), patients with trace MR were considered to have physiologic MR and placed in the group without MR. We found the indexed aortic valve to membrane distance to be signifi cantly greater in the group of patients with MR. The mechanism for the development of MR in patients with subaortic stenosis is not well understood. One explanation may be the mechanical tethering of the anterior mitral valve lea fl et toward the interventricular septum by the membrane attachments to the 2 structures. This may result in tenting of the leafl et as seen by 2-dimensional echocardiographic imaging (Figure 3). This tenting may affect leafl et motion, preventing normal leafl et coaptation. This theory is supported by the resolution of MR in most of our patients after surgical resection of the membrane. Surgical resection of all membrane attachments from the anterior mitral valve leafl et may be necessary to prevent MR. Although the incidence of aortic regurgitation is also reported to be higher with membranes that are more displaced into the left ventricle, the mechanism for the development of MR differs from that of aortic regurgitation 4 : where the high-velocity

Decreased fat intake with weight loss and increased exercise may reduce the risk of diabetes mellitus in persons with impaired glucose tolerance. This study was undertaken to assess the effects of a low-fat dietary pattern on incidence of treated diabetes among generally healthy postmenopausal women.A randomized controlled trial was conducted at 40 US clinical centers from 1993 to 2005, including 48,835 postmenopausal women aged 50 to 79 years. Women were randomly assigned to a usual-diet comparison group (n = 29,294 [60.0%]) or an intervention group with a 20% low-fat dietary pattern with increased vegetables, fruits, and grains (n = 19,541 [40.0%]). Self-reported incident diabetes treated with oral agents or insulin was assessed.Incident treated diabetes was reported by 1303 intervention participants (7.1%) and 2039 comparison participants (7.4%) (hazard ratio, 0.96; 95% confidence interval, 0.90-1.03; P = .25). Weight loss occurred in the intervention group, with a difference between intervention and comparison groups of 1.9 kg after 7.5 years (P.001). Subgroup analysis suggested that greater decreases in percentage of energy from total fat reduced diabetes risk (P for trend = .04), which was not statistically significant after adjusting for weight loss.A low-fat dietary pattern among generally healthy postmenopausal women showed no evidence of reducing diabetes risk after 8.1 years. Trends toward reduced incidence were greater with greater decreases in total fat intake and weight loss. Weight loss, rather than macronutrient composition, may be the dominant predictor of reduced risk of diabetes.

The issue of antitrust injury in Section 8 warrants deeper judicial review from both a technical legal as well as a policy perspective because there are strong arguments on both sides of the issue.

International audience; The chapter goes as follows. In the first section it is demonstrated how the Tour de France is a high quality product. This is a result from its accurate design, its management, its economic model and its finance structure, both in comparison to other mega-sporting events and with reference to tournament theory. It is not easy to assess the competitive balance in the Tour de France since, as was demonstrated in chapter 10, it is at the same time an individual and a team sport contest. After reviewing some results published in literature so far, a new metrics for evaluating competitive balanced in the Tour de France is presented in section 2. Finally, the Tour de France cannot ignore doping as a potential threat to fan attendance and TV viewing. We therefore discuss the issue of doping and a new procedure to deal with doping in section 3.