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Background: longitudinal analyses of physical activity (PA) and arterial stiffness in populations of older adults are scarce. We examined associations between long-term change of PA and arterial stiffness in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). Methods: we assessed PA in SAPALDIA 2 (2001-03) and SAPALDIA 3 (2010-11) using a short questionnaire with a cut-off of at least 150 min of moderate-to-vigorous PA per week for sufficient activity. Arterial stiffness was measured oscillometrically by means of the brachial-ankle pulse wave velocity (baPWV) in SAPALDIA 3. We used multivariable mixed linear regression models adjusted for several potential confounders in 2,605 persons aged 50-81. Results: adjusted means of baPWV were significantly lower in persons with sufficient moderate-to-vigorous PA (i) in SAPALDIA 2 but not in SAPALDIA 3 (P = 0.048) and (ii) in both surveys (P = 0.001) compared with persons with insufficient activity in both surveys. There was a significant interaction between sex and the level of change in PA concerning baPWV (P = 0.03). The triples of parameter estimates describing the association between level of PA change and baPWV were not significantly different between the two sex-specific models (P = 0.07). Conclusions: keeping up or adopting a physically active lifestyle was associated with lower arterial stiffness in older adults after a follow-up of almost a decade. Increasing the proportion of older adults adhering to PA recommendations incorporating also vigorous PA may have a considerable impact on vascular health at older age and may contribute to healthy ageing in general.

We estimated the association between regular physical activity and the incidence of restrictive spirometry pattern. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and physical activity were assessed in 2 population-based European cohorts (European Community Respiratory Health Survey: n = 2,757, aged 39-67 years; and Swiss Study on Air Pollution and Lung and Heart Diseases in Adults: n = 2,610, aged 36-82 years) first in 2000-2002 and again approximately 10 years later (2010-2013). Subjects with restrictive or obstructive spirometry pattern at baseline were excluded. We assessed the association of being active at baseline (defined as being physically active at least 2-3 times/week for ≥1 hour) with restrictive spirometry pattern at follow-up (defined as a postbronchodilation FEV1/FVC ratio of at least the lower limit of normal and FVC of

Purpose The purpose of this paper is to provide a description of a Swiss outpatient group therapy for adolescent and young men with intellectual disabilities who have sexually offended. Design/methodology/approach The findings from two studies that examined the treatment independently from one another are brought together. These combine the qualitative methods of document analysis of programme tools, overt participant observations of treatment sessions and semi-structured interviews with programme designers. Findings At the heart of Forio treatment is a seven-step programme that aims to enable participants to increase their risk management capacities and foster pro-social behaviours. Responsivity issues are a key consideration, and the use of a traffic light system to distinguish acceptable, borderline and unacceptable behaviours provides a central reference point throughout treatment and beyond. Treatment relies on individuals practising newly learned pro-social behaviours in their daily life. To facilitate this, risks are managed, and support is provided via close networking between therapists and the supervision and social care network. Practical implications This paper offers detailed descriptions of the programme setting, structure and tools, which will allow international readers to adapt the techniques discussed to suit their specific treatment context. Particularly, the close networking between treatment providers and those managing risks in the community is commendable. Originality/value The Forio programme has not previously been described in English language papers. Even though it arises from the same evidence base as the internationally more widely known programmes, this paper offers unique insights into ways in which known concepts have been adapted to suit local circumstances.

Background and aims Alpha-1 antitrypsin (A1AT) is the most abundant serine protease inhibitor in human blood and exerts important anti-inflammatory and immune-modulatory effects. In combination with smoking or other long-term noxious exposures such as occupational dust and fumes, genetic A1AT deficiency can cause chronic obstructive pulmonary disease, a condition with elevated cardiovascular risk. The effects of A1AT deficiency on cardiovascular risk have hardly been studied today. Methods Using data from 2614 adults from the population-based SAPALDIA cohort, we tested associations of serum A1AT and SERPINA1 mutations with carotid intima-media thickness (CIMT, measured by B-mode ultrasonography) or self-reported arterial hypertension or cardiovascular disease in multiple regression models using a Mendelian Randomization like analysis design. Mutations Pi-S and Pi-Z were coded as ordinal genotype score (MM, MS, MZ/SS, SZ and ZZ), according to their progressive biological impact. Results Serum A1AT concentration presented a u-shaped association with CIMT. At the lower end of the A1AT distribution, an analogous, linear association between SERPINA1 score and higher CIMT was observed, resulting in an estimated 1.2% (95%-confidence interval -0.1-2.5) increase in CIMT per unit (p = 0.060). Genotype score was significantly associated with arterial hypertension with an odds ratio (OR) of 1.2 (1.0–1.5) per unit (p = 0.028). The association with cardiovascular disease was not significant (OR 1.3 (0.9–1.9)). Conclusions Our results support a possible causal relationship between genetic A1AT deficiency and increased cardiovascular risk, which needs to be better taken into account for the management of affected patients and first-degree relatives.

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch), Respiratory diseases are associated with increased cardiovascular risk in adults, but little is known on the early impact on the vasculature in youth. The SAPALDIA Youth study, the offspring study of the Swiss Study on Air Pollution and Lung and Heart Disease In Adults (SAPALDIA), investigated the association between physician-diagnosed asthma status and common carotid artery intima media thickness (CIMT). Offspring underwent standardized clinical protocols and provided information on early life factors, health, and lifestyle. The association between per subject averages of CIMT and asthma was estimated using mixed linear regression analyses adjusting for main confounders, testing for interaction with gender and age. Of 257 offspring (mean age 15 years, 53% female), 11.5% reported doctor-diagnosed asthma (male 17%, female 7%). Mean CIMT was significantly different by gender (male 0.53 mm (± 0.045), female 0.50 mm (± 0.048); p

Introduction: Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry. Methods: Restrictive spirometry pattern was defined as a having post-bronchodilator FEV1/FVC ≥ Lower Limit of Normal and a FVC

BACKGROUND Non-communicable diseases (NCDs) account for the vast majority of deaths in Switzerland. Insufficient physical activity (PA) is an established NCD risk factor and PA is known to be beneficial for physical and mental wellbeing. Sedentary behaviour (SB) is an additional, independent risk factor and associated with frailty in older adults. This study aimed at describing cross-sectional PA patterns in a general population sample of subjects aged 52 years and older (52+) from eight areas across different language regions of Switzerland. Additionally, the predictive association of self-reported PA for objectively measured PA was tested. METHODS Participants 52+ of the Swiss Cohort Study on Air Pollution And Lung and Heart Disease In Adults (SAPALDIA) who completed accelerometer data collection at the most recent follow-up (SAPALDIA4 in 2017/18) and provided information on determinants of interest (sex, age, body mass index [BMI], language region, education, employment status, civil status, smoking) were included in the analysis (n = 1314). The accelerometer-derived average time spent in different PA intensities (SB, light PA [LPA], moderate-to-vigorous PA [MVPA]) was estimated according to participant characteristics with control for season and wear time using multiple linear regressions. In further analyses, the predictive effect of changes in self-reported PA over roughly ten years between SAPALDIA2 (2001/02) and SAPALDIA3 (2010/11) (remaining inactive [RI]; becoming inactive [BI]; becoming active [BA]; remaining active [RA]) on the objectively measured SB, LPA and MVPA obtained seven years later by accelerometry (SAPALDIA4), was assessed using multiple linear regression models. RESULTS Overall, 21.7% of 52+ participants met the Swiss recommendations for subjectively assessed PA. Obese participants, 75+ year-olds, smokers and subjects living alone spent more time in SB and less time in LPA and MVPA compared with participants with a BMI below 25 kg/m2, between 52 and 64 years old, not smoking and being married, respectively. Residents living in the French-speaking part of Switzerland were less likely to engage in MVPA compared with residents from the German-speaking part and thus were less likely to meet the PA recommendations. A trend for increasing PA and decreasing SB was observed consistently across the four groups (RI, BI, BA, RA) of predictive self-reported PA patterns with participants remaining active over the course of roughly ten years showing highest levels of PA and lowest levels of SB measured objectively at SAPALDIA4. CONCLUSION The high proportion of SB points to the need of physical activity promotion for the older part of the population in Switzerland. According to our data, behavioural changes in PA are possible and sustainable as we can see in the group of participants becoming active and this is essential for health promotion recommendations.

Introduction: A restrictive spirometry pattern is associated with high morbidity and mortality. Whether regular physical activity (PA) protects against this pattern has never been studied.Objective ...

Associations of physical activity (PA) intensity with arterial stiffness in older adults at the population level are insufficiently studied. We examined cross-sectional associations of self-reported PA intensities with arterial stiffness in elderly Caucasians of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults. Mixed central and peripheral arterial stiffness was measured oscillometrically by the cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). The self-reported International Physical Activity Questionnaire long version was administered to classify each subject's PA level. We used univariable and multivariable mixed linear and logistic regression models for analyses in 1908 persons aged 50 years and older. After adjustment for several confounders moderate, vigorous and total PA were inversely associated with CAVI (p = 0.02-0.03). BaPWV showed negative and marginally significant associations with vigorous and moderate PA (each p = 0.06), but not with total PA (p = 0.28). Increased arterial stiffness (CAVI ≥ 9, upper tertile) was inversely and significantly associated with vigorous PA [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.48-0.88], and marginally significantly with total PA (OR 0.76, 95% CI 0.57-1.02) and moderate PA (OR 0.75, 95% CI 0.56-1.01). The odds ratio for baPWV ≥ 14.4 was 0.67 (95% CI 0.48-0.93) across the vigorous PA levels, and was non-significant across the total (OR 0.91, 95% CI 0.66-1.23) and moderate PA levels (OR 0.94, 95% CI 0.69-1.28). In this general Caucasian population of older adults higher levels especially of vigorous PA were associated with lower arterial stiffness. These data support the importance of PA for improving cardiovascular health in elderly people.

BACKGROUND: There is an increasing interest in oscillometric arterial stiffness measurement for cardiovascular risk stratification. We assessed reproducibility of the cuff based arterial stiffness measures cardio ankle vascular index (CAVI) brachial ankle pulse wave velocity (baPWV) and peripheral augmentation index (pAI) in a subsample of the second follow up of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA 3). METHODS: CAVI baPWV and pAI were measured twice within 90 days in a representative subsample (n = 105) of SAPALDIA 3 with a mean age of 63 years (52.4 female). RESULTS: The mean coefficient of variation for CAVI was 4.4 baPWV 3.9 and pAI 7.4. The intraclass correlation coefficient ranged from 0.6 for pAI to 0.8 for CAVI and 0.9 for baPWV. The mixed linear model revealed that 68.7/80.1/55.0 of the CAVI/baPWV/pAI variance was accounted for by the subject 5.2/8.1/ < 0.01 by the fieldworker 6.7/7.8/28.5 by variation between measurement days and 19.4/4/16.5 by measurement error. Bland Altman plots showed no particular dispersion patterns except for pAI. CONCLUSIONS: Oscillometric arterial stiffness measurement by CAVI and baPWV has proved to be highly reproducible in Caucasians. Results of the pAI showed lower reproducibility. CAVI and baPWV can be implemented as easy to apply arterial stiffness measures in population wide cardiovascular risk assessment in Caucasians.

Introduction Regular physical activity has been shown to reduce cardiovascular disease risk in the general population. While smaller studies in specified groups (highly trained versus untrained individuals) indicate a certain dose-dependent effect of physical activity on the reduction of carotid stiffness (an indicator of subclinical vascular disease), it is unclear whether this association is present in a representative sample. Thus, we investigated this question cross-sectionally in participants from the population-based Swiss Cohort Study on Air Pollution And Lung and Heart Diseases In Adults (SAPALDIA). Methods Self-reported total, moderate and vigorous physical activity and distensibility as a measure of local arterial stiffness among 1636 participants aged 50 to 81 years without clinically manifest diseases were evaluated. Mixed regression models were used to examine associations of physical activity intensity with distensibility. Results Vigorous physical activity, but not total nor moderate physical activity, was significantly associated with increased distensibility (= reduced carotid stiffness) in univariate analyses (percent change in the geometric mean and 95% confidence interval per 1 standard deviation increment in vigorous physical activity = 2.54 (0.69; 4.43), p

Introduction and objectives Air pollution and insufficient physical activity have been associated with inflammation and oxidative stress, molecular mechanisms linked to arterial stiffness and cardiovascular disease. There are no studies on how physical activity modifies the association between air pollution and arterial stiffness. We examined whether the adverse cardiovascular effects of air pollution were modified by individual physical activity levels in 2823 adults aged 50–81 years from the well-characterized Swiss Cohort Study on Air Pollution and Lung and Heart Diseases (SAPALDIA). Methods We assessed arterial stiffness as the brachial-ankle pulse wave velocity (baPWV [m/s]) with an oscillometric device. We administered a self-reported physical activity questionnaire to classify each subject’s physical activity level. Air pollution exposure was estimated by the annual average individual home outdoor PM 10 and PM 2.5 (particulate matter 2 (nitrogen dioxide) exposure estimated for the year preceding the survey. Exposure estimates for ultrafine particles calculated as particle number concentration (PNC) and lung deposited surface area (LDSA) were available for a subsample (N = 1353). We used mixed effects logistic regression models to regress increased arterial stiffness (baPWV ≥ 14.4 m/s) on air pollution exposure and physical activity while adjusting for relevant confounders. Results We found evidence that the association of air pollution exposure with baPWV was different between inactive and active participants. The probability of having increased baPWV was significantly higher with higher PM 10 , PM 2.5 , NO 2 , PNC and LDSA exposure in inactive, but not in physically active participants. We found some evidence of an interaction between physical activity and ambient air pollution exposure for PM 10 , PM 2.5 and NO 2 ( p interaction = 0.06, 0.09, and 0.04, respectively), but not PNC and LDSA ( p interaction = 0.32 and 0.35). Conclusions Our study provides some indication that physical activity may protect against the adverse vascular effects of air pollution in low pollution settings. Additional research in large prospective cohorts is needed to assess whether the observed effect modification translates to high pollution settings in mega-cities of middle and low-income countries.

Objective Carotid intima media thickness (CIMT) and local stiffness are vascular biomarkers of atherosclerotic burden. We investigated the variability and reproducibility of clinically relevant structural (CIMT, lumen diameter) and functional parameters (strain, distensibility, compliance, β-stiffness index, Peterson's elastic modulus and Young's elastic modulus) measured in B-mode ultrasound sequences of the common carotid artery in the second follow up of the S wiss Cohort Study on A ir P ollution a nd L ung and Heart D iseases I n A dults (SAPALDIA3). Methods Ultrasound sequential images were examined twice over a 1 cm segment across at least one heart cycle in 165 SAPALDIA3 participants. To assess variability and reproducibility of structural and functional parameters, individual coefficients of variation (CV), intraclass correlation (ICC), Bland–Altman plots and mixed effect regressions were used. Results ICCs of repeated examinations ranged between 0.67 and 0.77 for blood pressure indices, between 0.87 and 0.97 for structural properties and between 0.75 and 0.79 for functional parameters. CV was lowest in structural parameters (1.6–4.6%), followed by blood pressure (5.1–7.9%) and functional indices (11.0–13.1%). Variations in all parameters were predominantly explained by subjects (>74% in functional, >82% in structural properties). Bland–Altman plots for functional indices showed mean and standard deviation of the respective mean value of 4.2(19.6)% for strain, 1.9(24.4)% for distensibility, 2.4(22.2)% for compliance, 3.0(24.4)% for β-stiffness index, 0.9(25.7)% for Peterson's elastic modulus and 1.2(27.9)% for Young's elastic modulus. Conclusion The results show that SAPALDIA3 measurements of transcutaneous ultrasound examinations have an excellent reproducibility of structural parameters and a good reproducibility of functional indices.

People with intellectual disabilities face an exceptionally high risk of being victims of sexual abuse and thereby becoming involved in the criminal justice system. Coping effectively with this system is enough of a challenge for those without disability, but it is far more difficult for the intellectually disabled. As a result, greater attention needs to be paid to their needs. From the opposite perspective, dealing with people with intellectual disabilities is a challenge for experts in forensic and criminal law practice. This short report presents the background, design, and preliminary findings of a study examining how far the police, judges, prosecutors, forensic-psychiatric experts, forensic-psychological experts, and social workers are able to ensure that victims with intellectual disabilities experience procedural fairness by taking their particular needs into account in everyday criminal proceedings.

Noise annoyance (NA) might lead to behavioral patterns not captured by noise levels, which could reduce physical activity (PA) either directly or through impaired sleep and constitute a noise pathway towards cardiometabolic diseases. We investigated the association of long-term transportation NA and its main sources (aircraft, road, and railway) at home with PA levels. We assessed 3842 participants (aged 37–81) that attended the three examinations (SAP 1, 2, and 3 in years 1991, 2001 and 2011, respectively) of the population-based Swiss cohort on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). Participants reported general 24-h transportation NA (in all examinations) and source-specific NA at night (only SAP 3) on an ICBEN-type 11-point scale. We assessed moderate, vigorous, and total PA from a short-questionnaire (SAP 3). The main outcome was moderate PA (active/inactive: cut-off ≥ 150 min/week). We used logistic regression including random effects by area and adjusting for age, sex, socioeconomic status, and lifestyles (main model) and evaluated potential effect modifiers. We analyzed associations with PA at SAP 3 a) cross-sectionally: for source-specific and transportation NA in the last year (SAP 3), and b) longitudinally: for 10-y transportation NA (mean of SAP 1 + 2), adjusting for prior PA (SAP 2) and changes in NA (SAP 3-2). Reported NA (score ≥ 5) was 16.4%, 7.5%, 3%, and 1.1% for 1-year transportation, road, aircraft, and railway at SAP 3, respectively. NA was greater in the past, reaching 28.5% for 10-y transportation NA (SAP 1 + 2). The 10-y transportation NA was associated with a 3.2% (95% CI: 6%–0.2%) decrease in moderate PA per 1-NA rating point and was related to road and aircraft NA at night in cross-sectional analyses. The longitudinal association was stronger for women, reported daytime sleepiness or chronic diseases and it was not explained by objectively modeled levels of road traffic noise at SAP 3. In conclusion, long-term NA (related to psychological noise appraisal) reduced PA and could represent another noise pathway towards cardiometabolic diseases. Keywords: Noise, Annoyance, Traffic, Aircraft, Physical activity, Disease

Structural parameters of the common carotid artery (CCA) have shown to correlate with the risk of cardiovascular disease, but their precise measurement is challenging. We developed an automatic detection system with manual interaction capabilities that can reliably analyze B-mode ultrasound sequences of the CCA over several heart cycles. We evaluated 3824 frames from 40 sequences in two data qualities. Two readers measured the intima media thickness (IMT) and the lumen diameter at two evaluation times (T1/T2). A Bland-Altman analysis of the average IMT showed a bias ± SD of 0.002 ± 0.010 mm (T1), −0.004 ± 0.008 mm (T2) for completely automatic detections and −0.004 ± 0.010 mm (T1), −0.003 ± 0.010 mm (T2) for clips with manual corrections. The combination of automated analysis and manual intervention provides precise parameters as biomarkers for the atherosclerotic process and makes the system suitable for large scale epidemiological research, diagnostic and clinical practice.

Introduction: Asthma has been associated with cardiovascular risk in adults. Data on respiratory health impact on vascular health in youth is scarce. The SAPALDIA Youth study, offspring study of the Swiss Study on Air Pollution and Lung and Heart Disease In Adults, investigated the association between asthma status and common carotid artery intima media thickness (CIMT). Methods: 288 adolescents underwent standardized clinical protocols: anthropometry, blood pressure, ultrasound CIMT, spirometry, blood draw. Offspring and parents gave information on early life, health and lifestyle. Using mixed linear regression analyses the association between per subject averages of CIMT and doctor-diagnosed asthma was estimated, adjusting for main confounders and testing for interaction with sex and age. Results: In 251 offspring (mean age 15 yrs., 53% girls) with high quality CIMT and main covariates asthma was reported by 11.5% (boys 17%, girls 7%). Mean CIMT was 0.529 mm (sd 0.045) in boys and 0.501 in girls (sd 0.048). Overall effect was borderline (0.020mm, 95%CI -0.0025; 0.042), however, interaction was highly significant by sex (p=0.001) yielding a significant increase of ∼1 sd CIMT in asthmatic boys (0.043mm, 0.021;0.066) vs. non-asthmatics, but not in asthmatic girls (-.008mm, -0.052;-0.037). Conclusion: Our study points to a pediatric population of increased risk for early vascular change: adolescent asthmatic boys. The sex-specificity seen in this age group might relate to earlier manifestation of asthma in males. The long-term relevance remains an open question. The findings call for joint efforts of pulmonology and cardiology to further understand the link between lung and vessels to prevent vascular damage early on.

Purpose:To date, there has been limited research examining the influence of pacing pattern (PP) on middle-distance swimming performance. As such, the purpose of the current study was to examine the influence of PP manipulation on 400-m freestyle swimming performance.Methods:15 front-crawl swimmers (5 female, 10 male; age 18 ± 2 y) performed 3 simulated 400-m swimming events. The initial trial was self-selected pacing (PPSS). The following 2 trials were performed in a counterbalanced order and required participants to complete the first 100 m more slowly (PPSLOW: 4.5% ± 2.2%) or quickly (PPFAST: 2.4% ± 1.6%) than the PPSS trial. 50-m split times were recorded during each trial.Results:Overall performance time was faster in PPSS (275.0 ± 15.9 s) than in PPFAST (278.5 ± 16.4 s, P = .05) but not significantly different from PPSLOW (277.5 ± 16.2 s, P = .22). However, analysis for practical relevance revealed that pacing manipulation resulted in a “likely” (>88.2%) decrease in performance compared with PPSS.Conclusion:Moderate manipulation of the starting speed during simulated 400-m freestyle races seems to affect overall performance. The observed results indicate that PPSS is optimal in most individuals, yet it seems to fail in some swimmers. Future research should focus on the identification of athletes possibly profiting from manipulations.

Manifestation of cardiovascular disease (CVD) occurs with clear sex differences. Carotid stiffness (CS) parameters are increasingly used for CVD risk assessment but the sex-specific association with CVD risk factors as well as association patterns between CS parameters are largely unknown, which we investigated in SAPALDIA population-based cohort participants. Risk factors of 2545 participants without clinically manifest disease were evaluated in 2001-2003 and different CS parameters were assessed in carotid ultrasound scans in 2010-2011. Stratified and non-stratified mixed linear models and multivariate regression analyses were used to examine sex-specific associations, differences and association patterns of single risk factors and CS parameters. HDL cholesterol was the only significant protective determinant of reduced CS for both sexes (ranges of CS parameters: -3.7; -0.8% of changes in geometric mean per 1SD of the risk factor on an inverted scale) and significant adverse risk factors were BMI (-0.5; 4.7%), systolic (-1.23; 4.7%) and diastolic blood pressure (1.4; 4.4%), heart rate (2.7; 7.9%), C-reactive protein (0.6; 3.3%) and smoking (-2.82; 1%), all p-values of multivariate analyses were

As the burden of cardiovascular disease (CVD) increases globally, its prevention and risk assessment becomes ever more important. We thus investigated the longitudinal association of the cardiovascular risk scores in the population-based cohort SAPALDIA with carotid intima media thickening (CIMT), an indicator of sub-clinical disease, and CVD incidence.; In 2,832 SAPALDIA participants, the Swiss and ESC heart risk score (AGLA, SCORE) were calculated based on 2001 data and CIMT was measured in 2010/11. We ran multi-level linear regression analyses between scores and CIMT, stratified for CVD status and gender, and logistic analyses for doctor-diagnosed CVD incidence. Path analyses investigated direct and indirect effects on CIMT.; AGLA and SCORE were positively associated with increasing CIMT in both healthy and CVD diagnosed subjects and men and women. Participants in highest risk categories showed a significant CIMT difference of 1%), even larger in CVD healthy subjects and men. With increasing risk the odds of CVD incidence increased (Ref. >1%; 10 yr. risk AGLA

Objective: Hypertension is a major risk factor of cardiovascular events. To identify potential sex specific differences in the association of prior blood pressure (BP) to arterial stiffness, we studies the relative change of lumen diameter for a given pulse pressure (distensibility) in participants of the SAPALDIA cohort study. Methods: In the first follow up in 2002 brachial systolic and diastolic BP were examined in 6456 participants. They were divided into five BP categories (systolicBP/diastolicBP mmHg): ‘optimal’

Background Cigarette smoking is a prevalent risk behavior among adolescents and tracks into adulthood. Little is known on the early impact of smoking on the vasculature in adolescence, although smoking is considered highly atherogenic in adults. We investigated the association between active smoking and Carotid artery Intima Media Thickness (CIMT), an early indicator of atherosclerosis. Methods and results The SAPALDIA Youth Study is a nested study involving 356 offspring (8–20 yrs) of the Swiss SAPALDIA cohort who reported on early life, health and lifestyle, smoking habits and disease history. 288 youth underwent clinical examination. Mean average and maximum CIMT were calculated across all images of right and left common carotid. Multi-level linear regression was performed with weekly smoking, daily number of cigarettes and serum cotinine, adjusting for participant's and parental confounders. Valid CIMT data was available in 275 offspring (mean age 15 yrs, 53% girls). Weekly smoking was reported by 10% and current parental smoking by 24%. Individual mean and maximal CIMT averaged to 0.52 mm (sd 0.05) and 0.60 mm (sd. 0.05), respectively. Regression analyses yielded significant increase in average CIMT (mm) in weekly smokers (0.025, 95% CI 0.006; 0.045), per cigarette/day (0.003, 95% CI 0.001; 0.005) and serum cotinine level (0.008/100 μg/l, 95% CI 0.002; 0.015), which remained consistent after adjusting for parental confounders. Conclusion Our study yields evidence of an early adverse impact of active tobacco exposure on atherogenesis in adolescents, independent of parental smoking, underlining the public health importance of prevention of adolescent smoking.

Purpose:To analyze the reproducibility of pacing in elite swimmers during competitions and to compare heats and finals within 1 event.Methods:Finals and heats of 158 male swimmers (age 22.8 ± 2.9 y) from 29 nations were analyzed in 2 competitions (downloaded from swimrankings.net). Of these, 134 were listed in the world’s top 50 in 2010; the remaining 24 were finalists of the Pan Pacific Games or European Championships. The level of both competitions for the analysis had to be at least national championships (7.7 ± 5.4 wk apart). Standard error of measurement expressed as percentage of the subject’s mean score (CV) with 90% confidence limits (CL) for each 50-m split time and for total times were calculated. In addition, mixed general modeling was used to determine standard deviations between and within swimmers.Results:CV for total time in finals ranged between 0.8% and 1.3% (CL 0.6–2.2%). Regarding split times, 200-m freestyle showed a consistent pacing over all split times (CV 0.9–1.6%). During butterfly, backstroke, and 400-m freestyle, CVs were low in the first 3 and 7 sections, respectively (CV 0.9–1.7%), with greater variability in the last section (1.9–2.2%). In breaststroke, values were higher in all sections (CV 1.2–2.3%). Within-subject SDs for changes between laps were between 0.9% and 2.6% in all finals. Split-time variability for finals and heats ranged between 0.9% and 2.5% (CL 0.3–4.9%).Conclusion:Pacing profiles are consistent between different competitions. Variability of pacing seems to be a result of the within-subject variation rather than a result of different competitions

Associations of physical activity (PA) intensity with arterial stiffness in older adults at the population level are insufficiently studied. We examined cross-sectional associations of self-reported PA intensities with arterial stiffness in elderly Caucasians of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults. Mixed central and peripheral arterial stiffness was measured oscillometrically by the cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). The self-reported International Physical Activity Questionnaire long version was administered to classify each subject's PA level. We used univariable and multivariable mixed linear and logistic regression models for analyses in 1908 persons aged 50 years and older. After adjustment for several confounders moderate, vigorous and total PA were inversely associated with CAVI (p = 0.02-0.03). BaPWV showed negative and marginally significant associations with vigorous and moderate PA (each p = 0.06), but not with total PA (p = 0.28). Increased arterial stiffness (CAVI ≥ 9, upper tertile) was inversely and significantly associated with vigorous PA [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.48-0.88], and marginally significantly with total PA (OR 0.76, 95% CI 0.57-1.02) and moderate PA (OR 0.75, 95% CI 0.56-1.01). The odds ratio for baPWV ≥ 14.4 was 0.67 (95% CI 0.48-0.93) across the vigorous PA levels, and was non-significant across the total (OR 0.91, 95% CI 0.66-1.23) and moderate PA levels (OR 0.94, 95% CI 0.69-1.28). In this general Caucasian population of older adults higher levels especially of vigorous PA were associated with lower arterial stiffness. These data support the importance of PA for improving cardiovascular health in elderly people.

Purpose: This nested study of the second follow-up of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA 3) aimed at analysing the reproducibility of the arterial stiffness marker cardio-ankle vascular index (CAVI) in Caucasians. Methods: In 105 persons aged 50-80yrs (50 males, 55 females, 63.0±6.9yrs) two measurements of CAVI were taken on each of two days within 3 months using a VaseraVS-1500 vascular screening system (Fukuda Denshi) in supine position after 15 min of rest. The analyses involved mean coefficients of variation (CV), Bland-Altman Plots (BAP) and intraclass correlation coefficients (ICC). In order to allow for a fieldworker effect on the measurement of CAVI a mixed linear model with a fixed effect of time (i.e., first and second measurement day) and random effects for subject and time within subject (measurement date) and fieldworker was applied. Results: The CV was 4.4% and the ICC reflecting the ratio of between and within subject variability was 0.803 and when excluding subjects with differing fieldworker 4.3% and 0.805, respectively (N=82). The limits of agreement of the BAP were -1.155 to 1.445 with a mean difference of 0.145 (CI 0.019-0.271). The BAP displayed no particular dispersion pattern. The mixed linear model revealed that the random subject effect accounted for 75.7% of the variability of CAVI measurements, the subject-specific time effect for 14.1%, the fieldworker effect for 5.7% and short-term variability for 4.5%. ![Figure][1] Bland-Altman Plot of CAVI measurement Conclusions: These results are in line with previous findings in Asian populations and show that the measurement of CAVI is highly reproducible also in Caucasians. Since the fieldworker effect is negligible CAVI can be regarded as an easy-to-apply tool for population wide application. [1]: pending:yes

Background: Subclinical atherosclerosis has been associated with long-term exposure to particulate matter (PM), but the relevance of particle size and sources of exposure remains unclear. Objectives: We investigated the association of long-term exposure to PM10 (≤ 10 μm), PM2.5 (≤ 2.5 μm: total mass, vehicular, and crustal sources), and ultrafine particles [UFP < 0.1 μm: particle number concentration (PNC) and lung-deposited surface area (LDSA)] with carotid intima-media thickness (CIMT). Methods: We used data from 1,503 participants ≥ 50 years old who participated in the third examination of the Swiss SAPALDIA cohort. Exposures were obtained from dispersion models and land-use regression models. Covariate information, including previous cardiovascular risk factors, was obtained from the second and third SAPALDIA examinations. Results: The adjusted percent difference in CIMT associated with an exposure contrast between the 10th and 90th percentile was 1.58% (95% CI: –0.30, 3.47%) for PM10, 2.10% (95% CI: 0.04, 4.16%) for PM2.5, 1.67% (95% CI: –0.13, 3.48%) for the vehicular source of PM2.5, –0.58% (95% CI: –3.95, 2.79%) for the crustal source of PM2.5, 2.06% (95% CI: 0.03, 4.10%) for PNC, and 2.32% (95% CI: 0.23, 4.40%) for LDSA. Stronger associations were observed among diabetics, subjects with low-educational level, and those at higher cardiovascular risk. Conclusions: CIMT was associated with exposure to PM10, PM2.5, and UFP. The PM2.5 source-specific analysis showed a positive association for the vehicular source but not for the crustal source. Although the effects of PNC and LDSA were similar in magnitude, two-pollutant and residual-based models suggested that LDSA may be a better marker for the health relevance of UFP. Citation: Aguilera I, Dratva J, Caviezel S, Burdet L, de Groot E, Ducret-Stich RE, Eeftens M, Keidel D, Meier R, Perez L, Rothe T, Schaffner E, Schmit-Trucksäss A, Tsai MY, Schindler C, Künzli N, Probst-Hensch N. 2016. Particulate matter and subclinical atherosclerosis: associations between different particle sizes and sources with carotid intima-media thickness in the SAPALDIA study. Environ Health Perspect 124:1700–1706; http://dx.doi.org/10.1289/EHP161

Purpose: Cardiovascular mortality has a close association with body mass index (BMI). A subclinical vascular biomarker for atherosclerosis is the elastic modulus introduced by Peterson (EP). However, whether BMI is associated with EP has not been investigated. Therefore, the aim of the study was to investigate the association of prior BMI and current EP examined by ultrasound device in participants of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases In Adults (SAPALDIA). Methods: BMI [kg/m2] was measured in 8047 participants of the first follow up of SAPALDIA (SAP2) in 2002 and classified as normal weight (18.5-24.9 BMI), overweight (25-29.9 BMI) and obese (>30 BMI). Further, age, sex, smoking status, brachial systolic (sBP) and diastolic blood pressure (dBP), total cholesterol (TC) and high-density cholesterol (HDL) were examined. In the second follow up in 2010/11 (SAP3) ultrasound clips of the common carotid artery were accomplished in 3490 participants. Lumen diameter (LD) was analyzed over a standardized 1cm segment proximal to the bifurcation over at least one heart cycle. dBP and sBP was measured directly after ultrasound examination. EP was defined as (diastolic LD) × (sBP – dBP)/(systolic LD – diastolic LD). Overall, the study sample included 1815 participants (44.4% men, 55.6% women) with complete measurements. The associations between log-transformed EP and BMI categories were assessed using multiple linear regression analysis with additional adjustment for above mentioned prior cardiovascular risk factors and study centers. Results: Means and standard deviations in SAP2 were: 55.1 (8.1) years for age, 127.0 (18.8) mmHg for sBP, 80.1 (10.7) mmHg for dBP, 6.1 (1.1) mmol/l for TC and 1.5 (0.4) mmol/l for HDL. In the sample, 48.8% were of normal weight, 38.2% overweight and 13% obese. Means and standard deviations in SAP3 were 155.3 (75.0) kPa for EP, 135.1 (18.5) mmHg for sBP and 78.1 (9.4) mmHg for dBP. Adjusted geometric means with 95% confidence intervals for EP [kPa] were 139.2 (136.2, 142.2) for normal weight, 145.7 (142.3, 149.2) for overweight, 147.7 (141.8, 153.9) for obese subjects. Overweight (p=0.013) and obese subjects (p=0.023) differed significantly from normal weight subjects, but there was also a significant difference of EP between overweight and obesity (p=0.018). Conclusions: The results showed significantly higher EP values of the carotid artery for each increase in BMI category. This indicates that prior overweight and obesity is associated with current reduced vascular health status which indicates a harmful long term effect of increased BMI.