👤 Kelsey L McAlister

Physical activity (PA), sedentary behavior (SB), and sleep independently influence cardiometabolic health in youth. Because these behaviors are interdependent within a 24-hour day, compositional data analysis has emerged as a method to examine how the distribution of time across behaviors relates to health. While evidence exists for adults and preschool-aged children, findings for school-aged youth, who are at higher risk for inactivity, remain limited. This systematic review examined associations between light PA (LPA), moderate-to-vigorous PA (MVPA), SB, and sleep and cardiometabolic health among youth aged 6 to 17 years. In May 2024, two reviewers conducted systematic searches across five databases following Cochrane criteria. Eligible studies were peer reviewed, included youth aged 6 to 17 years, and used compositional data analysis to assess cardiometabolic outcomes. Of 1,021 records screened, 10 studies met inclusion criteria, and 9 were rated moderate or high quality. MVPA, particularly vigorous PA, showed the most consistent benefits, including lower adiposity, reduced cardiometabolic risk, and higher fitness. SB was generally associated with adverse outcomes, while findings for LPA and sleep were mixed or null. Overall, evidence suggests that daily movement behavior distributions are important predictors of cardiometabolic health in youth and support movement-based public health guidance. Show less

Patients with cardiomyopathies are a heterogeneous group of patients who experience high morbidity and mortality. Early cardiac assessment and intervention with access to genetic counselling in a multidisciplinary Cardiomyopathy Clinic may improve outcomes and prevent progression to advanced heart failure. Our prospective cohort study was conducted at a multidisciplinary Cardiomyopathy Clinic with 421 patients enrolled (42.5% female, median age 58 years), including 224 patients with dilated cardiomyopathy (DCM, 42.9% female, median age 57 years), 72 with hypertrophic cardiomyopathy (HCM, 43.1% female, median age 60 years), 79 with infiltrative cardiomyopathy (65.8% female, median age 70 years) and 46 who were stage A/at risk for genetic cardiomyopathy (54.3% female, median age 36 years). Patients were seen in follow-up at a median of 18 months. A pathogenic/likely pathogenic variant was identified in 28.5% of the total cohort, including 33.3% of the DCM cohort (28% TTN mutations) and 34.1% of the HCM cohort (60% MYBPC3 and 20% MYH7) who underwent genetic testing. The use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitor (48.3-69.5% of total cohort, P < 0.001), β-blockers (58.4-72.4%, P < 0.001), mineralocorticoid receptor antagonists (33.9-41.4%, P = 0.0014) and sodium/glucose cotransporter-2 inhibitors (5.3-27.9%, P < 0.001) all increased at follow-up. Precision-based therapies were also implemented, including tafamidis for transthyretin amyloidosis (n = 21), enzyme replacement therapy for Fabry disease (n = 14) and mavacamten (n = 4) for HCM. Optimization of medications and devices resulted in improvements in left ventricular ejection fraction (LVEF) from 27% to 43% at follow-up for DCM patients with reduced LVEF at baseline (P < 0.001) and reduction in left ventricular mass index (LVMI) from 156 g/m Our study demonstrates that a multidisciplinary cardiomyopathy clinic can improve the clinical profiles of patients with diverse genetic cardiomyopathies. Show less

The deleterious effects of psychological stress on mainstream T lymphocytes are well documented. However, how stress impacts innate-like T cells is unclear. We report that long-term stress surprisingly abrogates both T helper 1 (T Show less