Proprotein convertase subtilisin/kexin type 9 (PCSK9) is one of the key regulators of low-density lipoprotein cholesterol plasma levels. Circulating PCSK9, which differs between genders, represents a valid pharmacological target for preventing cardiovascular (CV) events. We aimed to investigate sex-related associations between PCSK9 plasma levels and biochemical and anthropomorphic factors, and familial and personal morbidities, in a large European cohort (n = 3673) of men (47.9%) and women (52.1%). Individuals (aged 54-79 years) free of CV diseases were enrolled in seven centers of five European countries: Finland, France, Italy, the Netherlands, and Sweden. PCSK9 plasma levels were measured by ELISA. PCSK9 was higher in women than in men. Multiple linear regression analysis showed that latitude, sex, and treatments with statins and fibrates were the strongest predictors of PCSK9 in the whole group. These variables, together with triglycerides and high-density lipoprotein cholesterol, were also associated with PCSK9 in men or women. Mean corpuscular hemoglobin concentration and pack-years were PCSK9 independent predictors in women, whereas hypercholesterolemia and physical activity were independent predictors in men. The associations between PCSK9 and latitude, uric acid, diabetes, hypercholesterolemia and physical activity were significantly different in men and women (p_interaction <0.05 for all). Besides confirming the association with lipids in the whole group, our study revealed previously unknown differences in PCSK9 predictors in men and women. These might be taken into account when defining individual risk for CV events and/or for refining PCSK9 lowering treatments.

Physical activity in adolescence is promoted for its multi-dimensional health benefits. However, too intensive sports participation is associated with an increased injury risk. Our aim was to compare the occurrence of acute and overuse injuries in Finnish sports club members and non-members and to report training and competing habits associated with a higher injury risk in sports club members. In this cross-sectional survey targeted at 14–16-year-old adolescents, a structured questionnaire was completed by 1077 sports club members and 812 non-members. The main outcome measures were self-reported acute and overuse injuries, their location and type. At least one acute injury in the past year was reported by 44.0% of sports club members and 19.8% of non-members (P < 0.001). The sex-adjusted odds ratio (OR) for acute injury in sports club members compared to non-members was 3.13 (95% confidence interval (95% CI) 2.54–3.87). Thirty-five percent of sports club members and 17.4% of non-members (P < 0.001) reported at least one overuse injury during the past year. The overuse injury OR for sports club members was 2.61 (95% CI 2.09–3.26). Sports club members who trained 7–14 h per week during training (OR 1.61, 95% CI 1.21–2.12, P = 0.001) or competition season (OR 1.55, 95% CI 1.18–2.06, P = 0.002) were more likely to report an injury compared to members who trained 3–6 h per week. Those sports club members who participated in forty competitions or more compared to 7–19 competitions per year were more likely to report an acute injury (OR 1.55, 95% CI 1.05–2.08, P = 0.028) or for an overuse injury (OR 1.53, 95% CI 1.02–2.30, P = 0.038). Both acute and overuse injuries are common among youth sports club members, and the number increases along with increasing amounts of training and competitions. More effective injury prevention is needed both for adolescents engaging in sports club activities and for other adolescents.

Context: There is plenty of information on electrocardiogram (ECG) and blood pressure (BP) changes in senior athletes. However, a corresponding data in adolescent athletes are scarce. Objective: To study the differences in resting ECG and BP between adolescent endurance athletes, non-endurance athletes, and non-athletes. Design: Cross-Sectional Study Setting: A total of 154 youth sports clubs from COUNTRY-XXX and 100 secondary schools for comparison data. Patients or Other Participants: We recruited young athletes (n=410) aged 14–16 among 10 popular sport disciplines, including both winter and summer as well as team and individual sports, and categorized them as “endurance sports” or “non-endurance sports”. Comparison data composed of age-matched non-sports club participants (n=164) collected via secondary schools. Main Outcome Measure(s): Resting ECG including heart rate, PR interval, QRS duration, QRS axis, QRS amplitude, T axis and QT interval as well as systolic and diastolic blood pressure from all participants. Results: No differences in any ECG variable of interest was found between the endurance and non-endurance athletes. The PR interval was longer in endurance athletes than in non-athletes (P = .05). The QRS amplitude (P = .03) was higher among non-endurance athletes than in non-athletes. Diastolic BP among endurance (P = .002) and non-endurance (P = .02) athletes was lower than non-athletes. Endurance athletes (OR 2.85, 95% CI 1.81–4.50) and non-endurance athletes (OR 2.19, 95% CI 1.43–3.35) were more likely to have sinus bradycardia than non-athletes. Non-endurance athletes were more likely to have elevated systolic BP than endurance athletes (OR 1.70, 95% CI 1.07–2.72) and non-athletes (OR 1.73, 95% CI 1.04–2.87). Conclusions: Young athletes mainly have similar ECG and BP findings independent of the sport. Particular physiological adaptations like sinus bradycardia, higher QRS amplitude and lower diastolic BP, commonly found in adult athletes, are visible also among adolescent athletes.

(1) Background and purpose: circulating proprotein convertase subtilisin/kexin type 9 (PCSK9) is one of the key regulators of cholesterol metabolism. Despite this, its role as a player in atherosclerosis development is still matter of debate. Here, we investigated the relationships between this protein and several markers of subclinical atherosclerosis. (2) Methods: the IMPROVE study enrolled 3703 European subjects (54–79 years; 48% men; with ≥3 vascular risk factors), asymptomatic for cardiovascular diseases. PCSK9 levels were measured by ELISA. B-mode ultrasound was used to measure markers of carotid subclinical atherosclerosis. (3) Results: in the crude analysis, PCSK9 levels were associated with several baseline measures of carotid intima-media thickness (cIMT) (all p < 0.0001); with cIMT change over time (Fastest-IMTmax-progr) (p = 0.01); with inter-adventitia common carotid artery diameter (ICCAD) (p < 0.0001); and with the echolucency (Grey Scale Median; GSM) of both carotid plaque and plaque-free common carotid IMT (both p < 0.0001). However, after adjustment for age, sex, latitude, and pharmacological treatment, all the afore-mentioned correlations were no longer statistically significant. The lack of correlation was also observed after stratification for sex, latitude, and pharmacological treatments. (4) Conclusions: in subjects who are asymptomatic for cardiovascular diseases, PCSK9 plasma levels do not correlate with vascular damage and/or subclinical atherosclerosis of extracranial carotid arteries.

Background: Increased physical activity (PA) may mitigate the negative cardiovascular health effects of sedentary behavior in adolescents. However, the relationship of PA and sedentary time from childhood with cardiac function in adolescence remains underexplored. Therefore, we investigated the associations of cumulative sedentary time and PA from childhood to adolescence with cardiac function in adolescence. Methods and Results: Participants were 153 adolescents (69 girls) who were aged 6 to 8 years at baseline, 8 to 10 years at 2‐year follow‐up, and 15 to 17 years at 8‐year follow‐up. Cumulative sedentary time and PA exposure between baseline and 2‐year follow‐up and between baseline and 8‐year follow‐up were measured using a combined accelerometer and heart rate monitor. Cardiac function was assessed using impedance cardiography at 8‐year follow‐up. The data were analyzed using linear regression analyses adjusted for age and sex. Cumulative moderate to vigorous PA (standardized regression coefficient [β]=−0.323 [95% CI, −0.527 to −0.119]) and vigorous PA (β=−0.295 [95% CI, −0.508 to −0.083]) from baseline to 8‐year follow‐up were inversely associated with cardiac work at 8‐year follow‐up. Conversely, cumulative sedentary time had a positive association (β=0.245 [95% CI, 0.092−0.398]). Cumulative vigorous PA from baseline to 8‐year follow‐up was inversely associated with cardiac work index at 8‐year follow‐up (β=−0.218 [95% CI, −0.436 to 0.000]). Conclusions: Higher levels of sedentary time and lower levels of PA during childhood were associated with higher cardiac work in adolescence, highlighting the importance of increasing PA and reducing sedentary time from childhood.

Purpose: To examine the associations between longitudinal physical activity (PA) patterns and the development of cardiometabolic risk factors from adolescence to young adulthood.Methods: This cohort study encompassed 250 participants recruited from sports clubs and schools, and examined at mean age 15 and 19. Device‐measured moderate‐to‐vigorous PA was grouped into five patterns (via a data‐driven method, usinginactivity maintainersas a reference). The outcomes were:glucose,insulin,homeostasis model assessment for insulin resistance(HOMA‐IR),total cholesterol,HDL and LDL cholesterol,triglycerides,blood pressure, andbody mass index(BMI). Linear growth curve models were applied with adjustment for sex, age, fruit/vegetable consumption, cigarette/snuff use, and change in the device wear‐time.Results: Insulin and BMI increased amongdecreasers from moderate to low PA(βfor insulin 0.23, 95% CI 0.03–0.46;βfor BMI 0.90; CI 0.02–1.78). The concentration of HDL cholesterol decreased (β−0.18, CI −0.31 to −0.05) and that of glucose increased (β0.18, CI 0.02–0.35) amongdecreasers from high to moderate PA. By contrast, amongincreasers, blood pressure declined (systolicβ−6.43, CI −12.16 to −0.70; diastolicβ−6.72, CI −11.03 to −2.41).Conclusions: Already during the transition to young adulthood, changes in PA are associated with changes in cardiometabolic risk factors. Favorable blood pressure changes were found among PAincreasers. Unfavorable changes in BMI, insulin, glucose, and HDL cholesterol were found in groups with decreasing PA. The changes were dependent on the baseline PA and the magnitude of the PA decline.