Pet Ownership and Cardiovascular Risk
2013; Lippincott Williams & Wilkins; Volume: 127; Issue: 23 Linguagem: Inglês
10.1161/cir.0b013e31829201e1
ISSN1524-4539
AutoresGlenn N. Levine, Karen Allen, Lynne T. Braun, Hayley Christian, Erika Friedmann, Kathryn A. Taubert, Sue A. Thomas, Deborah L. Wells, Richard A. Lange,
Tópico(s)Eating Disorders and Behaviors
ResumoHomeCirculationVol. 127, No. 23Pet Ownership and Cardiovascular Risk Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBPet Ownership and Cardiovascular RiskA Scientific Statement From the American Heart Association Glenn N. Levine, MD, FAHA, Chair, Karen Allen, PhD, Lynne T. Braun, PhD, CNP, FAHA, Hayley E. Christian, PhD, Erika Friedmann, PhD, Kathryn A. Taubert, PhD, FAHA, Sue Ann Thomas, RN, PhD, Deborah L. Wells, PhD and Richard A. Lange, MD, MBA, FAHAon behalf of the American Heart Association Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing Glenn N. LevineGlenn N. Levine , Karen AllenKaren Allen , Lynne T. BraunLynne T. Braun , Hayley E. ChristianHayley E. Christian , Erika FriedmannErika Friedmann , Kathryn A. TaubertKathryn A. Taubert , Sue Ann ThomasSue Ann Thomas , Deborah L. WellsDeborah L. Wells and Richard A. LangeRichard A. Lange and on behalf of the American Heart Association Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing Originally published9 May 2013https://doi.org/10.1161/CIR.0b013e31829201e1Circulation. 2013;127:2353–2363Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2013: Previous Version 1 IntroductionCardiovascular disease (CVD) is the leading cause of death in the United States.1 Despite efforts promoting primary and secondary CVD prevention,2–8 obesity and physical inactivity remain at epidemic proportions, with >60% of Americans adults overweight or obese and >50% not performing recommended levels of physical activity.9 Similarly, hypertension, hypercholesterolemia, and other CVD risk factors remain poorly controlled in many Americans. Despite numerous pharmacological and device-based advances in the management of patients with established CVD, morbidity and mortality associated with this condition remain substantial. Hence, a critical need exists for novel strategies and interventions that can potentially reduce the risk of CVD and its attendant morbidity and mortality.Numerous studies have explored the relationship between pet (primarily dog or cat) ownership and CVD, with many reporting beneficial effects, including increased physical activity, favorable lipid profiles, lower systemic blood pressure, improved autonomic tone, diminished sympathetic responses to stress, and improved survival after an acute coronary syndrome. Accordingly, the potential cardiovascular benefits of pet ownership have received considerable lay press and medical media coverage and attention from the Centers for Disease Control and Prevention10 and have been the focus of a meeting sponsored by the National Institutes of Health.11 The purpose of this American Heart Association Scientific Statement is to critically assess the data regarding the influence of pet ownership on the presence and reduction of CVD risk factors and CVD risk.Pet Ownership and Systemic HypertensionSome, but not all, studies of pet ownership and systemic blood pressure have found an association between pet ownership and lower blood pressure. An Australian study of 5741 participants attending a free screening clinic found that pet owners had significantly (P=0.03) lower systolic blood pressures than pet nonowners despite similar body mass index (BMI) and socioeconomic profiles.12 In a study of 240 married couples with or without pets, both systolic and diastolic blood pressures were significantly (P<0.01) lower in participants with a pet (dog or cat) than in those without a pet (Allen et al13 and personal communication from Karen Allen on P values, August 12, 2012). An online electronic survey of dog owners (n=536) and nonowners (n=380) found a greater adjusted odds ratio (OR) of self-reported hypertension in nonowners (OR, 1.71; 95% confidence interval [CI], 1.03–2.83).14 A study of 1179 subjects found that pet owners had lower systolic blood pressure (132.8 versus 139.5 mm Hg), pulse pressure (55.5 versus 63.9 mm Hg), and mean arterial pressure (105.0 versus 107.6 mm Hg) than nonowners and a lower incidence of hypertension (OR, 0.62; 95% CI, 0.49–0.80); however, after adjustment for age and other confounders, pet ownership was no longer associated with a lower blood pressure or incidence of hypertension.15 A community survey of 5079 middle-aged adults found pet owners and nonowners had similar systolic blood pressures, and those with pets had slightly higher diastolic blood pressures.16The only randomized data on pet ownership and blood pressure come from a presented17 but unpublished study of 30 participants with borderline hypertension who were randomized either to adopt a dog from a shelter or to defer adoption of a dog. Ambulatory resting systolic blood pressure was similar in both groups at baseline (before dog adoption or deferred adoption). Ambulatory blood pressure monitoring 2 and 5 months after dog adoption demonstrated significantly (P<0.001) lower systolic blood pressures in the dog-adoption group than in the deferred-adoption group. Interestingly, at later follow-up, after all study participants had adopted dogs, systolic blood pressure was found to be similarly lowered in the deferred-adoption group as well.Pet Ownership and HyperlipidemiaThere are minimal data on the association of pet ownership and lipid levels. In a study of 5741 participants attending a free screening clinic, male (but not female) dog owners had significantly but clinically modestly lower total cholesterol (201 versus 206 mg/dL; P=0.02) and triglyceride (108 versus 125 mg/dL; P=0.01) levels than nonowners of dogs.12 In a small (n=32) cross-sectional study of adults ≥60 years of age, pet owners had significantly lower triglyceride levels than pet nonowners (109 versus 192 mg/dL; P<0.01).18In a cross-sectional online survey (n=916), dog nonowners were more likely to report elevated serum cholesterol levels and diabetes mellitus than dog owners who regularly walked their dogs.14 These findings persisted after controlling for owner's age and intensity of physical activity but not after also controlling for BMI. In addition, tobacco use was more common among dog nonowners than dog owners.14Pet Ownership and Physical ActivityOf all pets, dogs appear most likely to positively influence the level of human physical activity. Cross-sectional studies show that dog owners engage in more physical activity and walking and are more likely to achieve the recommended level of physical activity than nonowners of dogs.18–38 For example, data from an online survey of 5253 Japanese adults revealed that after controlling for age, sex, and socioeconomic status, dog owners engaged in significantly more walking and physical activity than nonowners and were 54% more likely to obtain the recommended level of physical activity.25 Similarly, an Australian study that controlled for sociodemographic, neighborhood, social environmental, and intrapersonal factors reported that dog owners engaged in significantly more minutes per week of physical activity (322.4 versus. 267.1, P<0.001) and walking (150.3 versus 110.9, P<0.001) and were 57% more likely to meet the recommended level of physical activity than nonowners.27 A Canadian study (n=351) found that dog owners walked an average of 300 minutes per week compared with 168 minutes per week for nonowners (P<0.01), with the obligation to care for one's dog being the key mediator of this association.28 After controlling for sociodemographic, health, and housing characteristics, the California Health Interview Survey found that dog owners walked 18.9 minutes more per week than pet nonowners.30 Some,23,32,33 but not all,39 studies of adolescents and children found a relationship between the presence of a family dog and physical activity. A meta-analysis of 11 studies found that dog owners walked significantly more and were more physically active than nonowners, with the differences between the 2 groups being small to moderate.40Not surprisingly, dog owners who walk their dogs are more likely to achieve the recommended level of physical activity than dog owners who do not walk their dogs.25,26,41–44 Unfortunately, a significant proportion of dog owners do not regularly walk their dogs.25,27,31,36,43,45 No significant associations have been reported between physical activity and cat or other types of pet ownership.18,25,26,30,38,39,46Several studies have assessed changes in physical activity after acquisition of a pet. A prospective cohort study of people who adopted either a dog or a cat from an animal shelter found a marked and sustained increase in the number and duration of recreational walks among those who adopted a dog but no or little change among those who adopted a cat or no pet (Figure 1).46 Similarly, a longitudinal study of Western Australians taking part in the Residential Environments (RESIDE) project found that self-reported recreational walking increased 22 to 31 minutes per week among those who acquired a dog.47 The primary mechanism through which acquisition of a dog leads to an increase in physical activity is believed to be behavioral intention (via the dog's positive effect on the owner's cognitive beliefs about walking), as well as motivation and social support for walking.47,48Download figureDownload PowerPointFigure 1. Changes over time in the units of recreational walks in people adopting a dog or cat from an animal shelter or not adopting a pet. Walk "units" represent a combination of the number and length of recreational walks taken during the prior fortnight. Results are displayed for baseline and at 1-, 6-, and 10-month follow-up. Median, upper and lower quartiles, and maximum and minimum scores are shown. *P<0.05; ****P 25 kg/m2) between pet nonowners (56%), dog owners (53%), and other pet owners (58%; P=0.09).34In contrast, dog walking, as opposed to pet or dog ownership, does appear to be associated with a lower incidence of obesity. An observational epidemiological study44 of 2199 subjects noted significantly fewer obese (BMI >30 kg/m2) dog walkers (17%) compared with both owners who did not walk their dogs (28%) and nonowners (22%). In this study, dog walking was associated with a higher proportion of participants who met national recommendations for moderate to vigorous physical activity (53%) compared with those who had owned but did not walk their dog (33%) and dog nonowners (46%).44 Similar results were noted in a recent study showing that individuals who did not own a dog had nearly a 2-fold greater odds (OR, 1.92; 95% CI, 1.45–2.56) of being overweight (BMI >25 kg/m2), whereas those who did not walk their dog had a 60% higher odds (OR, 1.58; 95% CI, 1.07–2.33) of being overweight compared with dog walkers.14 In one study of younger children, the odds of being overweight or obese were lower among those whose family owned a dog than among families without a dog (OR, 0.5; 95% CI, 0.3–0.8).55Whether people walking with their dogs would lose more weight after 1 year than people walking alone was assessed in the People and Pets Exercising Together (PPET) Study.56 Thirty-six pairs of overweight or obese people with an obese pet and 56 overweight or obese people without pets participated in a 1-year prospective, controlled weight loss study in which people received dietary and physical activity counseling and dogs were fed a calorie-controlled prescription diet. Both people and their pets successfully lost weight; however, obese pet owners had similar weight loss as those without pets (4.7% versus 5.2%, respectively; P=NS).Pet Ownership and Autonomic Function and Cardiovascular ReactivityA positive or beneficial relationship between pet ownership and autonomic function or cardiovascular reactivity to stress has been reported in most13,57–69 but not all69–72 published studies. For example, cardiovascular reactivity to stress (ie, mental arithmetic and cold pressor) was assessed in 240 couples, half of whom owned a cat or dog. People with pets had significantly lower resting baseline heart rates and blood pressure, significantly smaller increases in heart rate and blood pressure in response to stress, and faster recovery of these parameters to baseline after cessation of stress. Reactivity to stress was lowest and recovery fastest in couples tested when their pet was present.13One published randomized study on pet ownership and cardiovascular reactivity was identified. As part of a study of blood pressure response to mental stress, 48 hypertensive patients with a high-stress occupation who were interested in stress reduction and had agreed to acquire a pet if chosen to do so were randomized to acquire or not acquire a pet.59 Physiological responses to mental stress were assessed before pet adoption and 6 months later, with pets present for those who had adopted them. Compared with pet nonowners, those who adopted a pet had similar physiological responses to mental stress at baseline but significantly diminished increases in systolic and diastolic blood pressure, heart rate, and plasma renin activity when exposed to mental stress at 6 months (Figure 2).Download figureDownload PowerPointFigure 2. Physiological responses to mental stress at 6-month follow-up among those who acquired pets (gray bars) and those who did not (black bars). DBP indicates diastolic blood pressure; HR, heart rate; MATH, mental arithmetic tasks; PRA, plasma renin activity; and SBP, systolic blood pressure. Figures modified from Allen et al.59 Copyright © 2001, American Heart Association, Inc.Two studies measured heart rate variability with 24-hour Holter monitors to assess autonomic function.57,58 In people with ≥1 cardiac risk factor, pet (primarily dog or cat) owners (n=82) had greater elevated parasympathetic and diminished sympathetic nervous activities than nonowners (n=109), which indicates that pet ownership (1) attenuated the imbalance in autonomic nervous activity among patients with lifestyle-related diseases and (2) was associated with greater adaptability to perturbations in the cardiovascular system.57 Among 102 post–myocardial infarction patients, owners of pets (dogs or cats) had significantly higher heart rate variability than nonowners,58 which has been associated with decreased cardiac mortality among such patients.73Although most studies of autonomic and cardiovascular reactivity involved dogs or cats, several studies demonstrated beneficial effects on these parameters associated with goat,60 fish,74 chimpanzee,61 and snake75 ownership. One experiment even demonstrated a benefit on cardiovascular stress responses with "virtual" animals, which were presented in the form of video recordings.76Pet Ownership and Survival in People Without Established CVDThere are scant data on pet ownership and survival in people without established CVD. Analysis of data from a large national health survey (published in an open-access journal) did not find a survival advantage associated with pet ownership.34 Likewise, analysis of data from the NHANES II, a longitudinal cohort study, did not find pet ownership was associated with reduced overall mortality.77Pet Ownership and Survival in Patients With Established CVDPet ownership is an important nonhuman form of social support and may provide cardioprotective benefits in patients with established CVD. In a substudy of the Cardiac Arrhythmia Suppression Trial (CAST), 1-year survival data were assessed in 369 study participants on the basis of whether or not the participant owned a pet. Overall, pet ownership of any kind tended to be independently associated with survival (P=0.085). Dog ownership was strongly associated with decreased mortality, with the likelihood of mortality being 4.05 times greater for dog nonowners than for dog owners (P<0.05); the benefit of dog ownership on survival was independent of physiological measures or the severity of CVD. Cat ownership was not found to be associated with decreased mortality or cardiac-related rehospitalization.78One-year survival was prospectively assessed in 96 patients admitted to a cardiac care unit or intensive care unit with myocardial infarction or angina pectoris.79 At 1-year follow-up, 11 (28%) of 39 pet nonowners had died compared with only 3 (6%) of 53 pet (primarily dog) owners (P=0.002); the beneficial effect of pet ownership on survival appeared to be independent of age and the physiological severity of CVD. A post hoc analysis of survivors of myocardial infarction who were followed up in the Psychosocial Responses in the Home Automated External Defibrillator Trial (PR-HAT) found that lack of pet ownership was a significant (P=0.036) predictor of mortality.80In contrast to the findings in the above studies, a study of 412 patients with acute coronary syndrome found that the 1-year risk of readmission or cardiac death was not statistically different between dog owners and nonowners (OR, 1.59; 95% CI, 0.759–3.321; P=0.22) and was greater in cat owners than in nonowners (OR, 3.22; 95% CI, 1.44–7.19; P=0.004).81Summary, Conclusions, and RecommendationsA summary of the most relevant studies of pet ownership and cardiovascular risk is given in Table 1. Table 2 displays the American College of Cardiology Foundation and American Heart Association scheme for the classification of recommendations and level of evidence. The writing group's conclusions and recommendations using this classification scheme are listed below.Table 1. Summary of the Most Relevant Studies of Pet Ownership and Cardiovascular RiskReferenceStudy Type, Design, and PopulationPrimary FindingsBlood pressure and hypertensionAnderson et al12Cohort analysis of cardiac risk factors in 5741 participants (784 pet owners; 4957 nonowners) attending a free screening clinicPet owners had lower SBPs than nonowners (P=0.03) despite similar BMI and socioeconomic profilesAllen et al13Prospective study of heart rate, BP, and cardioreactivity in 240 married couples, half of whom owned a pet (dog or cat)Pet owners had lower resting heart rates and BPs (P=0.001)Wright et al15Cohort analysis of 1179 community-dwelling men and women, aged 50 to 95 years, who owned ordid not own a pet, assessing BPPet owners had lower SBP, pulse pressure, and mean arterial pressure and a reduced risk of hypertension (OR, 0.62; 95% CI, 0.49–0.80)No significant association remained after adjustment for age and other confoundersParslow and Jorm16Community survey of 5079 middle-aged petowners and nonownersPet owners and nonowners had similar SBPPet owners had slightly higher DBPAllen (unpublished data and reference 17)Randomized study assessing BP changes in 30 participants with borderline hypertension randomized either to adopt or defer adoptionof a dogAmbulatory BP monitoring 2 and 5 months after adoption demonstrated significantly lower SBP in the dog-adoption group (P<0.001)Physical activitySerpell46Observational study of 97 adults comparing PA between 28 pet nonowners and 71 pet ownerswho recently acquired a pet (dog or cat) from an animal shelterCompared with nonowners and new cat owners, new dog owners increased their recreational walking significantly more over a 10-mo period (from 1 h to 5 h/wk; P<0.05)Bauman et al36Cross-sectional analysis of PA in 894 adult dog owners (45.6%) and nonowners (54.4%)On average, dog owners engaged in 210 min/wk of PA (95% CI, 186–228) compared with 198 min/wk (95% CI, 174–216) among nonownersOn average, dog owners walked for 120 min/wk (95% CI, 108–132) compared with 102 min/wk (95% CI, 84–108) among nonownersNo significant difference was seen in the proportion of dog owners vs nonowners achieving the recommended level of PAForty percent of dog owners were physically active with their dog and walked with a median frequency of 3 times/wk and median duration of 57 min/wkBrown and Rhodes28Cross-sectional study of PA in 351 randomly sampled adult dog owners (19.9%) andnonowners (80.1%)On average, dog owners engaged in significantly more PA than nonowners (410.3 vs 287.5 min/wk; P<0.01)On average, dog owners walked significantly more than nonowners (300.2 vs 168.4 min/wk; P<0.01)Thorpe et al (Health ABC Study)26Cross-sectional study of PA in 2533 older (aged 70–79 years) pet owners (12.9% dog owners;6.6% cat owners; 2.2% dog and cat owners) andpet nonownersCompared with nonowners, dog owners were 32% (OR, 1.32; 95% CI, 1–1.76) more likely to engage in any weekly PA67.9% of dog owners and 32.1% of nonowners did some nonexercise walking weekly (P 0.05)Cutt et al27Cross-sectional study of PA in 1813 adult dog owners (44%) and nonowners (56%)On average, dog owners engaged in significantly more PA (322.4 vs 267.1 min/wk; P<0.001) and walking (150.3 vs 110.9 min/wk; P<0.001) than nonownersAfter adjustment, dog owners were 57% more likely than nonowners to achieve the recommended level of PA (95% CI, 1.14–2.16)After adjustment, dog owners were 59% more likely than nonowners to walk ≥150 min/wk (95% CI, 1.08–2.36)23% of dog owners walked with their dog ≥5 times/wk; 22% did no walking with their dogCutt et al43Cross-sectional study of PA in 629 adult dogwalkers (77%) and nonwalkersSignificantly more dog walkers than nonwalkers achieved the recommended level of PA (72% vs 44%; P<0.001)Dog walkers engaged in significantly more PA (356 vs 211 min/wk; P<0.001), walking (180 vs 72 min/wk; P<0.001), and walking for recreation (134 vs 41 min/wk; P<0.001) than nonwalkersCutt et al47Longitudinal 12-month study of PA of 92 dog nonowners acquiring a dogAfter adjustment for baseline variables, dog acquisition was associated with an additional 31 min/wk (95% CI, 7.39–54.22) of neighborhood recreational walking. The increase was only 22 min/wk (95% CI, −1.53 to 45.42) after further adjustment for change in baseline to follow-up variablesReferenceStudy Type, Design, and PopulationPrimary FindingsYabroff et al30Cross-sectional study of PA in a population-based sample of 41 514 pet (dog or cat) owners (17.7% dogs; 13% cats; 8.5% dog and cat) and nonownersAfter adjustment, dog owners were 64% more likely than nonowners to do any walking for leisure (95% CI, 1.52–1.77)After adjustment, cat owners were 9% less likely to do any walking for leisure than nonowners (95% CI, 0.84–0.99)Oka and Shibata25Cross-sectional study of PA among 5177 adult pet owners (18% dog owners) and non–pet ownersDog owners engaged in significantly more moderate- to vigorous-intensity PA than dog nonowners and pet nonowners (17.0 vs 10.9 vs 11.7 h/wk, respectively; P<0.001) and significantly more hours of walking per week(12.4 vs 10.5 vs 9.8, respectively; P 30 kg/m2) dog walkers (17%) than either owners who did not walk their dogs (28%) or nonowners (22%)No difference in overweight (BMI >25 kg/m2) status among dog walkers, (60%) dog owners who did not walk their dogs (62%), and nonowners (56%)Gillum et al; NHANES III34National health survey (n=11 394) of pet owners and nonowners (NHANES III)No difference in incidence of being overweight (BMI <25 kg/m2) between non–pet owners (56%), dog owners (53%), and other pet owners (58%; P=0.09)Kushner et al; PPET56Prospective, controlled study (n=92) of weight loss in dog owners and nonownersObese patients with dogs and those without dogs enrolled in comparable weight loss programs had similar weight loss at 12 months (4.7% vs 5.2%, respectively; P=NS)Timperio et al55Observational study of dog owners and nonowners including children (n=1145) and their parents (n=1108)The odds of being overweight or obese were lower among younger children who owned a dog (OR, 0.5; 95% CI, 0.3–0.8) and higher among mothers whose families walked the dog together (OR, 1.3; 95% CI, 1.0–1.7)Lentino et al14Observational online study (n=916) of dog owners and nonownersCompared with dog walkers, those who did not own or walk their dog reported less PA (MET-min per week) and a higher BMI (P 25.0 kg/m2) than those who did not own pets (58% vs 46%), although mean BMI was similar between groups (mean=25.4 and 25.7 kg/m2, respectively)Westgarth et al38Observational study of pregnant women with or without pets (n=14 273)No association between dog ownership and weight statusBird ownership was associated with maternal overweight or obesity (OR, 1.55; 95% CI, 1.25–1.93; P=0.001) after adjustment for confounding factorsCat ownership was associated with maternal overweight or obesity (OR, 1.27; 95% CI, 1.00–1.62; P=0.05) after adjustment for confounding factorsCardiovascular reactivity and autonomic functionAllen et al59Randomized, controlled 6-mo clinical trial of 48 stockbrokers with BP >160/100 mm Hg treated with ACE inhibitor and randomized to pet (dog or cat) adoption or no adoptionACE inhibitor therapy alone lowered resting BP, but not BP reactivity to mental stress (P<0.001)Combination of ACE inhibitor therapy and pet ownership lowered BP responses to mental stress (P<0.001)Cats and dogs were associated equally with lower BP responses to mental stressAllen et al13Prospective study of heart rate, BP, and cardioreactivity in 240 married couples, half of whom owned a pet (dog or cat)Relative to people without pets, people with pets had:– lower resting BP and heart rate (P<0.001)– smaller increases in heart rate and BP from baseline level during mental and physical stress (P<0.001)– faster recovery (back toward baseline) of heart rate and BP from mental and physical stress (P<0.001)Cats and dogs were associated equally with lower responses to and recovery from stressPets elicited the lowest reactivity to stress, whereas spouses caused highestReferenceStudy Type, Design, and PopulationPrimary FindingsBaun et al63Prospective study of BP, heart rate, and respiratory rate in 24 adults assessed during 3 conditions: petting an unknown dog; petting a well-known dog; or reading quietlySignificant (P<0.05) decrease in both SBP and DBP while petting a well-known dog paralleled the relaxation effect of quiet readingJenkins et al66Prospective study of BP and heart rate in 20 participants (aged 9–58 years) while petting a familiar dog and reading aloudLower BP (P<0.001) while petting the dog than while reading aloudAiba et al57Prospective 24-hour Holter monitor study of 191 patients with 1 or more cardiac risk factor who either owned a pet (primarily dog or cat) or did not own a petPet owners had elevated parasympathetic and diminished sympathetic nervous activities compared with nonownersFriedmann et al; CAST substudy58CAST substudy post hoc analysis of 102 post-MI patients with or without pets (dog or cat) who underwent Holter monitoringGreater heart rate variability among pet owners than nonowners (P<0.05)Survival in people without established CVDGillum and Obisesan34National health survey (n=11 394) of pet owners and nonowners (NHANES III)After adjustment for numerous factors, no significant differences in mortality between individuals living or not living with a dogQureshi et al77Post hoc subgroup analysis of NHANES II database of people (n=4435) queried about whether or not they owned pets (dog or cat)In general, no signif
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