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Comment & Response |

The Link Between Sauna Bathing and Mortality May Be Noncausal

Yoram Epstein, PhD1,2; Yehuda Shoenfeld, MD1,2
[+] Author Affiliations
1Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel
2Department of Internal Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
JAMA Intern Med. 2015;175(10):1718-1719. doi:10.1001/jamainternmed.2015.3429.
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To the Editor In their recent report, Laukkanen et al1 summarize a 25-year longitudinal study, indicating that regular sauna bathing (4-7 times per week) is associated with a reduced risk of cardiovascular diseases and all-cause mortality. We would like to suggest that regular sauna bathing is an indicator for a healthy lifestyle. Adopting habits of frequent physical activity, avoiding rich food high in saturated fat, and allowing for more relaxation and leisure time have been proven to be the best measures against many diseases and are also associated with improved health and longevity. Laukkanen et al do not provide data to explain this observation, but other studies suggest that regular sauna bathing lowers blood pressure, improves endothelial function, increases left ventricular ejection fraction, and reduces total and low-density lipoprotein cholesterol levels.2,3 Clinical and laboratory data on sauna bathing and its effect on diminishing cardiovascular risk factors (eg, metabolic syndrome symptoms) should be the aim for further studies.


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October 1, 2015
Mika Kivimäki, PhD; Marianna Virtanen, PhD; Jane E. Ferrie, PhD
1Department of Epidemiology and Public Health, University College London, London, United Kingdom
2Finnish Institute of Occupational Health, Helsinki, Finland
1Department of Epidemiology and Public Health, University College London, London, United Kingdom3School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
JAMA Intern Med. 2015;175(10):1718. doi:10.1001/jamainternmed.2015.3426.
October 1, 2015
Tanjaniina Laukkanen, MSc; Hassan Khan, MD, PhD; Francesco Zaccardi, MD
1Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
2Department of Medicine, Emory University, Atlanta, Georgia
3Institute of Internal Medicine and Diabetes Care Unit, Catholic University School of Medicine, Rome, Italy
JAMA Intern Med. 2015;175(10):1719. doi:10.1001/jamainternmed.2015.3432.
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Sauna use and cardiovascular mortality
Posted on October 6, 2015
David L Keller
Conflict of Interest: None Declared
I submitted the following letter to JAMA-IM on 4/18/2015:

Laukkanen and colleagues note an association between increased frequency of sauna bathing
and decreased risk of adverse cardiovascular events. Their observational study does not
establish that sauna bathing causes better cardiac health; rather, their results may be due to
self­-selection. Persons at higher risk for adverse cardiac events may experience unpleasant
symptoms due to the tachycardia induced by sitting in a hot sauna, such as mild dyspnea,
orthostasis, or chest discomfort, at higher frequency or severity than persons in good
cardiovascular health, These adverse symptoms might cause them to avoid saunas as much
as possible, thereby biasing the group of frequent sauna­ bathers to include persons at lower
risk of adverse cardiac events than the general public.

The authors suggest that, based on this study, \"sauna bathing is a recommendable health
habit\". I disagree, and suggest that physicians should await the results of a randomized trial of
sauna bathing before we recommend it for health enhancement.
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