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Comment & Response
October 2015

The Link Between Sauna Bathing and Mortality May Be Noncausal

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

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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    1 Comment for this article
    Sauna use and cardiovascular mortality
    David L Keller | none
    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.