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Rayner JJ, Neubauer S, Rider OJ. The paradox of obesity cardiomyopathy and the potential for weight loss as a therapy. Obes Rev 2015; 16:679-90. [PMID: 26096833 DOI: 10.1111/obr.12292] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/08/2015] [Accepted: 04/23/2015] [Indexed: 12/18/2022]
Abstract
Obesity is an independent risk factor for developing heart failure and the combination of the two disease states will prove to be a significant health burden over the coming years. Obesity is likely to contribute to the development of heart failure through a variety of mechanisms, including structural and functional changes, lipotoxicity and steatosis and altered substrate selection. However, once heart failure has developed, it seems that obesity confers a beneficial influence on prognosis in what has been termed the 'obesity paradox'. This may be a statistical phenomenon, but it should be considered that there is truly a protective state in the physiology of obesity. There is little evidence regarding the impact of weight loss in obese heart failure and whether or not this is beneficial. There have been small studies regarding the cardiovascular effects of both dietary weight loss and bariatric surgery, but few in heart failure. This is an important and increasingly relevant clinical question which must be addressed.
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Affiliation(s)
- J J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - S Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - O J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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The expression of Ubc9 and the intensity of SERCA2a-SUMOylation were reduced in diet-induced obese rats and partially restored by trimetazidine. J Cardiovasc Pharmacol 2015; 65:47-53. [PMID: 25329748 DOI: 10.1097/fjc.0000000000000162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reduced expression of sarcoplasmic reticulum calcium-transporting ATPase isoform 2a (SERCA2a) has been shown to play a significant role in the cardiac dysfunction of obese animal models. It was reported recently that SUMOylation enhances the stability and activity of SERCA2a. We hypothesized that SERCA2a-SUMOylation might be involved in obesity-mediated reduction of SERCA2a. METHOD AND RESULTS Trimetazidine (TMZ), the drug that inhibits fatty acid oxidation, was used in diet-induced obese (DIO) rats and palmitic acid (PA)-treated cardiomyocytes. The intensity of SERCA2a-SUMOylation and proteins involved in SERCA2a-SUMOylation were investigated in vivo and in vitro. DIO rats presented cardiac dysfunction, which was alleviated by TMZ treatment. Reductions of SERCA2a protein and the intensity of SERCA2a-SUMOylation were observed in DIO rats and PA-treated cardiomyocytes. These reductions were partially restored by TMZ. However, TMZ itself did not alter the intensity of SERCA2a-SUMOylation in control cardiomyocytes. The variations of protein and messenger RNA levels of Ubiquitin carrier protein 9 are in accordance with the intensity of SERCA2a-SUMOylation. Whereas the other proteins involved in SERCA2a-SUMOylation were not changed by DIO and PA. CONCLUSIONS TMZ alleviates the DIO- and PA-induced reductions of SERCA2a-SUMOylation. Ubiquitin carrier protein 9 is involved in the reductions.
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Direct, inflammation-mediated and blood-pressure-mediated effects of total and abdominal adiposity on diastolic function: EPIPorto study. Int J Cardiol 2015; 191:64-70. [DOI: 10.1016/j.ijcard.2015.04.250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 01/11/2015] [Accepted: 04/30/2015] [Indexed: 12/18/2022]
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Cao B. Estimating the Effects of Obesity and Weight Change on Mortality Using a Dynamic Causal Model. PLoS One 2015; 10:e0129946. [PMID: 26110432 PMCID: PMC4481504 DOI: 10.1371/journal.pone.0129946] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 05/14/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A well-known challenge in estimating the mortality risks of obesity is reverse causality attributable to illness-associated and smoking-associated weight loss. Given that the likelihood of chronic and acute illnesses rises with age, reverse causality is most threatening to estimates derived from elderly populations. METHODS I analyzed data from 12,523 respondents over 50 years old from a nationally representative longitudinal dataset, the Health and Retirement Study (HRS). The effects of both baseline body weight and time-varying weight change on mortality are estimated, adjusting for demographic and socio-economic variables, as well as time-varying confounders including illness and smoking. Body weight is measured by body mass index (BMI). In survival models for mortality, illness and smoking were lagged to minimize bias from reverse causality in estimates of the effect of weight change. Furthermore, because illness both causes and is caused by changes in BMI, I used a marginal structural model (MSM) rather than standard adjustment to control confounding by this and other time-dependent factors. RESULTS Overall, relative to normal weight, underweight and Class II/III at baseline are associated with hazard ratios that are 2.07 (95% confidence interval (CI): 1.28-3.37) and 1.82 (1.54-2.16) respectively, whereas overweight and Class I obesity do not significantly lower or raise the mortality risks. Furthermore, relative to stable weight change, all types of weight change lead to significantly increased risk of mortality. Specifically, large weight loss results in a mortality risk that is nearly 3.86 (3.26-4.58) times of staying in the stable weight range and small weight loss is about 1.81 (1.55-2.11 ) times riskier. In contrast, large weight gain and small weight gain are associated with hazard ratios that are 1.98 (1.67-2.35) and 1.20 (1.02-1.41) respectively. CONCLUSIONS Being underweight or severe obese at baseline is associated with excess mortality risk, and weight change tend to raise mortality risk. Both the confounding by illness and by smoking lead to overestimates of the effects of being underweight at baseline and of weight loss, but underestimates the effect of being obese at baseline.
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Affiliation(s)
- Bochen Cao
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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156
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Bakkum MJ, Danad I, Romijn MAJ, Stuijfzand WJA, Leonora RM, Tulevski II, Somsen GA, Lammertsma AA, van Kuijk C, van Rossum AC, Raijmakers PG, Knaapen P. The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function. Eur J Nucl Med Mol Imaging 2015; 42:1562-73. [PMID: 26054890 PMCID: PMC4521095 DOI: 10.1007/s00259-015-3087-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/11/2015] [Indexed: 12/14/2022]
Abstract
Purpose Epicardial adipose tissue (EAT) has been linked to coronary artery disease (CAD) and coronary microvascular dysfunction. However, its injurious effect may also impact the underlying myocardium. This study aimed to determine the impact of obesity on the quantitative relationship between left ventricular mass (LVM), EAT and coronary microvascular function. Methods A total of 208 (94 men, 45 %) patients evaluated for CAD but free of coronary obstructions underwent quantitative [15O]H2O hybrid positron emission tomography (PET)/CT imaging. Coronary microvascular resistance (CMVR) was calculated as the ratio of mean arterial pressure to hyperaemic myocardial blood flow. Results Obese patients [body mass index (BMI) > 25, n = 133, 64 % of total] had more EAT (125.3 ± 47.6 vs 93.5 ± 42.1 cc, p < 0.001), a higher LVM (130.1 ± 30.4 vs 114.2 ± 29.3 g, p < 0.001) and an increased CMVR (26.6 ± 9.1 vs 22.3 ± 8.6 mmHg×ml−1×min−1×g−1, p < 0.01) as compared to nonobese patients. Male gender (β = 40.7, p < 0.001), BMI (β = 1.61, p < 0.001), smoking (β = 6.29, p = 0.03) and EAT volume (β = 0.10, p < 0.01) were identified as independent predictors of LVM. When grouped according to BMI status, EAT was only independently associated with LVM in nonobese patients. LVM, hypercholesterolaemia and coronary artery calcium score were independent predictors of CMVR. Conclusion EAT volume is associated with LVM independently of BMI and might therefore be a better predictor of cardiovascular risk than BMI. However, EAT volume was not related to coronary microvascular function after adjustments for LVM and traditional risk factors. Electronic supplementary material The online version of this article (doi:10.1007/s00259-015-3087-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M. J. Bakkum
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - I. Danad
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - M. A. J. Romijn
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - W. J. A. Stuijfzand
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - R. M. Leonora
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - I. I. Tulevski
- />Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - G. A. Somsen
- />Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - A. A. Lammertsma
- />Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - C. van Kuijk
- />Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - A. C. van Rossum
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - P. G. Raijmakers
- />Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - P. Knaapen
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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Zhang Y, Bao M, Dai M, Wang X, He W, Tan T, Lin D, Wang W, Wen Y, Zhang R. Cardiospecific CD36 suppression by lentivirus-mediated RNA interference prevents cardiac hypertrophy and systolic dysfunction in high-fat-diet induced obese mice. Cardiovasc Diabetol 2015; 14:69. [PMID: 26036798 PMCID: PMC4464858 DOI: 10.1186/s12933-015-0234-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/26/2015] [Indexed: 01/12/2023] Open
Abstract
Background Fatty acid (FA) catabolism abnormality has been proved to play an important role in obesity-related cardiomyopathy. We hypothesized that cardiospecific suppression of CD36, the predominant membrane FA transporter, would protect against obesity-related cardiomyopathy. Methods Four-wk-old male C57BL/6 J mice were fed with either high-fat-diet (HFD) or control-normal-diet for 2 wk. Then they were subjected to intramyocardial injection with recombinant lentiviral vectors containing short hairpin RNAs to selectively downregulate the expression of either cardiac CD36 or irrelevant gene by RNA interference. After a 10-wk continuation of the diet, biochemical, functional, morphological, histological, metabolic and molecular profiles were assessed. Results HFD administration elicited obesity, cardiac hypertrophy and systolic dysfunction accompanied with elevated serum levels of blood urea nitrogen (BUN), creatinine, fasting serum glucose (FSG), total cholesterol (TC) and triglyceride. Additionally, HFD consumption promoted lipid accumulation and reactive oxygen species (ROS) generation in the cardiomyocytes. Cardiospecific CD36 inhibition protected against HFD induced cardiac remodeling by decreasing heart/body weight ratio, increasing left ventricular (LV) ejection fraction and fractional shortening as well as normalizing LV diameter, without influencing body weight gain. Inhibition of cardiac CD36 also mitigated obesity induced alteration in BUN, creatinine and triglyceride, but had no effect on FSG or TC. Moreover, cardiospecific CD36 deficiency corrected myocardial lipid overaccumulation and intracellular ROS overproduction that were induced by HFD feeding. Conclusions Cardiospecific CD36 inhibition protects against the aggravation of cardiac functional and morphological changes associated with HFD induced obesity. CD36 represents a potential therapeutic target for obesity cardiomyopathy.
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Affiliation(s)
- Yijie Zhang
- Department of Cardiology, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China. .,Cardiovascular Research Institute of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China. .,Central Laboratory of Renmin Hospital, Wuhan University, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China.
| | - Mingwei Bao
- Department of Cardiology, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China. .,Cardiovascular Research Institute of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China.
| | - Mingyan Dai
- Department of Cardiology, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China. .,Cardiovascular Research Institute of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China.
| | - Xin Wang
- Department of Cardiology, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China. .,Cardiovascular Research Institute of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China.
| | - Wenbo He
- Department of Cardiology, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China. .,Cardiovascular Research Institute of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China.
| | - Tuantuan Tan
- Department of Ultrasonography, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China.
| | - Dandan Lin
- Department of Oncology, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China.
| | - Wei Wang
- Department of Thoracic Surgery, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China.
| | - Ying Wen
- Department of Cardiology, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China. .,Cardiovascular Research Institute of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China.
| | - Rui Zhang
- Cardiovascular Research Institute of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Peoples Republic of China.
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Nyström PK, Carlsson AC, Leander K, de Faire U, Hellenius ML, Gigante B. Obesity, metabolic syndrome and risk of atrial fibrillation: a Swedish, prospective cohort study. PLoS One 2015; 10:e0127111. [PMID: 25978738 PMCID: PMC4433194 DOI: 10.1371/journal.pone.0127111] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/10/2015] [Indexed: 01/09/2023] Open
Abstract
Aim We aimed to investigate whether different measures of obesity could similarly predict atrial fibrillation, and whether the atrial fibrillation risk associated with obesity is dependent on presence of metabolic syndrome. Material and Methods We performed our study in a population-based longitudinal cardiovascular study, comprising 1 924 men and 2 097 women, aged 60 years, from Stockholm. Body mass index, waist circumference, sagittal abdominal diameter and components of metabolic syndrome (systolic- and diastolic blood pressure, fasting glucose, triglycerides, high-density lipoprotein-cholesterol) were recorded at baseline. Participants were classified by their body mass index (normal weight, overweight or obese), waist circumference (normal, semi-elevated or elevated), and according to presence of metabolic syndrome. Atrial fibrillation risk was estimated by Cox proportional hazards regression models, adjusted for common atrial fibrillation risk factors, expressed as HR and 95% CI. Results During a mean follow-up of 13.6 years, 285 incident atrial fibrillation cases were recorded. One standard deviation increment of each obesity measure was associated with increased atrial fibrillation risk as: body mass index 1.25 (1.12 – 1.40), waist circumference 1.35 (1.19 – 1.54) and sagittal abdominal diameter 1.28 (1.14 – 1.44). Compared to normal weight subjects without metabolic syndrome, increased atrial fibrillation risk was noted for overweight subjects with metabolic syndrome, 1.67 (1.16 – 2.41), obese subjects without metabolic syndrome, 1.75 (1.11 – 2.74) and obese subjects with metabolic syndrome, 1.92 (1.34 – 2.74). Compared to subjects with normal waist circumference without metabolic syndrome, subjects with elevated waist circumference and metabolic syndrome suffered increased atrial fibrillation risk, 2.03 (1.44 – 2.87). Conclusions Body mass index, waist circumference and sagittal abdominal diameter could similarly predict atrial fibrillation. Obesity was associated with an increased atrial fibrillation risk regardless of metabolic syndrome, whereas overweight and elevated waist circumference was associated with increased atrial fibrillation risk only if metabolic syndrome was present.
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Affiliation(s)
- Petter K. Nyström
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Axel C. Carlsson
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Karin Leander
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulf de Faire
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mai-Lis Hellenius
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Bruna Gigante
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
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159
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Is low V˙O2max/kg in obese heart failure patients indicative of cardiac dysfunction? Int J Cardiol 2015; 184:755-762. [DOI: 10.1016/j.ijcard.2015.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/22/2015] [Accepted: 02/15/2015] [Indexed: 12/14/2022]
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Abstract
For individuals and the society as a whole, the increased risk of sudden cardiac death in obese patients is becoming a major challenge, especially since obesity prevalence has been increasing steadily around the globe. Traditional risk factors and obesity often coexist. Hypertension, diabetes, obstructive sleep apnea and metabolic syndrome are well-known risk factors for CV disease and are often present in the obese patient. Although the bulk of evidence is circumstantial, sudden cardiac death and obesity share common traditional CV risk factors. Structural, functional and metabolic factors modulate and influence the risk of sudden cardiac death in the obese population. Other risk factors such as left ventricular hypertrophy, increased number of premature ventricular complexes, altered QT interval and reduced heart rate variability are all documented in both obese and sudden cardiac death populations. The present review focuses on out-of-hospital sudden cardiac death and potential mechanisms leading to sudden cardiac death in this population.
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Affiliation(s)
- Benoit Plourde
- Department of Medicine, Faculty of Medicine, Quebec City, QC, Canada
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162
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Rossignol P, Masson S, Barlera S, Girerd N, Castelnovo A, Zannad F, Clemenza F, Tognoni G, Anand IS, Cohn JN, Anker SD, Tavazzi L, Latini R. Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: insights from the GISSI-HF and Val-HeFT trials. Eur J Heart Fail 2015; 17:424-33. [DOI: 10.1002/ejhf.240] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/21/2014] [Accepted: 01/05/2015] [Indexed: 01/06/2023] Open
Affiliation(s)
- Patrick Rossignol
- INSERM; Centre d'Investigations Cliniques-Plurithématique 1433; Nancy France
- Université de Lorraine; France
- INSERM U1116; Nancy France
| | - Serge Masson
- Department of Cardiovascular Research; IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Simona Barlera
- Department of Cardiovascular Research; IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Nicolas Girerd
- INSERM; Centre d'Investigations Cliniques-Plurithématique 1433; Nancy France
- Université de Lorraine; France
- INSERM U1116; Nancy France
| | - Angelo Castelnovo
- Department of Cardiovascular Research; IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Faiez Zannad
- INSERM; Centre d'Investigations Cliniques-Plurithématique 1433; Nancy France
- Université de Lorraine; France
- INSERM U1116; Nancy France
| | - Francesco Clemenza
- Heart Failure Unit-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione); Palermo Italy
| | | | - Inder S. Anand
- Veterans Affairs Medical Center and University of Minnesota; Minneapolis MN USA
| | - Jay N. Cohn
- Cardiovascular Division; University of Minnesota Medical School; Minneapolis MN USA
| | - Stefan D. Anker
- Department of Innovative Clinical Trials; University Medical Centre Göttingen; Göttingen Germany
- Institute of Diabetes for Older People (IDOP); University of Bedfordshire; UK
| | - Luigi Tavazzi
- GVM Hospitals of Care and Research; E.S Health Science Foundation; Cotignola Italy
| | - Roberto Latini
- Department of Cardiovascular Research; IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
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Banack HR, Kaufman JS. Does selection bias explain the obesity paradox among individuals with cardiovascular disease? Ann Epidemiol 2015; 25:342-9. [PMID: 25867852 DOI: 10.1016/j.annepidem.2015.02.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/30/2015] [Accepted: 02/08/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The objectives of this article are to demonstrate that the obesity paradox may be explained by collider stratification bias and to estimate the biasing effects of unmeasured common causes of cardiovascular disease (CVD) and mortality on the observed obesity-mortality relationship. METHODS We use directed acyclic graphs, regression modeling, and sensitivity analyses to explore whether the observed protective effect of obesity among individuals with CVD can be plausibly attributed to selection bias. Data from the third National Health and Examination Survey was used for the analyses. RESULTS The adjusted total effect of obesity on mortality was a risk difference (RD) of 0.03 (95% confidence interval [CI]: 0.02, 0.05). However, the controlled direct effect of obesity on mortality among individuals without CVD was RD = 0.03 (95% CI: 0.01, 0.05) and RD = -0.12 (95% CI: -0.20, -0.04) among individuals with CVD. The adjusted total effect estimate demonstrates an increased number of deaths among obese individuals relative to nonobese counterparts, whereas the controlled direct effect shows a paradoxical decrease in morality among obese individuals with CVD. CONCLUSIONS Sensitivity analysis demonstrates unmeasured confounding of the mediator-outcome relationship provides a sufficient explanation for the observed protective effect of obesity on mortality among individuals with CVD.
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Affiliation(s)
- Hailey R Banack
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
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165
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Obesity and the Obesity Paradox in Heart Failure. Can J Cardiol 2015; 31:195-202. [DOI: 10.1016/j.cjca.2014.08.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/02/2014] [Accepted: 08/03/2014] [Indexed: 12/11/2022] Open
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Abstract
Overweight and obesity have reached epidemic proportions in the USA and most of the rest of the world. Particularly concerning is the very high prevalence of class III obesity (BMI ≥40 kg/m(2)), which has reached ∼3% in the USA. In the past few years, controversy has surrounded the idea that some individuals with obesity can be considered healthy with regards to their metabolic and cardiorespiratory fitness, which has been termed the 'obesity paradox'. These controversies are reviewed in detail here, including discussion of the very favourable prognosis in patients with obesity who have no notable metabolic abnormalities and who have preserved fitness. The article also discusses the suggestion that greater emphasis should be placed on improving fitness rather than weight loss per se in the primary and secondary prevention of cardiovascular diseases, at least in patients with overweight and class I obesity (BMI 30-35 kg/m(2)).
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA
| | - Alban De Schutter
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA
| | - Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA
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169
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Obesity-related cardiomyopathy is an adipocyte-mediated paracrine disease. Trends Cardiovasc Med 2014; 25:127-8. [PMID: 25454380 DOI: 10.1016/j.tcm.2014.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 09/26/2014] [Indexed: 02/03/2023]
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Lavie CJ, Milani RV, Ventura HO. Effects of Obesity and Weight Changes on Cardiac and Vascular Structure and Function. JACC-HEART FAILURE 2014; 2:509-11. [DOI: 10.1016/j.jchf.2014.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/20/2022]
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Cavalera M, Wang J, Frangogiannis NG. Obesity, metabolic dysfunction, and cardiac fibrosis: pathophysiological pathways, molecular mechanisms, and therapeutic opportunities. Transl Res 2014; 164:323-35. [PMID: 24880146 PMCID: PMC4180761 DOI: 10.1016/j.trsl.2014.05.001] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/28/2014] [Accepted: 05/03/2014] [Indexed: 02/09/2023]
Abstract
Cardiac fibrosis is strongly associated with obesity and metabolic dysfunction and may contribute to the increased incidence of heart failure, atrial arrhythmias, and sudden cardiac death in obese subjects. This review discusses the evidence linking obesity and myocardial fibrosis in animal models and human patients, focusing on the fundamental pathophysiological alterations that may trigger fibrogenic signaling, the cellular effectors of fibrosis, and the molecular signals that may regulate the fibrotic response. Obesity is associated with a wide range of pathophysiological alterations (such as pressure and volume overload, metabolic dysregulation, neurohumoral activation, and systemic inflammation); their relative role in mediating cardiac fibrosis is poorly defined. Activation of fibroblasts likely plays a major role in obesity-associated fibrosis; however, inflammatory cells, cardiomyocytes, and vascular cells may also contribute to fibrogenic signaling. Several molecular processes have been implicated in regulation of the fibrotic response in obesity. Activation of the renin-angiotensin-aldosterone system, induction of transforming growth factor β, oxidative stress, advanced glycation end-products, endothelin 1, Rho-kinase signaling, leptin-mediated actions, and upregulation of matricellular proteins (such as thrombospondin 1) may play a role in the development of fibrosis in models of obesity and metabolic dysfunction. Moreover, experimental evidence suggests that obesity and insulin resistance profoundly affect the fibrotic and remodeling response after cardiac injury. Understanding the pathways implicated in obesity-associated fibrosis may lead to the development of novel therapies to prevent heart failure and attenuate postinfarction cardiac remodeling in patients with obesity.
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Affiliation(s)
- Michele Cavalera
- Division of Cardiology, Department of Medicine, The Wilf Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
| | - Junhong Wang
- Division of Cardiology, Department of Medicine, The Wilf Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
| | - Nikolaos G Frangogiannis
- Division of Cardiology, Department of Medicine, The Wilf Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York.
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172
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Targeting Sleep Disordered Breathing to Prevent Heart Failure: What is the Evidence? CURRENT CARDIOVASCULAR RISK REPORTS 2014; 8:403. [PMID: 25215169 DOI: 10.1007/s12170-014-0403-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The inter-relationships of sleep disordered breathing (SDB) and heart failure (HF) are becoming increasingly well-characterized. The pathways linking the two entities are likely bi-directional and key underlying pathophysiological mechanisms at play include autonomic nervous system fluctuations, intermittent hypoxia, intrathoracic cardiac mechanical influences, rostral fluid shifts and up-regulation of systemic inflammation and oxidative stress. Given the increased morbidity and mortality which accompanies heart failure, the recognition and treatment of factors such as sleep disordered breathing is paramount in order to mitigate these untoward downstream health consequences. Recently, the management of HF requires combining several treatments including pharmacotherapy, electrophysiologic therapy, and cardiac surgery to target the various complex facets of HF. Despite the development of HF treatments, HF remains to pose a great challenge to the general cardiologist. Herein we review several interventional studies highlighting the effects of treating SDB on HF morbidity and mortality with a notable predominance of literature focusing on HF reduced ejection fraction (HF-REF) as well as emerging data describing SDB treatment effects in HF preserved EF (HF-PEF). These data are compelling yet with intrinsic limitations which underscore the need for appropriately powered clinical trials employing rigorous clinical trials methodology to examine the effect of SDB treatment on HF progression and associated adverse outcomes.
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173
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Valencia WM, Stoutenberg M, Florez H. Weight loss and physical activity for disease prevention in obese older adults: an important role for lifestyle management. Curr Diab Rep 2014; 14:539. [PMID: 25183491 DOI: 10.1007/s11892-014-0539-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Weight loss in older adults has been a controversial topic for more than a decade. An obesity paradox has been previously described and the issue of weight status on health outcomes remains a highly debated topic. However, there is little doubt that physical activity (PA) has a myriad of benefits in older adults, especially in obese individuals who are inactive and have a poor cardiometabolic profile. In this review, we offer a critical view to clarify misunderstandings regarding the obesity paradox, particularly as it relates to obese older adults. We also review the evidence on PA and lifestyle interventions for the improvement of cardiorespiratory fitness, which can prevent disease and provide benefits to obese older adults, independent of weight changes.
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Affiliation(s)
- Willy Marcos Valencia
- Geriatrics Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA,
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174
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Alpert MA, Lavie CJ, Agrawal H, Aggarwal KB, Kumar SA. Obesity and heart failure: epidemiology, pathophysiology, clinical manifestations, and management. Transl Res 2014; 164:345-56. [PMID: 24814682 DOI: 10.1016/j.trsl.2014.04.010] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/10/2014] [Accepted: 04/12/2014] [Indexed: 01/21/2023]
Abstract
Obesity is a risk factor for heart failure (HF) in both men and women. The mortality risk of overweight and class I and II obese adults with HF is lower than that of normal weight or underweight adults with HF of comparable severity, a phenomenon referred to as the obesity paradox. Severe obesity produces hemodynamic alterations that predispose to changes in cardiac morphology and ventricular function, which may lead to the development of HF. The presence of systemic hypertension, sleep apnea, and hypoventilation, comorbidities that occur commonly with severe obesity, may contribute to HF in such patients. The resultant syndrome is known as obesity cardiomyopathy. Substantial weight loss in severely obese persons is capable of reversing most obesity-related abnormalities of cardiac performance and morphology and improving the clinical manifestations of obesity cardiomyopathy.
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Affiliation(s)
- Martin A Alpert
- Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri.
| | - Carl J Lavie
- Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana
| | - Harsh Agrawal
- Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri
| | - Kul B Aggarwal
- Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri
| | - Senthil A Kumar
- Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri
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175
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Poirier P. Exploring the spectrum of diseases influenced by excess adiposity. Transl Res 2014; 164:278-83. [PMID: 25046478 DOI: 10.1016/j.trsl.2014.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada and Faculté de Pharmacie, Université Laval, Québec, Canada.
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176
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Wohlfahrt P, Redfield MM, Lopez-Jimenez F, Melenovsky V, Kane GC, Rodeheffer RJ, Borlaug BA. Impact of general and central adiposity on ventricular-arterial aging in women and men. JACC-HEART FAILURE 2014; 2:489-99. [PMID: 25194285 DOI: 10.1016/j.jchf.2014.03.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/11/2014] [Accepted: 03/21/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to assess the effects of central and general obesity measures on long-term longitudinal changes in ventricular-arterial mechanics. BACKGROUND Obesity, female sex, and ventricular-arterial stiffening are associated with the development of heart failure with preserved ejection fraction. Fat distribution and chronic changes in body composition may affect longitudinal changes in LV properties, independent of arterial load. METHODS In 1,402 subjects from a randomly selected, community-based population, comprehensive echo-Doppler echocardiography was performed at two examinations separated by 4 years. From this population, 788 subjects had paired data adequate for determining left ventricular end-systolic elastance (Ees), end-diastolic elastance (Eed), and effective arterial elastance (Ea). RESULTS Over 4 years, Ea was decreased by 3% in tandem with improved blood pressure control, whereas Ees and Eed were increased by 14% and 8% (all, p < 0.001). Greater weight loss over 4 years was associated with progressively greater decreases in Ea in men and women. After adjustment for Ea change, weight gain was correlated with increases in Eed in both women and men. Central obesity was associated with greater age-related increases in Ees in women but not in men, independent of arterial load, but central obesity did not predict changes in Eed or Ea. CONCLUSIONS In these subjects, weight gain was associated with increases in LV diastolic stiffness, even after adjustment for changes in arterial afterload, whereas weight loss was associated with reductions in arterial stiffness. Age-related LV systolic stiffening was increased in women, but not in men, with central obesity. Strategies for promoting weight loss and reducing central adiposity may be effective in preventing heart failure with preserved ejection fraction, particularly in women.
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Affiliation(s)
- Peter Wohlfahrt
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Margaret M Redfield
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Francisco Lopez-Jimenez
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Vojtech Melenovsky
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota; Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Garvan C Kane
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Richard J Rodeheffer
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota.
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177
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Heart Failure and Obesity in Adults: Pathophysiology, Clinical Manifestations and Management. Curr Heart Fail Rep 2014; 11:156-65. [DOI: 10.1007/s11897-014-0197-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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178
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Lavie CJ, Ventura HO. Clinical Implications of Weight Loss in Heart Failure. J Card Fail 2014; 20:190-2. [DOI: 10.1016/j.cardfail.2014.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 01/02/2014] [Indexed: 11/28/2022]
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179
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Lavie CJ, McAuley PA, Church TS, Milani RV, Blair SN. Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. J Am Coll Cardiol 2014; 63:1345-54. [PMID: 24530666 DOI: 10.1016/j.jacc.2014.01.022] [Citation(s) in RCA: 410] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/17/2013] [Accepted: 01/06/2014] [Indexed: 12/11/2022]
Abstract
Obesity has been increasing in epidemic proportions, with a disproportionately higher increase in morbid or class III obesity, and obesity adversely affects cardiovascular (CV) hemodynamics, structure, and function, as well as increases the prevalence of most CV diseases. Progressive declines in physical activity over 5 decades have occurred and have primarily caused the obesity epidemic. Despite the potential adverse impact of overweight and obesity, recent epidemiological data have demonstrated an association of mild obesity and, particularly, overweight on improved survival. We review in detail the obesity paradox in CV diseases where overweight and at least mildly obese patients with most CV diseases seem to have a better prognosis than do their leaner counterparts. The implications of cardiorespiratory fitness with prognosis are discussed, along with the joint impact of fitness and adiposity on the obesity paradox. Finally, in light of the obesity paradox, the potential value of purposeful weight loss and increased physical activity to affect levels of fitness is reviewed.
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana.
| | - Paul A McAuley
- Department of Human Performance and Sport Sciences, Winston-Salem State University, Winston-Salem, North Carolina
| | - Timothy S Church
- Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana
| | - Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana
| | - Steven N Blair
- Department of Exercise Science and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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