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Mabeza RM, Richardson S, Vadlakonda A, Chervu N, Roberts J, Yetasook A, Benharash P. Bariatric surgery improves outcomes of hospitalizations for acute heart failure: a contemporary, nationwide analysis. Surg Obes Relat Dis 2023; 19:681-687. [PMID: 36697325 DOI: 10.1016/j.soard.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/31/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The link between obesity and poor outcomes in heart failure (HF) has been well-established. OBJECTIVES This retrospective study sought to examine national rates and outcomes of acute HF hospitalizations in obese individuals with a prior history of bariatric surgery. SETTING Academic, university-affiliated; the United States. METHODS Adult admissions (≥18 years) including a diagnosis of severe obesity were identified in the 2016-2019 Nationwide Readmissions Database. Patients who previously underwent bariatric operations were categorized into the Bariatric cohort. Multivariable linear and logistic models were used to assess the association of prior bariatric surgery with outcomes of interest. RESULTS Of an estimated 10,343,828 admissions for a diagnosis of severe obesity, 925,716 (8.9%) comprised the bariatric cohort. After risk adjustment, bariatric surgery was associated with significantly decreased odds of acute HF hospitalization (adjusted odds ratio [AOR]: .40, 95% confidence interval [CI]: .38-.41). Among acute HF hospitalizations, prior bariatric surgery was linked to lower odds of mortality (AOR: .68, 95% CI: .52-.89), prolonged mechanical ventilation (AOR .44, 95% CI: .32-.61), acute renal failure (AOR: .76, 95% CI: .70-.82), and prolonged hospitalization (AOR: .77, 95% CI: .68-.87). Bariatric surgery was linked to a decrement of 1 day (95% CI: .7-1.1) and $1200 in hospitalization costs (95% CI: 400-1900), but no significant difference in odds of 30-day readmission. CONCLUSIONS Bariatric surgery is associated with reduced admissions for acute HF. Among acute HF hospitalizations, bariatric surgery is linked to significantly improved clinical and financial outcomes. Given its potential benefits in obesity and related diseases, bariatric surgery holds promise for promoting value-based healthcare for HF.
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Affiliation(s)
- Russyan Mark Mabeza
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California
| | - Shannon Richardson
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jacob Roberts
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Amy Yetasook
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California.
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Age-Related Development of Cardiac Remodeling and Dysfunction in Young Black and White Adults: The Coronary Artery Risk Development in Young Adults Study. J Am Soc Echocardiogr 2020; 34:388-400. [PMID: 33212181 DOI: 10.1016/j.echo.2020.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the timing of preclinical heart failure (HF) development, particularly among blacks. The primary aims of this study were to delineate age-related left ventricular (LV) structure and function evolution in a biracial cohort and to test the hypothesis that young-adult LV parameters within normative ranges would be associated with incident stage B-defining LV abnormalities over 25 years, independent of cumulative risk factor burden. METHODS Data from the Coronary Artery Risk Development in Young Adults study were analyzed. Participants (n = 2,833) had a mean baseline age of 30.1 years; 45% were black, and 56% were women. Generalized estimating equation logistic regression was used to estimate age-related probabilities of stage B LV abnormalities (remodeling, hypertrophy, or dysfunction) and logistic regression to examine risk factor-adjusted associations between baseline LV parameters and incident abnormalities. Cox regression was used to assess whether baseline LV parameters associated with incident stage B LV abnormalities were also associated with incident clinical (stage C/D) HF events over >25 years' follow-up. RESULTS Probabilities of stage B LV abnormalities at ages 25 and 60 years were 10.5% (95% CI, 9.4%-11.8%) and 45.0% (95% CI, 42.0%-48.1%), with significant race-sex disparities (e.g., at age 60, black men 52.7% [95% CI, 44.9%-60.3%], black women 59.4% [95% CI, 53.6%-65.0%], white men 39.1% [95% CI, 33.4%-45.0%], and white women 39.1% [95% CI, 33.9%-44.6%]). Over 25 years, baseline LV end-systolic dimension indexed to height was associated with incident systolic dysfunction (adjusted odds ratio per 1 SD higher, 2.56; 95% CI, 1.87-3.52), eccentric hypertrophy (1.34; 95% CI, 1.02-1.75), concentric hypertrophy (0.69; 95% CI, 0.51-0.91), and concentric remodeling (0.68; 95% CI, 0.58-0.79); baseline LV mass indexed to height2.7 was associated with incident eccentric hypertrophy (1.70; 95% CI, 1.25-2.32]), concentric hypertrophy (1.63; 95% CI, 1.19-2.24), and diastolic dysfunction (1.24; 95% CI, 1.01-1.52). Among the entire cohort with baseline echocardiographic data available (n = 4,097; 72 HF events), LV end-systolic dimension indexed to height and LV mass indexed to height2.7 were significantly associated with incident clinical HF (adjusted hazard ratios per 1 SD higher, 1.56 [95% CI, 1.26-1.93] and 1.42 [95% CI, 1.14-1.75], respectively). CONCLUSIONS Stage B LV abnormalities and related racial disparities were present in young adulthood, increased with age, and were associated with baseline variation in indexed LV end-systolic dimension and mass. Baseline indexed LV end-systolic dimension and mass were also associated with incident clinical HF. Efforts to prevent the LV abnormalities underlying clinical HF should start from a young age.
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Razavi AC, Fernandez C, He J, Kelly TN, Krousel-Wood M, Whelton SP, Carmichael OT, Bazzano LA. Left Ventricular Mass Index Is Associated With Cognitive Function in Middle-Age: Bogalusa Heart Study. Circ Cardiovasc Imaging 2020; 13:e010335. [PMID: 32772573 PMCID: PMC7428065 DOI: 10.1161/circimaging.119.010335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Elevated cardiovascular disease risk factor burden is a recognized contributor to poorer cognitive function; however, the physiological mechanisms underlying this association are not well understood. We sought to assess the potential mediation effect of left ventricular (LV) remodeling on the association between lifetime systolic blood pressure and cognitive function in a community-based cohort of middle-aged adults. METHODS Nine hundred sixty participants of the Bogalusa Heart Study (59.2% women, 33.8% black, aged 48.4±5.1 years) received 2-dimensional echocardiography to quantify relative wall thickness, LV mass, and diastolic and systolic LV function; and a standardized neurocognitive battery to assess memory, executive functioning, and language processing. Multivariable linear regression assessed the association of cardiac structure and function with a global composite cognitive function score, adjusting for traditional cardiovascular disease risk factors. Mediation analysis assessed the effect of LV mass index on the association between lifetime systolic blood pressure burden and cognitive function. RESULTS There were 233 (24.3%) and 136 (14.2%) individuals with concentric LV remodeling and concentric LV hypertrophy, respectively. Each g/m2.7 increment in LV mass index was associated with a 0.03 standardized unit decrement in global cognitive function (P=0.03). Individuals with concentric LV remodeling and isolated diastolic dysfunction had the poorest cognitive function, and a greater ratio between early mitral inflow velocity and early diastolic mitral annular velocity (E/e') was associated with poorer cognitive function, even after adjustment for LV mass index (B=-0.12; P=0.03). A total of 18.8% of the association between lifetime systolic blood pressure burden and midlife cognitive function was accounted for by LV mass index. CONCLUSIONS Cardiac remodeling partially mediates the association between lifespan systolic blood pressure burden and adult cognition in individuals without dementia or clinical cardiovascular disease. Slowing or reversing the progression of cardiac remodeling in middle-age may be a novel therapeutic approach to prevent cognitive decline.
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Affiliation(s)
- Alexander C. Razavi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Camilo Fernandez
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Tanika N. Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Marie Krousel-Wood
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Seamus P. Whelton
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Owen T. Carmichael
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
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Razavi AC, Bazzano LA, He J, Li S, Fernandez C, Whelton SP, Krousel-Wood M, Nierenberg JL, Shi M, Li C, Mi X, Kinchen J, Kelly TN. Pseudouridine and N-formylmethionine associate with left ventricular mass index: Metabolome-wide association analysis of cardiac remodeling. J Mol Cell Cardiol 2020; 140:22-29. [PMID: 32057737 DOI: 10.1016/j.yjmcc.2020.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart failure (HF) is the fastest growing form of cardiovascular disease both nationally and globally, underlining a need to phenotype subclinical HF intermediaries to improve primary prevention. OBJECTIVES We aimed to identify novel metabolite associations with left ventricular (LV) remodeling, one upstream HF intermediary, among a community-based cohort of individuals. METHODS We examined 1052 Bogalusa Heart Study participants (34.98% African American, 57.41% female, aged 33.6-57.5 years). Measures of LV mass and relative wall thickness (RWT) were obtained using two-dimensional-guided echocardiographic measurements via validated eqs. LV mass was indexed to height2.7 to calculate left ventricular mass index (LVMI). Untargeted metabolomic analysis of fasting serum samples was conducted. In combined and ethnicity-stratified analyses, multivariable linear and multinomial logistic regression models tested the associations of metabolites with the continuous LVMI and RWT and categorical LV geometry phenotypes, respectively, after adjusting for demographic and traditional cardiovascular disease risk factors. RESULTS Pseudouridine (B = 1.38; p = 3.20 × 10-5) and N-formylmethionine (B = 1.65; 3.30 × 10-6) were significantly associated with LVMI in the overall sample as well significant in Caucasians, with consistent effect direction and nominal significance (p < .05) in African Americans. Upon exclusion of individuals with self-report myocardial infarction or congestive HF, we similarly observed a 1.33 g/m2.7 and 1.52 g/m2.7 higher LVMI for each standard deviation increase in pseudouridine and N-formylmethionine, respectively. No significant associations were observed for metabolites with RWT or categorical LV remodeling outcomes. CONCLUSIONS The current analysis identified novel associations of pseudouridine and N-formylmethionine with LVMI, suggesting that mitochondrial-derived metabolites may serve as early biomarkers for LV remodeling and subclinical HF.
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Affiliation(s)
- Alexander C Razavi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Shengxu Li
- Children's Minnesota Research Institute, Children's Hospitals & Clinics of Minnesota, Minneapolis, MN, United States of America
| | - Camilo Fernandez
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Seamus P Whelton
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Marie Krousel-Wood
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Jovia L Nierenberg
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Mengyao Shi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Changwei Li
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, United States of America
| | - Xuenan Mi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Jason Kinchen
- Metabolon, Inc., Durham, NC, United States of America
| | - Tanika N Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America.
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Razavi AC, Bazzano LA, He J, Fernandez C, Whelton SP, Krousel-Wood M, Li S, Nierenberg JL, Shi M, Li C, Mi X, Kinchen J, Kelly TN. Novel Findings From a Metabolomics Study of Left Ventricular Diastolic Function: The Bogalusa Heart Study. J Am Heart Assoc 2020; 9:e015118. [PMID: 31992159 PMCID: PMC7033875 DOI: 10.1161/jaha.119.015118] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Diastolic dysfunction is one important causal factor for heart failure with preserved ejection fraction, yet the metabolic signature associated with this subclinical phenotype remains unknown. Methods and Results Ultra‐high‐performance liquid chromatography–tandem mass spectroscopy was used to conduct untargeted metabolomic analysis of fasting serum samples in 1050 white and black participants of the BHS (Bogalusa Heart Study). After quality control, 1202 metabolites were individually tested for association with 5 echocardiographic measures of left ventricular diastolic function using multivariable‐adjusted linear regression. Measures of left ventricular diastolic function included the ratio of peak early filling velocity to peak late filling velocity, ratio of peak early filling velocity to mitral annular velocity, deceleration time, isovolumic relaxation time, and left atrial maximum volume index (LAVI). Analyses adjusted for multiple cardiovascular disease risk factors and used Bonferroni‐corrected alpha thresholds. Eight metabolites robustly associated with left ventricular diastolic function in the overall population and demonstrated consistent associations in white and black study participants. N‐formylmethionine (B=0.05; P=1.50×10−7); 1‐methylhistidine (B=0.05; P=1.60×10−7); formiminoglutamate (B=0.07; P=5.60×10−7); N2, N5‐diacetylornithine (B=0.05; P=1.30×10−7); N‐trimethyl 5‐aminovalerate (B=0.04; P=5.10×10−6); 5‐methylthioadenosine (B=0.04; P=1.40×10−5); and methionine sulfoxide (B=0.04; P=3.80×10−6) were significantly associated with the natural log of the ratio of peak early filling velocity to mitral annular velocity. Butyrylcarnitine (B=3.18; P=2.10×10−6) was significantly associated with isovolumic relaxation time. Conclusions The current study identified novel findings of metabolite associations with left ventricular diastolic function, suggesting that the serum metabolome, and its underlying biological pathways, may be implicated in heart failure with preserved ejection fraction pathogenesis.
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Affiliation(s)
- Alexander C Razavi
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA.,Department of Medicine Tulane University School of Medicine New Orleans LA
| | - Lydia A Bazzano
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA.,Department of Medicine Tulane University School of Medicine New Orleans LA
| | - Jiang He
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA.,Department of Medicine Tulane University School of Medicine New Orleans LA
| | - Camilo Fernandez
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA.,Department of Medicine Tulane University School of Medicine New Orleans LA
| | - Seamus P Whelton
- The Ciccarone Center for the Prevention of Heart Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Marie Krousel-Wood
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA.,Department of Medicine Tulane University School of Medicine New Orleans LA
| | - Shengxu Li
- Children's Minnesota Research Institute Children's Hospitals & Clinics of Minnesota Minneapolis MN
| | - Jovia L Nierenberg
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
| | - Mengyao Shi
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
| | - Changwei Li
- Department of Epidemiology and Biostatistics University of Georgia College of Public Health Athens GA
| | - Xuenan Mi
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
| | | | - Tanika N Kelly
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
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Izumaru K, Hata J, Nakano T, Nakashima Y, Nagata M, Fukuhara M, Oda Y, Kitazono T, Ninomiya T. Reduced Estimated GFR and Cardiac Remodeling: A Population-Based Autopsy Study. Am J Kidney Dis 2019; 74:373-381. [PMID: 31036390 DOI: 10.1053/j.ajkd.2019.02.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/02/2019] [Indexed: 12/18/2022]
Abstract
RATIONALE & OBJECTIVE Evidence suggests that cardiac remodeling, including left ventricular hypertrophy and myocardial fibrosis, develops with progression of kidney disease. Few studies have examined cardiac pathology across a range of estimated glomerular filtration rates (eGFRs), which was the objective of this investigation. STUDY DESIGN Population-based cross-sectional study of deceased patients undergoing autopsy. SETTING & PARTICIPANTS 334 of 694 consecutive deceased patients undergoing autopsy with available cardiac tissue, with a prior health examination within 6 years and without a prior diagnosis of heart disease. EXPOSURE eGFR. OUTCOMES The thickness of the left ventricular wall, sizes of cardiac cells, and percentages of fibrosis, estimated from pathology examination of autopsy samples. ANALYTICAL APPROACH Generalized estimating equations. RESULTS Lower eGFRs were associated with greater left ventricular wall thickness. Deceased patients with eGFRs≥60, 45 to 59, 30 to 44, and <30mL/min/1.73m2 had left ventricular wall thicknesses of 9.1, 9.5, 9.8, and 10.3mm, respectively (P for trend<0.05). Lower eGFRs were also significantly associated with greater mean values of cardiac cell size in the left ventricular wall after adjusting for confounders: 15.3, 16.1, 16.4, and 17.4μm for eGFRs≥60, 45 to 59, 30 to 44, and <30mL/min/1.73m2 (P for trend<0.01). Patients with lower eGFRs had significantly higher multivariable-adjusted geometric mean values for fibrosis percentage in the left ventricular wall: 3.22%, 4.33%, 3.83%, and 6.14% for eGFRs≥60, 45 to 59, 30 to 44, and <30mL/min/1.73m2 (P for trend<0.001). The negative association of eGFR with multivariable-adjusted mean values of cardiac cell width was stronger among patients with than those without anemia. LIMITATIONS Cross-sectional study with a high proportion of elderly patients, no available information for severity or duration of hypertension and other cardiovascular risk factors, no information for medication use. CONCLUSIONS These findings suggest that reduced eGFR is associated with cardiac hypertrophy and fibrosis of the left ventricle, cardiac cell enlargement, and cardiac fibrosis.
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Affiliation(s)
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | - Masayo Fukuhara
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Sun D, Li X, Heianza Y, Nisa H, Shang X, Rabito F, Kelly T, Harville E, Li S, He J, Bazzano L, Chen W, Qi L. History of Asthma From Childhood and Arterial Stiffness in Asymptomatic Young Adults: The Bogalusa Heart Study. Hypertension 2018; 71:928-936. [PMID: 29632104 PMCID: PMC5898648 DOI: 10.1161/hypertensionaha.118.10916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/05/2018] [Accepted: 03/05/2018] [Indexed: 12/12/2022]
Abstract
Asthma is related to various cardiovascular risk. Whether a history of asthma from childhood contributes to arterial stiffness in adulthood, a noninvasive surrogate for cardiovascular events, is unknown. Prospective analyses were performed among 1746 Bogalusa Heart Study participants aged 20 to 51 years with data on self-report asthma collected since childhood. Aorta-femoral pulse wave velocity (af-PWV, m/s) was repeatedly assessed among adults ≥aged 18 years. Generalized linear mixed models and generalized linear models were fitted for the repeated measurements of af-PWV and its changes between the last and the first measurements, respectively. After a median follow-up of 11.1 years, participants with a history of asthma from childhood had a higher af-PWV (6.78 versus 6.13; P=0.048) and a greater increase in af-PWV (8.99 versus 2.95; P=0.043) than those without asthma, adjusted for age, sex, race, smoking status, heart rate, body mass index, systolic blood pressure, lipids, and glycemia. In addition, we found significant interactions of asthma with body mass index and systolic blood pressure on af-PWV and its changes (P for interaction <0.01). The associations of asthma with af-PWV and its changes appeared to be stronger among participants who were overweight and obese (body mass index ≥25 kg/m2) or with prehypertension and hypertension (systolic blood pressure ≥120 mm Hg) compared with those with a normal body mass index or systolic blood pressure. Our findings indicate that a history of asthma from childhood is associated with higher af-PWV and greater increases in af-PWV, and such associations are stronger among young adults who are overweight or with elevated blood pressure.
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Affiliation(s)
- Dianjianyi Sun
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Xiang Li
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Yoriko Heianza
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Hoirun Nisa
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Xiaoyun Shang
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Felicia Rabito
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Tanika Kelly
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Emily Harville
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Shengxu Li
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Jiang He
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Lydia Bazzano
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Wei Chen
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Lu Qi
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.).
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Rodriguez Flores M, Aguilar Salinas C, Piché ME, Auclair A, Poirier P. Effect of bariatric surgery on heart failure. Expert Rev Cardiovasc Ther 2017; 15:567-579. [PMID: 28714796 DOI: 10.1080/14779072.2017.1352471] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Obesity increases the risk of heart failure (HF), which continues to be a significant proportion of all cardiovascular diseases and affects increasingly younger populations. The cross-talk between adipose and the heart involves insulin resistance, adipokine signaling and inflammation, with the capacity of adipose tissue to mediate hemodynamic signals, promoting progressive cardiomyopathy. Areas covered: From a therapeutic perspective, there is not yet a single obesity-related pathway that when addressed, can ameliorate cardiomyopathy in obese patients and this is a matter of ongoing research. There is poor evidence of the beneficial long-term effect of small nonsurgical intentional weight loss on HF outcomes, in contrast to the field of HF accompanying severe obesity where observational studies have shown that bariatric surgery is associated with improved cardiac structure/function in severely obese patients with HF and preserved ejection fraction (HFpEF) as well as with improved cardiac structure/function in those with HF and reduced ejection fraction (HFrEF). Few studies report positive outcomes in subjects with obesity and HF, both severe, who underwent bariatric surgery as a rescue treatment, including bridge to heart transplantation. Expert commentary: The fast growing prevalence of obesity will continue to require the development of appropriate interventions directed at controlling or slowing pathways of cardiac damage in these patients, but at present, bariatric surgery should be considered an option to try to decrease morbidity associated with HF in severely obese adults.
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Affiliation(s)
- Marcela Rodriguez Flores
- a Endocrinology Department , Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico
| | - Carlos Aguilar Salinas
- a Endocrinology Department , Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico
| | - Marie-Eve Piché
- b Cardiology Department , Institut Universitaire de Cardiologie et de Pneumologie de Québec , Québec , Canada.,c Faculty of Medicine , Laval University , Québec , Canada
| | - Audrey Auclair
- b Cardiology Department , Institut Universitaire de Cardiologie et de Pneumologie de Québec , Québec , Canada
| | - Paul Poirier
- b Cardiology Department , Institut Universitaire de Cardiologie et de Pneumologie de Québec , Québec , Canada.,d Faculty of Pharmacy , Laval University , Québec , Canada
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McCrindle BW. Cardiovascular Consequences of Childhood Obesity. Can J Cardiol 2015; 31:124-30. [DOI: 10.1016/j.cjca.2014.08.017] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 08/22/2014] [Accepted: 08/22/2014] [Indexed: 12/11/2022] Open
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Tang ZH, Wang L, Zeng F, Zhang K. Association and predictive value analysis for metabolic syndrome on systolic and diastolic heart failure in high-risk patients. BMC Cardiovasc Disord 2014; 14:124. [PMID: 25249273 PMCID: PMC4192327 DOI: 10.1186/1471-2261-14-124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/18/2014] [Indexed: 01/14/2023] Open
Abstract
Background The purpose of this study was, in high-risk patients, to simultaneously estimate the effect of metabolic syndrome (MetS) on diastolic or systolic heart failure (DHF or SHF), to evaluate MetS predictive value for both outcomes. Method We retrospective enrolled 347 high-risk patients who were scheduled to undergo coronary angiography. They were categorized into DHF cases, SHF cases and reference group. The association of MetS with DHF or SHF was assessed by multinomial logistic regression model. The shared contributor to both outcomes was estimated by bivariate association analysis. The predictive performance of MetS severity score was evaluated using the area under the receiver-operating characteristic curve (AUC). Result Hypertension (HT) and triglycerides (TG) were detected to independently associate with DHF (P = 0.044 and 0.049, respectively), while HT and fasting plasma glucose (FPG) independently associate with SHF (P = 0.036 and 0.016, respectively). Bivariate association analysis showed that HT as a shared predictor to both outcomes (P = 0.028). MetS severity score significantly associated with DHF or SHF independently (P = 0.004 and 0.043, respectively), and was a shared predictor to both outcomes (P = 0.049), and showed a high value in predicting DHF and SHF (AUC = 0.701 and 0.722, respectively). Conclusion Our findings signify that MetS is an independently shared predictor of DHF and SHF, and HT is also independently associated with both outcomes in high-risk patients. Prevalence of DHF or SHF trends to increase with increasing MetS severity showing high predictive value for both outcomes.
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Affiliation(s)
- Zi-Hui Tang
- Department of Endocrinology and Metabolism, Shanghai Tongji Hospital, Tongji University School of Medicine, Building 2nd, NO,389 Xincun Road, Shanghai 200063, China.
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Westerståhl M, Hedvall Kallerman P, Hagman E, Ek AE, Rössner SM, Marcus C. Nocturnal blood pressure non-dipping is prevalent in severely obese, prepubertal and early pubertal children. Acta Paediatr 2014; 103:225-30. [PMID: 24148136 DOI: 10.1111/apa.12479] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/15/2013] [Accepted: 10/17/2013] [Indexed: 01/20/2023]
Abstract
AIM To investigate the prevalence of nocturnal blood pressure dipping among obese prepubertal and early pubertal children and to analyse the relationship between dipping and measures of insulin-glucose metabolism or sleep-disordered breathing. METHODS We studied 76 obese children (41% girls) under clinical care, with an average age of 10.4 ± 1.7 and a body mass index Z-score (BMI Z-score) of 6.2 ± 1.6. We performed a 24-h ambulatory blood pressure measurement. Non-dipping was defined as a nocturnal blood pressure reduction of <10%. We calculated measures of insulin-glucose metabolism from the performed frequently sampled intravenous glucose-tolerance test and from fasting blood samples. Overnight sleep polygraph recordings were performed to assess sleep-disordered breathing. RESULTS Forty-two percent of the children were systolic non-dippers, and 17% were diastolic non-dippers. There were no associations between systolic or diastolic dipping and measures of insulin-glucose metabolism after adjustments for BMI Z-score, gender and pubertal status. There were no associations between dipping and measures of sleep-disordered breathing. CONCLUSION Nocturnal non-dipping was two times higher among severely obese, prepubertal and early pubertal children, compared to previous reports among children in general. There were no associations between nocturnal dipping and insulin-glucose metabolism or measures of sleep-disordered breathing in this group.
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Affiliation(s)
- M Westerståhl
- Division of Clinical Physiology; Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
- Division of Paediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - P Hedvall Kallerman
- Division of Paediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - E Hagman
- Division of Paediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - A E Ek
- Division of Paediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - S M Rössner
- Department of Woman and Child Health; Karolinska Institutet; Stockholm Sweden
| | - C Marcus
- Division of Paediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- National Childhood Obesity Centre; Karolinska University Hospital Huddinge; Stockholm Sweden
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Tang ZH, Zeng F, Li Z, Si Y, Zhou L. The association and predictive value analysis of metabolic syndrome on diastolic heart failure in patients at high risk for coronary artery disease. Diabetol Metab Syndr 2013; 5:30. [PMID: 23800086 PMCID: PMC3698118 DOI: 10.1186/1758-5996-5-30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 06/16/2013] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The purpose of the present study was to evaluate the effect and predictive value of metabolic syndrome (MetS) and its components on diastolic heart failure (DHF) in patients at high risk for coronary artery disease (CAD). MATERIALS AND METHODS We enrolled 261 patients with normal left ventricular ejection fraction (≥50%) who were scheduled to undergo coronary angiography for suspected myocardial ischemia. They were categorized into three groups (non-MetS, pre-MetS and MetS) based on the number of MetS criteria. Echocardiography was used to assess left ventricular (LV) diastolic function. The association between MetS and DHF was assessed by multivariate logistic regression (MLR) analysis (non-DHF patients as reference group) after controlling for confounders. The predictive performance of the MetS severity score (MSS) was evaluated using the area under the receiver-operating characteristic curve (AUC). RESULTS A tendency toward increased DHF prevalence with increasing MSS was found (p < 0.001). MLR analysis showed that in patients with an MSS of 1, the odds ratio (OR) of DHF was 1.60 (95% confidence interval-CI, 1.19-2.16; p = 0.02) compared to non-DHF patients; in patients with MSS ≥4, the OR was 6.61 (95% CI, 4.90-8.90; p < 0.001) compared to non-DHF patients. MSSs strongly predicted DHF (AUC = 0.73, 95% CI, 0.66-0.78, p < 0.001). MLR with MetS components as binary variables showed that blood pressure (BP) and triglycerides (TGs) were significantly associated with DHF (P = 0.001 and 0.043, respectively). CONCLUSION Our findings signify that MetS and its components of BP or TG were associated with DHF in high-risk CAD patients. DHF prevalence tends to increase with increasing MSS that has a high value in predicting DHF in high-risk CAD patients.
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Affiliation(s)
- Zi-Hui Tang
- Department of Endocrinology and Metabolism, Huashan Hospital of Fudan University, NO. 12 Wulumuqi Mid Road, Building 0#, Jing’an District, Shanghai 200040, China
| | - Fangfang Zeng
- Department of Cardiology, Huashan Hospital of Fudan University, NO. 12 Wulumuqi Mid Road, Building 0#, Jing’an District, Shanghai 200040, China
| | - Zhongtao Li
- Department of Endocrinology and Metabolism, Huashan Hospital of Fudan University, NO. 12 Wulumuqi Mid Road, Building 0#, Jing’an District, Shanghai 200040, China
| | - Yibing Si
- Department of Cardiology, Huashan Hospital of Fudan University, NO. 12 Wulumuqi Mid Road, Building 0#, Jing’an District, Shanghai 200040, China
| | - Linuo Zhou
- Department of Endocrinology and Metabolism, Huashan Hospital of Fudan University, NO. 12 Wulumuqi Mid Road, Building 0#, Jing’an District, Shanghai 200040, China
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Ybarra J, Romeo JH, Férnandez S, Sanchez-Hernandez J. The influence of obesity duration on left ventricular mass, volume and function: A pilot study. Health (London) 2012. [DOI: 10.4236/health.2012.412a205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cardiovascular health, risks and diseases in contemporary China. Int J Cardiol 2011; 152:285-94. [DOI: 10.1016/j.ijcard.2011.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 08/03/2011] [Indexed: 11/23/2022]
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Botero's Fat Figures and the Risk of Heart Failure. J Am Coll Cardiol 2011; 58:1351-2. [DOI: 10.1016/j.jacc.2011.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 06/21/2011] [Indexed: 11/23/2022]
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