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Vest AR, Schauer PR, Rodgers JE, Sanderson E, LaChute CL, Seltz J, Lavie CJ, Mandras SA, Tang WHW, daSilva-deAbreu A. Obesity and Weight Loss Strategies for Patients With Heart Failure. JACC. HEART FAILURE 2024:S2213-1779(24)00506-7. [PMID: 39093256 DOI: 10.1016/j.jchf.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 08/04/2024]
Abstract
Obesity is a common comorbidity among patients with heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), with the strongest pathophysiologic link of obesity being seen for HFpEF. Lifestyle measures are the cornerstone of weight loss management, but sustainability is a challenge, and there are limited efficacy data in the heart failure (HF) population. Bariatric surgery has moderate efficacy and safety data for patients with preoperative HF or left ventricular dysfunction and has been associated with reductions in HF hospitalizations and medium-term mortality. Antiobesity medications historically carried concerns for cardiovascular adverse effects, but the safety and weight loss efficacy seen in general population trials of glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide/GLP-1 agonists are highly encouraging. Although there are safety concerns regarding GLP-1 agonists in advanced HFrEF, trials of the GLP-1 agonist semaglutide for treatment of obesity have confirmed safety and efficacy in patients with HFpEF.
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Affiliation(s)
- Amanda R Vest
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Philip R Schauer
- Metamor Metabolic Institute, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Jo E Rodgers
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Emily Sanderson
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, USA
| | - Courtney L LaChute
- Department of Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Jessica Seltz
- Frances Stern Nutrition Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Carl J Lavie
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana, USA; University of Queensland Ochsner Clinical School, University of Queensland, New Orleans, Louisiana, USA
| | - Stacy A Mandras
- Transplant Institute, AdventHealth Orlando, Orlando, Florida, USA
| | - W H Wilson Tang
- Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Adrian daSilva-deAbreu
- Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Miller PE, Gajjar P, Mitchell GF, Khan SS, Vasan RS, Larson MG, Lewis GD, Shah RV, Nayor M. Clusters of multidimensional exercise response patterns and estimated heart failure risk in the Framingham Heart Study. ESC Heart Fail 2024. [PMID: 38943268 DOI: 10.1002/ehf2.14797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/28/2024] [Accepted: 03/21/2024] [Indexed: 07/01/2024] Open
Abstract
AIMS New tools are needed to identify heart failure (HF) risk earlier in its course. We evaluated the association of multidimensional cardiopulmonary exercise testing (CPET) phenotypes with subclinical risk markers and predicted long-term HF risk in a large community-based cohort. METHODS AND RESULTS We studied 2532 Framingham Heart Study participants [age 53 ± 9 years, 52% women, body mass index (BMI) 28.0 ± 5.3 kg/m2, peak oxygen uptake (VO2) 21.1 ± 5.9 kg/m2 in women, 26.4 ± 6.7 kg/m2 in men] who underwent maximum effort CPET and were not taking atrioventricular nodal blocking agents. Higher peak VO2 was associated with a lower estimated HF risk score (Spearman correlation r: -0.60 in men and -0.55 in women, P < 0.0001), with an observed overlap of estimated risk across peak VO2 categories. Hierarchical clustering of 26 separate CPET phenotypes (values residualized on age, sex, and BMI to provide uniformity across these variables) identified three clusters with distinct exercise physiologies: Cluster 1-impaired oxygen kinetics; Cluster 2-impaired vascular; and Cluster 3-favourable exercise response. These clusters were similar in age, sex distribution, and BMI but displayed distinct associations with relevant subclinical phenotypes [Cluster 1-higher subcutaneous and visceral fat and lower pulmonary function; Cluster 2-higher carotid-femoral pulse wave velocity (CFPWV); and Cluster 3-lower CFPWV, C-reactive protein, fat volumes, and higher lung function; all false discovery rate < 5%]. Cluster membership provided incremental variance explained (adjusted R2 increment of 0.10 in women and men, P < 0.0001 for both) when compared with peak VO2 alone in association with predicted HF risk. CONCLUSIONS Integrated CPET response patterns identify physiologically relevant profiles with distinct associations to subclinical phenotypes that are largely independent of standard risk factor-based assessment, which may suggest alternate pathways for prevention.
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Affiliation(s)
- Patricia E Miller
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Priya Gajjar
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Sadiya S Khan
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ramachandran S Vasan
- Boston University's and NHLBI's Framingham Heart Study, Framingham, MA, USA
- University of Texas School of Public Health San Antonio, San Antonio, TX, USA
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- Department of Population Health Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Boston University's and NHLBI's Framingham Heart Study, Framingham, MA, USA
| | - Gregory D Lewis
- Division of Cardiology, Cardiovascular Research Center, and Pulmonary Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ravi V Shah
- Division of Cardiology, Vanderbilt Translational and Clinical Research Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew Nayor
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Boston University's and NHLBI's Framingham Heart Study, Framingham, MA, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, 72 E Concord Street, Suite L-516, Boston, MA, 02118, USA
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Kunutsor SK, Kaminsky LA, Lehoczki A, Laukkanen JA. Unraveling the link between cardiorespiratory fitness and cancer: a state-of-the-art review. GeroScience 2024:10.1007/s11357-024-01222-z. [PMID: 38831183 DOI: 10.1007/s11357-024-01222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/24/2024] [Indexed: 06/05/2024] Open
Abstract
Cardiorespiratory fitness (CRF) not only reflects an individual's capacity to perform physical activities but also encapsulates broader effects on the basic biology of aging. This review aims to summarize the evidence on the influence of CRF on overall and site-specific cancer risks. It delves into the biological mechanisms through which CRF may exert its effects, explores the clinical implications of these findings, identifies gaps in the current evidence base, and suggests directions for future research. The synthesis of findings reveals that higher CRF levels (general threshold of > 7 METs) are consistently associated with a reduced risk of a range of cancers, including head and neck, lung, breast, gastrointestinal, particularly pancreatic and colorectal, bladder, overall cancer incidence and mortality, and potentially stomach and liver, bile duct, and gall bladder cancers. These inverse associations between CRF and cancer risk do not generally differ across age groups, sex, race, or adiposity, suggesting a universal protective effect of CRF. Nonetheless, evidence linking CRF with skin, mouth and pharynx, kidney, and endometrial cancers is limited and inconclusive. Conversely, higher CRF levels may be potentially linked to an increased risk of prostate cancer and hematological malignancies, such as leukemia and myeloma, although the evidence is still not conclusive. CRF appears to play a significant role in reducing the risk of several cancers through various biological mechanisms, including inflammation reduction, immune system enhancement, hormonal regulation, and metabolic improvements. Overall, enhancing CRF through regular physical activity offers a vital, accessible strategy for reducing cancer risk and extending the health span. Future research should aim to fill the existing evidence gaps regarding specific cancers and elucidate the detailed dose-response relationships between CRF levels and cancer risk. Studies are also needed to elucidate the causal relationships and mechanistic pathways linking CRF to cancer outcomes.
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Affiliation(s)
- Setor K Kunutsor
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4WP, UK.
| | - Leonard A Kaminsky
- Clinical Exercise Physiology, College of Health, Ball State University, Muncie, IN, USA
| | - Andrea Lehoczki
- Department of Public Health, Semmelweis University, Budapest, Hungary
- Doctoral College, Health Sciences Program, Semmelweis University, Budapest, Hungary
- Department of Haematology and Stem Cell Transplantation, National Institute for Haematology and Infectious Diseases, South Pest Central Hospital, 1097, Budapest, Hungary
| | - Jari A Laukkanen
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Wellbeing Services County of Central Finland, Jyväskylä, Finland
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Kokkinos P, Faselis C, Pittaras A, Samuel IBH, Lavie CJ, Vargas JD, Lamonte M, Franklin B, Assimes TL, Murphy R, Zhang J, Sui X, Myers J. Cardiorespiratory fitness and risk of heart failure with preserved ejection fraction. Eur J Heart Fail 2024; 26:1163-1171. [PMID: 38152843 DOI: 10.1002/ejhf.3117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023] Open
Abstract
AIMS Preventive strategies for heart failure with preserved ejection fraction (HFpEF) include pharmacotherapies and lifestyle modifications. However, the association between cardiorespiratory fitness (CRF) assessed objectively by a standardized exercise treadmill test (ETT) and the risk of HFpEF has not been evaluated. Thus, we evaluated the association between CRF and HFpEF incidence. METHODS AND RESULTS We assessed CRF in US Veterans (624 551 men; mean age 61.2 ± 9.7 years and 43 179 women; mean age 55.0 ± 8.9 years) by a standardized ETT performed between 1999 and 2020 across US Veterans Affairs Medical Centers. All had no evidence of heart failure or myocardial infarction prior to completion of the ETT. We assigned participants to one of five age- and gender-specific CRF categories (quintiles) based on peak metabolic equivalents (METs) achieved during the ETT and four categories based on CRF changes in those with two ETT evaluations (n = 139 434) ≥1.0 year apart. During a median follow-up of 10.1 years (interquartile range 6.0-14.3 years), providing 6 879 229 person-years, there were 16 493 HFpEF events with an average annual rate of 2.4 events per 1000 person-years. The adjusted risk of HFpEF decreased across CRF categories as CRF increased, independent of comorbidities. For fit individuals (≥10.5 METs) the hazard ratio (HR) was 0.48 (95% confidence interval [CI] 0.46-0.51) compared with least fit (≤4.9 METs; referent). Being unfit carried the highest risk (HR 2.88, 95% CI 2.67-3.11) of any other comorbidity. The risk of unfit individuals who became fit was 37% lower (HR 0.63, 95% CI 0.57-0.71), compared to those who remained unfit. CONCLUSIONS Higher CRF levels are independently associated with lower HFpEF in a dose-response manner. Changes in CRF reflected proportional changes in HFpEF risk, suggesting that the HFpEF risk was modulated by CRF.
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Affiliation(s)
- Peter Kokkinos
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
- Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, New Brunswick, NJ, USA
- Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Charles Faselis
- DC Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University School of Medicine, and Health Sciences, Washington, DC, USA
| | - Andreas Pittaras
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University School of Medicine, and Health Sciences, Washington, DC, USA
| | - Immanuel Babu Henry Samuel
- War Related Illness and Injury Study Center, DC Veterans Affairs Medical Center, Washington, DC, USA
- The Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Jose D Vargas
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Michael Lamonte
- Department of Social and Preventive Medicine, University of Buffalo, Buffalo, NY, USA
| | - Barry Franklin
- Preventive Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | | | - Rayelynn Murphy
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina System, Columbia, SC, USA
| | - Jonathan Myers
- Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Cardiology, Stanford University, Stanford, CA, USA
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Kaminsky LA, Myers J, Brubaker PH, Franklin BA, Bonikowske AR, German C, Arena R. 2023 update: The importance of cardiorespiratory fitness in the United States. Prog Cardiovasc Dis 2024; 83:3-9. [PMID: 38360462 DOI: 10.1016/j.pcad.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
The American Heart Association issued a Policy Statement in 2013 that characterized the importance of cardiorespiratory fitness (CRF) as an essential marker of health outcomes and specifically the need for increased assessment of CRF. This statement summarized the evidence demonstrating that CRF is "one of the most important correlates of overall health status and a potent predictor of an individual's future risk of cardiovascular disease." Subsequently, this Policy Statement led to the development of a National Registry for CRF (Fitness Registry and the Importance of Exercise: A National Data Base [FRIEND]) which established normative reference values for CRF for adults in the United States (US). This review provides an overview of the progress made in the past decade to further our understanding of the importance of CRF, specifically related to prevention and for clinical populations. Additionally, this review overviews the evolvement and additional uses of FRIEND and summarizes a hierarchy of assessment methods for CRF. In summary, continued efforts are needed to expand the representation of data from across the US, and to include data from pediatric populations, to further develop the CRF Reference Standards for the US as well as further develop Global CRF Reference Standards.
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Affiliation(s)
- Leonard A Kaminsky
- Clinical Exercise Physiology, Ball State University, Muncie, IN, United States of America; Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, United States of America
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, United States of America
| | - Barry A Franklin
- Corewell Health East, William Beaumont University Hospital, Preventive Cardiology and Cardiac Rehabilitation, Oakland University William Beaumont School of Medicine, Beaumont Health and Wellness Center, Royal Oak, MI, United States of America
| | - Amanda R Bonikowske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Charles German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, United States of America
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Mirzai S, Neeland IJ, Lavie CJ. The transiency of metabolically healthy obesity: Metabolic decline and atherosclerotic risk. Diabetes Metab Res Rev 2024; 40:e3765. [PMID: 38598738 DOI: 10.1002/dmrr.3765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Saeid Mirzai
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Los Angeles, USA
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7
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Alebna PL, Mehta A, Yehya A, daSilva-deAbreu A, Lavie CJ, Carbone S. Update on obesity, the obesity paradox, and obesity management in heart failure. Prog Cardiovasc Dis 2024; 82:34-42. [PMID: 38199320 DOI: 10.1016/j.pcad.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
Obesity is a major public health challenge worldwide. It is costly, predisposes to many cardiovascular (CV) diseases (CVD), is increasing at an alarming rate, and disproportionately affects people of low-socioeconomic status. It has a myriad of deleterious effects on the body, particularly on the CV system. Obesity is a major risk factor for heart failure (HF) and highly prevalent in this population, particularly in those with HF with preserved ejection fraction (HFpEF), to the extent that an obesity HFpEF phenotype has been proposed in the literature. However, once HF is developed, an obesity paradox exists where those with obesity have better short- and mid-term survival than normal or underweight individuals, despite a greater risk for hospitalizations. It may be argued that excess energy reserve, younger patient population, higher tolerability of HF therapy and better nutritional status may account for at least part of the obesity paradox on survival. Furthermore, body mass index (BMI) may not be an accurate measure of body composition, especially in HF, where there is an excess volume status. BMI also fails to delineate fat-free mass and its components, which is a better predictor of functional capacity and cardiorespiratory fitness (CRF), which particularly is increasingly being recognized as a risk modifier in both healthy individuals and in persons with comorbidities, particularly in HF. Notably, when CRF is accounted for, the obesity paradox disappears, suggesting that improving CRF might represent a therapeutic target with greater importance than changes in body weight in the setting of HF. In this narrative review, we discuss the current trends in obesity, the causal link between obesity and HF, an update on the obesity paradox, and a description of the major flaws of BMI in this population. We also present an overview of the latest in HF therapy, weight loss, CRF, and the application of these therapeutic approaches in patients with HF and concomitant obesity.
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Affiliation(s)
- Pamela L Alebna
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, United States of America
| | - Anurag Mehta
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, United States of America
| | - Amin Yehya
- Sentara Heart Hospital, Eastern Virginia Medical School, United States of America
| | - Adrian daSilva-deAbreu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Salvatore Carbone
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, United States of America; Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America.
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Gafni T, Weinstein G, Leonard D, Barlow CE, DeFina LF, Pettee Gabriel K, Berry JD, Shuval K. Independent and joint associations of cardiorespiratory fitness and BMI with dementia risk: the Cooper Center Longitudinal Study. BMJ Open 2023; 13:e075571. [PMID: 38086580 PMCID: PMC10729062 DOI: 10.1136/bmjopen-2023-075571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aimed to examine the association of midlife fitness and body mass index (BMI) with incident dementia later in life. DESIGN AND PARTICIPANTS A cohort study of 6428 individuals (mean age 50.9±7.6 years) from the Cooper Center Longitudinal Study. MEASURES Cardiorespiratory fitness and BMI were assessed twice (1970-1999) during visits to the Cooper Clinic, a preventive medicine clinic in Dallas, Texas. These measures were examined as continuous and categorical variables. As continuous variables, fitness and BMI were examined at baseline (averaged of two examinations) and as absolute change between exams (mean time 2.1±1.8 years). Variables were categorised: unfit versus fit and normal versus overweight/obese. Medicare claims data were used to obtain all-cause dementia incidence (1999-2009). Mean follow-up between midlife examinations and Medicare surveillance was 15.7 ((SD=6.2) years. Multivariable models were used to assess the associations between fitness, BMI and dementia. RESULTS During 40 773 person years of Medicare surveillance, 632 cases of dementia were identified. After controlling for BMI and covariates, each 1-metabolic equivalent increment in fitness was associated with 5% lower (HR 0.95; 95% CI 0.90 to 0.99) dementia risk. In comparison, after controlling for fitness and covariates, each 1 kg/m2 increment in BMI was associated with a 3.0% (HR 1.03; 95% CI 1.00 to 1.07) higher risk for dementia, yet without significance (p=0.051). Similar findings were observed when the exposures were categorised. Changes in fitness and BMI between examinations were not related to dementia. Jointly, participants who were unfit and overweight/obese had the highest (HR 2.28 95% CI 1.57 to 3.32) dementia risk compared with their fit and normal weight counterparts. CONCLUSION Lower midlife fitness is a risk marker for dementia irrespective of weight status. Being unfit coupled with overweight/obese status might increase one's risk for dementia even further.
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Affiliation(s)
- Tal Gafni
- Department of Epidemiology, University of Haifa, Haifa, Israel
| | - Galit Weinstein
- Department of Epidemiology, University of Haifa, Haifa, Israel
| | - David Leonard
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Carolyn E Barlow
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Laura F DeFina
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabam, USA
| | | | - Kerem Shuval
- Department of Research, The Cooper Institute, Dallas, Texas, USA
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Haidar A, Horwich T. Obesity, Cardiorespiratory Fitness, and Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1565-1571. [PMID: 37831388 PMCID: PMC10682063 DOI: 10.1007/s11886-023-01975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE OF REVIEW Obesity, generally defined by body mass index (BMI), is an established risk factor for the development of cardiovascular disease (CVD), while cardiorespiratory fitness (CRF) decreases risk. In chronic CVD, an obesity survival paradox in which higher BMI is associated with improved prognosis has been reported. This paper will examine the effect of obesity on CVD risk, explore obesity as a risk factor in patients with established CVD, and investigate the relationship between CRF, obesity, and CVD. RECENT FINDINGS Through metabolic and hemodynamic changes, obesity increases the risk for CVD and contributes to the development of other cardiovascular risk factors such as diabetes, dyslipidemia, and hypertension. Obesity is associated with metabolic, hormonal, and inflammatory changes that leads to atherosclerosis increasing the risk for coronary artery disease, and myocardial remodeling increasing the risk for heart failure. However, it has also been observed that overweight/obese patients with established CVD have a better prognosis when compared to non-obese individuals termed the obesity paradox. CRF is a vital component of health associated with improved cardiovascular outcomes and furthermore has been shown to markedly attenuate or nullify the relationship between obesity and CVD risk/prognosis. Increasing CRF mitigates CVD risk factors and improves overall prognosis in CVD regardless of obesity status.
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Affiliation(s)
- Amier Haidar
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tamara Horwich
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Oguntade AS, Islam N, Malouf R, Taylor H, Jin D, Lewington S, Lacey B. Body Composition and Risk of Incident Heart Failure in 1 Million Adults: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc 2023; 12:e029062. [PMID: 37345755 PMCID: PMC10356078 DOI: 10.1161/jaha.122.029062] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/15/2023] [Indexed: 06/23/2023]
Abstract
Background The aim of this systematic review was to quantify the associations between body composition measures and risk of incident heart failure (HF) and its subtypes in the general population. Methods and Results We searched Medline, Embase, and Global Health databases from each database inception to January 19, 2023 for prospective studies reporting on body composition and HF risk. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Newcastle-Ottawa scale was used to assess the risk of bias of included studies. Fixed-effects models were used for meta-analysis. Thirty-five studies were included (ntotal=1 137 044; ncases=34 422). Summary relative risk (RR) per 5-kg/m2 higher body mass index was 1.42 (95% CI, 1.40-1.42; 𝜁2=0.02, I2=94.4%), 1.28 (95% CI, 1.26-1.31; 𝜁2=0.01, I2=75.8%) per 10-cm higher waist circumference, and 1.33 (95% CI, 1.28-1.37; 𝜁2=0.04, I2=94.9%) per 0.1-unit higher waist-hip ratio. Pooled estimates of the few studies that reported on regional fat suggested significant positive association between HF risk and both visceral fat (RR, 1.08 [95% CI, 1.04-1.12]) and pericardial fat (RR, 1.08 [95% CI, 1.06-1.10]). Among HF subtypes, associations were stronger for HF with preserved ejection fraction than HF with reduced ejection fraction. No study reported on lean mass. Conclusions Pooled data suggested strong associations between adiposity and HF. The association with adiposity is stronger for HF with preserved ejection fraction than HF with reduced ejection fraction, indicating that different mechanisms may be at play in etiopathogenesis of HF subtypes. Future studies are needed to investigate role of regional fat mass and lean mass in HF risk. Registration Information REGISTRATION: URL: www.crd.york.ac.uk/prospero/. Unique identifier: CRD42020224584.
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Affiliation(s)
- Ayodipupo S. Oguntade
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
| | - Nazrul Islam
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
- School of Primary Care, Population Sciences and Medical Education, Faculty of MedicineUniversity of SouthamptonUK
| | - Reem Malouf
- National Perinatal Epidemiological Unit, Nuffield Department of Population HealthUniversity of OxfordUK
| | - Hannah Taylor
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
| | - Danyao Jin
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
| | - Sarah Lewington
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
- MRC Population Health Research Unit, NDPHUniversity of OxfordUK
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Ben Lacey
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
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Kunutsor SK, Jae SY, Kurl S, Laukkanen JA. The Interplay Between Systolic Blood Pressure, Cardiorespiratory Fitness, and Mortality Risk: A Prospective Cohort Study. J Cardiopulm Rehabil Prev 2023; 43:222-224. [PMID: 36727902 DOI: 10.1097/hcr.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Setor K Kunutsor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, England (Dr Kunutsor); Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea (Dr Jae); Departments of Sport Science (Dr Jae) and Urban Big Data Convergence (Dr Jae), University of Seoul, Seoul, South Korea; Institute of Public Health and Clinical Nutrition (Drs Kurl and Laukkanen) and Institute of Clinical Medicine, Department of Medicine (Dr Laukkanen), University of Eastern Finland, Kuopio, Finland; and Central Finland Health Care District, Department of Medicine, Jyväskylä, Finland (Dr Laukkanen)
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12
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Carbone S, Elagizi A, Lavie CJ. Better pharmacotherapy in heart failure with reduced ejection fraction may partly explain the obesity paradox. Eur J Heart Fail 2023; 25:711-713. [PMID: 36974755 PMCID: PMC10330429 DOI: 10.1002/ejhf.2832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, USA
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Andrew Elagizi
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Carl J. Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA
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13
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Kunutsor SK, Kurl S, Laukkanen JA. High Fitness Levels Attenuate the Increased Risk of Chronic Kidney Disease in Men With High Systolic Blood Pressure: A Prospective Cohort Study. J Cardiopulm Rehabil Prev 2023:01273116-990000000-00087. [PMID: 37014995 DOI: 10.1097/hcr.0000000000000793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Setor K Kunutsor
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom (Dr Kunutsor); Institute of Public Health and Clinical Nutrition (Drs Kurl and Laukkanen) and Institute of Clinical Medicine, Department of Medicine (Dr Laukkanen), University of Eastern Finland, Kuopio, Finland; and Wellbeing Services County of Central Finland, Department of Medicine, Jyväskylä, Finland (Dr Laukkanen)
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14
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Xing Z, Xiao B, Hu X, Chai X. Relationship Between Regional Adiposity Distribution and Incident Heart Failure in General Populations without Cardiovascular Disease. Am J Med 2023; 136:277-283.e2. [PMID: 36495933 DOI: 10.1016/j.amjmed.2022.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obesity is associated with a high risk of heart failure. However, the contribution of regional fat distribution evaluated using bioimpedance analysis toward heart failure risk in the general population without cardiovascular disease has rarely been studied. METHODS This study included 483,316 participants without heart failure and cardiovascular disease from the UK Biobank study. The regional fat mass was determined by bioimpedance analysis and calculated by dividing the square of height in meters (kg/m2). This study evaluated the association of regional fat mass (arm fat index [AFI], trunk fat index [TFI], and leg fat index [LFI]) with the risk of incident heart failure and whether regional fat mass adds a further prognostic value for heart failure besides body mass index (BMI) in a large prospective cohort study. RESULTS During the median 12.1 years, 3134 incident heart failure cases occurred. After adjustment for BMI and other confounding factors, each 1-standard deviation increase in LFI was associated with a 21% lower heart failure risk even after adjusting for BMI and other confounding factors (hazard ratio [HR] 0.79; 95% confidence interval [CI], 0.73-0.85). However, we did not observe heart failure-associated risks with AFI and TFI (HR 1.04; 95% CI, 0.99-1.09; HR 0.97, 95% CI, 0.91-1.04, respectively). Subgroup analysis demonstrated that the protective role of LFI was more prominent in the elderly and female participants (P < .01). CONCLUSION Regional fat measurement other than BMI can improve heart failure risk stratification; leg fat plays a protective role, yet arm and trunk fat do not, in the general population without cardiovascular disease.
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Affiliation(s)
- Zhenhua Xing
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China; Emergency Medicine and Difficult Diseases Institute
| | - Bing Xiao
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China; Emergency Medicine and Difficult Diseases Institute
| | - Xinqun Hu
- Department of Cardiovascular Medicine, Central South University, Changsha, China
| | - Xiangping Chai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China; Emergency Medicine and Difficult Diseases Institute.
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15
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Franklin BA, Wedig IJ, Sallis RE, Lavie CJ, Elmer SJ. Physical Activity and Cardiorespiratory Fitness as Modulators of Health Outcomes: A Compelling Research-Based Case Presented to the Medical Community. Mayo Clin Proc 2023; 98:316-331. [PMID: 36737120 DOI: 10.1016/j.mayocp.2022.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/29/2022] [Accepted: 09/19/2022] [Indexed: 02/04/2023]
Abstract
The beneficial health effects and prognostic significance of regular moderate-to-vigorous physical activity (PA), increased cardiorespiratory fitness (CRF), or both are often underappreciated by the medical community and the patients they serve. Individuals with low CRF have higher annual health care costs, higher rates of surgical complications, and are two to three times more likely to die prematurely than their fitter counterparts when matched for risk factor profile or coronary calcium score. Increased levels of habitual PA before hospitalization for acute coronary syndromes are also associated with better short-term cardiovascular outcomes. Accordingly, this review examines these relations and the potential underlying mechanisms of benefit (eg, exercise preconditioning), with specific reference to the incidence of cardiovascular, cancer, and coronavirus diseases, and the prescriptive implications and exercise thresholds for optimizing health outcomes. To assess the evidence supporting or refuting the benefits of PA and CRF, we performed a literature search (PubMed) and critically reviewed the evidence to date. In aggregate, these data are presented in the context of clarifying the impact that regular PA and/or increased CRF have on preventing and treating chronic and infectious diseases, with reference to evidence-based exercise thresholds that the medical community can embrace and promote.
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Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation Department, Beaumont Health, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Isaac J Wedig
- Department of Kinesiology and Integrative Physiology, and Health Research Institute, Michigan Technological University, Houghton, MI, USA
| | - Robert E Sallis
- Department of Family and Sports Medicine, Kaiser Permanente Medical Center, Fontana, CA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Steven J Elmer
- Department of Kinesiology and Integrative Physiology, and Health Research Institute, Michigan Technological University, Houghton, MI, USA.
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16
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Sex-specific impact of anthropometric parameters on outcomes after transcatheter edge-to-edge repair for secondary mitral regurgitation. Int J Cardiol 2023; 371:312-318. [PMID: 36115443 DOI: 10.1016/j.ijcard.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/05/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Body surface area (BSA) has been reported to be the stronger predictor for prognosis than body mass index in heart failure (HF) patients. The sex-specific association of BSA with mortality has been unclear. METHODS EuroSMR, a European multicenter registry, included patients who underwent edge-to-edge repair (TEER) for secondary mitral regurgitation (SMR). The outcome was two-year all-cause mortality. RESULTS The present cohort included 1594 HF patients (age, 74 ± 10 years; male, 66%). Association of calculated BSA with two-year all-cause mortality was evaluated. Patients were classified into three BSA groups: the lowest 10% (S), the highest 10% (L), and intermediate between S and L (M). Mean BSA was 1.87 ± 0.21 m2 (male, 1.94 ± 0.18 m2; female, 1.73 ± 0.18 m2). The association of BSA with the endpoint in females showed a U-shaped curve, indicating worse prognosis for both S and L. The association in males followed a linear regression, demonstrating better prognosis for L. Hazard ratio (HR) of L to S in males was 0.43 (95% confidence interval [CI], 0.25-0.74; p = 0.002), whereas HR of L to M in females was 1.76 (95% CI, 1.11-2.78; p = 0.016) (p for interaction = 0.003). CONCLUSIONS Sex-specific association patterns demonstrate the complex influence of anthropomorphic factors in HF patients scheduled for TEER. Further investigation beyond simple evaluation of weight and height is needed for better comprehension of the obesity paradox and better prediction of the results of transcatheter therapy in HF patients.
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17
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Cardiometabolic-based chronic disease: adiposity and dysglycemia drivers of heart failure. Heart Fail Rev 2023; 28:47-61. [PMID: 35368233 DOI: 10.1007/s10741-022-10233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) is a complex clinical syndrome, associated with high rates of mortality, hospitalization, and impairment of quality of life. Obesity and type 2 diabetes are major cardiometabolic drivers, represented as distinct stages of adiposity- and dysglycemia-based chronic disease (ABCD, DBCD), respectively, and leading to cardiometabolic-based chronic disease (CMBCD). This review focuses on one aspect of the CMBCD model: how ABCD and DBCD influence genesis and progression of HF phenotypes. Specifically, the relationships of ABCD and DBCD stages with structural and functional heart disease, HF risk, and outcomes in overt HF are detailed. Also, evidence-based lifestyle, pharmacological, and procedural interventions that promote or reverse cardiac remodeling and outcomes in individuals at risk or with HF are discussed. In summary, driver-based chronic disease models for individuals at risk or with HF can expose prevention targets for more comprehensive interventions to improve clinical outcomes. Future randomized trials that investigate structured lifestyle, pharmacological, and procedural therapies specifically tailored for the CMBCD model are needed to develop personalized care plans to decrease HF susceptibility and improve outcomes.
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18
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Franklin B, H. Eijsvogels T. A narrative review on exercise and cardiovascular disease: Physical activity thresholds for optimizing health outcomes. HEART AND MIND 2023. [DOI: 10.4103/hm.hm_1_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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19
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Peniche PDC, Aguiar LT, Ferreira Dos Reis MT, Faria CDCDM. An Equation With Clinical Applicability and Adequate Validity to Predict the Maximum Oxygen Consumption of Individuals Post-stroke. Arch Phys Med Rehabil 2022; 104:769-775. [PMID: 36493868 DOI: 10.1016/j.apmr.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To develop an equation with clinical applicability and adequate validity to predict the maximum oxygen consumption (V̇o2max) of individuals post-stroke. DESIGN A cross-sectional study. SETTING A university laboratory. PARTICIPANTS Individuals post-stroke in the chronic phase (at least 6 months post-stroke). Step-1 (equation development): n=50, aged 55±12 years; Step-2 (validity investigation): n=20, aged 58±8 years (N=50 [step 1], N=20 [step 2]). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Step-1 (equation development): multiple linear regression analysis was performed. DEPENDENT VARIABLE V̇o2max (mL/kg/min) in the cardiopulmonary exercise test. INDEPENDENT VARIABLES age (years), sex (1-women, 2-men), body mass index (BMI) (kg/m2), and distance (meters) in the Six-Minute Walk Test (6MWT) (6MWT-Equation) or in the Incremental Shuttle Walk Test (ISWT) (ISWT-Equation). Step-2 (validity investigation): agreement between the V̇o2max measured and predicted was evaluated with the intraclass correlation coefficient (ICC) with 95% confidence interval (CI) and the Bland-Altman method (α=5%). RESULTS In step-1 (equation development), the 4 independent variables for each equation were retained (6MWT-Equation: R2=0.68, P<.001; ISWT-Equation: R2=0.58, P<.001). In step-2 (validity investigation), the 6MWT-Equation showed an ICC of 0.73 (95% CI=0.30, 0.89; P=.004) and a mean bias of 0.003 mL/kg/min; and the ISWT-Equation showed an imprecise ICC of 0.55 (95% CI=-0.12, 0.82; P=.045) and a mean bias of 0.971 mL/kg/min. 6MWT-Equation (V̇o2max=22.239+0.02 × distance in the 6MWT+4.039 × sex-0.157 × age-0.265 × BMI) showed adequate validity. CONCLUSIONS An equation with clinical applicability and adequate validity in the investigated sample was developed to predict the V̇o2max of individuals post-stroke in the chronic phase (6MWT-Equation). Future studies with larger sample should investigate its external validity.
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Affiliation(s)
- Paula da Cruz Peniche
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Tavares Aguiar
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Physical Therapy, Faculdade Ciências Médicas de Minas Gerais (FCM-MG), Belo Horizonte, Minas Gerais, Brazil
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20
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Bohmke NJ, Billingsley HE, Kirkman DL, Carbone S. Nonpharmacological Strategies in Heart Failure with Preserved Ejection Fraction. Cardiol Clin 2022; 40:491-506. [PMID: 36210133 PMCID: PMC10280381 DOI: 10.1016/j.ccl.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) suffer from a high rate of cardiometabolic comorbidities with limited pharmaceutical therapies proven to improve clinical outcomes and cardiorespiratory fitness (CRF). Nonpharmacologic therapies, such as exercise training and dietary interventions, are promising strategies for this population. The aim of this narrative review is to present a summary of the literature published to date and future directions related to the efficacy of nonpharmacologic, lifestyle-related therapies in HFpEF, with a focus on exercise training and dietary interventions.
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Affiliation(s)
- Natalie J Bohmke
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA
| | - Hayley E Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA
| | - Danielle L Kirkman
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA.
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA.
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21
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Kunutsor SK, Jae SY, Kauhanen J, Laukkanen JA. High Fitness Levels Offset the Increased Risk of Chronic Kidney Disease due to Low Socioeconomic Status: A Prospective Study. Am J Med 2022; 135:1247-1254.e2. [PMID: 35820458 DOI: 10.1016/j.amjmed.2022.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Socioeconomic status (SES) and cardiorespiratory fitness (CRF) are each independently associated with chronic kidney disease. The interplay among SES, CRF, and chronic kidney disease is not well understood. We aimed to evaluate the separate and joint associations of SES and CRF with chronic kidney disease risk in a cohort of Caucasian men. METHODS In 2099 men aged 42-61 years with normal kidney function at baseline, SES was self-reported and CRF was directly measured using a respiratory gas exchange analyzer during cardiopulmonary exercise testing. Hazard ratios (HRs) (95% confidence interval) were estimated for chronic kidney disease. RESULTS A total of 197 chronic kidney disease events occurred during a median follow-up of 25.8 years. Comparing low versus high SES, the multivariable-adjusted HR (95% confidence interval) for chronic kidney disease was 1.55 (1.06-2.25), which remained consistent on further adjustment for CRF 1.53 (1.06-2.22). Comparing high versus low CRF, the multivariable-adjusted HR for chronic kidney disease was 0.66 (0.45-0.96), which persisted on further adjustment for SES 0.67 (0.46-0.97). Compared with high SES-high CRF, low SES-low CRF was associated with an increased risk of chronic kidney disease 1.88 (1.23-2.87), with no evidence of an association for low SES-high CRF and chronic kidney disease risk 1.32 (0.85-2.05). Positive additive (relative excess risk due to interaction = 0.31) and multiplicative (ratio of HRs = 1.14) interactions were found between SES and CRF in relation to chronic kidney disease risk. CONCLUSIONS In middle-aged and older males, SES and CRF are each independently associated with risk of incident chronic kidney disease. There exists an interplay among SES, CRF and chronic kidney disease risk, with high CRF levels appearing to offset the increased chronic kidney disease risk related to low SES.
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Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
| | - Sae Young Jae
- Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea; Department of Sport Science, University of Seoul, Seoul, South Korea; Department of Urban Big Data Convergence, University of Seoul, Seoul, Republic of Korea
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
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22
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Cardiorespiratory Fitness, Inflammation, and Risk of Chronic Obstructive Pulmonary Disease in Middle-Aged Men: A COHORT STUDY. J Cardiopulm Rehabil Prev 2022; 42:347-351. [PMID: 35121704 DOI: 10.1097/hcr.0000000000000674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is characterized by chronic lung inflammation. The relationship between cardiorespiratory fitness (CRF) and COPD has not been well characterized. We aimed to evaluate the independent and joint associations of inflammation (high-sensitivity C-reactive protein [hsCRP]) and CRF with COPD risk in a cohort of White men. METHODS Among 2274 men aged 42-61 yr at baseline, serum hsCRP level was measured using an immunometric assay and CRF was assessed using a respiratory gas exchange analyzer. The level of hsCRP was categorized as normal and high (≤3 and >3 mg/L, respectively) and CRF as low and high. We corrected for within-person variability in exposures using repeat measurements taken several years apart. RESULTS A total of 116 COPD cases occurred during a median follow-up of 26.0 yr. The age-adjusted regression dilution ratio of hsCRP and CRF was 0.57 (95% CI, 0.50-0.64) and 0.58 (95% CI, 0.53-0.64), respectively. Comparing high versus normal hsCRP levels, the multivariable-adjusted HR for COPD was 1.79 (95% CI, 1.20-2.68). The COPD risk decreased linearly with increasing CRF. The multivariable-adjusted HR for COPD per 1-SD increase in CRF was 0.75 (95% CI, 0.60-0.95). Compared with men with normal hsCRP-low CRF, high hsCRP-low CRF was associated with an increased COPD risk, 1.80 (95% CI, 1.12-2.89), with no evidence of an association for high hsCRP-high CRF and COPD risk, 1.35 (95% CI, 0.68-2.69). CONCLUSIONS Both hsCRP and CRF are associated with COPD risk in middle-aged men. However, high CRF levels attenuate the increased COPD risk related to high hsCRP levels.
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Rao P, Belanger MJ, Robbins JM. Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases. Cardiol Rev 2022; 30:167-178. [PMID: 34560712 PMCID: PMC8920940 DOI: 10.1097/crd.0000000000000416] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation (AF), respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary prevention of ASCVD, including their beneficial effects on both traditional and nontraditional risk mediators; exercise "prescriptions" for ASCVD; the role of PA regular exercise in the prevention and treatment of heart failure; and the relationships between, PA, exercise, and AF. While our understanding of the relationship between exercise and CVD has evolved considerably, several key questions remain including the association between extreme volumes of exercise and subclinical ASCVD and its risk; high-intensity exercise and resistance (strength) training as complementary modalities to continuous aerobic exercise; and dose- and intensity-dependent associations between exercise and AF. Recent advances in molecular profiling technologies (ie, genomics, transcriptomics, proteomics, and metabolomics) have begun to shed light on interindividual variation in cardiometabolic responses to PA and exercise and may provide new opportunities for clinical prediction in addition to mechanistic insights.
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Affiliation(s)
- Prashant Rao
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Jeremy M. Robbins
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Laukkanen JA, Kurl S, Voutilainen A, Mäkikallio T, Kunutsor SK. Cardiorespiratory Fitness, Inflammation, and Risk of Sudden Cardiac Death in Middle-Aged Men. Am J Cardiol 2022; 174:166-171. [PMID: 35483978 DOI: 10.1016/j.amjcard.2022.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/01/2022]
Abstract
Inflammation and cardiorespiratory fitness (CRF) are each independently related to the risk of sudden cardiac death (SCD). The interplay between CRF, inflammation and SCD is not well understood. We aimed to study the separate and joint associations of inflammation (high-sensitivity C-reactive protein [hsCRP]) and CRF with SCD risk in a cohort of Caucasian men. In 1,749 men aged 42 to 61 years without a history of coronary heart disease at baseline, serum hsCRP was measured using an immunometric assay, and CRF was assessed using a respiratory gas exchange analyzer during exercise testing. hsCRP was categorized as normal and high (≤3 and >3 mg/L, respectively) and CRF as low and high (median cutoff). A total of 148 SCD events occurred during a median follow-up of 28.9 years. Comparing high versus normal hsCRP, the multivariable-adjusted hazard ratio (95% confidence interval) for SCD was 1.65 (1.11 to 2.45), which remained similar on further adjustment for CRF 1.62 (1.09 to 2.40). Comparing high versus low CRF, the multivariable-adjusted hazard ratio for SCD was 0.61 (0.42 to 0.89), which remained persistent after adjustment for hsCRP 0.64 (0.44 to 0.93). Compared with normal hsCRP-low CRF, normal hsCRP-high CRF was associated with a decreased SCD risk of 0.65 (0.43 to 0.99), high hsCRP-low CRF was associated with an increased SCD risk of 1.72 (1.10 to 2.69), with no evidence of a relationship between high hsCRP-high CRF and SCD risk 0.86 (0.39 to 1.88). Positive additive and multiplicative interactions were found between hsCRP and CRF. In a middle-aged Finnish male population, both hsCRP and CRF are independently associated with SCD risk. However, high CRF levels appear to offset the increased SCD risk related to high hsCRP levels.
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25
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Carbone S. Intramuscular and Intermuscular Adipose Tissue in Older Adults: Noncardiac Body Composition Depots and HF Risk. JACC. HEART FAILURE 2022; 10:494-497. [PMID: 35772860 PMCID: PMC9390805 DOI: 10.1016/j.jchf.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Salvatore Carbone
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
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Abstract
Overweight and obesity adversely impact cardiac structure and function, affecting systolic and diastolic ventricular function. Epidemiologic studies have documented an obesity paradox in large heart failure cohorts, where overweight and obese individuals with established heart failure have a better short- and medium-term prognosis compared with leaner patients; this relationship is strongly impacted by level of cardiorespiratory fitness. There are implications for therapies aimed at increasing lean mass as well as weight loss and improvements in quality of diet for the prevention and treatment of heart failure and concomitant obesity to improve cardiorespiratory fitness.
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Kunutsor SK, Jae SY, Mäkikallio TH, Laukkanen JA. High Fitness Levels Attenuate the Increased Risk of Hypertension Due to Low Socioeconomic Status in Middle-Aged Men: A Cohort Study. J Cardiopulm Rehabil Prev 2022; 42:134-136. [PMID: 35121703 DOI: 10.1097/hcr.0000000000000673] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, England; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, England; and Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland
| | - Sae Young Jae
- Department of Sport Science, University of Seoul, Seoul, Republic of Korea
| | - Timo H Mäkikallio
- Department of Medicine, University of Helsinki, Helsinki, Finland; and Department of Medicine, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Jari A Laukkanen
- Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; and Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
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Kunutsor SK, Jae SY, Mäkikallio TH, Laukkanen JA. Cardiorespiratory fitness does not offset the increased risk of chronic obstructive pulmonary disease attributed to smoking: a cohort study. Eur J Epidemiol 2022; 37:423-428. [PMID: 35122562 PMCID: PMC9187537 DOI: 10.1007/s10654-021-00835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
Though evidence suggests that higher cardiorespiratory fitness (CRF) levels can offset the adverse effects of other risk factors, it is unknown if CRF offsets the increased risk of chronic obstructive pulmonary disease (COPD) due to smoking. We aimed to evaluate the combined effects of smoking status and CRF on incident COPD risk using a prospective cohort of 2295 middle-aged and older Finnish men. Peak oxygen uptake, assessed with a respiratory gas exchange analyzer, was used as a measure of CRF. Smoking status was self-reported. CRF was categorised as low and high based on median cutoffs, whereas smoking status was classified into smokers and non-smokers. Multivariable-adjusted hazard ratios with confidence intervals (CIs) were calculated. During 26 years median follow-up, 119 COPD cases were recorded. Smoking increased COPD risk 10.59 (95% CI 6.64–16.88), and high CRF levels decreased COPD risk 0.43 (95% CI 0.25–0.73). Compared with non-smoker-low CRF, smoker-low CRF was associated with an increased COPD risk in multivariable analysis 9.79 (95% CI 5.61–17.08), with attenuated but persisting evidence of an association for smoker-high CRF and COPD risk 6.10 (95% CI 3.22–11.57). An additive interaction was found between smoking status and CRF (RERI = 6.99). Except for CRF and COPD risk, all associations persisted on accounting for mortality as a competing risk event. Despite a wealth of evidence on the ability of high CRF to offset the adverse effects of other risk factors, it appears high CRF levels have only modest attenuating effects on the very strong association between smoking and COPD risk.
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Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK. .,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK. .,Department of Medicine, Central Finland Health Care District Hospital District, Finland District, Jyväskylä, Finland.
| | - Sae Young Jae
- Department of Sport Science, University of Seoul, Seoul, Republic of Korea
| | - Timo H Mäkikallio
- Department of Medicine, University of Helsinki, Helsinki, Finland.,Department of Medicine, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Jari A Laukkanen
- Department of Medicine, Central Finland Health Care District Hospital District, Finland District, Jyväskylä, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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29
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Davis ME, Blake C, Perrotta C, Cunningham C, O'Donoghue G. Impact of training modes on fitness and body composition in women with obesity: A systematic review and meta-analysis. Obesity (Silver Spring) 2022; 30:300-319. [PMID: 35088563 DOI: 10.1002/oby.23305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to assess the effectiveness of different exercise modalities and determine the optimal exercise prescription for improving cardiorespiratory fitness, body composition, and metabolic health of women with obesity. METHODS A systematic review of randomized controlled trials (RCTs) published between January 1988 and October 2020 was conducted. The RCTs were screened using the following inclusion criteria: 1) participants: women aged 18 to 65 years with BMI > 30 kg/m2 and without comorbidities; 2) intervention: exercise; 3) comparison: non-intervention control; and 4) outcomes measures: cardiorespiratory fitness (maximal oxygen consumption), body composition (i.e., body weight, percentage body fat), and/or metabolic measures (i.e., blood pressure, cholesterol). RESULTS A total of 20 RCTs with a total of 2,062 participants were included. Although the results showed that any form of exercise was more effective than control, improvements in fitness and body composition were modest. Aerobic exercise (vigorous and moderate intensity) appeared most promising for improving fitness and body weight, whereas low-load resistance training resulted in the largest improvements in body fatness. CONCLUSIONS In women living with obesity, aerobic exercise was consistently effective in improving fitness and body composition. Although both resistance training and combined exercise interventions appear promising, more research is needed to evaluate their efficacy and determine an optimal exercise prescription for this population.
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Affiliation(s)
- Mary E Davis
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Gráinne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
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Wammer F, Haberberger A, Linge AD, Myklebust TÅ, Vemøy S, Hoff DAL. Lifestyle modification for weight loss: Effects on cardiorespiratory capacity in patients with class II and class III obesity. Obes Sci Pract 2022; 8:45-55. [PMID: 35127121 PMCID: PMC8804912 DOI: 10.1002/osp4.544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevalence of obesity has increased worldwide. Obesity affects the lungs and airways, limits peak oxygen uptake, and hampers physical performance; however, objective data are scarce. Does lifestyle modification for weight loss (LM) have an impact on cardiorespiratory capacity (CRC) in patients with class II and class III obesity? METHOD This was a single-center prospective 2-year follow-up pilot study. Four separated stays in the inpatient specialized medical center Muritunet with an integrated approach to LM, including an individual plan on diet and physical activity (PA) goals. Furthermore, it included lectures and counseling on human anatomy and physiology, nutrition, physical exercise, and motivation, as well as daily PA. Cardiopulmonary and blood chemistry tests were conducted. RESULTS Seventy-seven participants were included; however, 47% (n = 36) dropped out during follow-up. Forty-one participants completed the study. At baseline (BL), the mean age was 45.4 (SD 10.2, range 23-62) years, with a mean body mass index (BMI) of 41.3 (SD 5.4) kg/m2, and 85% (n = 35) had one or more comorbidities, such as obstructive pulmonary disease (n = 15, 37%), obstructive sleep apnea (n = 19, 46%), type 2 diabetes (n = 20, 49%), and hypertension (n = 17, 41%). The mean functional residual capacity increased, significantly the second year (p = 0,037). CRC increased significantly the first year (p = 0.032). Weight and BMI declined, reaching statistical significance at 2 years for both males and females (p = 0.033 and p = 0.003, respectively). At BL, the participants reported lower health-related quality of life compared to the general Norwegian population. Across time the physical component summary score (quality of life) for both males and females (p = 0.011 and p = 0.049, respectively) increased significantly. CONCLUSION Lifestyle modification for weight loss improves CRC in patients with class II and class III obesity.
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Affiliation(s)
- Finn Wammer
- Centre for Achievement and RehabilitationMuritunet A/SValldalNorway
| | | | - Anita Dyb Linge
- Centre for Achievement and RehabilitationMuritunet A/SValldalNorway
- Institute of Social ScienceVolda University CollegeVoldaNorway
| | - Tor Åge Myklebust
- Department of Research and InnovationMøre & Romsdal Hospitsal TrustÅlesundNorway
- Department of RegistrationCancer Registry of NorwayOsloNorway
| | - Sveinung Vemøy
- Centre for Achievement and RehabilitationMuritunet A/SValldalNorway
| | - Dag Arne Lihaug Hoff
- Department of MedicineÅlesund HospitalMøre & Romsdal Hospital TrustÅlesundNorway
- Department of Clinical and Molecular MedicineFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
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31
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Stretti L, Zippo D, Coats AJS, Anker MS, von Haehling S, Metra M, Tomasoni D. A year in heart failure: an update of recent findings. ESC Heart Fail 2021; 8:4370-4393. [PMID: 34918477 PMCID: PMC9073717 DOI: 10.1002/ehf2.13760] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022] Open
Abstract
Major changes have occurred in these last years in heart failure (HF) management. Landmark trials and the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of HF have established four classes of drugs for treatment of HF with reduced ejection fraction: angiotensin‐converting enzyme inhibitors or an angiotensin receptor‐neprilysin inhibitor, beta‐blockers, mineralocorticoid receptor antagonists, and sodium‐glucose co‐transporter 2 inhibitors, namely, dapagliflozin or empagliflozin. These drugs consistently showed benefits on mortality, HF hospitalizations, and quality of life. Correction of iron deficiency is indicated to improve symptoms and reduce HF hospitalizations. AFFIRM‐AHF showed 26% reduction in total HF hospitalizations with ferric carboxymaltose vs. placebo in patients hospitalized for acute HF (P = 0.013). The guanylate cyclase activator vericiguat and the myosin activator omecamtiv mecarbil improved outcomes in randomized placebo‐controlled trials, and vericiguat is now approved for clinical practice. Treatment of HF with preserved ejection fraction (HFpEF) was a major unmet clinical need until this year when the results of EMPEROR‐Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic HFpEF) were issued. Compared with placebo, empagliflozin reduced by 21% (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P < 0.001), the primary outcome of cardiovascular death or HF hospitalization. Advances in the treatment of specific phenotypes of HF, including atrial fibrillation, valvular heart disease, cardiomyopathies, cardiac amyloidosis, and cancer‐related HF, also occurred. Coronavirus disease 2019 (COVID‐19) pandemic still plays a major role in HF epidemiology and management. All these aspects are highlighted in this review.
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Affiliation(s)
- Lorenzo Stretti
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Dauphine Zippo
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Markus S Anker
- Department of Cardiology (CBF), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Marco Metra
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Kunutsor SK, Jae SY, Mäkikallio TH, Kurl S, Laukkanen JA. High fitness levels offset the increased risk of chronic obstructive pulmonary disease due to low socioeconomic status: A cohort study. Respir Med 2021; 189:106647. [PMID: 34655960 DOI: 10.1016/j.rmed.2021.106647] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Evidence suggests that higher cardiorespiratory fitness (CRF) levels can offset the increased risk of adverse outcomes due to other risk factors. The impact of high CRF levels on the increased risk of chronic obstructive pulmonary disease (COPD) due to low socioeconomic status (SES) is unknown. We aimed to assess the combined effects of SES and CRF on the future risk of COPD. METHODS We employed a prospective cohort of 2312 Finnish men aged 42-61 years at study entry. Socioeconomic status was self-reported and CRF was objectively assessed using respiratory gas exchange analyzers. Both exposures were categorized as low and high based on median cutoffs. Multivariable-adjusted hazard ratios (HRs) with confidence intervals (CIs) were estimated. RESULTS During 26.0 years median follow-up, 120 COPD cases occurred. Low SES was associated with increased COPD risk and high CRF was associated with reduced COPD risk. Compared with high SES-low CRF, low SES-low CRF was associated with an increased COPD risk 2.36 (95% CI: 1.44-3.87), with no evidence of an association for low SES-high CRF and COPD risk 1.46 (95% CI:0.82-2.60). CONCLUSION In middle-aged Finnish men, SES and CRF are each independently associated with COPD risk. However, high CRF levels offset the increased COPD risk related to low SES.
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Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK; Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland.
| | - Sae Young Jae
- Department of Sport Science, University of Seoul, Seoul, Republic of Korea
| | - Timo H Mäkikallio
- Department of Medicine, University of Helsinki, Helsinki, Finland; Department of Medicine, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
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Obesity paradox in joint replacement for osteoarthritis - truth or paradox? GeroScience 2021; 44:651-659. [PMID: 34453272 PMCID: PMC8396800 DOI: 10.1007/s11357-021-00442-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/12/2021] [Indexed: 10/31/2022] Open
Abstract
Obesity is associated with an increased risk of cardiovascular disease (CVD) and other adverse health outcomes. In patients with pre-existing heart failure or coronary heart disease, obese individuals have a more favourable prognosis compared to individuals who are of normal weight. This paradoxical relationship between obesity and CVD has been termed the 'obesity paradox'. This phenomenon has also been observed in patients with other cardiovascular conditions and diseases of the respiratory and renal systems. Taking into consideration the well-established relationship between osteoarthritis (OA) and CVD, emerging evidence shows that overweight and obese individuals undergoing total hip or knee replacement for OA have lower mortality risk compared with normal weight individuals, suggesting an obesity paradox. Factors proposed to explain the obesity paradox include the role of cardiorespiratory fitness ("fat but fit"), the increased amount of lean mass in obese people, additional adipose tissue serving as a metabolic reserve, biases such as reverse causation and confounding by smoking, and the co-existence of older age and specific comorbidities such as CVD. A wealth of evidence suggests that higher levels of fitness are accompanied by prolonged life expectancy across all levels of adiposity and that the increased mortality risk attributed to obesity can be attenuated with increased fitness. For patients about to have joint replacement, improving fitness levels through physical activities or exercises that are attractive and feasible, should be a priority if intentional weight loss is unlikely to be achieved.
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34
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Carbone S, daSilva-deAbreu A, Lavie CJ. The sodium-glucose co-transporter 2 inhibitor dapagliflozin improves prognosis in systolic heart failure independent of the obesity paradox. Eur J Heart Fail 2021; 23:1673-1676. [PMID: 34427026 DOI: 10.1002/ejhf.2336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Salvatore Carbone
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA.,Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian daSilva-deAbreu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,Heart and Vascular Center, Yale-New Haven Hospital, New Haven, CT, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
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Enarsson M, Feldreich T, Byberg L, Nowak C, Lind L, Ärnlöv J. Association between Cardiorespiratory Fitness and Circulating Proteins in 50-Year-Old Swedish Men and Women: a Cross-Sectional Study. SPORTS MEDICINE-OPEN 2021; 7:52. [PMID: 34312731 PMCID: PMC8313632 DOI: 10.1186/s40798-021-00343-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/04/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS A strong cardiorespiratory fitness is suggested to have beneficial effects on cardiovascular risk; the exact mechanisms underlying the cardioprotective effects of fitness remain uncertain. Our aim was to investigate associations between cardiorespiratory fitness and multiple plasma proteins, in order to obtain insights about physiological pathways associated with the effects of exercise on cardiovascular health. METHODS In the Prospective investigation of Obesity, Energy and Metabolism (POEM) study (n=444 adults aged 50 years, 50% women), cardiorespiratory fitness was measured by a maximal exercise test on bicycle ergometer with gas exchange (VO2peak) normalized for body lean mass (dual-energy X-ray absorptiometry (DXA)). We measured 82 cardiovascular proteins associated with cardiovascular pathology and inflammation in plasma samples with a proximity extension assay. RESULTS In sex-adjusted linear regression, VO2peak was associated with 18 proteins after Bonferroni correction for multiple testing (p<0.0006). Following additional adjustment for fat mass (DXA), fasting glucose (mmol/L), low-density lipoprotein (LDL, mmol/L), smoking status, waist/hip ratio, blood pressure (mmHg), education level, and lpnr (lab sequence number), higher VO2peak was significantly associated with lower levels of 6 proteins: fatty-acid binding protein-4 (FABP4), interleukin-6 (IL-6), leptin, cystatin-B (CSTB), interleukin-1 receptor antagonist (IL-1RA), and growth differentiation factor 15 (GDF-15), and higher levels of 3 proteins: galanin, kallikrein-6 (KLK6), and heparin-binding EGF-like growth factor (HB-EGF), at nominal p-values (p<0.05). CONCLUSIONS We identified multiple novel associations between cardiorespiratory fitness and plasma proteins involved in several atherosclerotic processes and key cellular mechanisms such as inflammation, energy homeostasis, and protease activity, which shed new light on how exercise asserts its beneficial effects on cardiovascular health. Our findings encourage additional studies in order to understand the underlying causal mechanisms for these associations.
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Affiliation(s)
- Malin Enarsson
- Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Nissers väg 3, 79182, Falun, Sweden
| | - Tobias Feldreich
- School of Health and Social Studies, Dalarna University, 79188, Falun, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Dag Hammarskjölds väg 14, B 75185, Uppsala, Sweden
| | - Christoph Nowak
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Alfred Nobels Allé 23, 14183, Huddinge, SE, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Dag Hammarskölds väg 10B, 75237, Uppsala, Sweden
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, 79188, Falun, Sweden. .,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Alfred Nobels Allé 23, 14183, Huddinge, SE, Sweden.
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Kondamudi N, Thangada N, Patel KV, Ayers C, Chandra A, Berry JD, Neeland IJ, Pandey A. Regional adiposity, cardiorespiratory fitness, and left ventricular strain: an analysis from the Dallas Heart Study. J Cardiovasc Magn Reson 2021; 23:78. [PMID: 34120624 PMCID: PMC8201708 DOI: 10.1186/s12968-021-00757-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/06/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Low cardiorespiratory fitness (CRF), high body mass index, and excess visceral adiposity are each associated with impairment in left ventricular (LV) peak circumferential strain (Ecc), an intermediate phenotype that precedes the development of clinical heart failure (HF). However, the association of regional fat distribution and CRF with Ecc independent of each other and other potential confounders is not known. METHODS Participants from the Dallas Heart Study Phase 2 who underwent dual energy X-ray absorptiometry assessment of regional fat distribution, CRF assessment by submaximal treadmill test, and Ecc quantification by tissue-tagged cardiovascular magnetic resonance were included in the analysis. The cross-sectional associations of measures of regional adiposity, namely visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and lower-body fat (LBF) with Ecc after adjustment for CRF and other potential confounders (independent variables) were assessed using multivariable linear regression analysis. RESULTS The study included 1089 participants (55% female, 39% black). In the unadjusted analysis, higher VAT was associated with greater impairment in Ecc. After adjustment for baseline risk factors, CRF, parameters of LV structure and function, and other fat depots such as SAT and LBF, higher VAT remained associated with greater impairment in Ecc (β: 0.19, P = 0.002). SAT and LBF were not significantly associated with Ecc, however, CRF remained associated with Ecc in the fully adjusted model including all fat depots (β: - 0.15, P < 0.001). CONCLUSIONS VAT and CRF are each independently associated with impairment in Ecc, suggesting that higher VAT burden and low CRF mediate pathological cardiac remodeling through distinct mechanisms.
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Affiliation(s)
- Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA
| | - Neela Thangada
- Division of Cardiology, Department of Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Kershaw V Patel
- Division of Cardiology, Department of Internal Medicine, Houston Methodist Hospital, 6550 Fannin St., Houston, TX, 77030, USA
| | - Colby Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA
| | - Alvin Chandra
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA
| | - Jarret D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA
| | - Ian J Neeland
- Division of Cardiology, Department of Internal Medicine, University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, 2103 Cornell Road, Cleveland, OH, 44106, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA.
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Aune D, Schlesinger S, Leitzmann MF, Tonstad S, Norat T, Riboli E, Vatten LJ. Physical activity and the risk of heart failure: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol 2020; 36:367-381. [PMID: 33331992 PMCID: PMC8076120 DOI: 10.1007/s10654-020-00693-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
Although physical activity is an established protective factor for cardiovascular diseases such as ischemic heart disease and stroke, less is known with regard to the association between specific domains of physical activity and heart failure, as well as the association between cardiorespiratory fitness and heart failure. We conducted a systematic review and meta-analysis of prospective observational studies to clarify the relations of total physical activity, domains of physical activity and cardiorespiratory fitness to risk of heart failure. PubMed and Embase databases were searched up to January 14th, 2020. Summary relative risks (RRs) were calculated using random effects models. Twenty-nine prospective studies (36 publications) were included in the review. The summary RRs for high versus low levels were 0.77 (95% CI 0.70–0.85, I2 = 49%, n = 7) for total physical activity, 0.74 (95% CI 0.68–0.81, I2 = 88.1%, n = 16) for leisure-time activity, 0.66 (95% CI 0.59–0.74, I2 = 0%, n = 2) for vigorous activity, 0.81 (95% CI 0.69–0.94, I2 = 86%, n = 3) for walking and bicycling combined, 0.90 (95% CI 0.86–0.95, I2 = 0%, n = 3) for occupational activity, and 0.31 (95% CI 0.19–0.49, I2 = 96%, n = 6) for cardiorespiratory fitness. In dose–response analyses, the summary RRs were 0.89 (95% CI 0.83–0.95, I2 = 67%, n = 4) per 20 MET-hours per day of total activity and 0.71 (95% CI 0.65–0.78, I2 = 85%, n = 11) per 20 MET-hours per week of leisure-time activity. Nonlinear associations were observed in both analyses with a flattening of the dose–response curve at 15–20 MET-hours/week for leisure-time activity. These findings suggest that high levels of total physical activity, leisure-time activity, vigorous activity, occupational activity, walking and bicycling combined and cardiorespiratory fitness are associated with reduced risk of developing heart failure.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK.
- Department of Nutrition, Bjørknes University College, Oslo, Norway.
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Ullevål, Oslo, Norway.
| | - Sabrina Schlesinger
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg, Germany
| | - Serena Tonstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Lars J Vatten
- Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Tomasoni D, Adamo M, Anker MS, von Haehling S, Coats AJS, Metra M. Heart failure in the last year: progress and perspective. ESC Heart Fail 2020; 7:3505-3530. [PMID: 33277825 PMCID: PMC7754751 DOI: 10.1002/ehf2.13124] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM-HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA-HF and EMPEROR-Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65-0.85; P < 0.001 and HR 0.75; 95% CI 0.65-0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82-0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.
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Affiliation(s)
- Daniela Tomasoni
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
- Cardiology and Cardiac Catheterization Laboratory, Cardio‐thoracic DepartmentCivil HospitalsBresciaItaly
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
- Cardiology and Cardiac Catheterization Laboratory, Cardio‐thoracic DepartmentCivil HospitalsBresciaItaly
| | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité–University Medicine BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany
- Department of Cardiology (CBF)Charité–University Medicine BerlinBerlinGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Andrew J. S. Coats
- Centre for Clinical and Basic Research, Department of Medical SciencesIRCCS San Raffaele PisanaRomeItaly
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
- Cardiology and Cardiac Catheterization Laboratory, Cardio‐thoracic DepartmentCivil HospitalsBresciaItaly
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Abstract
PURPOSE OF REVIEW The focus of this review is to discuss obesity, physical activity (and physical inactivity/sedentary behavior), cardiovascular disease (CVD), and their often interrelated health implications. The authors summarize the pathophysiological changes associated with obesity, which lead to the development of CVD, recommendations for interventions such as diet, increased physical activity, and weight loss according to current literature and guidelines, and the critical importance of cardiorespiratory fitness (CRF). RECENT FINDINGS Clinical trials continue to demonstrate improved outcomes among overweight or obese individuals who achieve a healthy weight using various methods. Increasing CRF levels appears to demonstrate the largest health improvements, regardless of underlying comorbidities or achieving weight loss. CRF, which is perhaps the single most important predictor of overall health, seems more important than weight loss alone regarding improved CVD outcomes in the obese population. These findings are reproduced in studies involving patients with various forms of CVD and CVD risk factors. The importance of CRF is well established; future endeavors to establish specific CRF targets for various patient cohorts are needed.
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Affiliation(s)
- Andrew Elagizi
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA
| | - Sergey Kachur
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA.
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Preserved Skeletal Muscle Mitochondrial Function, Redox State, Inflammation and Mass in Obese Mice with Chronic Heart Failure. Nutrients 2020; 12:nu12113393. [PMID: 33158222 PMCID: PMC7694273 DOI: 10.3390/nu12113393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Skeletal muscle (SM) mitochondrial dysfunction, oxidative stress, inflammation and muscle mass loss may worsen prognosis in chronic heart failure (CHF). Diet-induced obesity may also cause SM mitochondrial dysfunction as well as oxidative stress and inflammation, but obesity per se may be paradoxically associated with high SM mass and mitochondrial adenosine triphosphate (ATP) production, as well as with enhanced survival in CHF. Methods: We investigated interactions between myocardial infarction(MI)-induced CHF and diet-induced obesity (12-wk 60% vs. standard 10% fat) in modulating gastrocnemius muscle (GM) mitochondrial ATP and tissue superoxide generation, oxidized glutathione (GSSG), cytokines and insulin signalling activation in 10-wk-old mice in the following groups: lean sham-operated, lean CHF (LCHF), obese CHF (ObCHF; all n = 8). The metabolic impact of obesity per se was investigated by pair-feeding ObCHF to standard diet with stabilized excess body weight until sacrifice at wk 8 post-MI. Results: Compared to sham, LCHF had low GM mass, paralleled by low mitochondrial ATP production and high mitochondrial reative oxygen species (ROS) production, pro-oxidative redox state, pro-inflammatory cytokine changes and low insulin signaling (p < 0.05). In contrast, excess body weight in pair-fed ObCHF was associated with high GM mass, preserved mitochondrial ATP and mitochondrial ROS production, unaltered redox state, tissue cytokines and insulin signaling (p = non significant vs. Sham, p < 0.05 vs. LCHF) despite higher superoxide generation from non-mitochondrial sources. Conclusions: CHF disrupts skeletal muscle mitochondrial function in lean rodents with low ATP and high mitochondrial ROS production, associated with tissue pro-inflammatory cytokine profile, low insulin signaling and muscle mass loss. Following CHF onset, obesity per se is associated with high skeletal muscle mass and preserved tissue ATP production, mitochondrial ROS production, redox state, cytokines and insulin signaling. These paradoxical and potentially favorable obesity-associated metabolic patterns could contribute to reported obesity-induced survival advantage in CHF.
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Mehta A, Kondamudi N, Laukkanen JA, Wisloff U, Franklin BA, Arena R, Lavie CJ, Pandey A. Running away from cardiovascular disease at the right speed: The impact of aerobic physical activity and cardiorespiratory fitness on cardiovascular disease risk and associated subclinical phenotypes. Prog Cardiovasc Dis 2020; 63:762-774. [PMID: 33189764 DOI: 10.1016/j.pcad.2020.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 02/06/2023]
Abstract
Higher levels of physical activity (PA) and cardiorespiratory fitness (CRF) are associated with lower risk of incident cardiovascular disease (CVD). However, the relationship of aerobic PA and CRF with risk of atherosclerotic CVD outcomes and heart failure (HF) seem to be distinct. Furthermore, recent studies have raised concerns of potential toxicity associated with extreme levels of aerobic exercise, with higher levels of coronary artery calcium and incident atrial fibrillation noted among individuals with very high PA levels. In contrast, the relationship between PA levels and measures of left ventricular structure and function and risk of HF is more linear. Thus, personalizing exercise levels to optimal doses may be key to achieving beneficial outcomes and preventing adverse CVD events among high risk individuals. In this report, we provide a comprehensive review of the literature on the associations of aerobic PA and CRF levels with risk of adverse CVD outcomes and the preceding subclinical cardiac phenotypes to better characterize the optimal exercise dose needed to favorably modify CVD risk.
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Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Ulrik Wisloff
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Barry A Franklin
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Del Buono MG, Iannaccone G, Scacciavillani R, Carbone S, Camilli M, Niccoli G, Borlaug BA, Lavie CJ, Arena R, Crea F, Abbate A. Heart failure with preserved ejection fraction diagnosis and treatment: An updated review of the evidence. Prog Cardiovasc Dis 2020; 63:570-584. [DOI: 10.1016/j.pcad.2020.04.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/19/2020] [Indexed: 12/20/2022]
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Pandey A, Patel KV, Bahnson JL, Gaussoin SA, Martin CK, Balasubramanyam A, Johnson KC, McGuire DK, Bertoni AG, Kitzman D, Berry JD. Association of Intensive Lifestyle Intervention, Fitness, and Body Mass Index With Risk of Heart Failure in Overweight or Obese Adults With Type 2 Diabetes Mellitus: An Analysis From the Look AHEAD Trial. Circulation 2020; 141:1295-1306. [PMID: 32134326 PMCID: PMC9976290 DOI: 10.1161/circulationaha.119.044865] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with a higher risk for heart failure (HF). The impact of a lifestyle intervention and changes in cardiorespiratory fitness (CRF) and body mass index on risk for HF is not well established. METHODS Participants from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. Time-to-event analyses were used to compare the risk of incident HF between the intensive lifestyle intervention and diabetes support and education groups. The associations of baseline measures of CRF estimated from a maximal treadmill test, body mass index, and longitudinal changes in these parameters with risk of HF were evaluated with multivariable adjusted Cox models. RESULTS Among the 5109 trial participants, there was no significant difference in the risk of incident HF (n=257) between the intensive lifestyle intervention and the diabetes support and education groups (hazard ratio, 0.96 [95% CI, 0.75-1.23]) over a median follow-up of 12.4 years. In the most adjusted Cox models, the risk of HF was 39% and 62% lower among moderate fit (tertile 2: hazard ratio, 0.61 [95% CI, 0.44-0.83]) and high fit (tertile 3: hazard ratio, 0.38 [95% CI, 0.24-0.59]) groups, respectively (referent group: low fit, tertile 1). Among HF subtypes, after adjustment for traditional cardiovascular risk factors and interval incidence of myocardial infarction, baseline CRF was not significantly associated with risk of incident HF with reduced ejection fraction. In contrast, the risk of incident HF with preserved ejection fraction was 40% lower in the moderate fit group and 77% lower in the high fit group. Baseline body mass index also was not associated with risk of incident HF, HF with preserved ejection fraction, or HF with reduced ejection fraction after adjustment for CRF and traditional cardiovascular risk factors. Among participants with repeat CRF assessments (n=3902), improvements in CRF and weight loss over a 4-year follow-up were significantly associated with lower risk of HF (hazard ratio per 10% increase in CRF, 0.90 [95% CI, 0.82-0.99]; per 10% decrease in body mass index, 0.80 [95% CI, 0.69-0.94]). CONCLUSIONS Among participants with type 2 diabetes mellitus in the Look AHEAD trial, the intensive lifestyle intervention did not appear to modify the risk of HF. Higher baseline CRF and sustained improvements in CRF and weight loss were associated with lower risk of HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kershaw V. Patel
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Judy L. Bahnson
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC
| | - Sarah A. Gaussoin
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC
| | - Corby K. Martin
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Ashok Balasubramanyam
- Section of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Darren K. McGuire
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alain G. Bertoni
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC
| | - Dalane Kitzman
- Department of Internal Medicine, Wake Forest University, Winston-Salem, NC
| | - Jarett D. Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Dalle Grave R, Soave F, Ruocco A, Dametti L, Calugi S. Quality of Life and Physical Performance in Patients with Obesity: A Network Analysis. Nutrients 2020; 12:E602. [PMID: 32110862 PMCID: PMC7146222 DOI: 10.3390/nu12030602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the interconnections between specific quality-of-life domains in patients with obesity and high or low physical performance using a network approach. METHODS 716 consecutive female and male patients (aged 18-65 years) with obesity seeking weight-loss treatment were included. The 36-item Short Form Health Survey (SF-36) and the six-minute walking test (6MWT) were used to assess quality of life and physical performance, respectively. The sample was split into two groups according to the distance walked in the 6MWT. Network structures of the SF-36 domains in the two groups were assessed and compared, and the relative importance of individual items in the network structures was determined using centrality analyses. RESULTS 35.3% (n = 253) of participants covered more distance than expected, and 64.7% (n = 463) did not. Although low-performing patients showed lower quality of life domain scores, the network structures were similar in the two groups, with the SF-36 Vitality representing the central domain in both networks. Mental Health was a node with strong connections in patients who walked less distance. CONCLUSIONS These findings indicate that psychosocial variables represent the most influential and interconnected features as regards quality of life in both groups.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, 37138 Garda (VR), Italy; (F.S.); (A.R.); (L.D.); (S.C.)
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Jae SY, Kurl S, Bunsawat K, Franklin BA, Choo J, Kunutsor SK, Kauhanen J, Laukkanen JA. Impact of cardiorespiratory fitness on survival in men with low socioeconomic status. Eur J Prev Cardiol 2020; 28:450-455. [PMID: 33966081 DOI: 10.1177/2047487319901057] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/28/2019] [Indexed: 12/12/2022]
Abstract
AIMS Although both low socioeconomic status (SES) and poor cardiorespiratory fitness (CRF) are associated with increased chronic disease and heightened mortality, it remains unclear whether moderate-to-high levels of CRF are associated with survival benefits in low SES populations. This study evaluated the hypothesis that SES and CRF predict all-cause mortality and cardiovascular disease mortality and that moderate-to-high levels of CRF may attenuate the association between low SES and increased mortality. METHODS This study included 2368 men, who were followed in the Kuopio Ischaemic Heart Disease Study cohort. CRF was directly measured by peak oxygen uptake during progressive exercise testing. SES was characterized using self-reported questionnaires. RESULTS During a 25-year median follow-up, 1116 all-cause mortality and 512 cardiovascular disease mortality events occurred. After adjusting for potential confounders, men with low SES were at increased risks for all-cause mortality (hazard ratio 1.49, 95% confidence interval: 1.30-1.71) and cardiovascular disease mortality (hazard ratio1.38, 1.13-1.69). Higher levels of CRF were associated with lower risks of all-cause mortality (hazard ratio 0.54, 0.45-0.64) and cardiovascular disease mortality (hazard ratio 0.53, 0.40-0.69). In joint associations of SES and CRF with mortality, low SES-unfit had significantly higher risks of all-cause mortality (hazard ratio 2.15, 1.78-2.59) and cardiovascular disease mortality (hazard ratio 1.95, 1.48-2.57), but low SES-fit was not associated with a heightened risk of cardiovascular disease mortality (hazard ratio 1.09, 0.80-1.48) as compared with their high SES-fit counterparts. CONCLUSION Both SES and CRF were independently associated with subsequent mortality; however, moderate-to-high levels of CRF were not associated with an excess risk of cardiovascular disease mortality in men with low SES.
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Affiliation(s)
- Sae Young Jae
- Department of Sport Science, University of Seoul, Republic of Korea.,Division of Urban Social Health, Graduate School of Urban Public Health, University of Seoul, Republic of Korea
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Kanokwan Bunsawat
- Department of Internal Medicine, Division of Geriatrics, University of Utah, USA
| | - Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, USA
| | - Jina Choo
- College of Nursing, Korea University, Republic of Korea
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, UK
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.,Faculty of Sport and Health Science, University of Jyväskylä, Finland
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Abstract
Obesity has reached worldwide epidemic proportions, adversely impacting health on a global scale. Overweight and obesity adversely impact cardiac structure and function, affecting systolic and diastolic ventricular function. Studies and meta-analyses have documented an obesity paradox in large heart failure cohorts, where overweight and obese individuals with established heart failure have a better short- and medium-term prognosis compared with lean patients; this relationship is strongly impacted by level of cardiorespiratory fitness. There are implications for therapies aimed at increasing lean and muscle mass, and weight loss, for the prevention and treatment of compared with in patients with concomitant obesity.
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Abstract
The obesity paradox, which suggests a survival advantage for the obese in heart failure (HF) has sparked debate in the medical community. Studies demonstrate a survival advantage in obese patients with HF, including those with advanced HF requiring continuous inotropic support for palliation or disease modifying therapy with a left ventricular assist device (LVAD) or heart transplantation (HT). Importantly, the obesity paradox is affected by the level of cardiorespiratory fitness (CRF). It is now recommended that HF patients with body mass index ≥35 kg/m2 achieve at least 5-10% weight loss, in order to improve symptoms and cardiac function, though more robust data are urgently needed. CRF may be the single best predictor of overall health and small improvements in fitness levels may lead to improved outcomes in HF. In addition to implications of obesity in chronic HF, we also discuss management of obese patients with advanced HF and their implications for therapies such as LVAD implantation and HT.
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48
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Kirkman DL, Bohmke N, Billingsley HE, Carbone S. Sarcopenic Obesity in Heart Failure With Preserved Ejection Fraction. Front Endocrinol (Lausanne) 2020; 11:558271. [PMID: 33117276 PMCID: PMC7561426 DOI: 10.3389/fendo.2020.558271] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a public health epidemic that is projected to double over the next two decades. Despite the high prevalence of HFpEF, there are currently no FDA approved therapies for health-related outcomes in this clinical syndrome making it one the greatest unmet needs in cardiovascular medicine. Aging and obesity are hallmarks of HFpEF and therefore there is a high incidence of sarcopenic obesity (SO) associated with this syndrome. The presence of SO in HFpEF patients is noteworthy as it is associated with co-morbidities, worsened cardiovascular health, hospitalizations, quality of life, and mortality. Furthermore, SO plays a central role in exercise intolerance, the most commonly reported clinical symptom of this condition. The aim of this review is to provide insights into the current knowledge pertaining to the contributing pathophysiological mechanisms and clinical outcomes associated with HFpEF-related SO. Current and prospective therapies to address SO in HFpEF, including lifestyle and pharmaceutical approaches, are discussed. The urgent need for future research aimed at better understanding the multifaceted physiological contributions to SO in HFpEF and implementing interventional strategies to specifically target SO is highlighted.
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Lavie CJ, Carbone S, Kachur S, OʼKeefe EL, Elagizi A. Effects of Physical Activity, Exercise, and Fitness on Obesity-Related Morbidity and Mortality. Curr Sports Med Rep 2019; 18:292-298. [PMID: 31389871 DOI: 10.1249/jsr.0000000000000623] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Obesity is associated with increased prevalence of cardiovascular (CV) disease (CVD) risk factors, which may adversely impact CV structure and function and may increase the prevalence of most CVD, particularly heart failure (HF) and coronary heart disease (CHD). Physical activity (PA), exercise training (ET) and cardiorespiratory fitness (CRF) are all associated with marked reductions in most CVD, including HF and CHD. Additionally, PA/ET and, especially CRF, markedly alter the relationship between adiposity and subsequent major CVD outcomes and dramatically impact the "obesity paradox," which are all reviewed, including attention to the debate regarding "fitness versus fatness" for long-term prognosis, including in patients with established CVD.
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Salvatore Carbone
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, VA
| | - Sergey Kachur
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Evan L OʼKeefe
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Andrew Elagizi
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
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Oh A, Okazaki R, Sam F, Valero-Muñoz M. Heart Failure With Preserved Ejection Fraction and Adipose Tissue: A Story of Two Tales. Front Cardiovasc Med 2019; 6:110. [PMID: 31428620 PMCID: PMC6687767 DOI: 10.3389/fcvm.2019.00110] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is characterized by signs and symptoms of heart failure in the presence of a normal left ventricular ejection fraction. Although it accounts for up to 50% of all clinical presentations of heart failure, there are no evidence-based therapies for HFpEF to reduce morbidity and mortality. Additionally there is a lack of mechanistic understanding about the pathogenesis of HFpEF. HFpEF is associated with many comorbidities (such as obesity, hypertension, type 2 diabetes, atrial fibrillation, etc.) and is coupled with both cardiac and extra-cardiac abnormalities. Large outcome trials and registries reveal that being obese is a major risk factor for HFpEF. There is increasing focus on investigating the link between obesity and HFpEF, and the role that the adipose tissue and the heart, and the circulating milieu play in development and pathogenesis of HFpEF. This review discusses features of the obese-HFpEF phenotype and highlights proposed mechanisms implicated in the inter-tissue communication between adipose tissue and the heart in obesity-associated HFpEF.
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Affiliation(s)
- Albin Oh
- Evans Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Ross Okazaki
- Boston University School of Medicine, Boston, MA, United States
| | - Flora Sam
- Evans Department of Medicine, Boston Medical Center, Boston, MA, United States
- Boston University School of Medicine, Boston, MA, United States
- Section of Cardiovascular Medicine, Boston Medical Center, Boston, MA, United States
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, United States
| | - Maria Valero-Muñoz
- Boston University School of Medicine, Boston, MA, United States
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, United States
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