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Boyle LD, Akbas F, Yazıcı D, McGowan BM, Yumuk V. Pharmacotherapy for older people with obesity. Eur J Intern Med 2024:S0953-6205(24)00192-4. [PMID: 38897877 DOI: 10.1016/j.ejim.2024.05.006] [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: 03/06/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 06/21/2024]
Abstract
Rates of obesity continue to rise, including in older adults. Use of medication for obesity in the elderly has been considered controversial, due to concerns around potential progression of age-related sarcopenia and a general lack of evidence for its use in this age group. Within this review, we describe the general considerations when prescribing obesity pharmacotherapy for older adults living with obesity. We evaluate in detail the anti-obesity medications currently licenced in Europe, with emphasis on the available efficacy, safety and cardiovascular outcome data gathered from study of older people. Finally, we discuss future directions and avenues of research.
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Affiliation(s)
- Luke D Boyle
- Centre for Obesity, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Feray Akbas
- Department of Internal Medicine Clinic, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Dilek Yazıcı
- Koç University Medical School Section of Endocrinology and Metabolism, Istanbul, Turkey
| | - Barbara M McGowan
- Centre for Obesity, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Volkan Yumuk
- Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Division of Endocrinology, Metabolism, and Diabetes, Istanbul, Turkey
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2
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Henney AE, Wilding JPH, Alam U, Cuthbertson DJ. Obesity pharmacotherapy in older adults: a narrative review of evidence. Int J Obes (Lond) 2024:10.1038/s41366-024-01529-z. [PMID: 38710803 DOI: 10.1038/s41366-024-01529-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
The prevalence of obesity in older adults (people aged >60 years) is increasing in line with the demographic shift in global populations. Despite knowledge of obesity-related complications in younger adults (increased risk of type 2 diabetes, liver and cardiovascular disease and malignancy), these considerations may be outweighed, in older adults, by concerns regarding weight-loss induced reduction in skeletal muscle and bone mass, and the awareness of the 'obesity paradox'. Obesity in the elderly contributes to various obesity-related complications from cardiometabolic disease and cancer, to functional decline, worsening cognition, and quality of life, that will have already suffered an age-related decline. Lifestyle interventions remain the cornerstone of obesity management in older adults, with emphasis on resistance training for muscle strength and bone mineral density preservation. However, in older adults with obesity refractory to lifestyle strategies, pharmacotherapy, using anti-obesity medicines (AOMs), can be a useful adjunct. Recent evidence suggests that intentional weight loss in older adults with overweight and obesity is effective and safe, hence a diminishing reluctance to use AOMs in this more vulnerable population. Despite nine AOMs being currently approved for the treatment of obesity, limited clinical trial evidence in older adults predominantly focuses on incretin therapy with glucagon-like peptide-1 receptor agonists (liraglutide, semaglutide, and tirzepatide). AOMs enhance weight loss and reduce cardiometabolic events, while maintaining muscle mass. Future randomised controlled trials should specifically evaluate the effectiveness of novel AOMs for long-term weight management in older adults with obesity, carefully considering the impact on body composition and functional ability, as well as health economics.
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Affiliation(s)
- Alex E Henney
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK.
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK.
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK.
| | - John P H Wilding
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
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3
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Alfuhied A, Gulsin GS, Athithan L, Brady EM, Parke K, Henson J, Redman E, Marsh AM, Yates T, Davies MJ, McCann GP, Singh A. The impact of lifestyle intervention on left atrial function in type 2 diabetes: results from the DIASTOLIC study. Int J Cardiovasc Imaging 2022; 38:2013-2023. [PMID: 35233724 PMCID: PMC10247829 DOI: 10.1007/s10554-022-02578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/21/2022] [Indexed: 11/05/2022]
Abstract
Aerobic exercise training and low energy diets have been shown to improve left ventricular remodelling and diastolic function in adults with type 2 diabetes (T2D), albeit with differential effects. The impact of these lifestyle interventions on left atrial (LA) function, however, has not previously been reported. The DIASTOLIC study was a prospective, randomised, open-label, blind endpoint trial, in which 90 people with obesity and T2D and no prevalent cardiovascular disease were randomised to a 12-week intervention of: (i) routine care, (ii) aerobic exercise training, or (iii) low energy (≈ 810 kcal/day) meal replacement plan (MRP). Cardiac magnetic resonance (CMR) imaging was performed pre- and post-intervention. Image analysis included LA volumes (LAV), emptying fraction (LAEF), and LA strain (LAS) corresponding to LA reservoir (LAS-r), conduit (LAS-cd), and booster pump (LAS-bp) function. 73 participants with T2D (mean age 50 ± 6 years, 62% male, body mass index (BMI) 36.1 ± 5.3 kg/m2) completed the trial and had analysable LA images. There was no significant change in CMR measured LA volumetric function (LAV/LAEF) in any group. The routine care group showed no significant change in BMI or LAS. In the MRP group, there were significant reductions in BMI (4.5 kg/m2) and a significant increase in LAS-r and LAS-bp (29.9 ± 7.0 to 32.3 ± 7.0%, p = 0.036 and 14.6 ± 5.3 to 17.2 ± 3.7%, p = 0.034). The exercise group showed a small reduction in BMI (0.49 kg/m2), with no significant change in LAS. Compared to routine care, weight loss via a 12-week MRP, led to improvements in LA filling and contractile function in adults with T2D and obesity. However, these within-group changes were not statistically significant on between-group comparison. ClinicalTrials.gov Identifier: NCT02590822.
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Affiliation(s)
- Aseel Alfuhied
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Kelly Parke
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Joseph Henson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Emma Redman
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Thomas Yates
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Melanie J. Davies
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
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Ren J, Wu NN, Wang S, Sowers JR, Zhang Y. Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications. Physiol Rev 2021; 101:1745-1807. [PMID: 33949876 PMCID: PMC8422427 DOI: 10.1152/physrev.00030.2020] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The prevalence of heart failure is on the rise and imposes a major health threat, in part, due to the rapidly increased prevalence of overweight and obesity. To this point, epidemiological, clinical, and experimental evidence supports the existence of a unique disease entity termed “obesity cardiomyopathy,” which develops independent of hypertension, coronary heart disease, and other heart diseases. Our contemporary review evaluates the evidence for this pathological condition, examines putative responsible mechanisms, and discusses therapeutic options for this disorder. Clinical findings have consolidated the presence of left ventricular dysfunction in obesity. Experimental investigations have uncovered pathophysiological changes in myocardial structure and function in genetically predisposed and diet-induced obesity. Indeed, contemporary evidence consolidates a wide array of cellular and molecular mechanisms underlying the etiology of obesity cardiomyopathy including adipose tissue dysfunction, systemic inflammation, metabolic disturbances (insulin resistance, abnormal glucose transport, spillover of free fatty acids, lipotoxicity, and amino acid derangement), altered intracellular especially mitochondrial Ca2+ homeostasis, oxidative stress, autophagy/mitophagy defect, myocardial fibrosis, dampened coronary flow reserve, coronary microvascular disease (microangiopathy), and endothelial impairment. Given the important role of obesity in the increased risk of heart failure, especially that with preserved systolic function and the recent rises in COVID-19-associated cardiovascular mortality, this review should provide compelling evidence for the presence of obesity cardiomyopathy, independent of various comorbid conditions, underlying mechanisms, and offer new insights into potential therapeutic approaches (pharmacological and lifestyle modification) for the clinical management of obesity cardiomyopathy.
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Affiliation(s)
- Jun Ren
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China.,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Ne N Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
| | - Shuyi Wang
- School of Medicine, Shanghai University, Shanghai, China.,University of Wyoming College of Health Sciences, Laramie, Wyoming
| | - James R Sowers
- Dalton Cardiovascular Research Center, Diabetes and Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | - Yingmei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
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Miklishanskaya SV, Solomasova LV, Mazur MA. Obesity and Mechanisms of its Negative Impact on the Cardiovascular System. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-02-09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Currently, the number of obese people in the world is constantly increasing. Obesity has a direct negative impact on the heart and blood vessels, which can be considered not only as an appropriate response to an increase in the volume of circulating blood due to an increase in body weight, but also as a side tissue reaction of the myocardium to hormonal and metabolic changes inherent in obesity. Our review is devoted to the description of the mechanisms of influence of obesity on the structural and functional parameters of the heart, which create prerequisites for the development of cardiovascular diseases, as well as the existing contradictions. Currently, the accumulated data suggest that an excessive amount of adipose tissue, in addition to metabolic disorders, including insulin resistance, imbalance of adipokines and inflammation markers, leading to the development of lipotoxicity, can directly penetrate the myocardium and cause violations of its contractile properties, as well as affect the conduction of excitation pulses and provoke the development of rhythm and conduction disorders. The development of endothelial dysfunction in obesity ultimately leads to the development of atherosclerosis and coronary heart disease. In addition, obesity contributes to the emergence of risk factors for hypertension, diabetes, atrial fibrillation, chronic heart failure, obstructive sleep apnea syndrome. Given the differences in the literature on the effect of obesity on long-term outcomes in patients with cardiovascular diseases, it is important to conduct prospective studies on the role of individual factors and their combinations that affect the mortality of patients with cardiovascular diseases.
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Affiliation(s)
| | | | - M. A. Mazur
- Russian Medical Academy of Continuous Professional Education
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Haywood C, Sumithran P. Treatment of obesity in older persons-A systematic review. Obes Rev 2019; 20:588-598. [PMID: 30645010 DOI: 10.1111/obr.12815] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023]
Abstract
The study aims to systematically review the available evidence regarding weight loss interventions (lifestyle, surgical, and pharmacological) for obesity in adults aged over 60 years. A search of prospective, randomized studies took place in January 2018, on Medline (Web of Science) and PubMed databases. Search terms included the following: elderly, obese, hypocaloric, pharmacotherapy, and bariatric surgery. Abstracts were screened for eligibility. A total of 256 publications regarding lifestyle interventions were identified; of these, 69 studies were eligible. As no eligible studies were identified for pharmacotherapy or bariatric surgery, the search was broadened to include non- randomized studies. Four pharmacotherapy and 66 surgery studies were included. Lifestyle intervention had similar weight loss efficacy in older compared with younger people, with positive effects on a number of relevant outcomes, including physical function and cardiovascular parameters. There was little data regarding obesity pharmacotherapy in older persons. The available data for bariatric surgery indicate comparable weight loss and resolution of type 2 diabetes, with similar or slightly higher complication rates in older compared with younger people. Older age alone should not be considered a contraindication to intensive lifestyle or surgical intervention for obesity. There are insufficient data to guide clinical decisions regarding obesity pharmacotherapy in older people.
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Affiliation(s)
- Cilla Haywood
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.,Department of Aged Care, Austin Health, Heidelberg, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
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Laszlo R, Baumann T, Konz H, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker JM. Right ventricular function assessed by tissue Doppler echocardiography in older subjects without evidence for structural cardiac disease. Aging Clin Exp Res 2017; 29:557-562. [PMID: 27245355 DOI: 10.1007/s40520-016-0590-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/18/2016] [Indexed: 12/23/2022]
Abstract
The aim of our study was to obtain right ventricular (RV) tissue Doppler imaging (TDI) data in older subjects (n = 95, mean age: 74.5 ± 4.6 years) without evidence of hemodynamically significant structural heart disease recruited from a large population-based cohort (ActiFE-Ulm study). Our data indicate that aging may be accompanied by decreasing RV diastolic function and at most little alterations of RV systolic function. Mean values of all parameters were still within the guideline-suggested reference range with most of them closer to the abnormality thresholds. On an individual basis, respective thresholds were also exceeded in some subjects (almost all parameters <20 %) despite the absence of evidence for structural cardiac disease. RV-TDI is a feasible method for evaluation of RV systolic and diastolic function also in a geriatric population as sufficient TDI data was obtainable in the majority of our participants. Published reference values also seem to be mostly suitable although among older subjects, presumed pathological measures might still be compatible with physiological age-related alterations. Therefore, they always have to be interpreted across the clinical context and in relation to other parameters of morphology and function obtained by other ultrasound imaging techniques (M-mode, B-mode, etc.) in the context of echocardiographic evaluation of the right heart.
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Affiliation(s)
- Roman Laszlo
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany.
| | - Tobias Baumann
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
| | - Hanna Konz
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
| | - Dhayana Dallmeier
- AGAPLESION Bethesda Clinic, Geriatric Medicine, University of Ulm, Zollernring 26, 89073, Ulm, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Clinic, Geriatric Medicine, University of Ulm, Zollernring 26, 89073, Ulm, Germany
| | - Wolfgang Koenig
- Klinik für Herz-& Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Juergen Michael Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
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Koc F, Kayaoglu HA, Celik A, Altunkas F, Karayakali M, Ozbek K, Karaman K, Kadi H, Yenidogan E. Effect of Weight Loss Induced by Intragastric Balloon Therapy on Cardiac Function in Morbidly Obese Individuals: A Pilot Study. Med Princ Pract 2015; 24:432-5. [PMID: 26112780 PMCID: PMC5588257 DOI: 10.1159/000431177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 05/06/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The aim of the study was to investigate the effect of intragastric balloon therapy on left ventricular function and left ventricular mass in a cohort of morbidly obese patients. SUBJECTS AND METHODS A prospective trial was performed in a cohort of 17 class II and class III morbidly obese individuals. The intragastric balloon was retained in the stomach for an average of 6 months. Conventional and tissue Doppler echocardiography were performed in all patients before and after the procedure. RESULTS The mean age of the study participants was 36 ± 10 years (range: 18-55). The mean body mass index was significantly decreased following the intragastric balloon insertion procedure (44 ± 8 vs. 38 ± 5, p < 0.001). The left ventricular mass index and left atrial volume index were significantly decreased following the procedure (112 ± 21 vs. 93 ± 17, p = 0.001 and 20 ± 6 vs. 14 ± 5, p = 0.02, respectfully). In addition, the ratio of mitral peak early diastolic velocity to tissue Doppler-derived peak diastolic velocity and tissue Doppler echocardiography-derived left ventricular myocardial performance index were decreased significantly following the procedure (9.5 ± 1.9 vs. 7.7 ± 1.5, p = 0.002 and 0.57 ± 0.11 vs. 0.46 ± 0.06, p = 0.001, respectively). CONCLUSIONS Intragastric balloon therapy resulted in significant weight reduction in morbidly obese patients. This weight reduction was associated with improved left ventricular function.
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Affiliation(s)
- Fatih Koc
- Department of Cardiology, Akdeniz University School of Medicine, Antalya, Turkey
| | | | - Atac Celik
- Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Fatih Altunkas
- Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
- *Dr. Fatih Koc, MD, Department of Cardiology, Akdeniz University School of Medicine, Dumlupinar Bulvari, TR-07985 Antalya (Turkey), E-Mail
| | - Metin Karayakali
- Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Kerem Ozbek
- Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Kayihan Karaman
- Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Hasan Kadi
- Department of Cardiology, Balikesir Universitesi School of Medicine, Balikesir, Turkey
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Serrano-Ferrer J, Walther G, Crendal E, Vinet A, Dutheil F, Naughton G, Lesourd B, Chapier R, Courteix D, Obert P. Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: effects of a 3-month lifestyle intervention program. Cardiovasc Diabetol 2014; 13:116. [PMID: 25407698 PMCID: PMC4149206 DOI: 10.1186/s12933-014-0116-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/20/2014] [Indexed: 01/18/2023] Open
Abstract
Background Growing evidence demonstrates subtle left ventricular myocardial dysfunction in patients with metabolic syndrome (MetS), with central obesity, glucose intolerance and inflammation emerging as important contributors. Whether these results can be translated to the right ventricle (RV) is not yet fully elucidated. Furthermore, although lifestyle intervention favorably impacts MetS components and inflammatory biomarkers, its effect on RV myocardial function remains unknown today. Methods Thirty-nine MetS adults free of diabetes were enrolled in a three month lifestyle intervention program including diet and physical exercise, and compared with forty healthy controls. Blood biochemistry, echocardiography including tissue Doppler imaging (TDI), and vector velocity imaging of the RV free wall to assess global longitudinal strain (GLS) and strain rates (SR) were obtained at baseline and after the intervention. Results Compared with controls, MetS patients presented similar right atrial and RV morphology but reduced systolic (P = 0.04) and early diastolic (P = 0.02) velocities of the tricuspid annulus. They showed attenuated RV GLS (−21.4 ± 4.5vs-25.7 ± 4.9%, P < 0.001) as well as early diastolic (P = 0.003) and systolic (P < 0.001) SR. Multiple regression analyses revealed log PAI-1 active, (P < 0.001), log adiponectin, (P = 0.01), LV mass indexed (P = 0.004) and central fat (P = 0.03) as independent predictors of RV GLS (R2 = 0.46, P < 0.001). Biological markers of MetS and inflammation as well as RV GLS (−21.8 ± 3.8vs-24.3 ± 3.0%, P = 0.009) and systolic (P = 0.003) and early diastolic (P = 0.01) SR, but not TDI indexes, significantly improved after diet and exercise training, and vector velocity imaging data in MetS following the lifestyle intervention no longer differed from controls. Conclusions MetS is associated with subtle impairments in both RV free wall diastolic and systolic myocardial function which could be partly related to central-obesity induced changes in pro- and anti-inflammatory cytokines and left ventricular remodeling. The favorable impact of healthy dieting and physical activity on RV free wall mechanics indicates that cellular and sub-cellular alterations responsible for the RV myocardial abnormalities are probably not permanent and modifiable throughout adequate interventional strategies. Trial registration American National Institutes of Health database NCT00917917.
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10
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Rider OJ, Lewis AJ, Neubauer S. Structural and Metabolic Effects of Obesity on the Myocardium and the Aorta. Obes Facts 2014; 7:329-338. [PMID: 25342107 PMCID: PMC5644846 DOI: 10.1159/000368429] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/08/2013] [Indexed: 12/12/2022] Open
Abstract
Obesity per se is a recognized risk factor for cardiovascular disease exerting independent adverse effects on the cardiovascular system. Despite this well documented link, the mechanisms by which obesity modulates cardiovascular risk are not well understood. Obesity is linked to a wide variety of cardiac changes, from subclinical diastolic dysfunction to end stage systolic heart failure. In addition, obesity causes changes in cardiac metabolism that make ATP production and utilization less efficient producing functional consequences that are linked to the increased rate of heart failure in this population. This review focuses on the cardiovascular structural and metabolic remodelling that occurs in obesity with and without co-morbidities and the potential links to increased mortality in this population. © 2014 S. Karger GmbH, Freiburg.
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Affiliation(s)
- Oliver J. Rider
- *Dr. Oliver J Rider, University of Oxford Centre for Clinical Magnetic Resonance Research, Level 0, John Radcliffe Hospital, Oxford OX3 9DU (UK),
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11
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Cardiovascular Effects of Weight Loss. CURRENT CARDIOVASCULAR RISK REPORTS 2011. [DOI: 10.1007/s12170-011-0211-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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