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Hong Y, Gao Z, Wei H, Wei Y, Qiu Z, Xiao J, Huang W. Bi-directional association of body size and composition with heart failure: A Mendelian randomization study. Int J Cardiol 2024; 407:132069. [PMID: 38642721 DOI: 10.1016/j.ijcard.2024.132069] [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: 11/18/2023] [Revised: 03/25/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE The effect of obesity on the development of heart failure (HF) has received attention, and this study intends to further explore the bidirectional association between body size or composition and HF by using Mendelian Randomization (MR) approach. DESIGN We performed a two-sample bidirectional MR study to investigate the association between body size or composition and the risk of HF using aggregated data from genome-wide association studies. Univariable MR analysis was used to investigate the causal relationship, and multivariable MR analysis was used to explore the mediating role of general and central obesity in the relationship between body size or composition and HF. RESULTS This forward MR study found that body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), fat mass (FM) and fat-free mass (FFM) were risk factors for the development of HF with the strength of causal association BMI > FM > WC > FFM > WHR. After adjusting for BMI, the observed associations between the remaining indicators and heart failure attenuated to null. After adjusting for WC, only BMI (OR = 1.59, 95%CI: 1.32-1.92, P = 9.53E-07) and FM (OR = 1.39, 95%CI: 1.20-1.62, P = 1.35E-0.5) kept significantly related to the risk of HF. Reverse MR analysis showed no association of changes in body size or composition with the onset of HF. CONCLUSION The two-sample bidirectional MR study found that general obesity, measured by BMI, was an independent indicator of the development of HF, while other related indicators were associated with HF incidence dependent on BMI, besides, no association was observed between HF diagnosis and the body size or composites.
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Affiliation(s)
- Yuqi Hong
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China; Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ziting Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Hongye Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Yajing Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Ziyi Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun Xiao
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China; Fujian Provincial Clinical Research Center for Cardiovascular Diseases Heart Center of Fujian Medical University, Fuzhou, Fujian, China.
| | - Wuqing Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China.
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Trappe HJ. [Anton Bruckner: the Linz cathedral organist, university teacher, symphonic musician : Could modern intensive care medicine have helped him and his illnesses?]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01083-y. [PMID: 37978071 DOI: 10.1007/s00063-023-01083-y] [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: 08/03/2023] [Revised: 08/13/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Anton Bruckner was a famous cathedral organist, university teacher, and symphonic composer, but his life, illnesses, death and dying are little or not known to many. OBJECTIVES Which illnesses determined Bruckner's life and did lifestyle and illnesses influence his compositional work? From today's perspective, could modern intensive care medicine have helped him? MATERIALS AND METHODS A detailed analysis of Bruckner's diseases was carried out using the scientific databases PubMed® and MEDLINE®. All published articles were evaluated and examined in detail. In addition, data from a concert tour of the author to Linz and the St. Florian Abbey Basilica were collected. RESULTS Anton Bruckner was born on 4 September 1824 in Ansfelden, Austria. As a child he received piano and organ lessons. After his father's death, he devoted himself to playing the organ and became in 1855 cathedral organist in Linz. His further career took him to Vienna, where he became a professor at the conservatory and turned to composition. His symphonies, his masses, and his Te Deum are his most famous works. During the first 40 years of his life, Bruckner suffered from psychopathological illnesses, including depression, delusions of persecution, and neuroses. Later, he suffered from chronic heart failure with recurrent right and left heart decompensation up to the development of cardiac cachexia, possibly caused by dilated cardiomyopathy due to alcohol toxicity. He died on 11 October 1896 in Vienna. CONCLUSION Bruckners life was marked by a wide variety of illnesses. His penchant for death and the dead was also striking. Modern medicine would probably have improved his quality of life through consequent heart failure therapy; an implantable automatic defibrillator with resynchronization therapy would probably have prolonged his life.
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Affiliation(s)
- Hans-Joachim Trappe
- Medizinische Klinik II (Schwerpunkte Kardiologie und Angiologie), Marienhospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
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Duarte RRP, Gonzalez MC, Oliveira JF, Goulart MR, Castro I. Is there an association between the nutritional and functional parameters and congestive heart failure severity? Clin Nutr 2020; 40:3354-3359. [PMID: 33229242 DOI: 10.1016/j.clnu.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS The association between markers of nutritional status (handgrip strength [HGS] and adductor pollicis muscle thickness [APMT]) and clinical markers of congestive heart failure (CHF) severity is currently unclear. The objective of this study was to evaluate the association between HGS, APMT, as markers of nutritional status and CHF severity. METHODS APMT and muscle strength was measured in 500 CHF patients bilaterally. Nutritional status was assessed by Subjective Global Assessment (SGA). Functional classification was performed according to guidelines provided by the New York Heart Association (NYHA) and ejection fraction (EF) was measured to classify CHF severity. Poisson regression, adjusted for sex and age, was performed to verify the association between nutritional factors and CHF severity markers. RESULTS The majority of patients (75.8%) were ≥60 years old and 53.6% were either overweight or obese. SGA identified 42.2% of the patients as malnourished, 12.6% with low APMT, and 29.0% with low HGS. Most of the patients were classified as NYHA III/IV (56.8%) and almost one third of patients (31.1%) had EF ≤ 40%. HGS and APMT were significantly lower in malnourished male patients and in male patients with a lower EF or worse NYHA classification. Even after controlling for the EF, malnourished patients showed a 2.5-fold increased risk of CHF severity by NYHA classification and for each kilogram of increase in the HGS, there was a significant decrease of 2% in the risk (RR: 0.98 p < 0.001). Malnourished patients presented a 52% higher risk (RR: 1.52 p = 0.016) of having a low EF, whereas for each APMT increase, there was a 5% decrease in the risk (RR: 0.95 p < 0.001), even after controlling for NYHA classification. CONCLUSIONS Malnutrition is highly prevalent among patients with CHF and it is associated with the functional class and the severity of the disease. Objective markers of strength (HGS) and muscle (APMT) are independently associated with the CHF severity, assessed by NYHA classification and EF, respectively, even after adjustment for other confounding variables. Thus, the implementation of these nutritional assessment methods in hospital routines, either by SGA or by objective methods, such as HGS and APMT, can configure effective measurements for early detection of malnutrition in patients at higher risk, and possibly a way to avoid their further functional decline.
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Affiliation(s)
- Rodrigo R P Duarte
- Post-graduate Cardiology Institute of Rio Grande do Sul, Cardiology University Foundation, Rio Grande do Sul, Brazil
| | - M Cristina Gonzalez
- Post-graduate Program in Health and Behavior, Catholic University of Pelotas, RS, Brazil.
| | | | - Maíra Ribas Goulart
- Post-graduate Cardiology Institute of Rio Grande do Sul, Cardiology University Foundation, Rio Grande do Sul, Brazil
| | - Iran Castro
- Post-graduate Cardiology Institute of Rio Grande do Sul, Cardiology University Foundation, Rio Grande do Sul, Brazil
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Bielecka-Dabrowa A, Ebner N, Dos Santos MR, Ishida J, Hasenfuss G, von Haehling S. Cachexia, muscle wasting, and frailty in cardiovascular disease. Eur J Heart Fail 2020; 22:2314-2326. [PMID: 32949422 DOI: 10.1002/ejhf.2011] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022] Open
Abstract
The last several years have seen increasing interest in understanding cachexia, muscle wasting, and physical frailty across the broad spectrum of patients with cardiovascular illnesses. This interest originally started in the field of heart failure, but has recently been extended to other areas such as atrial fibrillation, coronary artery disease, peripheral artery disease as well as to patients after cardiac surgery or transcatheter aortic valve implantation. Tissue wasting and frailty are prevalent among many of the affected patients. The ageing process itself and concomitant cardiovascular illness decrease lean mass while fat mass is relatively preserved, making elderly patients particularly prone to develop wasting syndromes and frailty. The aim of this review is to provide an overview of the available knowledge of body wasting and physical frailty in patients with cardiovascular illness, particularly focussing on patients with heart failure in whom most of the available data have been gathered. In addition, mechanisms of wasting and possible therapeutic targets are discussed.
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Affiliation(s)
- Agata Bielecka-Dabrowa
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | | | - Junishi Ishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, 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
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Büntzel J, Micke O, Kisters K, Büntzel J, Mücke R. Malnutrition and Survival - Bioimpedance Data in Head Neck Cancer Patients. In Vivo 2019; 33:979-982. [PMID: 31028225 PMCID: PMC6559905 DOI: 10.21873/invivo.11567] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Bioimpedance analysis (BIA) reflects the nutritional status of patients. The aim of this study was to examine whether BIA is able to document the possible impact of malnutrition on survival. MATERIALS AND METHODS The registered data of 42 head and neck cancer patients were analyzed. Survival data of 22 women and 20 men were included. The mean age was 67.3±10.77 years. BIA was measured by the Biocorpus 4000 RX (MEDIcal Health Care GmbH Karlsruhe) and summarized in individual phase angle (PA) of each patient. RESULTS Patients with normal PA>5.0 had a significantly better survival (p=0.016). The median survival time was 13.84 months (range=0.69-125.19 months) in malnourished patients (PA<5.0) compared to 51.16 months (range=7.02-116.79 months) in normally nourished head and neck cancer (HNC) patients (PA>5.0). Age adjusted body mass index had a similar impact on prognosis, but was not statistically significant (p=0.068) in the investigated study groups. CONCLUSION BIA is able to document the impact of malnutrition on the survival of head and neck cancer patients.
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Affiliation(s)
- Judith Büntzel
- Department of Hematology, Medical Oncology, University Hospital Göttingen, Göttingen, Germany
| | - Oliver Micke
- German Study Group 'Trace Elements and Electrolytes in Oncology' (AKTE), Bielefeld, Germany
| | - Klaus Kisters
- German Study Group 'Trace Elements and Electrolytes in Oncology' (AKTE), Bielefeld, Germany
| | - Jens Büntzel
- German Study Group 'Trace Elements and Electrolytes in Oncology' (AKTE), Bielefeld, Germany
- Department of Otolaryngology, Head Neck Surgery, Südharz Hospital, Nordhausen, Germany
| | - Ralph Mücke
- German Study Group 'Trace Elements and Electrolytes in Oncology' (AKTE), Bielefeld, Germany
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