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Akins JD, Martin ZT, Patik JC, Curtis BM, Campbell JC, Olvera G, Brothers RM. Young, non-hispanic black men and women exhibit divergent peripheral and cerebral vascular reactivity. Exp Physiol 2022; 107:450-461. [PMID: 35344241 PMCID: PMC9058228 DOI: 10.1113/ep090168] [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: 10/24/2021] [Accepted: 03/21/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of the study? Does peripheral and cerebral vascular function differ in young, non-Hispanic Black men and women? What is the main finding and its importance? The non-Hispanic, Black women in this study presented greater peripheral conduit artery and cerebrovascular reactivity, yet similar peripheral microvascular function relative to the non-Hispanic, Black men. These preliminary findings suggest that young, Black women and men possess divergent vascular function, possibly contributing to the unique non-Hispanic Black sex differences in cardiovascular and cerebrovascular diseases. ABSTRACT In the U.S., cardiovascular and cerebrovascular diseases remain more prominent in the non-Hispanic Black (BL) population relative to other racial/ethnic groups. Typically, sex differences emerge in the manifestation of these diseases, though these differences may not fully materialize in the BL population. While numerous mechanisms are implicated, differences in vascular function likely contribute. Research has demonstrated blunted vasodilation in several vascular regions in BL versus non-Hispanic White individuals, though much of this work did not assess sex differences. Therefore, this study aimed to ascertain if indices of vascular function are different between young, BL women (BW) and men (BM). Eleven BW and 15 BM (22 (4) vs. 23 (3) y) participated in this study. Each participant underwent testing for brachial artery flow-mediated dilation (FMD), post-occlusive reactive hyperemia (RH), and cerebral vasomotor reactivity during rebreathing-induced hypercapnia. BW exhibited greater adjusted FMD than BM (P < 0.05 for all), but similar or lower RH when assessed as blood velocity (P > 0.39 for all) or blood flow reactivity (P < 0.05 for all), respectively. Across a range of hypercapnia, BW had greater middle cerebral artery blood velocity and cerebrovascular conductance index than BM (P < 0.001 for both). These preliminary data suggest that young, BW have greater vascular function relative to young, BM, though this was inconsistent across different indices. These findings provide insight into the divergent epidemiological findings between BM and BW. Further research is needed to elucidate possible mechanisms and relate these physiological responses to epidemiological observations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- John D Akins
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, USA
| | - Zachary T Martin
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, USA
| | - Jordan C Patik
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, USA.,Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Bryon M Curtis
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, USA.,Institute for Exercise and Environmental Medicine, Dallas, TX, USA
| | - Jeremiah C Campbell
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, USA
| | - Guillermo Olvera
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, USA.,Institute for Exercise and Environmental Medicine, Dallas, TX, USA
| | - R Matthew Brothers
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, USA
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Zhou Y, Li H, Xia N. The Interplay Between Adipose Tissue and Vasculature: Role of Oxidative Stress in Obesity. Front Cardiovasc Med 2021; 8:650214. [PMID: 33748199 PMCID: PMC7969519 DOI: 10.3389/fcvm.2021.650214] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/10/2021] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular diseases (CVDs) rank the leading cause of morbidity and mortality globally. Obesity and its related metabolic syndrome are well-established risk factors for CVDs. Therefore, understanding the pathophysiological role of adipose tissues is of great importance in maintaining cardiovascular health. Oxidative stress, characterized by excessive formation of reactive oxygen species, is a common cellular stress shared by obesity and CVDs. While plenty of literatures have illustrated the vascular oxidative stress, very few have discussed the impact of oxidative stress in adipose tissues. Adipose tissues can communicate with vascular systems, in an endocrine and paracrine manner, through secreting several adipocytokines, which is largely dysregulated in obesity. The aim of this review is to summarize current understanding of the relationship between oxidative stress in obesity and vascular endothelial dysfunction. In this review, we briefly describe the possible causes of oxidative stress in obesity, and the impact of obesity-induced oxidative stress on adipose tissue function. We also summarize the crosstalk between adipose tissue and vasculature mediated by adipocytokines in vascular oxidative stress. In addition, we highlight the potential target mediating adipose tissue oxidative stress.
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Affiliation(s)
- Yawen Zhou
- Department of Pharmacology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Huige Li
- Department of Pharmacology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Ning Xia
- Department of Pharmacology, Johannes Gutenberg University Medical Center, Mainz, Germany
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Effect of bariatric surgery on flow-mediated dilation and carotid intima-media thickness in patients with morbid obesity: 1-year follow-up study. Anatol J Cardiol 2021; 23:218-222. [PMID: 32235138 PMCID: PMC7163217 DOI: 10.14744/anatoljcardiol.2019.85249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: Obesity is associated with increased cardiovascular (CV) mortality and morbidity. Bariatric surgery (BS) is currently an established therapeutic approach for severely obese patients. Carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilation (FMD) provide important prognostic information beyond traditional CV risk factors. This study aimed to examine the effect of bariatric surgery-induced weight loss on CIMT and brachial artery FMD in morbidly obese patients. Methods: A total of 23 morbidly obese patients (40.4±5.6 years, 13 females) were examined before and after BS for 1 year with 3-month periods. CIMT, FMD, body composition, and metabolic parameters were determined. Results: All the patients exhibited significant weight loss following BS (p<0.001). Carotid intima-media thickness reduction was not significant from baseline to 6 months (p=0.069), but at 9 months (p=0.004), it became significant. Similarly, the difference between the preoperative and 6-month FMD assessments was not significant (p=0.057), but at 9 months (p<0.001), it became significant. Conclusion: Our study reveals that weight loss following BS causes improvements in CV risk factors, which is evident after 9 months of surgery.
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Gogas Yavuz D, Apaydin T, Imre E, Uygur MM, Yazici D. Skin Autofluorescence and Carotid Intima-Media Thickness Evaluation Following Bariatric Surgery in Patients with Severe Obesity. Obes Surg 2020; 31:1055-1061. [PMID: 33123869 DOI: 10.1007/s11695-020-05077-z] [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: 07/02/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Advanced glycation end product (AGE) is a marker of metabolic memory. Accumulated AGEs in skin collagen measured with skin autofluorescence (SAF) was found to be associated with subclinical atherosclerosis. We aimed to evaluate SAF and carotid intima-media thickness (CIMT) and its association with clinical and biochemical parameters in severely obese patients before and after bariatric surgery. MATERIALS AND METHODS In this observational study, 432 morbid obese patients evaluated before and after 6 and 12 months of bariatric surgery for metabolic and anthropometric parameters, CIMT and SAF. SAF was assessed in the forearm with an AGE Reader. RESULTS SAF measurements were higher in diabetic (2.04 ± 0.52 AU) obese patients compared to non-diabetic (1.78 ± 0.40 AU) obese patients (p < 0.0001). Although bariatric surgery-induced weight loss resulted in a decrease in CIMT in the 6th and 12th months compared to baseline, weight loss and metabolic improvements were not associated with a parallel decrease in SAF measurements. SAF measurements were positively correlated with body mass index (r 0.527, p < 0.0001), HbA1c (r 0.362, p < 0.0001), and CIMT (r 0.319, p < 0.0001). Multivariate analysis showed the presence of diabetes (but not BMI, age, and sex) was independently associated with SAF (R2 = 7.62%), and the presence of diabetes, low-density cholesterol, and systolic blood pressure were independently associated with CIMT measurements (R2 = 21.7%). CONCLUSION Bariatric surgery-induced weight loss and metabolic improvement were found to be associated with improvement in CIMT, while skin AGE accumulation was not regressed in the first year of surgery.
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Affiliation(s)
- Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey.
| | - Tugce Apaydin
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| | - Eren Imre
- Department of Endocrinology and Metabolism, Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Meliha Melin Uygur
- Department of Endocrinology and Metabolism, Yeni Yuzyil University, Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Dilek Yazici
- Department of Endocrinology and Metabolism, Koc University Hospital, Istanbul, Turkey
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Golz AG, Davis WJ, Perry MW, Tonino PM, Garbis NG, Salazar DH. Improving the safety of shoulder arthroscopy in the beach chair position: a prospective randomized trial investigating the effect of compression stockings on cerebral desaturation events in obese patients. J Shoulder Elbow Surg 2020; 29:2027-2035. [PMID: 32590064 DOI: 10.1016/j.jse.2020.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Devastating transient and permanent postoperative neurocognitive complications in previously healthy, low-risk patients have been observed after elective shoulder arthroscopy in the beach chair position (BCP). Continuous monitoring of cerebral oxygen saturation has been recommended to identify cerebral desaturation events (CDEs) and improve patient safety. However, the relatively high cost and limited availability of monitoring may not be cost-effective. More cost-effective and available measures, including the use of thigh-high compression stockings (CS), have been investigated. However, efficacy data of CS usage is limited, especially for obese patients, who have been shown to be at increased risk for CDEs. The purpose of this was study was to determine if the intraoperative addition of thigh-high compression stockings decreases the incidence, frequency, and magnitude of CDEs in obese patients undergoing shoulder arthroscopy in the BCP. METHODS Thirty-three patients in the treatment group wore both thigh-high compression stockings (CS) and sequential compression devices (SCDs), and the remaining 33 patients in the control group wore SCDs alone. Cerebral oximetry was monitored during surgery using near-infrared spectroscopy. RESULTS The incidence of CDEs was equal between groups, with 9 patients (27%) in each experiencing desaturation events. The median number of CDEs per patient was 3 for the control group and 1 for patients wearing CS (P = .29). There was no difference between groups in terms of median time from induction of anesthesia to onset of CDE (P = .79), median time from upright positioning to onset of CDE (P = .60), mean CDE duration per patient (P = .22), and median cumulative CDE duration (P = .19). The median maximal desaturation from baseline was also not different between groups: 27.6% in the control group and 24.3% in the treatment group (P = .35). CONCLUSION The combination of thigh-high CS and SCDs did not decrease the incidence, frequency, or magnitude of CDEs in patients undergoing shoulder arthroscopy in the BCP. Twenty-seven percent of patients undergoing shoulder arthroscopy in the BCP demonstrated CDEs with or without the use of CS. Therefore, further research is required to identify cost-effective, minimally invasive, and universally available methods of decreasing the incidence of CDEs during this common surgical procedure.
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Affiliation(s)
- Andrew G Golz
- Loyola University Medical Center, Stritch School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, USA.
| | - William J Davis
- Loyola University Medical Center, Stritch School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, USA
| | - Michael W Perry
- Loyola University Medical Center, Stritch School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, USA
| | - Pietro M Tonino
- Loyola University Medical Center, Stritch School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, USA
| | - Nickolas G Garbis
- Loyola University Medical Center, Stritch School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, USA
| | - Dane H Salazar
- Loyola University Medical Center, Stritch School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, USA
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Logan JG, Kang H, Kim S, Duprez D, Kwon Y, Jacobs DR, Forbang N, Lobo JM, Sohn MW. Association of obesity with arterial stiffness: The Multi-Ethnic Study of Atherosclerosis (MESA). Vasc Med 2020; 25:309-318. [PMID: 32484395 DOI: 10.1177/1358863x20918940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Arterial stiffness (AS) and obesity are recognized as important risk factors of cardiovascular disease (CVD). The purpose of this study was to investigate the relationship between AS and obesity. AS was defined as high augmentation index (AIx) and low elasticity (C1, large artery elasticity; C2, small artery elasticity) in participants enrolled in the Multi-Ethnic Study of Atherosclerosis at baseline. We compared AIx, C1, and C2 by body mass index (BMI) (< 25, 25-29.9, 30-39.9, ⩾ 40 kg/m2) and waist-hip ratio (WHR) (< 0.85, 0.85-0.99, ⩾ 1). The obesity-AS association was tested across 10-year age intervals. Among 6177 participants (62 ± 10 years old, 52% female), a significant inverse relationship was observed between obesity and AS. After adjustments for CVD risk factors, participants with a BMI > 40 kg/m2 had 5.4% lower AIx (mean difference [Δ] = -0.82%; 95% CI: -1.10, -0.53), 15.4% higher C1 (Δ = 1.66 mL/mmHg ×10; 95% CI: 1.00, 2.33), and 40.2% higher C2 (Δ = 1.49 mL/mmHg ×100; 95% CI: 1.15, 1.83) compared to those with a BMI < 25 kg/m2 (all p for trend < 0.001). Participants with a WHR ⩾ 1 had 5.6% higher C1 (∆ = 0.92 mL/mmHg ×10; 95% CI: 0.47, 1.37) compared to those with a WHR < 0.85. The WHR had a significant interaction with age on AIx and C2, but not with BMI; the inverse relationships of the WHR with AIx and C2 were observed only in participants < 55 years between the normal (WHR < 0.85) and the overweight (0.85 ⩽ WHR < 0.99) groups. Different associations of WHR and BMI with arterial stiffness among older adults should be further investigated.
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Affiliation(s)
- Jeongok G Logan
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Hyojung Kang
- College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Soyoun Kim
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Daniel Duprez
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Younghoon Kwon
- UVA Heart and Vascular Center Fontaine, University of Virginia, Charlottesville, VA, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Nketi Forbang
- Department of Family Medicine and Public Health, Division of Preventive Medicine, UC San Diego, La Jolla, CA, USA
| | - Jennifer Mason Lobo
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Min-Woong Sohn
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
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Cintra RMR, Soares AAS, Breder I, Munhoz DB, Barreto J, Kimura-Medorima ST, Cavalcante P, Zanchetta R, Breder JC, Moreira C, Virginio VW, Bonilha I, Lima-Junior JC, Coelho-Filho OR, Wolf VLW, Guerra-Junior G, Oliveira DC, Haeitmann R, Fernandes VHR, Nadruz W, Chaves FRP, Arieta CEL, Quinaglia T, Sposito AC. Assessment of dapagliflozin effect on diabetic endothelial dysfunction of brachial artery (ADDENDA-BHS2 trial): rationale, design, and baseline characteristics of a randomized controlled trial. Diabetol Metab Syndr 2019; 11:62. [PMID: 31384310 PMCID: PMC6668143 DOI: 10.1186/s13098-019-0457-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 07/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Endothelial dysfunction (ED) is a hallmark in type 2 diabetes mellitus (T2DM) that favor both atherogenesis and ischemia and reperfusion injury (IRI). Sodium-glucose-2 co-transporter inhibitors (SGLT2i) may hypothetically improve microvascular and macrovascular functions via a broad spectrum of mechanisms, being superior to traditional antidiabetic therapy such as sulfonylurea, even in subjects under equivalent glycemic control. Hence, the present clinical trial was designed to compare the effect of these two treatments on markers of arterial wall function and inflammation in T2DM patients as well as on the potential mediating parameters. METHOD AND RESULTS ADDENDA-BHS2 is a prospective, single-center, active-controlled, open, randomized trial. Ninety-eight participants (40-70 years old) with HbA1c 7-9% were randomized (1:1, stratified by gender, BMI and HbA1c levels) to either dapagliflozin 10 mg/day or glibenclamide 5 mg/day on top of metformin. The primary endpoint was the change of flow-mediated dilation (FMD) after a 12-week period of treatment evaluated at rest and after IRI between dapagliflozin and glibenclamide arms. Secondary outcomes were defined as the difference between treatments regarding: plasma nitric oxide (NO) change after FMD, plasma isoprostane, plasma levels of vascular inflammatory markers and systemic inflammatory markers, plasma levels of adipokines, anthropometric measures, glucose control parameters, office and ambulatory BP control. Safety endpoints were defined as systolic and diastolic function assessed by echocardiography and retinopathy change. Serious adverse events were recorded. The study protocol was approved by the Independent Scientific Advisory Committee. CONCLUSION The ADDENDA-BHS2 trial is an investigator-initiated clinical trial comparing the effect of dapagliflozin versus glibenclamide on several aspects of vascular function in high cardiovascular risk T2DM patients. Besides, a large clinical and biochemical phenotype assessment will be obtained for exploring potential mediations and associations.Trial registration Clinical trial registration: NCT02919345 (September, 2016).
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Affiliation(s)
- Riobaldo M. R. Cintra
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Alexandre A. S. Soares
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Ikaro Breder
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Daniel B. Munhoz
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Joaquim Barreto
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Sheila T. Kimura-Medorima
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Pamela Cavalcante
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Renata Zanchetta
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Jessica Cunha Breder
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Camila Moreira
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Vitor W. Virginio
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Isabella Bonilha
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Jose Carlos Lima-Junior
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Otavio R. Coelho-Filho
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Vaneza L. W. Wolf
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Gil Guerra-Junior
- Growth and Body Composition Lab, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Daniela C. Oliveira
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Rodrigo Haeitmann
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Vicente H. R. Fernandes
- Growth and Body Composition Lab, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Wilson Nadruz
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Fernando R. P. Chaves
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Carlos E. L. Arieta
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Thiago Quinaglia
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Andrei C. Sposito
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
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Nguyen-Tu MS, Nivoit P, Oréa V, Lemoine S, Acquaviva C, Pagnon-Minot A, Fromy B, Sethi JK, Sigaudo-Roussel D. Inflammation-linked adaptations in dermal microvascular reactivity accompany the development of obesity and type 2 diabetes. Int J Obes (Lond) 2018; 43:556-566. [PMID: 30006585 PMCID: PMC6223541 DOI: 10.1038/s41366-018-0148-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/26/2018] [Accepted: 06/08/2018] [Indexed: 01/04/2023]
Abstract
Background/Objectives The increased prevalence of obesity has prompted great strides in our understanding of specific adipose depots and their involvement in cardio-metabolic health. However, the impact of obesity on dermal white adipose tissue (dWAT) and dermal microvascular functionality remains unclear. This study aimed to investigate the temporal changes that occur in dWAT and dermal microvascular functionality during the development of diet-induced obesity and type 2 diabetes in mice. Methods Metabolic phenotyping of a murine model of hypercaloric diet (HCD)-induced obesity and type 2 diabetes was performed at three time points that reflected three distinct stages of disease development; 2 weeks of HCD-overweight-metabolically healthy, 4 weeks of HCD-obese-prediabetic and 12 weeks of HCD-obese-type 2 diabetic mice. Expansion of dWAT was characterized histologically, and changes in dermal microvascular reactivity were assessed in response to pressure and the vasodilators SNP and Ach. Results HCD resulted in a progressive expansion of dWAT and increased expression of pro-inflammatory markers (IL1β and COX-2). Impairments in pressure-induced (PIV) and Ach-induced (endothelium-dependent) vasodilation occurred early, in overweight-metabolically healthy mice. Residual vasodilatory responses were NOS-independent but sensitive to COX inhibition. These changes were associated with reductions in NO and adiponectin bioavailability, and rescued by exogenous adiponectin or hyperinsulinemia. Obese-prediabetic mice continued to exhibit impaired Ach-dependent vasodilation but PIV appeared normalized. This normalization coincided with elevated endogenous adiponectin and insulin levels, and was sensitive to NOS, COX and PI3K, inhibition. In obese-type 2 diabetic mice, both Ach-stimulated and pressure-induced vasodilatory responses were increased through enhanced COX-2-dependent prostaglandin response. Conclusions We demonstrate that the development of obesity, metabolic dysfunction and type 2 diabetes, in HCD-fed mice, is accompanied by increased dermal adiposity and associated metaflammation in dWAT. Importantly, these temporal changes are also linked to disease stage-specific dermal microvascular reactivity, which may reflect adaptive mechanisms driven by metaflammation.
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Affiliation(s)
- Marie-Sophie Nguyen-Tu
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France.,University of Lyon 1, 69367, Lyon Cedex 07, France
| | - Pierre Nivoit
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France.,University of Lyon 1, 69367, Lyon Cedex 07, France
| | - Valérie Oréa
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France.,University of Lyon 1, 69367, Lyon Cedex 07, France
| | | | - Cécile Acquaviva
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France.,Centre de Biologie et Pathologie Est, University Hospital, Hospices Civils de Lyon, 69677, Bron, France
| | | | - Bérengère Fromy
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France.,University of Lyon 1, 69367, Lyon Cedex 07, France
| | - Jaswinder K Sethi
- Faculty of Medicine, University of Southampton, Institute of Developmental Sciences Building, Southampton General Hospital, Southampton, SO16 6YD, UK. .,National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD, UK. .,Institute for Life Sciences, Life Sciences Building 85, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - Dominique Sigaudo-Roussel
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France. .,University of Lyon 1, 69367, Lyon Cedex 07, France.
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9
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Piché ME, Poirier P, Lemieux I, Després JP. Overview of Epidemiology and Contribution of Obesity and Body Fat Distribution to Cardiovascular Disease: An Update. Prog Cardiovasc Dis 2018; 61:103-113. [PMID: 29964067 DOI: 10.1016/j.pcad.2018.06.004] [Citation(s) in RCA: 290] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 01/14/2023]
Abstract
Obesity is recognized as a heterogeneous condition in which individuals with similar body mass index may have distinct metabolic and cardiovascular risk profiles. Susceptibility to obesity-related cardiometabolic complications is not solely mediated by overall body fat mass, but is largely dependent upon individual differences in regional body fat distribution and ability of subcutaneous adipose tissue to expand. The present review will discuss to what extent the individual variation in body fat distribution is one of the clinical key variables explaining the metabolic heterogeneity of obesity and its related cardiovascular risk. We will present the evidence for the complex nature of the relationship between obesity and cardiovascular disease, outline our current understanding of the mechanisms involved, and identify future direction of research pertinent to this interaction.
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Affiliation(s)
- Marie-Eve Piché
- Quebec Heart and Lung Institute, Québec, Canada; Faculty of Medicine, Université Laval, Québec, Canada.
| | - Paul Poirier
- Quebec Heart and Lung Institute, Québec, Canada; Faculty of Pharmacy, Université Laval, Québec, Canada
| | | | - Jean-Pierre Després
- Quebec Heart and Lung Institute, Québec, Canada; Faculty of Medicine, Université Laval, Québec, Canada
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Mathew John C, Khaddaj Mallat R, George G, Kim T, Mishra RC, Braun AP. Pharmacologic targeting of endothelial Ca 2+-activated K + channels: A strategy to improve cardiovascular function. Channels (Austin) 2018; 12:126-136. [PMID: 29577810 PMCID: PMC5972810 DOI: 10.1080/19336950.2018.1454814] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/15/2018] [Indexed: 12/17/2022] Open
Abstract
Endothelial small and intermediate-conductance, Ca2+-activated K+ channels (KCa2.3 and KCa3.1, respectively) play an important role in the regulation of vascular function and systemic blood pressure. Growing evidence indicates that they are intimately involved in agonist-evoked vasodilation of small resistance arteries throughout the circulation. Small molecule activators of KCa2.x and 3.1 channels, such as SKA-31, can acutely inhibit myogenic tone in isolated resistance arteries, induce effective vasodilation in intact vascular beds, such as the coronary circulation, and acutely decrease systemic blood pressure in vivo. The blood pressure-lowering effect of SKA-31, and early indications of improvement in endothelial dysfunction suggest that endothelial KCa channel activators could eventually be developed into a new class of endothelial targeted agents to combat hypertension or atherosclerosis. This review summarises recent insights into the activation of endothelial Ca2+ activated K+ channels in various vascular beds, and how tools, such as SKA-31, may be beneficial in disease-related conditions.
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Affiliation(s)
- Cini Mathew John
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rayan Khaddaj Mallat
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Grace George
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Taeyeob Kim
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ramesh C. Mishra
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew P. Braun
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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11
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Fuster JJ, Ouchi N, Gokce N, Walsh K. Obesity-Induced Changes in Adipose Tissue Microenvironment and Their Impact on Cardiovascular Disease. Circ Res 2017; 118:1786-807. [PMID: 27230642 DOI: 10.1161/circresaha.115.306885] [Citation(s) in RCA: 402] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/16/2016] [Indexed: 02/07/2023]
Abstract
Obesity is causally linked with the development of cardiovascular disorders. Accumulating evidence indicates that cardiovascular disease is the collateral damage of obesity-driven adipose tissue dysfunction that promotes a chronic inflammatory state within the organism. Adipose tissues secrete bioactive substances, referred to as adipokines, which largely function as modulators of inflammation. The microenvironment of adipose tissue will affect the adipokine secretome, having actions on remote tissues. Obesity typically leads to the upregulation of proinflammatory adipokines and the downregulation of anti-inflammatory adipokines, thereby contributing to the pathogenesis of cardiovascular diseases. In this review, we focus on the microenvironment of adipose tissue and how it influences cardiovascular disorders, including atherosclerosis and ischemic heart diseases, through the systemic actions of adipokines.
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Affiliation(s)
- José J Fuster
- From the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA (J.J.F., N.G., K.W.); and Department of Molecular Cardiology, Nagoya University School of Medicine, Nagoya, Japan (N.O.).
| | - Noriyuki Ouchi
- From the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA (J.J.F., N.G., K.W.); and Department of Molecular Cardiology, Nagoya University School of Medicine, Nagoya, Japan (N.O.)
| | - Noyan Gokce
- From the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA (J.J.F., N.G., K.W.); and Department of Molecular Cardiology, Nagoya University School of Medicine, Nagoya, Japan (N.O.)
| | - Kenneth Walsh
- From the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA (J.J.F., N.G., K.W.); and Department of Molecular Cardiology, Nagoya University School of Medicine, Nagoya, Japan (N.O.).
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12
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Overweight status is associated with extensive signs of microvascular dysfunction and cardiovascular risk. Sci Rep 2016; 6:32282. [PMID: 27578554 PMCID: PMC5006075 DOI: 10.1038/srep32282] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 08/04/2016] [Indexed: 12/31/2022] Open
Abstract
The aim of this present study was to investigate if overweight individuals exhibit signs of vascular dysfunction associated with a high risk for cardiovascular disease (CVD). One hundred lean and 100 overweight participants were recruited for the present study. Retinal microvascular function was assessed using the Dynamic Retinal Vessel Analyser (DVA), and systemic macrovascular function by means of flow-mediated dilation (FMD). Investigations also included body composition, carotid intimal-media thickness (c-IMT), ambulatory blood pressure monitoring (BP), fasting plasma glucose, triglycerides (TG), cholesterol levels (HDL-C and LDL-C), and plasma von Willebrand factor (vWF). Overweight individuals presented with higher right and left c-IMT (p = 0.005 and p = 0.002, respectively), average 24-h BP values (all p < 0.001), plasma glucose (p = 0.008), TG (p = 0.003), TG: HDL-C ratio (p = 0.010), and vWF levels (p = 0.004). Moreover, overweight individuals showed lower retinal arterial microvascular dilation (p = 0.039) and baseline-corrected flicker (bFR) responses (p = 0.022), as well as, prolonged dilation reaction time (RT, p = 0.047). These observations emphasise the importance of vascular screening and consideration of preventive interventions to decrease vascular risk in all individuals with adiposity above normal range.
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13
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Kim J, Kim MG, Kang S, Kim BR, Baek MY, Park YM, Shin MS. Obesity and Hypertension in Association with Diastolic Dysfunction Could Reduce Exercise Capacity. Korean Circ J 2016; 46:394-401. [PMID: 27275176 PMCID: PMC4891604 DOI: 10.4070/kcj.2016.46.3.394] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/30/2015] [Accepted: 11/24/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Empirical evidence is lacking on the cumulative disease burden of obesity and hypertension and its impact on cardiac function and exercise capacity. The purpose of this study was to determine whether the presence of obesity and hypertension together was associated with cardiac dysfunction and exercise capacity. SUBJECTS AND METHODS Using a retrospective study design, medical records were reviewed for echocardiographic and treadmill exercise stress test data. Subjects were grouped according to four categories: normal control, obese, hypertensive, or obese and hypertensive. RESULTS Obese, hypertensive persons showed significantly lower Ea and E/A ratio and greater E/Ea ratio, deceleration time, left ventricular (LV) mass, and LV mass index compared to their counter parts (normal control, obese and/or hypertensive) (all p<0.05), after controlling for age and sex. After controlling for age and sex, significant differences in exercise capacity indices were found, with the obese group having shorter exercise time, lower metabolic equivalents, and lower maximal oxygen uptake than the normal control, hypertensive, or both groups (all p<0.05). The hypertensive or obese and hypertensive group had greater maximal blood pressure compared with the normal control group (all p<0.001). Obese and hypertensive persons were approximately three times more likely to have diastolic dysfunction (odd ratio=2.96, p=0.001), when compared to the reference group (normotensive, non-obese, or hypertensive only persons). CONCLUSION Diastolic dysfunction was associated with obesity and/or hypertension. The cumulative risk of obesity and hypertension and their impact on diastolic dysfunction which could be modifiable could reduce exercise capacity.
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Affiliation(s)
- JinShil Kim
- Gachon University College of Nursing, Incheon, Korea
| | - Myeong Gun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - SeWon Kang
- Dongseoi University College of Nursing, Pusan, Korea
| | - Bong Roung Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Min Young Baek
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yae Min Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.; Gachon University College of Medicine, Incheon, Korea
| | - Mi-Seung Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.; Gachon University College of Medicine, Incheon, Korea
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14
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Pigłowska M, Kostka T, Drygas W, Jegier A, Leszczyńska J, Bill-Bielecka M, Kwaśniewska M. Body composition, nutritional status, and endothelial function in physically active men without metabolic syndrome--a 25 year cohort study. Lipids Health Dis 2016; 15:84. [PMID: 27117476 PMCID: PMC4847354 DOI: 10.1186/s12944-016-0249-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/14/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this analysis was to investigate the relationship between body composition, metabolic parameters and endothelial function among physically active healthy middle-aged and older men. METHODS Out of 101 asymptomatic men prospectively tracked for traditional cardiovascular risk factors (mean observation period 25.1 years), 55 metabolically healthy individuals who maintained stable leisure time physical activity (LTPA) level throughout the observation and agreed to participate in the body composition assessment were recruited (mean age 60.3 ± 9.9 years). Body composition and raw bioelectrical parameters were measured with bioelectrical impedance analysis (BIA). Microvascular endothelial function was evaluated by means of the reactive hyperemia index (RHI) using Endo-PAT2000 system. RESULTS Strong correlations were observed between lifetime physical activity (PA), aerobic fitness and most of analyzed body composition parameters. The strongest inverse correlation was found for fat mass (p < 0.01) while positive relationship for fat-free mass (p < 0.01), total body water (p < 0.05 for current aerobic capacity and p < 0.01 for historical PA), body cell mass (p < 0.001), muscle mass (p < 0.001), calcium and potassium (p < 0.01 and p < 0.001 for current aerobic capacity and p < 0.001 and p < 0.01 for historical PA, respectively) and glycogen mass (p < 0.001). Among metabolic parameters, HDL cholesterol (HDL-C) and uric acid were significantly associated with most body composition indicators. Regarding endothelial function, a negative correlation was found for RHI and body mass (p < 0.05) while positive relationship for RHI and body cell mass (p < 0.05), calcium (p < 0.05) and potassium mass (p < 0.05). Impaired endothelial function was observed among 8 subjects. Among bioelectrical parameters, impedance (Z) and resistance (R) normalized for subjects' height were negatively related with body mass, body mass index (BMI) and waist circumference (p < 0.001); while reactance (Xc) normalized for patients' height was negatively related with body mass (p < 0.05). The mean phase angle value was relatively high (8.83 ± 1.22) what reflects a good level of cellularity and cell function. Phase angle was positively related with body mass and BMI (p < 0.05). CONCLUSIONS Both fat mass and muscle mass components are important predictors of metabolic profile. Maintaining regular high PA level and metabolically healthy status through young and middle adulthood may have beneficial influence on body composition parameters and may prevent age-related decrease of fat-free mass and endothelial dysfunction.
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Affiliation(s)
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Lodz, Poland
| | - Wojciech Drygas
- Department of Preventive Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752, Lodz, Poland
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
| | - Anna Jegier
- Department of Sports Medicine, Medical University of Lodz, 92-213, Lodz, Poland
| | - Joanna Leszczyńska
- Department of Sports Medicine, Medical University of Lodz, 92-213, Lodz, Poland
| | | | - Magdalena Kwaśniewska
- Department of Preventive Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752, Lodz, Poland.
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15
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López-Canales JS, Lozano-Cuenca J, López-Canales OA, Aguilar-Carrasco JC, Aranda-Zepeda L, López-Sánchez P, Castillo-Henkel EF, López-Mayorga RM, Valencia-Hernández I. Pharmacological characterization of mechanisms involved in the vasorelaxation produced by rosuvastatin in aortic rings from rats with a cafeteria-style diet. Clin Exp Pharmacol Physiol 2016; 42:653-61. [PMID: 25881486 PMCID: PMC4654262 DOI: 10.1111/1440-1681.12406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 03/07/2015] [Accepted: 04/07/2015] [Indexed: 12/13/2022]
Abstract
The present study aimed to investigate the possible influence of several inhibitors and blockers on the vascular effect produced by the acute in vitro application of rosuvastatin to phenylephrine-precontracted aortic rings from rats with a semi-solid, cafeteria-style (CAF) diet. It also aimed to examine the effects of rosuvastatin on the expression of endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase, constitutive cyclooxygenase, and inducible cyclooxygenase in aortic rings from rats with a CAF diet. From comparisons of the effect on phenylephrine-precontracted aortic rings extracted from rats with two different diets (a standard and a CAF diet), it was found that 10−9–10−5-mol/L rosuvastatin produced lower concentration-dependent vasorelaxation on rings from the CAF diet group. The vasorelaxant effect was unaffected by the vehicle, but it was significantly attenuated by 10−5-mol/L NG-nitro-l-arginine methyl ester, 10−2-mol/L tetraethylammonium, 10−3-mol/L 4-aminopyridine, 10−7-mol/L apamin plus 10−7-mol/L charybdotoxin, 10−5-mol/L indomethacin, or 10−5-mol/L cycloheximide. Moreover, in aortic rings from rats with a CAF diet, rosuvastatin enhanced the expression of eNOS, inducible nitric oxide synthase, constitutive cyclooxygenase, and inducible cyclooxygenase. The acute in vitro application of rosuvastatin to phenylephrine-precontracted aortic rings from rats with a CAF diet had a vasorelaxant effect. Overall, the present results suggest that the stimulation of eNOS, the opening of Ca2+-activated and voltage-activated K+ channels, the stimulation of prostaglandin synthesis and enhanced protein levels of eNOS, inducible nitric oxide synthase, constitutive cyclooxygenase, and inducible cyclooxygenase are involved in this relaxant effect.
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Affiliation(s)
- Jorge Skiold López-Canales
- Section of Postgraduate Studies, Higher School of Medicine, National Polytechnic Institute, Mexico City, Mexico.,Department of Cellular Biology, National Intstitute of Perinatology, Mexico City, Mexico
| | - Jair Lozano-Cuenca
- Department of Cellular Biology, National Intstitute of Perinatology, Mexico City, Mexico
| | - Oscar Alberto López-Canales
- Section of Postgraduate Studies, Higher School of Medicine, National Polytechnic Institute, Mexico City, Mexico
| | | | - Lidia Aranda-Zepeda
- Section of Postgraduate Studies, Higher School of Medicine, National Polytechnic Institute, Mexico City, Mexico
| | - Pedro López-Sánchez
- Section of Postgraduate Studies, Higher School of Medicine, National Polytechnic Institute, Mexico City, Mexico
| | | | - Ruth Mery López-Mayorga
- Section of Postgraduate Studies, Higher School of Medicine, National Polytechnic Institute, Mexico City, Mexico
| | - Ignacio Valencia-Hernández
- Section of Postgraduate Studies, Higher School of Medicine, National Polytechnic Institute, Mexico City, Mexico
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16
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Tauchen AJ, Salazar D, Barton GJ, Francois A, Tonino P, Garbis NG, Evans D. The Effect of Compression Stockings on Cerebral Desaturation Events in Obese Patients Undergoing Shoulder Arthroscopy in the Beach-Chair Position. Arthroscopy 2015; 31:2352-64. [PMID: 26248495 DOI: 10.1016/j.arthro.2015.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/02/2015] [Accepted: 06/17/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if the use of thigh-high compression stockings could decrease the incidence of cerebral desaturation events (CDEs) in patients with a body mass index (BMI) of 30 kg/m(2) or greater undergoing shoulder arthroscopy in the beach-chair position (BCP). METHODS Between December 2013 and May 2014, 23 patients aged 18 years or older with a BMI of 30 kg/m(2) or greater undergoing shoulder arthroscopy in the BCP were monitored intraoperatively using near-infrared spectroscopy while wearing thigh-high compression stockings. Data obtained on these patients were compared with data from a previous cohort at our institution comprising 24 patients with a BMI of 30 kg/m(2) or greater who underwent elective shoulder arthroscopy in the BCP with the same monitoring but without wearing compression stockings. The incidence of CDEs was identified in each group. RESULTS The incidence of CDEs in the group with compression stockings was 4% (1 of 23) compared with 18% (7 of 24) in the group without compression stockings (P = .048). There were no statistically significant differences in mean age (53.0 years v 53.3 years, P = .91), mean BMI (34.5 kg/m(2)v 36.2 kg/m(2), P = .21), or various medical comorbidities between the treatment group and control group. There was a significant difference in the operative time between the treatment group (156.6 minutes) and control group (94.1 minutes) (P < .001). CONCLUSIONS The use of thigh-high compression stockings may decrease the incidence of CDEs in obese patients undergoing shoulder arthroscopy in the BCP. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Alexander J Tauchen
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, U.S.A..
| | - Dane Salazar
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - Gregory J Barton
- Loyola University Stritch School of Medicine, Maywood, Illinois, U.S.A
| | - Audrice Francois
- Department of Anesthesia, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - Pietro Tonino
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - Nickolas G Garbis
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - Douglas Evans
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, U.S.A
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17
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Farb MG, Gokce N. Visceral adiposopathy: a vascular perspective. Horm Mol Biol Clin Investig 2015; 21:125-36. [PMID: 25781557 DOI: 10.1515/hmbci-2014-0047] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/04/2015] [Indexed: 12/27/2022]
Abstract
Obesity has emerged as one of the most critical health care problems globally that is associated with the development of insulin resistance, type 2 diabetes mellitus, metabolic dysfunction and cardiovascular disease. Central adiposity with intra-abdominal deposition of visceral fat, in particular, has been closely linked to cardiometabolic consequences of obesity. Increasing epidemiological, clinical and experimental data suggest that both adipose tissue quantity and perturbations in its quality termed "adiposopathy" contribute to mechanisms of cardiometabolic disease. The current review discusses regional differences in adipose tissue characteristics and highlights profound abnormalities in vascular endothelial function and angiogenesis that are manifest within the visceral adipose tissue milieu of obese individuals. Clinical data demonstrate up-regulation of pro-inflammatory and pro-atherosclerotic mediators in dysfunctional adipose tissue that may support pathological vascular changes not only locally in fat but also in multiple organ systems, including coronary and peripheral circulations, potentially contributing to mechanisms of obesity-related cardiovascular disease.
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18
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Dunet V, Rey-Bataillard V, Allenbach G, Beysard N, Lovis A, Prior JO, Heinzer R. Effects of continuous positive airway pressure treatment on coronary vasoreactivity measured by (82)Rb cardiac PET/CT in obstructive sleep apnea patients. Sleep Breath 2015; 20:673-9. [PMID: 26449551 DOI: 10.1007/s11325-015-1272-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/24/2015] [Accepted: 09/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Obstructive sleep apnea syndrome (OSA) increases the risk of cardiovascular disease. We aimed at evaluating the effect of continuous positive airway pressure (CPAP) treatment on coronary endothelium-dependent vasoreactivity in OSA patients by quantifying myocardial blood flow (MBF) response to cold pressure testing (CPT). METHODS In the morning after polysomnography (PSG), all participants underwent a dynamic (82)Rb cardiac positron emitting tomography/computed tomography (PET/CT) scan at rest, during CPT and adenosine stress. PSG and PET/CT were repeated at least 6 weeks after initiating CPAP treatment. OSA patients were compared to controls and according to response to CPAP. Patients' characteristics and PSG parameters were used to determine predictors of CPT-MBF. RESULTS Thirty-two untreated OSA patients (age 58 ± 13 years, 27 men) and 9 controls (age 62 ± 5 years, 4 men) were enrolled. At baseline, compared to controls (apnea-hypopnea index (AHI) = 5.3 ± 2.6/h), untreated OSA patients (AHI = 48.6 ± 19.7/h) tend to have a lower CPT-MBF (1.1 ± 0.2 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.09). After initiating CPAP, CPT-MBF was not different between well-treated patients (AHI <10/h) and controls (1.3 ± 0.3 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.83), but it was lower for insufficiently treated patients (AHI ≥10/h) (0.9 ± 0.2 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.0045). CPT-MBF was also higher in well-treated than in insufficiently treated patients (1.3 ± 0.3 mL/min/g vs. 0.9 ± 0.2 mL/min/g, p = 0.001). Mean nocturnal oxygen saturation (β = -0.55, p = 0.02) and BMI (β = -0.58, p = 0.02) were independent predictors of CPT-MBF in OSA patients. CONCLUSIONS Coronary endothelial vasoreactivity is impaired in insufficiently treated OSA patients compared to well-treated patients and controls, confirming the need for CPAP optimization.
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Affiliation(s)
- Vincent Dunet
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincianne Rey-Bataillard
- Center for Investigation and Research in Sleep (CIRS), Department of Pneumology, Lausanne University Hospital, Lausanne, Switzerland
| | - Gilles Allenbach
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Beysard
- Center for Investigation and Research in Sleep (CIRS), Department of Pneumology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alban Lovis
- Center for Investigation and Research in Sleep (CIRS), Department of Pneumology, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), Department of Pneumology, Lausanne University Hospital, Lausanne, Switzerland
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19
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Annesi JJ, Porter KJ. Reciprocal effects of exercise and nutrition treatment-induced weight loss with improved body image and physical self-concept. Behav Med 2015; 41:18-24. [PMID: 24965514 DOI: 10.1080/08964289.2013.856284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Improvements in self-image and mood are often reported as outcomes of obesity interventions. However, they may also concurrently influence weight loss, suggesting a reciprocal effect. Although previously reported for overweight women, such relationships were untested in morbidly obese women whose psychosocial responses to treatment may be different, and health-risks greater. Women (N = 161, Meanage = 42 years) with morbid obesity (MeanBMI = 45.1 kg/m(2)) participated in a 6-month, behaviorally based physical activity and nutrition treatment. Significant within-group improvements in weight-loss behaviors (physical activity and eating), weight, body satisfaction, physical self-concept, and depression were found. After controlling for age, mediation analyses indicated that, as a result of the treatment, weight loss was both an outcome and mediator of improvements in body-areas satisfaction and physical self-concept (reciprocal effects), but not depression. Results replicated findings from women with lower degrees of overweight, and suggested that weight-loss treatments emphasize changes in self-perception.
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20
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Endothelial function in hypertensive obese patients: 1 year after surgically induced weight loss. Obes Surg 2015; 24:1581-4. [PMID: 24908247 DOI: 10.1007/s11695-014-1328-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this study was to describe the effect of surgically induced weight loss on vascular function measured by flow-mediated dilatation (FMD) in hypertensive obese patients. This prospective study included 33 patients (78 % females, mean age 53 (9) years) undergoing bariatric surgery (BS). Before and 12 months postoperatively, the BMI, 24-h ambulatory BP, high-sensitivity C-reactive protein (hs-CRP), leptin, homeostasis model assessment (HOMA IR), and abdominal fat were measured. Endothelial function was assessed by FMD. After BS, the excess body weight loss was 71 %; the 24-h [systolic 18(11)//diastolic 7(7) mmHg] BP values, hs-CRP, leptin, HOMA, and abdominal fat significantly decreased, with no changes in endothelial function. Weight loss achieved by BS was associated with a significant improvement in BP and metabolic and inflammation parameters, but FMD did not improve.
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Sirbu A, Nicolae H, Martin S, Barbu C, Copaescu C, Florea S, Panea C, Fica S. IGF-1 and Insulin Resistance Are Major Determinants of Common Carotid Artery Thickness in Morbidly Obese Young Patients. Angiology 2015; 67:259-65. [DOI: 10.1177/0003319715586499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We assessed the relationship between insulin resistance, serum insulin-like growth factor 1 (IGF-1) levels, and common carotid intima–media thickness (CC-IMT) in morbidly obese young patients. A total of 249 patients (aged 37.9 ± 9.8 years, body mass index [BMI] 45.6 ± 8.3 kg/m2) were evaluated (metabolic tests, serum IGF-1 measurements, homeostasis model assessment—insulin resistance [HOMA-IR], and ultrasonographically assessed CC-IMT) in a research program for bariatric surgery candidates. After adjusting for age, gender, BMI, systolic blood pressure, uric acid, antihypertensive and lipid-lowering treatment, metabolic syndrome, and metabolic class, both HOMA-IR and IGF-1 z-score were significantly associated with CC-IMT. These results were confirmed in logistic regression analysis, in which age (β = 1.11, P = .001), gender (β = 3.19, P = .001), HOMA-IR (β = 1.221, P = .005), and IGF-1 z-score (β = 1.734, P = .009) were the only independent determinants of abnormal CC-IMT, presumably modulating the effect of the other risk factors included in the regression. Area under the receiver–operating characteristic curve for the model was 0.841 (confidence interval: 0.776-0.907; P < .001). In conclusion, in morbidly obese young adults, insulin resistance and IGF-1 z-score are significantly associated with CC-IMT, independent of other major cardiovascular risk factors.
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Affiliation(s)
- Anca Sirbu
- Endocrinology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Victor Babes Institute, Bucharest, Romania
| | - Horia Nicolae
- Neurology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Sorina Martin
- Endocrinology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Carmen Barbu
- Endocrinology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Suzana Florea
- Endocrinology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Panea
- Neurology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona Fica
- Endocrinology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Alosco ML, Spitznagel MB, Gunstad J. Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure. Heart Fail Rev 2015; 19:403-11. [PMID: 23743688 DOI: 10.1007/s10741-013-9399-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Heart failure (HF) has reached epidemic proportions and is a significant contributor to poor outcomes. HF is an established risk factor for Alzheimer's disease, vascular dementia, and abnormalities on neuroimaging. Moreover, up to 80% of HF patients also exhibit milder impairments on cognitive tests assessing attention, executive function, memory, and language. The mechanisms of cognitive impairment in HF are not entirely clear and involve a combination of physiological processes that negatively impact the brain. Cerebral hypoperfusion and common comorbid conditions in HF are among the most commonly proposed contributors to poor neurocognitive outcomes in this population. Obesity is another likely risk factor for adverse brain changes and cognitive impairment in HF, as it is a known contributor to neurocognitive outcomes in healthy and patient samples. This paper reviews the literature on HF and cognitive function and introduces obesity as a significant risk factor for poor neurocognitive outcomes in this population.
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Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, 340 Kent Hall, Kent, OH, 44224, USA,
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23
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Trøseid M, Nestvold TK, Nielsen EW, Thoresen H, Seljeflot I, Lappegård KT. Soluble CD14 is associated with markers of vascular dysfunction in bariatric surgery patients. Metab Syndr Relat Disord 2015; 13:119-24. [PMID: 25562385 DOI: 10.1089/met.2014.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Chronic endotoxemia has been proposed to contribute to obesity-related complications. We aimed to investigate the potential impact of lipopolysaccharide (LPS) and subsequent monocyte activation measured as soluble CD14 (sCD14) on markers of vascular dysfunction in obese subjects undergoing bariatric surgery. METHODS This was a prospective study of 49 obese patients and 17 controls, assessed by plasma levels of LPS, sCD14, asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA). RESULTS Levels of ADMA were increased in obese subjects compared to controls, but were not significantly reduced after bariatric surgery. In obese subjects at baseline, there was a significant trend to increasing levels of ADMA and SDMA through tertiles of sCD14 and decreasing levels of both markers through tertiles of LPS. In models adjusting for age and gender, sCD14 but not LPS remained independently associated with ADMA and SDMA. For every 10% age- and gender-adjusted increase in sCD14, ADMA increased 0.031 μM (5.6%), whereas SDMA increased 0.039 μM (10.8%). CONCLUSIONS Our results suggest that monocyte activation as measured by sCD14 is associated with obesity-related vascular dysfunction, whereas potential upstream triggers including microbial products should be investigated in future studies.
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Affiliation(s)
- Marius Trøseid
- 1 Department of Infectious Diseases, Oslo University Hospital , Oslo, Norway
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24
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Domienik-Karłowicz J, Lisik W, Rymarczyk Z, Dzikowska-Diduch O, Chmura A, Demkow U, Pruszczyk P. The short-term effect of bariatric surgery on non-invasive markers of artery function in patients with metabolic syndrome. Diabetol Metab Syndr 2015; 7:76. [PMID: 26379783 PMCID: PMC4571118 DOI: 10.1186/s13098-015-0076-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 09/09/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND An improved understanding of the vascular function, measured in non-invasive way, in constantly growing group of patients at increased risk of cardiovascular events is necessary. To evaluate the effects of metabolic syndrome in morbidly obese patients and body mass reduction secondary to gastric bypass surgery on convenient and new non-invasive markers of artery function: pulse wave velocity (PWV), flow- and nitroglycerin-mediated dilatation (FMD, NTG). METHODS There were 40 patients included into prospective study, who were qualified for bariatric surgery (OB1) and evaluated again 6 m after surgery (OB2). A control group (CG) consisted of 15 healthy women. A second control group (CG2) consisted of 15 women with grade 1 obesity. PWV, FMD, NTG were assessed. RESULTS The reduction of BMI (kg/m(2)) from 47.73 ± 6.18 (OB1) to 35.22 ± 5.20 (OB2) was observed. The PWV turned out to be higher before bariatric surgery (OB1 vs. OB2 8.53 ± 1.76 vs. 7.82 ± 1.49 m/s; p < 0.001), however it was no different than PWV in CG. In OB1 group PWV showed correlation with age (r = 0.492, p = 0.001), HR (r = 0.324, p = 0.04), %FM (r = 0.328; p = 0.039), NTG% (r = -0.332, p = 0.036) as well as hsCRP (r = 0.394, p = 0.014). A multivariate analysis showed that the most significant factors influencing PWV were age (p = 0.0005) and hsCRP (p = 0.0014), pseudo R(2) index 0.44365. The values of FMD differed between OB1 and OB2 groups (12.83 ± 5.15 vs. 17.52 ± 5.50 %; p < 0.0001), however, they were similar to results obtained in CG (14.45 ± 6.14 %; NS). The values of nitroglycerin-mediated dilatation differed between OB1 and OB2 groups (21.47 ± 8.31 vs. 28.54 ± 8.16 %; p < 0.0001) and were lower as compared with CG (31.42 ± 5.95 %; p = 0.0005). CONCLUSION Body mass reduction secondary to bariatric surgery in patients with severe obesity and metabolic syndrome results in improvement of functional markers of artery function and advantageous metabolic changes. The improvement in functional markers of artery function (NTG%) was correlated with change in triglyceride blood concentration.
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Affiliation(s)
- Justyna Domienik-Karłowicz
- />Department of General Medicine and Cardiology, Medical University of Warsaw, Lindley’a 5, 02-005 Warsaw, Poland
| | - Wojciech Lisik
- />Department of General Surgery and Transplantology, Medical University of Warsaw, Nowogrodzka 59, 02-005 Warsaw, Poland
| | - Zuzanna Rymarczyk
- />Department of General Medicine and Cardiology, Medical University of Warsaw, Lindley’a 5, 02-005 Warsaw, Poland
| | - Olga Dzikowska-Diduch
- />Department of General Medicine and Cardiology, Medical University of Warsaw, Lindley’a 5, 02-005 Warsaw, Poland
| | - Andrzej Chmura
- />Department of General Surgery and Transplantology, Medical University of Warsaw, Nowogrodzka 59, 02-005 Warsaw, Poland
| | - Urszula Demkow
- />Department of Laboratory Medicine and Clinical Immunology of Developmental Age, Medical University of Warsaw, Marszałkowska 24, 00-576 Warsaw, Poland
| | - Piotr Pruszczyk
- />Department of General Medicine and Cardiology, Medical University of Warsaw, Lindley’a 5, 02-005 Warsaw, Poland
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Megias-Rangil I, Merino J, Ferré R, Plana N, Heras M, Cabré A, Bonada A, Rabassa A, Masana L. Subclinical atherosclerosis determinants in morbid obesity. Nutr Metab Cardiovasc Dis 2014; 24:963-968. [PMID: 24907020 DOI: 10.1016/j.numecd.2014.04.012] [Citation(s) in RCA: 10] [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: 01/09/2014] [Revised: 03/31/2014] [Accepted: 04/20/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Obesity is associated with increased cardiovascular risk. However, the impact of morbid obesity on vascular structure and function is not well understood. This study was designed to appraise subclinical atherosclerosis markers, including carotid intima media thickness (cIMT), endothelial function, and arterial wall stiffness, and their determinants, in morbidly obese patients. METHODS AND RESULTS In this cross-sectional study 194 overweight and obese patients were distributed in morbid-obese patients (MOP, n = 110), obese (OP, n = 84) and overweight patients (OwP, n = 33) groups. Demography, anthropometry, clinical and standard biochemical data were recorded. cIMT, endothelial function, defined as the small artery reactivity index (saRHI), and artery wall rigidity, studied by the augmentation index, were determined. More than 50% of the MOP, OP and OwP had a cIMT above the 75th percentile per age and gender. No differences in cIMT or saRHI were observed, although overweight and obese patients (OOP) had higher arterial rigidity compared with the morbid-obese patients. In a multivariate regression test, while cholesterol was the main determinant of cIMT in overweight and obese patients, glucose metabolism was the determinant in MOP. CONCLUSION More than half of the population have a cIMT above general population ranges. OwP, OP and MOP have similar cIMT and saRHI. However, OOP have greater arterial wall rigidity. Dysglycemia is the main factor associated with subclinical atherosclerosis in MOP.
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Affiliation(s)
- I Megias-Rangil
- Dietetics and Nutrition Unit, Sant Joan University Hospital, Avinguda Josep Laporte Num 1, 43204 Reus, Spain.
| | - J Merino
- Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Rovira i Virgili University, IISPV, CIBERDEM. Reus, Spain
| | - R Ferré
- Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Rovira i Virgili University, IISPV, CIBERDEM. Reus, Spain
| | - N Plana
- Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Rovira i Virgili University, IISPV, CIBERDEM. Reus, Spain
| | - M Heras
- Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Rovira i Virgili University, IISPV, CIBERDEM. Reus, Spain
| | - A Cabré
- Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Rovira i Virgili University, IISPV, CIBERDEM. Reus, Spain
| | - A Bonada
- Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Rovira i Virgili University, IISPV, CIBERDEM. Reus, Spain
| | - A Rabassa
- Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Rovira i Virgili University, IISPV, CIBERDEM. Reus, Spain
| | - L Masana
- Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Rovira i Virgili University, IISPV, CIBERDEM. Reus, Spain
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Abstract
This study investigated the effects of a brief tailored intervention on self-efficacy beliefs and exercise energy expenditure in active and inactive overweight and obese women. Participants were randomly assigned to either control (N = 50) or intervention (N = 47) conditions, and their exercise self-efficacy was assessed three times over a 12-week period. Results showed that the intervention increased schedule, physical, exercise-worries efficacy, and energy expenditure in the previously inactive group. The results suggest that self-efficacy interventions are effective at increasing exercise energy expenditure in inactive overweight and obese women.
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27
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Franklin NC, Ali M, Goslawski M, Wang E, Phillips SA. Reduced vasodilator function following acute resistance exercise in obese women. Front Physiol 2014; 5:253. [PMID: 25071598 PMCID: PMC4083188 DOI: 10.3389/fphys.2014.00253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 06/17/2014] [Indexed: 11/29/2022] Open
Abstract
Obesity contributes to stress induced impairments in endothelium-dependent vasodilation (EDV), a precursor to atherosclerosis. Since obesity is associated with inflammation and oxidative stress, we sought to determine if a single bout of strenuous weight lifting (SWL) reduces EDV among sedentary obese adults. Participants included 9 obese (OB) (BMI 30.0–40.0 kg/m2) and 8 lean (LN) (BMI 18.5–24.9 kg/m2) sedentary young women. All participants underwent a single bout of SWL using a progressive leg-press protocol. Brachial artery flow-mediated dilation (FMD) (an index of EDV) was determined using ultrasonography before and after SWL. Sublingual nitroglycerin (NTG) was used to determine brachial artery endothelium-independent vasodilation following SWL. Brachial artery FMD was significantly reduced in OB and LN women (LN: 6.4 ± 1.6%, p = 0.22) after SWL. There was no difference in the magnitude of change pre- and post-SWL between groups (OB: −2.4 ± 0.6% and LN: −2.2 ± 1.6%, p = 0.84). Dilation to NTG was lower in OB (21.6 ± 1.3%) compared to LN women (27.6 ± 2.1%, p = 0.02) and associated with body weight (r = −0.70, p = 0.01). These data suggest that EDV is reduced in woman after acute resistance exercise. Dilations to NTG were lower in obese compared to lean woman and associated with body weight suggesting that changes in sensitivity of blood vessels to NO occurs during obesity. These findings may be important for understanding vascular risk following acute exercise in obesity.
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Affiliation(s)
- Nina C Franklin
- Department of Physical Therapy, University of Illinois at Chicago Chicago, IL, USA ; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago Chicago, IL, USA
| | - Mohamed Ali
- Department of Physical Therapy, University of Illinois at Chicago Chicago, IL, USA ; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago Chicago, IL, USA
| | - Melissa Goslawski
- Department of Physical Therapy, University of Illinois at Chicago Chicago, IL, USA
| | - Edward Wang
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago Chicago, IL, USA
| | - Shane A Phillips
- Department of Physical Therapy, University of Illinois at Chicago Chicago, IL, USA ; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago Chicago, IL, USA ; Department of Medicine, University of Illinois at Chicago Chicago, IL, USA
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28
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Joo Turoni C, Marañón RO, Felipe V, Bruno ME, Negrete A, Salas N, Bazán de Casella MC, Peral de Bruno M. Arterial stiffness and endothelial function in obese children and adolescents and its relationship with cardiovascular risk factors. Horm Res Paediatr 2014; 80:281-6. [PMID: 24060766 DOI: 10.1159/000354991] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 08/07/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity is related to an increase in the rates of cardiovascular disease. OBJECTIVE To establish the impact of obesity on vascular function (endothelial function and arterial stiffness) in children and adolescents and its relationship to cardiovascular risk factors. METHODS In obese (OB) children and adolescents, endothelial function and arterial stiffness were evaluated by a pulse plethysmography method (reactive hyperemia and index of digital volume waveforms, respectively). Data were compared with the non-obese (non-OB) group (body mass index >10th to <97th percentile). Anthropometric parameters, body fat percentage, fasting glucose, lipid profile, insulinemia, HOMA-IR and hemodynamic parameters were determined in both groups. RESULTS Body mass index, weight, waist circumference, body fat, insulinemia and HOMA-IR were significantly higher in the OB group. The OB group showed impaired endothelial function (15.8 ± 0.2%, n = 37) compared to the non-OB group (41.4 ± 5%, n = 20; p < 0.001) and increased arterial stiffness. Endothelial function was only negatively correlated with waist circumference and HOMA-IR in the OB group, whereas a positive correlation was found between insulinemia and HOMA-IR. CONCLUSIONS This study shows that impaired vascular function is already present in OB children and adolescents. The fact that obesity is associated with some markers of cardiovascular risk suggests the importance of early lifestyle interventions in this population to prevent cardiovascular disease.
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Affiliation(s)
- Claudio Joo Turoni
- Departamento Biomédico, Orientación Fisiología, Facultad de Medicina, Universidad Nacional de Tucumán, INSIBO-CONICET, Hospital del Niño Jesús, Tucumán, Argentina
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29
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Abstract
AbstractObesity, particularly abdominal obesity, is associated with increased risks of arterial hypertension, diabetes mellitus, hyperlipidemia, sleep apnea, coronary artery disease, stroke and mortality. Weight loss surgery is the most effective treatment for morbid obesity, mainly because medical and dietary treatments have been proven insufficient in the long run. Our primary end point was to study the gender effect on vascular responsiveness (endothelial function and the ankle brachial index [ABI]) 3 months post bariatric surgery. Our secondary end points were to study the effect of gender on antropometric parameters (BMI, waist circumference) and chronic diseases (diabetes mellitus type II, arterial hypertension) 3 months following bariatric surgery, and to find independent variables that may affect and predict the post-operative clinical outcome. Methods: In this prospective study, patients were evaluated one day before surgery and 3 months afterwards. Ankle brachial index was measured while the patient was supine after 15 minutes rest and measurement of the systolic blood pressure in all four extremities was done. The brachial artery method was used to measure endothelial function expressed as flow mediated diameter percent change (FMD %). FMD% more than 10% is considered a normal response. Results: Compared with diabetic females, diabetic males had a higher postoperative BMI (men with diabetes mellitus did not lose weight as much as diabetic women) (β=-0.299; P=0.04), while women with diabetes mellitus had a more significant reduction in BMI postoperatively (β=+0.287; P=0.04). Following bariatric surgery, 12 of the 21 patients with diabetes mellitus type II did not need any medications for diabetes (kept HbA1c% less than 6.5%). All other diabetic patients improved their diabetes mellitus status. Women significantly improved their ABI (average increase of 0.07, p=0.04) and their endothelial function (FMD% change was improved from -3.5±9.0% to 14.8±8.1%, an improvement of 18.3%, p<0.001). Systolic blood pressure was decreased significantly (by 6.6 mmHg, p=0.04). Men improved their endothelial function (FMD% change was improved from -1.3±10.1% to 11.7±6.2%, p<0.001), but no significant change was observed in systolic blood pressure (p=0.29) nor in ABI (P=0.8). A linear regression analysis found that a higher baseline FMD% significantly predicted a higher postoperative FMD% (β=0.294, P=0.03). In obese males, the higher the baseline BMI the worse the post operative endothelial function (β=-0.921, Pd<0.001) and the same adverse effect was documented for hypertensive men (β=-0.380, P=0.05). For females, the higher the baseline FMD% the higher the postoperative FMD% (β=+0.397; P=0.01) [a favorable outcome]. Discussion: Our study has demonstrated a possible mechanistic insight into gender effects observed in epidemiological studies through improvement in vascular response in females undergoing this operation including a better reduction in systolic blood pressure and a better weight reduction in diabetic women with improvement in ABI; unlike males, who did not improve their ABI and did not decrease systolic blood pressure, and the finding that obese diabetic males and obese hypertensive males did the worst.
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Suboc TM, Dharmashankar K, Wang J, Ying R, Couillard A, Tanner MJ, Widlansky ME. Moderate Obesity and Endothelial Dysfunction in Humans: Influence of Gender and Systemic Inflammation. Physiol Rep 2013; 1. [PMID: 24187612 PMCID: PMC3811111 DOI: 10.1002/phy2.58] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Our objective was to determine whether moderate obesity (Body Mass Index [BMI] ≥ 30 kg/m²) is associated with impaired conduit and microvascular endothelial function, and whether men or women are more susceptible to impairment of endothelial function related to moderate obesity. Forty-one middle aged, nondiabetic moderately obese (BMI 34.7 ± 4.0 kg/m2) and nonobese (BMI 24.3 ± 2.6 kg/m2) subjects of both sexes underwent noninvasive studies of endothelial function (brachial reactivity) and measurements of endothelial-dependent vasodilation of gluteal subcutaneous arterioles to acetylcholine (Ach). Endothelium-dependent vasodilation to Ach was decreased in the moderately obese compared with the nonobese (P < 0.001). Stratified analysis based on sex showed impairment of arteriolar endothelial function in women BMI ≥ 30 kg/m2 (P = 0.02), but not men. There was no difference between in vivo endothelial function flow-mediated dilation (FMD%) by BMI category. Sex-specific analysis showed FMD% was lower in women with BMI ≥ 30 kg/m2 compared to those with BMI < 30 kg/m2 (P = 0.02). No differences were seen in men based on BMI category (P = 0.18). In women, high sensitivity C-reactive protein (hsCRP) correlated with BMI (ρ = 0.68, P = 0.006). Moderate obesity is associated with impaired resistance arteriolar endothelial function. This is more prominent in women than men and is associated with systemic inflammation.
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Affiliation(s)
- Tisha M Suboc
- Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
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31
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Lupattelli G, De Vuono S, Boni M, Helou R, Raffaele Mannarino M, Rita Roscini A, Alaeddin A, Pirro M, Vaudo G. Insulin resistance and not BMI is the major determinant of early vascular impairment in patients with morbid obesity. J Atheroscler Thromb 2013; 20:924-33. [PMID: 23903296 DOI: 10.5551/jat.18663] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Several factors contribute to the development of atherogenesis in patients with obesity. The aim of our study was to evaluate the different roles of insulin resistance, strictly correlated to visceral adiposity, and the body mass index (BMI), an estimate of overall adiposity, on early vascular impairment in patients with morbid obesity. METHODS We enrolled 65 morbidly obese subjects (BMI 44.6 ± 7 kg/m(2)) who were free of previous cardiovascular events and 28 nonobese subjects (control group) in a cross-sectional study. The presence of glycemia and insulinemia, the levels of lipids and liver parameter and the ultrasonographic assessment of the flow-mediated dilatation (FMD), carotid intima-media thickness (IMT) and visceral fat area (VFA) were evaluated in all subjects. RESULTS In the obese patients with a median HOMA value of ≥ 3.5, the FMD was significantly lower (p < .05) and the left carotid maximum-IMT was significantly higher (p < .05) than those observed in the group with lower HOMA values. No vascular differences were found between the two groups that were subdivided according to the BMI median value. Both the left max-IMT and FMD exhibited a significant correlation with HOMA-IR ("ρ" .292, p=0.02 , "ρ"-.292, p=0.02 respectively) but not with BMI. According to a multivariate analysis, the VFA was an independent predictor of a reduced FMD (β - .541, p.002; p of the model .002), while age (β .611 p < .0001) and HOMA-IR (β .399 p < .001) were independent predictors of the left max-IMT (p of the model .002). CONCLUSIONS The HOMA-IR, which is strictly related to visceral fat and is an index of metabolic impairment, and not BMI, which reflects of global adiposity, can be used to identify early vascular impairment in patients with morbid obesity.
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Affiliation(s)
- Graziana Lupattelli
- Internal Medicine, Angiology and Atherosclerosis, Department of Clinical and Experimental Medicine, University of Perugia
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Saleh MH, Bertolami MC, Assef JE, Taha MI, de Freitas W, Petisco ACG, Barretto RBM, Le Bihan DC, Barbosa JEM, de Jesus CA, Sousa AGMR. Improvement of atherosclerotic markers in non-diabetic patients after bariatric surgery. Obes Surg 2013; 22:1701-7. [PMID: 22777211 DOI: 10.1007/s11695-012-0706-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The objective of this study was to assess the impact of bariatric surgery performed in extremely obese non-diabetic subjects on the following parameters: endothelial function, inflammatory processes (assessed by high-sensitivity C-reactive protein [hs-CRP]), carotid artery intima-media thickness (CIMT), and glucose and lipid profiles. METHODS Forty-seven obese individuals with body mass index >40 kg/m(2) underwent bariatric surgery and returned for post-procedure assessment between 6 and 19 months after surgery. Ninety-three percent of patients were female. Their age ranged from 18 to 65 (mean 41) years old at baseline. Baseline was defined as the maximum of 30 days before surgery. Before and after surgery, all patients were subjected to a brachial artery ultrasound examination to evaluate endothelial-dependent dilation, CIMT by ultrasound, and laboratory analyses including glucose, lipid and inflammatory profiles were performed. RESULTS Subjects lost an average of 33 % of their original weight (p < 0.001). Flow-mediated dilation showed significant improvement after surgery from 7.4 % to 18.9 % (p < 0.001) on average. There was regression of CIMT, with the median being reduced from 0.8 to 0.5 mm (p < 0.001). The median Hs-CRP reduced from 0.83 to 0.18 mg/dl (p < 0.001), while glucose and lipid profiles were also improved after surgery. CONCLUSIONS This study shows that severely obese, non-diabetic patients who had pronounced weight loss after bariatric surgery had an overall improvement in brachial flow-mediated dilation, CIMT, high-sensitivity CRP, and glucose and lipid metabolism. The best responses of the brachial flow-mediated dilation after surgery were observed in non-smokers and in younger subjects.
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Affiliation(s)
- Mohamed Hassan Saleh
- Instituto Dante Pazzanese de Cardiologia, State of Sao Paulo - Health Secretary, Sao Paulo, Brazil.
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Mohler ER, Sibley AA, Stein R, Davila-Roman V, Wyatt H, Badellino K, Rader DJ, Klein S, Foster GD. Endothelial function and weight loss: comparison of low-carbohydrate and low-fat diets. Obesity (Silver Spring) 2013; 21:504-9. [PMID: 23404949 PMCID: PMC3630284 DOI: 10.1002/oby.20055] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 08/10/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The effect of weight loss on obesity-associated endothelial dysfunction is not clear because of conflicting data, demonstrating both improvement and no change in endothelial function after weight loss in obese subjects. A 2-year prospective study (n = 121) was conducted to examine: (1) the effect of obesity and weight loss (either a low-carbohydrate or and low-fat diet) on flow mediated vasodilatation (FMD), a measure of endothelial function. DESIGN AND METHODS Participants reduced body weight by 7.1% ± 4.4%, 8.7% ± 6.8%, 7.1% ± 7.8%, and 4.1% ± 7.7% at 3, 6, 12, and 24 months, respectively with no significant differences between the low-fat and low-carbohydrate groups. RESULTS Endothelial function was inversely correlated with waist circumference, triglyceride level, and directly correlated with leptin in obese persons prior to weight loss. These weight losses did not confer any improvements in FMD. There were no differences between the low-fat and low-carbohydrate diets in FMD at any time point. At 6 months (r = 0.26, P = 0.04) and 1 year (r =0.28, P = 0.03), there were positive correlations between change in FMD and change in leptin but not at 2 years. CONCLUSION There was no significant improvement in endothelial function after 7.1% ± 7.8% weight loss at 1 year and 4.1% ± 7.7% at 2 years, achieved by either a low carbohydrate or a low fat diet.
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Affiliation(s)
- Emile R Mohler
- Department of Medicine, Cardiovascular Division, Section of Vascular Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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34
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Alosco ML, Spitznagel MB, Raz N, Cohen R, Sweet LH, Colbert LH, Josephson R, van Dulmen M, Hughes J, Rosneck J, Gunstad J. Obesity interacts with cerebral hypoperfusion to exacerbate cognitive impairment in older adults with heart failure. Cerebrovasc Dis Extra 2012; 2:88-98. [PMID: 23272007 PMCID: PMC3507266 DOI: 10.1159/000343222] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Cerebral hypoperfusion accompanies heart failure (HF) and is associated with reduced cognitive performance. Obesity is prevalent in persons with HF and is also a likely contributor to cognitive function, as it has been independently linked to cognitive impairment in healthy individuals. The current study examined the association between obesity and cognitive performance among older adults with HF and whether obesity interacts with cerebral hypoperfusion to exacerbate cognitive impairment. Methods Patients with HF (n = 99, 67.46 ± 11.36 years of age) completed neuropsychological testing and impedance cardiography. Cerebral blood flow velocity (CBF-V) measured by transcranial Doppler sonography quantified cerebral perfusion and body mass index (BMI) operationalized obesity. Results A hierarchical regression analysis showed that lower CBF-V was associated with reduced performance on tests of attention/executive function and memory. Elevated BMI was independently associated with reduced attention/executive function and language test performance. Notably, a significant interaction between CBF-V and BMI indicated that a combination of hypoperfusion and high BMI has an especially adverse influence on attention/executive function in HF patients. Conclusions The current findings suggest that cerebral hypoperfusion and obesity interact to impair cognitive performance in persons with HF. These results may have important clinical implications, as HF patients who are at high risk for cerebral hypoperfusion may benefit from weight reduction.
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Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, Kent, Ohio, USA
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Annesi JJ. Supported exercise improves controlled eating and weight through its effects on psychosocial factors: extending a systematic research program toward treatment development. Perm J 2012; 16:7-18. [PMID: 22529754 DOI: 10.7812/11-136] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Behavioral weight-loss treatments have been overwhelmingly unsuccessful. Many inadequately address both behavioral theory and extant research--especially in regard to the lack of viability of simply educating individuals on improved eating and exercise behaviors. OBJECTIVE The aim was to synthesize research on associations of changes in exercise behaviors, psychosocial factors, eating behaviors, and weight; and then conduct further direct testing to inform the development of an improved treatment approach. METHODS A systematic program of health behavior-change research based on social cognitive theory, and extensions of that theory applied to exercise and weight loss, was first reviewed. Then, to extend this research toward treatment development and application, a field-based study of obese adults was conducted. Treatments incorporated a consistent component of cognitive-behaviorally supported exercise during 26 weeks that was paired with either standard nutrition education (n = 183) or cognitive-behavioral methods for controlled eating that emphasized self-regulatory methods such as goal setting and caloric tracking, cognitive restructuring, and eating cue awareness (n = 247). RESULTS Both treatment conditions were associated with improved self-efficacy, self-regulation, mood, exercise, fruit and vegetable consumption, weight, and waist circumference; with improvements in self-regulation for eating, fruit and vegetable consumption, weight, and waist circumference significantly greater in the cognitive-behavioral nutrition condition. Changes in exercise- and eating-related self-efficacy and self-regulation were associated with changes in exercise and eating (R(2) = 0.40 and 0.17, respectively), with mood change increasing the explanatory power to R(2) = 0.43 and 0.20. Improved self-efficacy and self-regulation for exercise carried over to self-efficacy and self-regulation for controlled eating (β= 0.53 and 0.68, respectively). CONCLUSIONS Development and longitudinal testing of a new and different approach to behavioral treatment for sustained weight loss that emphasizes exercise program-induced psychosocial changes preceding the facilitation of improved eating and weight loss should be guided by our present research.
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Abstract
PURPOSE OF REVIEW Obesity is commonly associated with multiple conditions imparting adverse cardiovascular risk, including hypertension, dyslipidemia, and insulin resistance or diabetes. In addition, sleep disordered breathing, inflammation, left ventricular hypertrophy, left atrial enlargement, and subclinical left ventricular systolic and diastolic dysfunction may collectively contribute to increased cardiovascular morbidity and mortality. This review will describe improvements in cardiovascular risk factors after bariatric surgery. RECENT FINDINGS All of the cardiovascular risk factors listed above are improved or even resolved after bariatric surgery. Cardiac structure and function also have shown consistent improvement after surgically induced weight loss. The amount of improvement in cardiac risk factors is generally proportional to the amount of weight lost. The degree of weight loss varies with different bariatric procedures. On the basis of the improvement in risk profiles, it has been predicted that progression of atherosclerosis could be slowed and the 10-year risk of cardiac events would decline by ~50% in patients undergoing weight loss surgery. In keeping with these predictions, two studies have demonstrated reductions in 10-year total and cardiovascular mortality of approximately 50% in patients who had bariatric surgery. SUMMARY These encouraging data support the continued, and perhaps expanded, use of surgical procedures to induce weight loss in severely obese patients.
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Farb MG, Ganley-Leal L, Mott M, Liang Y, Ercan B, Widlansky ME, Bigornia SJ, Fiscale AJ, Apovian CM, Carmine B, Hess DT, Vita JA, Gokce N. Arteriolar function in visceral adipose tissue is impaired in human obesity. Arterioscler Thromb Vasc Biol 2011; 32:467-73. [PMID: 22095978 DOI: 10.1161/atvbaha.111.235846] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this study was to characterize the relationship between adipose tissue phenotype and depot-specific microvascular function in fat. METHODS AND RESULTS In 30 obese subjects (age 42±11 years, body mass index 46±11 kg/m(2)) undergoing bariatric surgery, we intraoperatively collected visceral and subcutaneous adipose tissue and characterized depot-specific adipose phenotypes. We assessed vasomotor function of the adipose microvasculature using videomicroscopy of small arterioles (75-250 μm) isolated from different fat compartments. Endothelium-dependent, acetylcholine-mediated vasodilation was severely impaired in visceral arterioles, compared to the subcutaneous depot (P<0.001 by ANOVA). Nonendothelium dependent responses to papaverine and nitroprusside were similar. Endothelial nitric oxide synthase inhibition with N(ω)-nitro-l-arginine methyl ester reduced subcutaneous vasodilation but had no effect on severely blunted visceral arteriolar responses. Visceral fat exhibited greater expression of proinflammatory, oxidative stress-related, hypoxia-induced, and proangiogenic genes; increased activated macrophage populations; and had a higher capacity for cytokine production ex vivo. CONCLUSIONS Our findings provide clinical evidence that the visceral microenvironment may be intrinsically toxic to arterial health providing a potential mechanism by which visceral adiposity burden is linked to atherosclerotic vascular disease. Our findings also support the evolving concept that both adipose tissue quality and quantity may play significant roles in shaping cardiovascular phenotypes in human obesity.
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Affiliation(s)
- Melissa G Farb
- Boston Medical Center, 88 East Newton St, D-8, Cardiology, Boston, MA 02118, USA
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Annesi JJ, Marti CN. Path analysis of exercise treatment-induced changes in psychological factors leading to weight loss. Psychol Health 2011; 26:1081-98. [DOI: 10.1080/08870446.2010.534167] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mah E, Matos MD, Kawiecki D, Ballard K, Guo Y, Volek JS, Bruno RS. Vitamin C status is related to proinflammatory responses and impaired vascular endothelial function in healthy, college-aged lean and obese men. ACTA ACUST UNITED AC 2011; 111:737-43. [PMID: 21515122 DOI: 10.1016/j.jada.2011.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 11/16/2010] [Indexed: 12/21/2022]
Abstract
Vitamin C supplementation has been suggested to reduce cardiovascular disease risk. However, no studies have examined the relationship between vitamin C status and vascular dysfunction in lean and obese individuals in the absence of supplementation. We examined whether vascular function is interrelated with vitamin C status and inflammation in healthy, college-aged lean and obese men with no history of dietary supplementation. A cross-sectional study was conducted during winter 2008 in lean and obese men aged 21±3 years (n=8/group). Brachial artery flow-mediated dilation (FMD) was measured to determine vascular endothelial function. Plasma antioxidants (vitamin C, vitamin E, and thiols), inflammatory proteins (C-reactive protein [CRP], myeloperoxidase [MPO], and cytokines), and cellular adhesion molecules were measured. Participants also completed 3-day food records on the days preceding their vascular testing. Group differences were evaluated by t tests, and correlation coefficients were determined by linear regression. FMD was 21% lower (P<0.05) in obese men. They also had 51% lower vitamin C intakes and 38% lower plasma vitamin C concentrations. Obese men had greater plasma concentrations of CRP, MPO, inflammatory cytokines, and cellular adhesion molecules. Participants' CRP and MPO were each inversely related (P<0.05) to FMD (r=-0.528 and -0.625) and plasma vitamin C (r=-0.646 and -0.701). These data suggest that low vitamin C status is associated with proinflammatory responses and impaired vascular function in lean and obese men. Additional study is warranted to determine whether improving dietary vitamin C intakes from food attenuate vascular dysfunction.
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Affiliation(s)
- Eunice Mah
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
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Bakris GL, Basile JN, Giles TD, Taylor AA. The role of nitric oxide in improving endothelial function andcardiovascular health: focus on nebivolol. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2011. [DOI: 10.15829/1728-8800-2011-2-116-121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Although β-blockers have been endorsed by guidelines committees for the treatment of patients with hypertension, particularly those with significant CVD and high CVD risk, there are concerns about conventional β-blockers related to poorer clinical outcomes compared with other classes of antihypertensive agents, as well as deleterious effects on quality of life and lipid and carbohydrate metabolism. β-blockers comprise a heterogeneous group of antihypertensive agents, including nonselective agents, cardioselective, nonvasodilating agents, and vasodilating agents that either combine β-nonselectivity with β-blockade or possess cardioselectivity without β-blockade. The pharmacologic, mechanistic, and hemodynamic differences between conventional, nonvasodilating β-blockers and vasodilating β-blockers are discussed in this review, with a focus on the cardioselective vasodilating β-blocker nebivolol. These differences may have important clinical implications, particularly in the treatment of complicated hypertension, such as that associated with patients with diabetes or cardiometabolic syndrome, elderly patients, and African American patients, suggesting that mechanism of action may be an important consideration when choosing a β-blocker.
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Affiliation(s)
- G. L. Bakris
- Hypertensive Diseases Unit, Department of Medicine, University of Chicago Medical Center
| | - J. N. Basile
- Seinsheimer Cardiovascular Health Program, College of Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center
| | - T. D. Giles
- Department of Medicine, Tulane University School of Medicine
| | - A. A. Taylor
- Departments of Medicine, Pharmacology, and Molecular Physiology, Baylor College of Medicine
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Doupis J, Rahangdale S, Gnardellis C, Pena SE, Malhotra A, Veves A. Effects of diabetes and obesity on vascular reactivity, inflammatory cytokines, and growth factors. Obesity (Silver Spring) 2011; 19:729-35. [PMID: 20829804 PMCID: PMC3676733 DOI: 10.1038/oby.2010.193] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We examined the influences of obesity and diabetes on endothelium-dependent and -independent vasodilation, inflammatory cytokines, and growth factors. We included 258 subjects, age 21-80 years in four groups matched for age and gender: 40 healthy nonobese (BMI <30 kg·m(-2)) nondiabetic subjects, 76 nonobese diabetic patients, 37 obese (BMI >30) nondiabetic subjects, and 105 obese (BMI >30) diabetic patients. The flow-mediated dilation (FMD, endothelium-dependent) and nitroglycerin-induced dilation (NID, endothelium-independent) in the brachial artery, the vascular reactivity at the forearm skin and serum growth factors and inflammatory cytokines were measured. FMD was reduced in the nonobese diabetic patients, obese nondiabetic controls, and obese diabetic patients (P < 0.0001). NID was different among all four groups, being highest in the obese nondiabetic subjects and lowest in the obese diabetic patients (P < 0.0001). The resting skin forearm blood flow was reduced in the obese nondiabetic subjects (P < 0.01). Vascular endothelial growth factor (VEGF) was higher in the obese nondiabetic subjects (P < 0.05), tumor necrosis factor-α was higher in the obese diabetic patients (P < 0.0001) and C-reactive protein was higher in both the obese nondiabetic and diabetic subjects (P < 0.0001). Soluble intercellular adhesion molecule-1 was elevated in the two diabetic groups and the obese nondiabetic subjects (P < 0.05). We conclude that diabetes and obesity affect equally the endothelial cell function but the smooth muscle cell function is affected only by diabetes. In addition, the above findings may be related to differences that were observed in the growth factors and inflammatory cytokines.
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Affiliation(s)
- John Doupis
- Microcirculation Laboratory, Joslin–Beth Israel Deaconess Foot Center, the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Shilpa Rahangdale
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Salvador E. Pena
- Microcirculation Laboratory, Joslin–Beth Israel Deaconess Foot Center, the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Atul Malhotra
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aristidis Veves
- Microcirculation Laboratory, Joslin–Beth Israel Deaconess Foot Center, the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Ayer JG, Harmer JA, David C, S Steinbeck K, Seale JP, Celermajer DS. Severe obesity is associated with impaired arterial smooth muscle function in young adults. Obesity (Silver Spring) 2011; 19:54-60. [PMID: 20489689 DOI: 10.1038/oby.2010.114] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The degree of arterial dilatation induced by exogenous nitrates (nitrate-mediated dilatation, NMD) has been similar in obese and normal-weight adults after single high-dose glyceryl trinitrate (GTN). We examined whether NMD is impaired in obesity by performing a GTN dose-response study, as this is a potentially more sensitive measure of arterial smooth muscle function. In this cross-sectional study, subjects were 19 obese (age 31.0 ± 1.2 years, 10 male, BMI 44.1 ± 2.1) and 19 age- and sex-matched normal-weight (BMI 22.4 ± 0.4) young adults. Blood pressure (BP), triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL)-cholesterol, glucose, insulin, high-sensitivity C-reactive protein (hs-CRP), carotid intima-media thickness (CIMT), and flow-mediated dilatation (FMD) were measured. After incremental doses of GTN, brachial artery maximal percent dilatation (maximal NMD) and the area under the dose-response curve (NMD AUC) were calculated. Maximal NMD (13.4 ± 0.9% vs. 18.3 ± 1.1%, P = 0.002) and NMD AUC (54,316 ± 362 vs. 55,613 ± 375, P = 0.018) were lower in obese subjects. The obese had significantly higher hs-CRP, insulin, and CIMT and lower HDL-cholesterol. Significant bivariate associations existed between maximal NMD or NMD AUC and BMI-group (r = -0.492, P = 0.001 or r = -0.383, P = 0.009), hs-CRP (r = -0.419, P = 0.004 or r = -0.351, P = 0.015), and HDL-cholesterol (r = 0.374, P = 0.01 or r = 0.270, P = 0.05). On multivariate analysis, higher BMI-group remained as the only significant determinant of maximal NMD (r² = 0.242, β = -0.492, P = 0.002) and NMD AUC (r² = 0.147, β = -0.383, P = 0.023). In conclusion, arterial smooth muscle function is significantly impaired in the obese. This may be important in their increased cardiovascular risk.
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Affiliation(s)
- Julian G Ayer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Yim-Yeh S, Rahangdale S, Nguyen ATD, Jordan AS, Novack V, Veves A, Malhotra A. Obstructive sleep apnea and aging effects on macrovascular and microcirculatory function. Sleep 2010; 33:1177-83. [PMID: 20857864 DOI: 10.1093/sleep/33.9.1177] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
STUDY OBJECTIVES Many patients with obstructive sleep apnea (OSA) are obese, and whether obesity itself explains the increased prevalence of cardiovascular disease in OSA is unknown. We hypothesize that OSA, independent of obesity, contributes to abnormal vascular function. DESIGN Physiology study. SETTING Academic medical centers. PATIENTS Obese subjects, free of known comorbidities, were enrolled. MEASUREMENTS AND RESULTS Vascular function was assessed with brachial artery ultrasound for flow-mediated dilation (FMD) and in skin microcirculation by laser Doppler flowmetry. Arterial stiffness was measured by arterial tonometry. Seventy-two subjects (43/72 women, 38/72 with OSA) were studied. FMD was impaired in patients with OSA, compared with control subjects (5.7% +/- 3.8% vs 8.3% +/- 4.1%, P = 0.005). In step-forward regression analysis inclusive of age, sex, and body mass index, age (P = 0.013) was a significant independent predictor of FMD. In a subgroup of subjects younger than 50 years of age (n = 59), however, OSA was the only independent predictor of FMD (P = 0.04), adjusted for known covariates. OSA did not significantly influence vascular function in the skin microcirculation. The augmentation index, a measure of arterial stiffness, was similar between the OSA and control groups (16.2% +/- 11.4% vs 20.4% +/- 10.1%, respectively, P = 0.10). In step-forward regression analysis of younger men (< or = 50 years old, 23 subjects), OSA independently predicted the augmentation index in men only (P = 0.001). CONCLUSIONS In obesity, both OSA and aging impair endothelial function and increase arterial stiffness. The influence of OSA on vascular function is most pronounced in young subjects. OSA, therefore, may be associated with functional impairment ("a premature aging effect") on the endothelium and on arterial stiffness (in men), although skin microcirculatory function appears preserved.
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Vessières E, Belin de Chantemèle EJ, Toutain B, Guihot AL, Jardel A, Loufrani L, Henrion D. Cyclooxygenase-2 inhibition restored endothelium-mediated relaxation in old obese zucker rat mesenteric arteries. Front Physiol 2010; 1:145. [PMID: 21423385 PMCID: PMC3059951 DOI: 10.3389/fphys.2010.00145] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 10/11/2010] [Indexed: 12/31/2022] Open
Abstract
Metabolic syndrome is associated with reduced endothelial vasodilator function. It is also associated with the induction of cyclooxygenase-2 (COX2), which produces vasoactive prostanoids. The frequency of metabolic syndrome increases with age and aging per se is a risk factor associated with reduced endothelium-mediated relaxation. Nevertheless, the combined effect of aging and metabolic syndrome on the endothelium is less known. We hypothesized that COX2 derived prostanoids may affect endothelium function in metabolic syndrome associated with aging. We used obese Zucker rats, a model of metabolic syndrome. First order mesenteric arteries were isolated from 4- and 12-month-old rats and acetylcholine (endothelium)-dependent relaxation determined using wire-myography. Endothelium-mediated relaxation, impaired in young Zucker rats (89 versus 77% maximal relaxation; lean versus Zucker), was further reduced in old Zucker rats (72 versus 51%, lean versus Zucker). The effect of the nitric oxide-synthesis inhibitor L-NAME on the relaxation was reduced in both young and old Zucker rats without change in eNOS expression level. COX inhibition (indomethacin) improved acetylcholine-mediated relaxation in old obese rats only, suggesting involvement of vasoconstrictor prostanoids. In addition, COX2 inhibition (NS398) and TxA2/PGH2 receptor blockade (SQ29548) both improved relaxation in old Zucker rat arteries. Old Zucker rats had the highest TxB2 (TxA2 metabolite) blood level associated with increased COX2 immunostaining. Chronic COX2 blockade (Celecoxib, 3 weeks) restored endothelium-dependent relaxation in old Zucker rats to the level observed in old lean rats. Thus the combination of aging and metabolic syndrome further impairs endothelium-dependent relaxation by inducing an excessive production of COX2-derived vasoconstrictor(s); possibly TxA2.
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Affiliation(s)
- Emilie Vessières
- Centre National de la Recherche Scientifique UMR 6214, Université d'Angers Angers, France
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Biasucci LM, Graziani F, Rizzello V, Liuzzo G, Guidone C, De Caterina AR, Brugaletta S, Mingrone G, Crea F. Paradoxical preservation of vascular function in severe obesity. Am J Med 2010; 123:727-34. [PMID: 20670727 DOI: 10.1016/j.amjmed.2010.02.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 01/28/2010] [Accepted: 02/02/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Obesity is associated with a high risk of coronary artery disease morbidity and mortality. Yet, postmortem studies have shown that severely obese subjects exhibit smooth coronary arteries, thus suggesting that they may be protected from atherosclerosis. We assessed vascular function and its possible determinants in a cohort of normal-weight to severely obese insulin-sensitive subjects (body mass index [BMI] 23.2-49 kg/m(2)). METHODS Seventy-one healthy, insulin-sensitive subjects (Homeostasis Model Assessment of Insulin Resistance index <2.5), divided into normal-weight (n = 13; BMI = 23.2 +/- 1.6), obese (n = 35; BMI=32.6+/-2.5), and severely obese (n=23; BMI=49.0+/-7.9) groups, were enrolled. Vascular function was evaluated by flow-mediated dilation and carotid intima-media thickness. High-sensitivity C-reactive protein, leptin, adiponectin, vascular growth factors, and CD34+KDR+/CD133+ endothelial progenitor cells, known markers of vascular health/protection, also were measured. RESULTS Flow-mediated dilation was higher in severely obese than in obese and normal-weight individuals (P=.019 and P=.011 respectively). Intima-media thickness was consistently lower in severely obese than in obese individuals (P=.040) and similar in severely obese and normal-weight individuals (P >.99). Levels of high-sensitivity C-reactive protein and leptin were higher in severely obese than in obese and normal-weight individuals (high-sensitivity C-reactive protein: P=.018 and P=.05, respectively; leptin: P <.001 for both comparisons). CD34+KDR+ endothelial progenitor cells were significantly higher in severely obese versus obese individuals (P=.039). CONCLUSION Our study demonstrates that vascular function is paradoxically better in severely obese than in obese subjects and similar to that found in normal-weight subjects. Despite higher levels of high-sensitivity C-reactive protein and leptin, severely obese individuals may be partially protected from atherosclerosis, possibly by a greater mobilization of endothelial progenitor cells.
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Abstract
Although beta-blockers have been endorsed by guidelines committees for the treatment of patients with hypertension, particularly those with significant CVD and high CVD risk, there are concerns about conventional beta-blockers related to poorer clinical outcomes compared with other classes of antihypertensive agents, as well as deleterious effects on quality of life and lipid and carbohydrate metabolism. beta-Blockers comprise a heterogeneous group of antihypertensive agents, including nonselective agents, cardioselective, nonvasodilating agents, and vasodilating agents that either combine beta-nonselectivity with alpha-blockade or possess cardioselectivity without alpha-blockade. The pharmacologic, mechanistic, and hemodynamic differences between conventional, nonvasodilating beta-blockers and vasodilating beta-blockers are discussed in this review, with a focus on the cardioselective vasodilating beta-blocker nebivolol. These differences may have important clinical implications, particularly in the treatment of complicated hypertension, such as that associated with patients with diabetes or the cardiometabolic syndrome, elderly patients, and African American patients, suggesting that mechanism of action may be an important consideration when choosing a beta-blocker.
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Hopkins ND, Green DJ, Tinken TM, Sutton L, McWhannell N, Cable NT, Stratton G, George K. Does brachial artery flow-mediated dilation scale to anthropometric characteristics? Eur J Appl Physiol 2010; 110:171-6. [PMID: 20440622 DOI: 10.1007/s00421-010-1490-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2010] [Indexed: 12/20/2022]
Abstract
Flow-mediated dilation (FMD) assesses the health of the vascular endothelium. Despite widespread adoption of scaling practices in cardiac research, scaling for body size or composition has not been used for FMD. The present study investigated the relationships between brachial FMD and body composition in 129 children aged 9-10 (75 female symbol, 54 male symbol), and 50 men aged 16-49. Body composition variables (total, lean, fat mass in the whole body, arm, forearm) were assessed by dual-energy X-ray absorptiometry, FMD was measured in the brachial artery using high-resolution ultrasound. FMD was scaled using simple ratios (y/x) and allometric approaches (y/x ( b )) after log-log least squares linear regression produced allometric exponents (b). Size independence was confirmed via bivariate correlations (x:y/x; x:y/x ( b )). No relationships were evident between FMD and body composition variables in adults. Small correlations existed between FMD and measures of segmental fat mass in children (r = -0.18 to -0.19, p < 0.05), there were no significant relationships between FMD and measures of lean or total mass in children. For all significant relationships, b-exponents were different from 1 (CIs -0.36 to 0.07), suggesting ratio scaling approaches were flawed. This was confirmed when ratio scaling produced negative residual size correlations, whereas allometric scaling produced size-independent indices. Correlations between FMD and body composition were weak in children and insignificant in adults. As the results of this study are limited to the populations examined, our findings do not support the adoption of scaling procedures to correct FMD.
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Affiliation(s)
- N D Hopkins
- Research Institute for Sport and Exercise Science, Liverpool John Moore's University, Liverpool, L3 2ET, UK
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Hamburg NM, Mott MM, Bigornia SJ, Duess MA, Kluge MA, Hess DT, Apovian CM, Vita JA, Gokce N. Maladaptive enlargement of the brachial artery in severe obesity is reversed with weight loss. Vasc Med 2010; 15:215-22. [PMID: 20375126 DOI: 10.1177/1358863x10362831] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Maladaptive peripheral arterial remodeling, which leads to large arteries with low shear stress, may be associated with increased cardiovascular risk. We tested the hypothesis that arterial enlargement in severe obesity represents maladaptive remodeling and that weight reduction would reverse this process. We evaluated brachial arterial diameter and flow using ultrasound in 244 severely obese patients (age 44 +/- 11 years, 80% female, body mass index (BMI) 46 +/- 9 kg/m) at baseline and in a group of 67 subjects who experienced weight loss at 1 year. Higher BMI was associated with larger brachial artery diameter (p = 0.01) and lower shear stress (p = 0.008), indicating maladaptive remodeling. Significant (> or = 10%) weight reduction was associated with a decrease in resting arterial diameter (-0.19 +/- 0.47 mm, p = 0.02) along with a trend toward increased shear stress. Decreased systemic inflammation was associated with weight loss-induced reverse remodeling of the brachial artery. Our findings demonstrate the presence of maladaptive arterial remodeling in advanced obesity that was ameliorated by significant weight loss.
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Affiliation(s)
- Naomi M Hamburg
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA.
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Bigornia SJ, Mott MM, Hess DT, Apovian CM, McDonnell ME, Duess MA, Kluge MA, Fiscale AJ, Vita JA, Gokce N. Long-term successful weight loss improves vascular endothelial function in severely obese individuals. Obesity (Silver Spring) 2010; 18:754-9. [PMID: 20057371 PMCID: PMC2857970 DOI: 10.1038/oby.2009.482] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Obesity is associated with increased cardiovascular risk. Although short-term weight loss improves vascular endothelial function, longer term outcomes have not been widely investigated. We examined brachial artery endothelium-dependent vasodilation and metabolic parameters in 29 severely obese subjects who lost > or =10% body weight (age 45 +/- 13 years; BMI 48 +/- 9 kg/m(2)) at baseline and after 12 months of dietary and/or surgical intervention. We compared these parameters to 14 obese individuals (age 49 +/- 11 years; BMI 39 +/- 7 kg/m(2)) who failed to lose weight. For the entire group, mean brachial artery flow-mediated dilation (FMD) was impaired at 6.7 +/- 4.1%. Following sustained weight loss, FMD increased significantly from 6.8 +/- 4.2 to 10.0 +/- 4.7%, but remained blunted in patients without weight decline from 6.5 +/- 4.0 to 5.7 +/- 4.1%, P = 0.013 by ANOVA. Endothelium-independent, nitroglycerin-mediated dilation (NMD) was unaltered. BMI fell by 13 +/- 7 kg/m(2) following successful weight intervention and was associated with reduced total and low-density lipoprotein cholesterol, glucose, hemoglobin A(1c), and high-sensitivity C-reactive protein (CRP). Vascular improvement correlated most strongly with glucose levels (r = -0.51, P = 0.002) and was independent of weight change. In this cohort of severely obese subjects, sustained weight loss at 1 year improved vascular function and metabolic parameters. The findings suggest that reversal of endothelial dysfunction and restoration of arterial homeostasis could potentially reduce cardiovascular risk. The results also demonstrate that metabolic changes in association with weight loss are stronger determinants of vascular phenotype than degree of weight reduction.
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Affiliation(s)
- Sherman J. Bigornia
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Melanie M. Mott
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Donald T. Hess
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Caroline M. Apovian
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Marie E. McDonnell
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mai-Ann Duess
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Matthew A. Kluge
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Joseph A. Vita
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Noyan Gokce
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
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Apovian CM. The causes, prevalence, and treatment of obesity revisited in 2009: what have we learned so far? Am J Clin Nutr 2010; 91:277S-279S. [PMID: 19906802 DOI: 10.3945/ajcn.2009.28473a] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Obesity is a chronic disease that is increasing in prevalence in the United States and worldwide and is often accompanied by multiple comorbidities that lead to type 2 diabetes and cardiovascular disease. In April 2009, the American Society for Nutrition hosted the symposium "An Integrative View of Obesity" at Experimental Biology 2009 in New Orleans, LA. The presentations addressed the causes of the obesity epidemic and notably discussed a combination of genetics, obesogenic environment, cultural and racial concerns, and treatment modalities based on what we have learned from research into the physiology and neuroendocrine regulation of appetite and satiety. The fat cell as an endocrine organ, in addition to contributions from the gut and pancreas, has helped us to understand the origins of this neuroendocrine regulation as a survival advantage in human ancestry, with obesogenic ramifications in today's toxic food environment. Suggestions for the reversal of the obesity epidemic were offered, including public health campaigns, community and medical programs, and industry-supported change in our food supply, eating patterns, and lifestyle. Community-structured programs for exercise and work-related physical activity could also engage a healthier lifestyle into the typical day for the average American as well as for individuals in other countries.
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