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Kałużna-Oleksy M, Krysztofiak H, Sawczak F, Kukfisz A, Szczechla M, Soloch A, Cierzniak M, Szubarga A, Przytarska K, Dudek M, Uchmanowicz I, Straburzyńska-Migaj E. Sex differences in the nutritional status and its association with long-term prognosis in patients with heart failure with reduced ejection fraction: a prospective cohort study. Eur J Cardiovasc Nurs 2024; 23:458-469. [PMID: 38170824 DOI: 10.1093/eurjcn/zvad105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024]
Abstract
AIMS Many studies show the association between malnutrition and poor prognosis in heart failure (HF) patients. Our research aimed to analyse sex differences in patients with HF with reduced ejection fraction (HFrEF), emphasizing nutritional status and the influence of selected parameters on the prognosis. METHODS AND RESULTS We enrolled 276 consecutive patients diagnosed with HFrEF. Nutritional status was assessed using Mini Nutritional Assessment (MNA), geriatric nutritional risk index (GNRI), and body mass index (BMI). The mean follow-up period was 564.4 ± 346.3 days. The analysed group included 81.2% of men. The median age was 58, interquartile range (IQR) 49-64 years. Among all patients, almost 60% were classified as NYHA III or IV. Half of the participants were at risk of malnutrition, and 2.9% were malnourished. During follow-up, 72 (26.1%) patients died. The female sex was not associated with a higher occurrence of malnutrition (P = 0.99) or nutritional risk (P = 0.85), according to MNA. Coherently, GNRI scores did not differ significantly between the sexes (P = 0.29). In contrast, BMI was significantly higher in males (29.4 ± 5.3 vs. 25.9 ± 4.7; P < 0.001). Impaired nutritional status assessed with any method (MNA, GNRI, BMI) was not significantly associated with a worse prognosis. In multivariable analysis, NYHA class, lower estimated glomerular filtration rate, higher B-type natriuretic peptide (BNP), higher N-terminal fragment of proBNP, and higher uric acid were independent of sex and age predictors of all-cause mortality. CONCLUSION There were no sex differences in the nutritional status in the HFrEF patients, apart from lower BMI in females. Impaired nutritional status was not associated with mortality in both men and women.
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Affiliation(s)
- Marta Kałużna-Oleksy
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Helena Krysztofiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Filip Sawczak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Agata Kukfisz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Curie-Sklodowska 9, 41-800 Zabrze, Poland
| | - Magdalena Szczechla
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Aleksandra Soloch
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Maria Cierzniak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Alicja Szubarga
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Katarzyna Przytarska
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Magdalena Dudek
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, Bartla 5, 51-618 Wroclaw, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
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Zhang K, Sun Y, Ding J, Ma Q, Zhang D, Huang W, Xing Y. Effect of nutritional status on adverse clinical events in elderly patients with nonvalvular atrial fibrillation: A retrospective cohort study. Ann Noninvasive Electrocardiol 2024; 29:e13130. [PMID: 38932572 PMCID: PMC11208721 DOI: 10.1111/anec.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 04/02/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE To explore the influence of nutritional status on adverse clinical events in elderly patients with nonvalvular atrial fibrillation. METHODS This retrospective observational cohort study included 196 patients, 75-102-years-old, with nonvalvular atrial fibrillation, hospitalized in our hospital. The nutritional status was assessed using Mini-Nutritional Assessment-Short Form (MNA-SF). Patients with MNA-SF scores of 0-11 and 12-14 were included in the malnutrition and nonmalnutrition groups, respectively. RESULTS The average age of the malnutrition group was higher than that of the nonmalnutrition group, and the levels of body mass index (BMI), hemoglobin (HGB), and albumin (ALB) were significantly lower than those of the nonmalnutrition group, with statistical significance (p < .05). The incidence of all-cause death in the malnutrition group was higher than that in the nonmalnutrition group (p = .007). Kaplan-Meier curve indicated that malnutrition patients have a higher risk of all-cause death (log-rank test, p = .001) and major bleeding events (p = .017). Multivariate Cox proportional hazard regression analysis corrected for confounders showed that malnutrition was an independent risk factor of all-cause death (HR = 1.780, 95%CI:1.039-3.050, p = .036). The malnutrition group had a significantly high incidence of major bleeding than the nonmalnutrition group (p = .026), and there was no significant difference in the proportion of anticoagulation therapy (p = .082) and the incidence of ischemic stroke/systemic embolism (p = .310) between the two groups. CONCLUSIONS Malnutrition is an independent risk factor of all-cause death in elderly patients with atrial fibrillation. The incidence of major bleeding in malnourished elderly patients with atrial fibrillation is high, and the benefit of anticoagulation therapy is not obvious.
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Affiliation(s)
- Kan Zhang
- Department of Geriatrics, Affiliated Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Ying Sun
- Department of Geriatrics, Affiliated Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Jiancao Ding
- Department of Geriatrics, Affiliated Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Qing Ma
- Department of Geriatrics, Affiliated Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Dai Zhang
- Department of Geriatrics, Affiliated Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Wei Huang
- Department of Geriatrics, Affiliated Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Yunli Xing
- Department of Geriatrics, Affiliated Beijing Friendship HospitalCapital Medical UniversityBeijingChina
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Bonikowske AR, Taylor JL, Larson KF, Hardwick J, Ozemek C, Harber MP, Kaminsky LA, Arena R, Lavie CJ. Evaluating current assessment techniques of cardiorespiratory fitness. Expert Rev Cardiovasc Ther 2024; 22:231-241. [PMID: 38855917 DOI: 10.1080/14779072.2024.2363393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Considerable and convincing global data from cohorts across the health spectrum (i.e. apparently healthy to known disease) indicate that cardiorespiratory fitness (CRF) is a major predictor of overall and cardiovascular disease (CVD)-survival, seemingly with greater prognostic resolution compared to other traditional CVD risk factors. Therefore, the assessment of CRF in research and clinical settings is of major importance. AREAS COVERED In this manuscript, we review the technology of measuring CRF assessed by the 'gold standard,' cardiopulmonary exercise testing (CPET), as well as with various other methods (e.g. estimated metabolic equivalents, 6-minute walk tests, shuttle tests, and non-exercise equations that estimate CRF), all of which provide significant prognostic information for CVD- and all-cause survival. The literature through May 2024 has been cited. EXPERT OPINION The promotion of physical activity in efforts to improve levels of CRF is needed throughout the world to improve lifespan and, more importantly, healthspan. The routine assessment of CRF should be considered a vital sign that is routinely assessed in clinical practice.
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Affiliation(s)
| | - Jenna L Taylor
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kathryn F Larson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joel Hardwick
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
| | - Matthew P Harber
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA
| | - Lenny A Kaminsky
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA, USA
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Fröhlich H, Bossmeyer A, Kazmi S, Goode KM, Agewall S, Atar D, Grundtvig M, Frey N, Cleland JGF, Frankenstein L, Clark AL, Täger T. Glycaemic control and insulin therapy are significant confounders of the obesity paradox in patients with heart failure and diabetes mellitus. Clin Res Cardiol 2024; 113:822-830. [PMID: 37608126 PMCID: PMC11108876 DOI: 10.1007/s00392-023-02268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/13/2022] [Indexed: 08/24/2023]
Abstract
BACKGROUND A high body mass index (BMI) confers a paradoxical survival benefit in patients with heart failure (HF) or diabetes mellitus (DM). There is, however, controversy whether an obesity paradox is also present in patients with HF and concomitant DM. In addition, the influence of glycaemic control and diabetes treatment on the presence or absence of the obesity paradox in patients with HF and DM is unknown. METHODS We identified 2936 patients with HF with reduced ejection fraction (HFrEF) in the HF registries of the universities of Heidelberg, Germany, and Hull, UK (general sample). Of these, 598 (20%) were treated for concomitant DM (DM subgroup). The relationship between BMI and all-cause mortality was analysed in both the general sample and the DM subgroup. Patients with concomitant DM were stratified according to HbA1c levels or type of diabetes treatment and analyses were repeated. RESULTS We found an inverse BMI-mortality relationship in both the general sample and the DM subgroup. However, the obesity paradox was less pronounced in patients with diabetes treated with insulin and it disappeared in those with poor glycaemic control as defined by HbA1c levels > 7.5%. CONCLUSION In patients with HFrEF, a higher BMI is associated with better survival irrespective of concomitant DM. However, insulin treatment and poor glycaemic control make the relationship much weaker.
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Affiliation(s)
- Hanna Fröhlich
- Department of Cardiology, Angiology, and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anna Bossmeyer
- Department of Cardiology, Angiology, and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Syed Kazmi
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Kevin M Goode
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Stefan Agewall
- Department of Cardiology, and Institute of Clinical Medicine, Oslo University Hospital Ulleval, University of Oslo, Oslo, Norway
| | - Dan Atar
- Department of Cardiology, and Institute of Clinical Medicine, Oslo University Hospital Ulleval, University of Oslo, Oslo, Norway
| | - Morten Grundtvig
- Medical Department, Innlandet Hospital Trust Division Lillehammer, Lillehammer, Norway
| | - Norbert Frey
- Department of Cardiology, Angiology, and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK
- Robertson Centre for Biostatistics and Clinical Trials, Glasgow, UK
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | | | - Tobias Täger
- Department of Cardiology, Angiology, and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Tagawa K, Tsuru Y, Yokoi K, Aonuma T, Hashimoto J. Inverse association between obesity and aortic pressure augmentation is attenuated in women: the Wakuya study. J Hypertens 2024; 42:783-788. [PMID: 38230603 DOI: 10.1097/hjh.0000000000003657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Pressure wave reflection predicts cardiovascular events in the general population. Obesity is negatively associated with pressure wave reflection. Muscular arterial diameter (responsible for pressure wave reflection) increases with obesity, and obesity-dependent dilation of muscular arteries is attenuated in women compared with men. We investigated the sex differences in the cross-sectional relationship between obesity and pressure wave reflection in a general population cohort. METHODS Tonometric pressure waveforms were recorded in 928 adults (mean age, 56 ± 10 years) to estimate the aortic augmentation index. The BMI was calculated using height and body weight, and waist circumference was recorded at the umbilical level. RESULTS Aortic augmentation index was significantly higher in women than in men. Indices of obesity (BMI and waist circumference) were negatively correlated with the aortic augmentation index in both men and women, even after adjusting for mean arterial pressure (both P < 0.001). Sex and BMI had no synergistic effect on the aortic augmentation index. However, when waist circumference was substituted for BMI, sex and waist circumference had a reciprocal influence on decreasing the aortic augmentation index independent of age, mean arterial pressure, diabetes, and hyperlipidemia (interaction, P = 0.045). CONCLUSION The negative correlation between overweight/obesity and aortic pressure augmentation from peripheral wave reflection is inhibited in women more than in men. Sex differences in aortic pressure augmentation are greater in individuals with central (abdominal) obesity than in those with general obesity.
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Affiliation(s)
- Kaname Tagawa
- Medical Center, Miyagi University of Education, Sendai
- Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba
| | | | | | | | - Junichiro Hashimoto
- Medical Center, Miyagi University of Education, Sendai
- Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Mathew RO, Kretov EI, Huang Z, Jones PG, Sidhu MS, O’Brien SM, Prokhorikhin AA, Rangaswami J, Newman J, Stone GW, Fleg JL, Spertus JA, Maron DJ, Hochman JS, Bangalore S. Body Mass Index and Clinical and Health Status Outcomes in Chronic Coronary Disease and Advanced Kidney Disease in the ISCHEMIA-CKD Trial. Am J Med 2024; 137:163-171.e24. [PMID: 37925061 PMCID: PMC10872316 DOI: 10.1016/j.amjmed.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study aimed to assess whether an obesity paradox (lower event rates with higher body mass index [BMI]) exists in participants with advanced chronic kidney disease (CKD) and chronic coronary disease in the International Study of Comparative Health Effectiveness of Medical and Invasive Approaches (ISCHEMIA)-CKD, and whether BMI modified the effect of initial treatment strategy. METHODS Baseline BMI was analyzed as both a continuous and categorical variable (< 25, ≥ 25 to < 30, ≥ 30 kg/m2). Associations between BMI and the primary outcome of all-cause death or myocardial infarction (D/MI), and all-cause death, cardiovascular death, and MI individually were estimated. Associations with health status were also evaluated using the Seattle Angina Questionnaire-7, the Rose Dyspnea Scale, and the EuroQol-5D Visual Analog Scale. RESULTS Body mass index ≥ 30 kg/m2 vs < 25 kg/m2 demonstrated increased risk for MI (hazard ratio [HR] [95% confidence interval] = 1.81 [1.12-2.92]) and for D/MI (HR 1.45 [1.06-1.96]) with a HR for MI of 1.22 (1.05-1.40) per 5 kg/m2 increase in BMI in unadjusted analysis. In multivariate analyses, a BMI ≥ 30 kg/m2 was marginally associated with D/MI (HR 1.43 [1.00-2.04]) and greater dyspnea throughout follow-up (P < .05 at all time points). Heterogeneity of treatment effect between baseline BMI was not evident for any outcome. CONCLUSIONS In the ISCHEMIA-CKD trial, an obesity paradox was not detected. Higher BMI was associated with worse dyspnea, and a trend toward increased D/MI and MI risk. Larger studies to validate these findings are warranted.
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Affiliation(s)
- Roy O. Mathew
- Department of Medicine, Loma Linda VA Health Care System, Loma Linda, CA, USA
| | - Evgeny I. Kretov
- National Medical Research Center of Ministry of Health of Russia, Novosibirsk, Russia
| | - Zhen Huang
- Duke Clinical and Research Institute and Duke University, Durham, NC, USA
| | - Philip G. Jones
- University of Missouri – Kansas City (UMKC)’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute/, Kansas City, MO, USA
| | | | - Sean M. O’Brien
- Duke Clinical and Research Institute and Duke University, Durham, NC, USA
| | | | - Janani Rangaswami
- George Washington University School of Medicine, Washington, DC, USA
- Washington DC Veteran Affairs Medical Center, Washington, DC, USA
| | - Jonathan Newman
- Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jerome L. Fleg
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - John A. Spertus
- University of Missouri – Kansas City (UMKC)’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute/, Kansas City, MO, USA
| | - David J. Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Judith S. Hochman
- Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Sripal Bangalore
- Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, New York, NY, USA
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Woo HG, Kim DH, Lee H, Kang MK, Song TJ. Association between changes in predicted body composition and occurrence of heart failure: a nationwide population study. Front Endocrinol (Lausanne) 2023; 14:1210371. [PMID: 37937051 PMCID: PMC10627176 DOI: 10.3389/fendo.2023.1210371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023] Open
Abstract
Background Large population-based studies on the association between changes in body composition and the occurrence of heart failure (HF) are rare. We aimed to determine the association between changes in body composition, including the predicted body fat mass index (pBFMI), predicted appendicular skeletal muscle mass index (pASMI), and predicted lean body mass index (pLBMI), and the occurrence of HF. Methods For present study, 2,036,940 people who consecutively underwent national health examinations from 2010~2011 (baseline period) to 2012~2013 (follow-up period) were included. The pBFMI, pASMI, and pLBMI were indirectly investigated using validated anthropometric prediction equations from the Korean National Health and Nutrition Examination Survey cohort. The outcome was defined as at least two or more claims of HF. Results During a median of 7.59 years of follow-up, 22,172 participants (event rate, 1.09%) with HF were observed. Decreased changes in the pASMI and pLBMI were associated with the occurrence of HF among males (hazard ratio [HR] 0.966, 95% confidence interval (CI) [0.944-0.988]; HR 0.939, 95%CI [0.923-0.955], respectively) and females (HR 0.924, 95%CI [0.900-0.947]; HR 0.951, 95%CI [0.939-0.963], respectively). An increased change in the pBFMI was associated with the occurrence of HF in males (HR 1.017, 95%CI [1.001-1.034]). However, paradoxically, a change in the pBFMI was associated with the occurrence of HF in females (HR 0.925, 95%CI [0.909-0.942]). Conclusion Decreased skeletal muscle mass was related to the occurrence of HF. However, the relationship between a change in fat mass and the occurrence of HF was different and even paradoxical depending on sex.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Dong-Hyeok Kim
- Department of Cardiology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hyungwoo Lee
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Min Kyoung Kang
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Digitale JC, Martin JN, Glidden DV, Glymour MM. Key concepts in clinical epidemiology: collider-conditioning bias. J Clin Epidemiol 2023; 161:152-156. [PMID: 37506950 DOI: 10.1016/j.jclinepi.2023.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Jean C Digitale
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
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Zhang C, Wang W, Chang X, Zhan S, Wang S, Feng L, Song Y. Obesity and risk of hearing loss in the middle-aged and elderly: a national cohort of Chinese adults. BMC Public Health 2023; 23:1048. [PMID: 37264346 DOI: 10.1186/s12889-023-15974-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/24/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The relationship between obesity and hearing loss among the middle-aged and older population remained unclear. Moreover, few studies have focused on the impact of gender on this association. METHODS This cohort study extracted the data from the China Health and Retirement Longitudinal Study, a national survey of adults aged 45 years or over. Waist circumference was categorized into three groups: normal, pre-central obesity, and central obesity. We classified BMI into four categories: underweight, normal weight, overweight, and obese. The primary endpoint was the incidence of self-reported hearing loss. RESULTS Of the 14,237 participants, 1972 incidents of hearing loss were identified during a median 6.9 years of follow-up. The cumulative incidence of hearing loss was 13.9% (95% CI 13.3% -14.4%). Our study showed that central obesity was significantly associated with hearing loss (HR 0.84, 95%CI 0.75-0.94), and this relationship was more prominent in males (HR 0.76, 95%CI 0.63-0.91). Among male participants, the underweight group was at the highest risk of hearing loss (HR 1.39, 95%CI 1.08-1.79). Compared with the normal weight group, the adjusted HR for hearing loss in the obese groups was 0.69 (95%CI 0.51-0.94) among men. Among female participants, only the overweight group had a lower risk of hearing loss than the normal weight group (HR 0.83, 95%CI 0.71-0.96). CONCLUSIONS Being overweight and obese were significantly associated with a decreased risk of hearing loss, whereas being underweight was associated with an increased risk of hearing loss.
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Affiliation(s)
- Chen Zhang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing 5 road, Huaiyin District, Jinan, 250021, China
| | - Weiwei Wang
- National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Xicheng District, Beijing, 100088, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xiaotian Chang
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 W 120th Street, New York, NY, 10027, USA
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Lei Feng
- National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Xicheng District, Beijing, 100088, China.
| | - Yongfeng Song
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing 5 road, Huaiyin District, Jinan, 250021, China.
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, 324 Jing 5 road, Huaiyin District, Jinan, 250021, China.
- Shandong Institute of Endocrine and Metabolic Diseases, 324 Jing 5 road, Huaiyin District, Jinan, 250021, China.
- Central Hospital Affiliated to Shandong First Medical University, 105 Jiefang road, Lixia District, Jinan, 250013, China.
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Täger T, Franke J, Frey N, Frankenstein L, Fröhlich H. Prognostic relevance of gradual weight changes on long-term mortality in chronic heart failure. Nutr Metab Cardiovasc Dis 2023; 33:416-423. [PMID: 36604261 DOI: 10.1016/j.numecd.2022.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND AIMS While obesity has been linked to better ouctomes (the obesity paradox), cachexia is associated with higher mortality in patients with heart failure with reduced ejection fraction (HFrEF). As opposed to overt cachexia, little is known about the prognostic impact of gradual, long-term weight changes in stable HFrEF. METHODS AND RESULTS We included ambulatory patients with clinically stable chronic HFrEF on individually optimized treatment. Next to other clinical and functional parameters, changes in body weight over the past one (n = 733, group 1) or two (n = 636, group 2) years were recorded. Four-year mortality was analysed with respect to baseline BMI and changes in body weight or BMI using fractional polynomials. In addition, outcome was stratified by BMI categories (18.5-25 kg/m2: normal weight, >25-30 kg/m2: overweight, >30 kg/m2: obesity). An obesity paradox was present in both groups, with overweight and obese patients having the best prognosis. In both groups, a gradual weight gain of 5% was associated with the lowest mortality, whereas mortality steadily increases with increasing weight loss. Excessive weight gain >10% was also related to higher mortality. Stratification by baseline BMI categories revealed that weight loss was most detrimental in normal weight patients, whereas the prognostic impact of weight change was weaker in obese patients. CONCLUSION In patients with chronic HFrEF, gradual weight loss is associated with steadily increasing mortality, whereas a weight gain of 5% is related to the best prognosis. Prevention of any inappropriate weight loss might be a therapeutic goal in HFrEF patient care.
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Affiliation(s)
- Tobias Täger
- University Hospital Heidelberg, Department for Cardiology, Angiology and Pulmology, Heidelberg, Germany
| | | | - Norbert Frey
- University Hospital Heidelberg, Department for Cardiology, Angiology and Pulmology, Heidelberg, Germany
| | - Lutz Frankenstein
- University Hospital Heidelberg, Department for Cardiology, Angiology and Pulmology, Heidelberg, Germany.
| | - Hanna Fröhlich
- University Hospital Heidelberg, Department for Cardiology, Angiology and Pulmology, Heidelberg, Germany
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11
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Sex-specific impact of anthropometric parameters on outcomes after transcatheter edge-to-edge repair for secondary mitral regurgitation. Int J Cardiol 2023; 371:312-318. [PMID: 36115443 DOI: 10.1016/j.ijcard.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/05/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Body surface area (BSA) has been reported to be the stronger predictor for prognosis than body mass index in heart failure (HF) patients. The sex-specific association of BSA with mortality has been unclear. METHODS EuroSMR, a European multicenter registry, included patients who underwent edge-to-edge repair (TEER) for secondary mitral regurgitation (SMR). The outcome was two-year all-cause mortality. RESULTS The present cohort included 1594 HF patients (age, 74 ± 10 years; male, 66%). Association of calculated BSA with two-year all-cause mortality was evaluated. Patients were classified into three BSA groups: the lowest 10% (S), the highest 10% (L), and intermediate between S and L (M). Mean BSA was 1.87 ± 0.21 m2 (male, 1.94 ± 0.18 m2; female, 1.73 ± 0.18 m2). The association of BSA with the endpoint in females showed a U-shaped curve, indicating worse prognosis for both S and L. The association in males followed a linear regression, demonstrating better prognosis for L. Hazard ratio (HR) of L to S in males was 0.43 (95% confidence interval [CI], 0.25-0.74; p = 0.002), whereas HR of L to M in females was 1.76 (95% CI, 1.11-2.78; p = 0.016) (p for interaction = 0.003). CONCLUSIONS Sex-specific association patterns demonstrate the complex influence of anthropomorphic factors in HF patients scheduled for TEER. Further investigation beyond simple evaluation of weight and height is needed for better comprehension of the obesity paradox and better prediction of the results of transcatheter therapy in HF patients.
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12
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Li S, Zhang W, Fu Z, Liu H. Impact of obesity on all-cause and cause-specific mortality among critically ill men and women: a cohort study on the eICU database. Front Nutr 2023; 10:1143404. [PMID: 37153915 PMCID: PMC10160369 DOI: 10.3389/fnut.2023.1143404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/03/2023] [Indexed: 05/10/2023] Open
Abstract
Background The effect of obesity on intensive care unit outcomes among critically ill patients and whether there are sex differences have not been well investigated. We sought to determine the association between obesity and 30-day all-cause and cause-specific mortality among critically ill men and women. Methods Adult participants who had body mass index (BMI) measurements were included from the eICU database. Participants were divided into six groups according to BMI (kg/m2) categories (underweight, <18.5; normal weight, 18.5-24.9; overweight, 25-29.9; class I obesity, 30-34.9; class II obesity, 35-39.9; class III obesity, ≥40). A multivariable adjusted logistic model was conducted with odds ratios (ORs) and 95% confidence intervals (CIs). A cubic spline curve based on the generalized additive model was used to represent the nonlinear association. Stratified analysis and sensitivity analysis were also performed. Results A total of 160,940 individuals were included in the analysis. Compared with the class I obesity category, the underweight and normal weight categories had higher all-cause mortality, and the multivariable adjusted ORs were 1.62 (95% CI: 1.48-1.77) and 1.20 (95% CI: 1.13-1.27) for the general population, 1.76 (95% CI: 1.54-2.01) and 1.22 (95% CI: 1.13-1.32) for men, and 1.51 (95% CI: 1.33-1.71) and 1.16 (95% CI: 1.06-1.27) for women, respectively. Accordingly, multivariable adjusted ORs for the class III obesity category were 1.14 (95% CI: 1.05-1.24) for the general population, 1.18 (95% CI: 1.05-1.33) for men, and 1.10 (95% CI: 0.98-1.23) for women. With cubic spline curves, the association between BMI and all-cause mortality was U-shaped or reverse J-shaped. Similar findings were observed for cause-specific mortality, with the underweight category associated with a higher risk of mortality. Class III obesity increased the risk of cardiovascular death among men (OR 1.51; 95% CI: 1.23-1.84) and increased the risk of other-cause death among women (OR 1.33; 95% CI: 1.10-1.61). Conclusion The obesity paradox appears to be suitable for all-cause and cause-specific mortality among critically ill men and women. However, the protective effect of obesity cannot be extended to severely obese individuals. The association between BMI and cardiovascular mortality was sex-specific and was more pronounced among men than among women. Graphical abstract.
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Affiliation(s)
- Shan Li
- Department of Cardiology, The Second Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Geriatric Disease, Beijing, China
- *Correspondence: Shan Li,
| | - Wei Zhang
- National Clinical Research Center for Geriatric Disease, Beijing, China
- Department of Outpatient, The Second Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Zhiqing Fu
- Department of Cardiology, The Second Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Hongbin Liu
- Department of Cardiology, The Second Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Geriatric Disease, Beijing, China
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13
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Zhang Y, He Q, Zhang W, Xiong Y, Shen S, Yang J, Ye M. Non-linear Associations Between Visceral Adiposity Index and Cardiovascular and Cerebrovascular Diseases: Results From the NHANES (1999–2018). Front Cardiovasc Med 2022; 9:908020. [PMID: 35811709 PMCID: PMC9263190 DOI: 10.3389/fcvm.2022.908020] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate associations between visceral adiposity index (VAI) and cardiovascular and cerebrovascular diseases (CCDs) in the American population from 1999 to 2018.MethodsData from the National Health and Nutrition Examination Survey (1998–2018) were analyzed in this study. Specifically, VAI scores were calculated using sex-specific equations that incorporate body mass index, waist circumference (WC), high-density lipoprotein (HDL), triglycerides (TG), and cholesterol. Weighted logistic regression analysis was conducted to assess the relationship between VAI tertile and increased risk of CCDs. Restricted cubic splines were used to evaluate the non-linear relationship between VAI and CCDs, such as heart failure, angina, heart attack, stroke, hypertension, and coronary heart disease. Sensitivity analysis was conducted, using VAI quartiles as independent variables.ResultsA total of 22,622 subjects aged over 20 years were included. In the fully adjusted model after controlling for covariates, the third VAI tertile was more strongly associated with CCDs than the first VAI tertile, with odds ratio (OR) and 95% confidence interval (95% CI) values for angina of 2.86, 1.68–4.85; heart attack, 1.75, 1.14–2.69; stroke, 2.01, 1.23–3.26; hypertension, 2.28, 1.86–2.78; and coronary heart disease, 1.78, 1.32–2.41; but there was no significant association with heart failure (p > 0.05). Restricted cubic splines revealed parabolic relationships between VAI score and angina (p for non-linear = 0.03), coronary heart disease (p for non-linear = 0.01), and hypertension (p for non-linear < 0.001). Sensitivity analysis indicated that the fourth VAI quartile was more strongly associated with an increased risk of angina (OR = 2.92, 95% CI, 1.49–5.69), hypertension (OR = 2.37, 95% CI, 1.90–2.97), heart attack (OR = 1.77, 95% CI, 1.09–2.88), and coronary heart disease (OR = 1.89, 95% CI, 1.24–2.86) than the first VAI quartile. VAI had superior predictive power for prevalent CCDs than other independent indicators (p < 0.05).ConclusionVisceral adiposity index score is positively correlated with angina, heart attack, stroke, hypertension, and coronary heart disease, but not heart failure, and the relationships between VAI score and angina, hypertension, and coronary heart disease are non-linear.
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Affiliation(s)
- Yangchang Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Qiang He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Weihao Zhang
- Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guizhou Medical University, Guiyang, China
| | - Yang Xiong
- West China Hospital, Sichuan University, Chengdu, China
| | - Shisi Shen
- The First School of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Jialu Yang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Mengliang Ye
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
- *Correspondence: Mengliang Ye,
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14
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Kwon W, Lee SH, Yang JH, Choi KH, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Ahn CM, Ko YG, Yu CW, Jang WJ, Kim HJ, Kwon SU, Jeong JO, Park SD, Cho S, Bae JW, Gwon HC. Impact of the Obesity Paradox Between Sexes on In-Hospital Mortality in Cardiogenic Shock: A Retrospective Cohort Study. J Am Heart Assoc 2022; 11:e024143. [PMID: 35658518 PMCID: PMC9238714 DOI: 10.1161/jaha.121.024143] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Several studies have shown that obesity is associated with better outcomes in patients with cardiogenic shock (CS). Although this phenomenon, the “obesity paradox,” reportedly manifests differently based on sex in other disease entities, it has not yet been investigated in patients with CS. Methods and Results A total of 1227 patients with CS from the RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With Cardiogenic Shock) registry in Korea were analyzed. The study population was classified into obese and nonobese groups according to Asian Pacific criteria (BMI ≥25.0 kg/m2 for obese). The clinical impact of obesity on in‐hospital mortality according to sex was analyzed using logistic regression analysis and restricted cubic spline curves. The in‐hospital mortality rate was significantly lower in obese men than nonobese men (34.2% versus 24.1%, respectively; P=0.004), while the difference was not significant in women (37.3% versus 35.8%, respectively; P=0.884). As a continuous variable, higher BMI showed a protective effect in men; conversely, BMI was not associated with clinical outcomes in women. Compared with patients with normal weight, obesity was associated with a decreased risk of in‐hospital death in men (multivariable‐adjusted odds ratio [OR], 0.63; CI, 0.43–0.92 [P=0.016]), but not in women (multivariable‐adjusted OR, 0.94; 95% CI, 0.55–1.61 [P=0.828]). The interaction P value for the association between BMI and sex was 0.023. Conclusions The obesity paradox exists and apparently occurs in men among patients with CS. The differential effect of BMI on in‐hospital mortality was observed according to sex. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02985008.
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Affiliation(s)
- Woochan Kwon
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seung Hun Lee
- Division of Cardiology Department of Internal Medicine Chonnam National University Hospital Gwangju Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Young Bin Song
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology Severance Cardiovascular HospitalYonsei University College of Medicine Seoul Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology Severance Cardiovascular HospitalYonsei University College of Medicine Seoul Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology Department of Internal Medicine Korea University Anam Hospital Seoul Republic of Korea
| | - Woo Jin Jang
- Department of Cardiology Ewha Woman's University Seoul HospitalEhwa Woman's University School of Medicine Seoul Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology Department of Medicine Konkuk University Medical Center Seoul Republic of Korea
| | - Sung Uk Kwon
- Division of Cardiology Department of Internal Medicine Ilsan Paik HospitalUniversity of Inje College of Medicine Seoul Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology Department of Internal Medicine Chungnam National University Hospital Daejeon Republic of Korea
| | - Sang-Don Park
- Division of Cardiology Department of Medicine Inha University Hospital Incheon Republic of Korea
| | - Sungsoo Cho
- Division of Cardiovascular Medicine Department of Internal Medicine Dankook University HospitalDankook University College of Medicine Cheonan Korea
| | - Jang-Whan Bae
- Department of Internal Medicine Chungbuk National University HospitalChungbuk National UniversityCollege of Medicine Cheongju Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea
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15
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Abstract
Overweight and obesity adversely impact cardiac structure and function, affecting systolic and diastolic ventricular function. Epidemiologic studies have documented an obesity paradox in large heart failure cohorts, where overweight and obese individuals with established heart failure have a better short- and medium-term prognosis compared with leaner patients; this relationship is strongly impacted by level of cardiorespiratory fitness. There are implications for therapies aimed at increasing lean mass as well as weight loss and improvements in quality of diet for the prevention and treatment of heart failure and concomitant obesity to improve cardiorespiratory fitness.
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16
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Tokatli MR, Sisti LG, Marziali E, Nachira L, Rossi MF, Amantea C, Moscato U, Malorni W. Hormones and Sex-Specific Medicine in Human Physiopathology. Biomolecules 2022; 12:413. [PMID: 35327605 PMCID: PMC8946266 DOI: 10.3390/biom12030413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/04/2022] [Indexed: 12/11/2022] Open
Abstract
A prodigious increment of scientific evidence in both preclinical and clinical studies is narrowing a major gap in knowledge regarding sex-specific biological responses observed in numerous branches of clinical practices. Some paradigmatic examples include neurodegenerative and mental disorders, immune-related disorders such as pathogenic infections and autoimmune diseases, oncologic conditions, and cardiovascular morbidities. The male-to-female proportion in a population is expressed as sex ratio and varies eminently with respect to the pathophysiology, natural history, incidence, prevalence, and mortality rates. The factors that determine this scenario incorporate both sex-associated biological differences and gender-dependent sociocultural issues. A broad narrative review focused on the current knowledge about the role of hormone regulation in gender medicine and gender peculiarities across key clinical areas is provided. Sex differences in immune response, cardiovascular diseases, neurological disorders, cancer, and COVID-19 are some of the hints reported. Moreover, gender implications in occupational health and health policy are offered to support the need for more personalized clinical medicine and public health approaches to achieve an ameliorated quality of life of patients and better outcomes in population health.
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Affiliation(s)
| | - Leuconoe Grazia Sisti
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.G.S.); (E.M.); (L.N.); (U.M.)
- National Institute for Health, Migration and Poverty, 00153 Rome, Italy
| | - Eleonora Marziali
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.G.S.); (E.M.); (L.N.); (U.M.)
| | - Lorenza Nachira
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.G.S.); (E.M.); (L.N.); (U.M.)
| | - Maria Francesca Rossi
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.F.R.); (C.A.)
| | - Carlotta Amantea
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.F.R.); (C.A.)
| | - Umberto Moscato
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.G.S.); (E.M.); (L.N.); (U.M.)
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.F.R.); (C.A.)
| | - Walter Malorni
- Course in Pharmacy, University of Tor Vergata, 00133 Rome, Italy;
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.G.S.); (E.M.); (L.N.); (U.M.)
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17
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Gotsman I, Keren A, Amir O, Zwas DR. Increased estimated fat-free mass and fat mass associated with improved clinical outcome in heart failure. Eur J Clin Invest 2022; 52:e13655. [PMID: 34293203 DOI: 10.1111/eci.13655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increased weight measured by body mass index is associated with better clinical outcomes in heart failure (HF). The effect of specific components of body mass on outcome is limited. We evaluated the impact of fat-free mass and fat mass on mortality and cardiovascular hospitalization in a large real-world cohort of patients with chronic HF. METHODS Body measurements were assessed in patients with chronic HF. Fat-free mass, fat mass and waist circumference were calculated based on specifically derived formulas. RESULTS The cohort included 6328 HF patients. Mean follow-up was 744 days. Increased body composition indices including body mass index, fat-free mass index and fat mass index, per cent body fat and waist circumference were associated with better survival. Cox regression analysis after adjustment for other significant parameters demonstrated that these indices were all associated with improved survival. The strongest association was seen with fat-free mass index with a graded increase in survival; lowest death in the highest quartile compared to reference second quartile (hazard ratio 0.79, 95% confidence interval 0.67-0.93, P < .01). There was no interaction with sex or HF type. Analysis of the clinical outcome of death and cardiovascular hospitalization demonstrated that a worse prognosis was in the lowest quartile of all the indices. A sensitivity analysis, analysing these indices as continuous parameters using restricted cubic splines, demonstrated a clear continuous association between these indices and increased survival in both sexes. CONCLUSIONS Body mass including fat-free mass and fat mass was associated with improved survival in patients with HF.
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Affiliation(s)
- Israel Gotsman
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Heart Failure Center, Clalit Health Services, Jerusalem, Israel
| | - Andre Keren
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Heart Failure Center, Clalit Health Services, Jerusalem, Israel
| | - Offer Amir
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Donna R Zwas
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Heart Failure Center, Clalit Health Services, Jerusalem, Israel
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Zhang Y, Zhang Y, Shi Y, Dong W, Mu Y, Wang J, Gao Y, Hu R, Xu Y, Chen Y, Ma J. Influence of Waist-to-Hip Ratio on the Prognosis of Heart Failure Patients With Revascularized Coronary Heart Disease. Front Cardiovasc Med 2021; 8:732200. [PMID: 34660733 PMCID: PMC8517130 DOI: 10.3389/fcvm.2021.732200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/01/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Heart failure (HF) is considered one of the most common complications of coronary heart disease (CHD), with a higher incidence of readmission and mortality. Thus, exploring the risk factors related to the prognosis is necessary. Moreover, the effect of the waist-to-hip ratio (WHR) on HF patients with revascularized CHD is still unclear. Thus, we aimed to assess the influence of WHR on the prognosis of HF patients with revascularized CHD. Methods: We collected data of HF patients with revascularized CHD who were referred to the Cardiac Rehabilitation Clinic of PLA Hospital from June 30, 2015, to June 30, 2019. Cox proportional hazard regression analysis was used to determine the relationship between WHR and prognosis of HF patients with revascularized CHD. Patients were divided into higher and lower WHR groups based on the cutoff WHR value calculated by the X-tile software. Cox regression analysis was used to analysis the two groups. We drew the receiver operating characteristic curve (ROC) of WHR and analyzed the differences between the two groups. Endpoints were defined as major adverse cardiac events (MACE) (including all-cause mortality, non-fatal myocardial infarction, unscheduled revascularization, and stroke). Results: During the median follow-up of 39 months and maximum follow-up of 54 months, 109 patients were enrolled, of which 91.7% were males, and the mean age was 56.0 ± 10.4 years. WHR was associated with the incidence of MACE in the Cox regression analysis (p = 0.001); an increase in WHR of 0.01 unit had a hazard ratio (HR) of 1.134 (95%CI: 1.057-1.216). The WHR cutoff value was 0.93. Patients in the higher WHR group had a significantly higher risk of MACE than those in the lower WHR group (HR = 7.037, 95%CI: 1.758-28.168). The ROC area under the curve was 0.733 at 4 years. Patients in the higher WHR group had a higher body mass index (BMI; 26.7 ± 3.5 vs. 25.4 ± 2.4, P = 0.033) than patients in the lower WHR group. Conclusions: WHR is an independent risk factor of the long-term prognosis of Chinese HF patients with revascularized CHD. Patients with WHR ≥ 0.93 require intensified treatment. Higher WHR is related to higher BMI and ΔVO2/ΔWR.
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Affiliation(s)
- Yingyue Zhang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Yan Zhang
- The First Affiliated Hospital of Dalian Medical University, Liaoning, China
| | - Yajun Shi
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Wei Dong
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yang Mu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jing Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yifan Gao
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Rong Hu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Yong Xu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Jing Ma
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
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19
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Impact of Body Composition Indices on Ten-year Mortality After Revascularization of Complex Coronary Artery Disease (From the Syntax Extended Survival Trial). Am J Cardiol 2021; 151:30-38. [PMID: 34049676 DOI: 10.1016/j.amjcard.2021.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022]
Abstract
Numerous studies have demonstrated a paradoxical association between higher baseline body mass index (BMI) and lower long-term mortality risk after coronary revascularization, known as the "obesity paradox", possibly relying on the single use of BMI. The current study is a post-hoc analysis of the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended follow-up of the SYNTAX trial comparing percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in patients with left-main coronary artery disease (LMCAD) or three-vessel disease (3VD). Patients were stratified according to baseline BMI and/or waist circumference (WC). Out of 1,800 patients, 1,799 (99.9%) and 1,587 (88.2%) had available baseline BMI and WC data, respectively. Of those, 1,327 (73.8%) patients had High BMI (≥25 kg/m2), whereas 705 (44.4%) patients had High WC (>102 cm for men or >88 cm for women). When stratified by both BMI and WC, 10-year mortality risk was significantly higher in patients with Low BMI/Low WC (adjusted hazard ratio [HR]: 1.65; 95% confidence interval [CI]: 1.09 to 2.51), Low BMI/ High WC (adjusted HR: 2.74; 95% CI: 1.12 to 6.69), or High BMI/High WC (adjusted HR: 1.59; 95% CI: 1.11 to 2.27) compared to those with High BMI/Low WC. In conclusion, the "obesity paradox" following coronary revascularization would be driven by low long-term mortality risk of the High BMI/Low WC group. Body composition should be assessed by the combination of BMI and WC in the appropriate evaluation of the long-term risk of obesity in patients with LMCAD or 3VD.
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Li X, Zhai Y, Zhao J, He H, Li Y, Liu Y, Feng A, Li L, Huang T, Xu A, Lyu J. Impact of Metabolic Syndrome and It's Components on Prognosis in Patients With Cardiovascular Diseases: A Meta-Analysis. Front Cardiovasc Med 2021; 8:704145. [PMID: 34336959 PMCID: PMC8319572 DOI: 10.3389/fcvm.2021.704145] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Patients with metabolic syndrome (MetS) have a higher risk of developing cardiovascular diseases (CVD). However, controversy exists about the impact of MetS on the prognosis of patients with CVD. Methods: Pubmed, Cochrane library, and EMBASE databases were searched. Cohort Studies and randomized controlled trials post hoc analyses that evaluated the impact of MetS on prognosis in patients (≥18 years) with CVD were included. Relative risk (RR), hazard rate (HR) and 95% confidence intervals (CIs) were calculated for each individual study by random-effect model. Subgroup analysis and meta-regression analysis was performed to explore the heterogeneity. Results: 55 studies with 16,2450 patients were included. Compared to patients without MetS, the MetS was associated with higher all-cause death [RR, 1.220, 95% CI (1.103 to 1.349), P, 0.000], CV death [RR, 1.360, 95% CI (1.152 to 1.606), P, 0.000], Myocardial Infarction [RR, 1.460, 95% CI (1.242 to 1.716), P, 0.000], stroke [RR, 1.435, 95% CI (1.131 to 1.820), P, 0.000]. Lower high-density lipoproteins (40/50) significantly increased the risk of all-cause death and CV death. Elevated fasting plasma glucose (FPG) (>100 mg/dl) was associated with an increased risk of all-cause death, while a higher body mass index (BMI>25 kg/m2) was related to a reduced risk of all-cause death. Conclusions: MetS increased the risk of cardiovascular-related adverse events among patients with CVD. For MetS components, there was an increased risk in people with low HDL-C and FPG>100 mg/dl. Positive measures should be implemented timely for patients with CVD after the diagnosis of MetS, strengthen the prevention and treatment of hyperglycemia and hyperlipidemia.
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Affiliation(s)
- Xiao Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Clinical Medicine, Qinghai Institute of Health Sciences, Xining, China
| | - Yajing Zhai
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Jiaguo Zhao
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
| | - Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuanjie Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yue Liu
- Xiyuan Hospital of China Academy of Chinese Medicinal Sciences, Beijing, China
| | - Aozi Feng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Li Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Anding Xu
- Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Abstract
Nutrition is the primary source of energy production for myocardial contractility and to maintaining cardiac efficiency. Although many studies provided evidence of the benefits of nutritional intervention in chronic heart failure patients (CHF), these effects are not still completely understood. We searched in PubMed and Embase articles related to the following keywords: "chronic heart failure" with "diet," "nutrition," "insulin resistance," and "caloric restriction." Of the 975 retrieved articles, 20 have been selected. The primary endpoint was the left ventricular (LV) function and the secondary mortality rate in HF patients. Some studies showed that the Mediterranean diet (MedDiet) had a beneficial effect on cardiac function, while others did not find any positive impact. Nutritional supplements and hypercaloric intake had positive effects on underweight HF patients, while hypocaloric diet was beneficial in obese HF patients improving glucose control and cardiac function. The effect of MedDiet in HF patients showed conflicting results. Changes in the dietary pattern can reduce the evolution of HF, considering not only the quality of food but also the caloric intake. The discriminant factor to prescribe a diet regime in HF patients is represented by body mass index (BMI). A well-balanced caloric diet represents an effective therapy in overweight HF patients to reduce the mortality rate. Long-term studies evaluating cause-effect of energy and macronutrients intake on cardiac function in HF patients are necessary.
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Affiliation(s)
- Vittorio Emanuele Bianchi
- Endocrinology and Metabolism, Clinical Center Stella Maris, Strada Rovereta, 42-47891 Falciano, Falciano, San Marino.
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Takahashi S, Tanno K, Yonekura Y, Ohsawa M, Kuribayashi T, Ishibashi Y, Omama S, Tanaka F, Onoda T, Sakata K, Koshiyama M, Itai K, Okayama A. Low educational level increases functional disability risk subsequent to heart failure in Japan: On behalf of the Iwate KENCO study group. PLoS One 2021; 16:e0253017. [PMID: 34101763 PMCID: PMC8186788 DOI: 10.1371/journal.pone.0253017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/27/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives The risk factors that contribute to future functional disability after heart failure (HF) are poorly understood. The aim of this study was to determine potential risk factors to future functional disability after HF in the general older adult population in Japan. Methods The subjects who were community-dwelling older adults aged 65 or older without a history of cardiovascular diseases and functional disability were followed in this prospective study for 11 years. Two case groups were determined from the 4,644 subjects: no long-term care insurance (LTCI) after HF (n = 52) and LTCI after HF (n = 44). We selected the controls by randomly matching each case of HF with three of the remaining 4,548 subjects who were event-free during the period: those with no LTCI and no HF with age +/-1 years and of the same sex, control for the no LTCI after HF group (n = 156), and control for the LTCI after HF group (n = 132). HF was diagnosed according to the Framingham diagnostic criteria. Individuals with a functional disability were those who had been newly certified by the LTCI during the observation period. Objective data including blood samples and several socioeconomic items in the baseline survey were assessed using a self-reported questionnaire. Results Significantly associated risk factors were lower educational levels (odds ratio (OR) [95% confidence interval (CI)]: 3.72 [1.63–8.48]) in the LTCI after HF group and hypertension (2.20 [1.10–4.43]) in no LTCI after HF group. Regular alcohol consumption and unmarried status were marginally significantly associated with LTCI after HF (OR [95% CI]; drinker = 2.69 [0.95–7.66]; P = 0.063; unmarried status = 2.54 [0.91–7.15]; P = 0.076). Conclusion Preventive measures must be taken to protect older adults with unfavorable social factors from disability after HF via a multidisciplinary approach.
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Affiliation(s)
- Shuko Takahashi
- Division of Medical Education, Iwate Medical University, Shiwa-gun, Iwate, Japan
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Health and Welfare, Iwate Prefectural Government, Morioka, Iwate, Japan
- * E-mail:
| | - Kozo Tanno
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | | | - Masaki Ohsawa
- Morioka Tsunagi Onsen Hospital, Morioka, Iwate, Japan
| | - Toru Kuribayashi
- Faculty of Humanities and Social Sciences, Iwate University, Morioka, Japan
| | - Yasuhiro Ishibashi
- Department of Neurology and Gerontology, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | - Shinichi Omama
- Department of Neurosurgery, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | - Fumitaka Tanaka
- Division of Nephrology and Hypertension, School of Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | | | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | | | - Kazuyoshi Itai
- Department of Nutritional Sciences, Morioka University, Takizawa, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
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Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, Lear SA, Ndumele CE, Neeland IJ, Sanders P, St-Onge MP. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e984-e1010. [PMID: 33882682 PMCID: PMC8493650 DOI: 10.1161/cir.0000000000000973] [Citation(s) in RCA: 1052] [Impact Index Per Article: 350.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. In this statement, we summarize the impact of obesity on the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, especially sudden cardiac death and atrial fibrillation. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.
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Saadati HM, Sabour S, Mansournia MA, Mehrabi Y, Nazari SSH. The Direct Effect of Body Mass Index on Cardiovascular Outcomes among Participants Without Central Obesity by Targeted Maximum Likelihood Estimation. Arq Bras Cardiol 2021; 116:879-886. [PMID: 34008807 PMCID: PMC8121468 DOI: 10.36660/abc.20200231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Body mass index (BMI) is the most commonly used index to categorize a person as obese or non-obese, which is subject to important limitations. OBJECTIVE To evaluate the direct effect of BMI on cardiovascular outcomes among participants without central obesity. METHODS This analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities Study (ARIC). BMI was measured as general obesity, and waist circumference (WC), waist-to-hip ratio (WHR) and hip circumference as central obesity. Targeted maximum likelihood estimation (TMLE) was used to estimate the total effects (TEs) and the controlled direct effects (CDEs). The proportion of TE that would be eliminated if all participants were non-obese regarding central obesity was computed using the proportion eliminated (PE) index. P <0.05 was considered statistically significant. Analyses were performed in the TMLE R package. RESULTS The risk of cardiovascular outcomes attributed to BMI was significantly reversed by eliminating WHR obesity (p<0.001). The proportion eliminated of BMI effects was more tangible for non-obese participants regarding WC (PE=127%; 95%CI (126,128)) and WHR (PE=97%; 95%CI (96,98)) for coronary heart disease (CHD), and WHR (PE=92%; 95%CI (91,94)) for stroke, respectively. With respect to sex, the proportion eliminated of BMI effects was more tangible for non-obese participants regarding WHR (PE=428%; 95%CI (408,439)) for CHD in males, and WC (PE=99%; 95%CI (89,111)) for stroke in females, respectively. CONCLUSION These results indicate different potential effects of eliminating central obesity on the association between BMI and cardiovascular outcomes for males and females. (Arq Bras Cardiol. 2021; 116(5):879-886).
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Affiliation(s)
- Hossein Mozafar Saadati
- Departamento de Epidemiologia, Faculdade de Saúde Pública e Segurança, Shahid Beheshti University of Medical Sciences, Tehran - Irã
| | - Siamak Sabour
- Departamento de Epidemiologia, Faculdade de Saúde Pública e Segurança, Shahid Beheshti University of Medical Sciences, Tehran - Irã
| | - Mohammad Ali Mansournia
- Departamento de Epidemiologia e Bioestatística, Faculdade de Saúde Pública, Tehran University of Medical Sciences, Tehran - Irã
| | - Yadollah Mehrabi
- Departamento de Epidemiologia, Faculdade de Saúde Pública e Segurança, Shahid Beheshti University of Medical Sciences, Tehran - Irã
| | - Seyed Saeed Hashemi Nazari
- Centro de Pesquisa de Prevenção de Doenças Cardiovasculares, Faculdade de Saúde Pública e Segurança, Shahid Beheshti University of Medical Sciences, Tehran - Irã
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Czapla M, Juárez-Vela R, Łokieć K, Karniej P. The Association between Nutritional Status and In-Hospital Mortality among Patients with Heart Failure-A Result of the Retrospective Nutritional Status Heart Study 2 (NSHS2). Nutrients 2021; 13:1669. [PMID: 34069058 PMCID: PMC8156051 DOI: 10.3390/nu13051669] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/02/2021] [Accepted: 05/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A nutritional status is related to the prognosis and length of hospitalisation of patients with heart failure (HF). This study aims to assess the effect of nutritional status on in-hospital mortality in patients with heart failure. METHODS We conducted a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of the University Clinical Hospital in Wroclaw (Poland). RESULTS A total of 1056 individuals were included in the analysis. A total of 5.5% of patients died during an in-hospital stay. It was found that in the sample group, 25% of patients who died had a BMI (body mass index) within the normal range, 6% were underweight, 47% were overweight, and 22% were obese. Our results show that non-survivors have a significantly higher nutrition risk screening (NRS) ≥3 (21% vs. 3%; p < 0.001); NYHA (New York Heart Association) grade 4 (70% vs. 24%; p < 0.001). The risk of death was lower in obese patients (HR = 0.51; p = 0.028) and those with LDL (low-density lipoprotein) levels from 116 to <190 mg/dL (HR = 0.10; p = 0.009, compared to those with LDL <55 mg/dL). The risk of death was higher in those with NRS (nutritional risk score) score ≥3 (HR = 2.31; p = 0.014), HFmrEF fraction (HR = 4.69; p < 0.001), and LDL levels > 190 mg/dL (HR = 3.20; p = 0.038). CONCLUSION The malnutrition status correlates with an increased risk of death during hospitalisation. Higher TC (total cholesterol) level were related to a lower risk of death, which may indicate the "lipid paradox". Higher BMI results were related to a lower risk of death, which may indicate the "obesity paradox".
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Affiliation(s)
- Michał Czapla
- Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland; (M.C.); (P.K.)
- Centre for Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Raúl Juárez-Vela
- Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Katarzyna Łokieć
- Department of Propaedeutic of Civilization Diseases, Medical University of Lodz, 90-251 Lodz, Poland;
| | - Piotr Karniej
- Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland; (M.C.); (P.K.)
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Brazile T, Mulukutla S, Thoma F, Estes NAM, Jain S, Saba S. Inverse association of mortality and body mass index in patients with left ventricular systolic dysfunction of both ischemic and non-ischemic etiologies. Clin Cardiol 2021; 44:495-500. [PMID: 33675050 PMCID: PMC8027570 DOI: 10.1002/clc.23556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Obesity is a worldwide epidemic that has been associated with poor outcomes. Previous studies have demonstrated an inverse relationship between body mass index (BMI) and outcomes, the 'obesity paradox', in several diseases. HYPOTHESIS We sought to evaluate whether the obesity paradox is present in patients with left ventricular systolic dysfunction (LVSD) of all etiologies, using all-cause mortality as the primary endpoint and hospitalization as the secondary endpoint. METHODS We conducted a retrospective cohort study of LVSD patients (n = 18 003) seen within the University of Pittsburgh Medical Center network between January 2011 and December 2017. Patients were divided into four BMI categories (underweight, normal weight, overweight, and obese) and stratified by left ventricular ejection fraction (LVEF): <20%, 20-35%, and 35-50%. RESULTS Over a median follow-up of 2.28 years, higher BMI (mean 28.9 ± 6.8) was associated with better survival for the overall cohort and within LVEF strata (p < .0001). The most common cause of hospitalization was subendocardial infarction among underweight and normal weight patients and heart failure among overweight and obese patients. Cox proportional hazards model showed that BMI, age, and comorbid conditions of diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and prior myocardial infarction are independent predictors of death. CONCLUSIONS Our results support the existence of an obesity paradox impacting all-cause mortality in patients with LVSD of ischemic and non-ischemic etiologies even after adjusting for LVEF and comorbidities. Additional research is needed to understand the effect of weight loss on survival once a diagnosis of LVSD is established.
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Affiliation(s)
- Tiffany Brazile
- Department of MedicineUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Suresh Mulukutla
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Floyd Thoma
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - N. A. Mark Estes
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Sandeep Jain
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Samir Saba
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
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Mozafar Saadati H, Sabour S, Mansournia MA, Mehrabi Y, Hashemi Nazari SS. Effect modification of general and central obesity by sex and age on cardiovascular outcomes: Targeted maximum likelihood estimation in the atherosclerosis risk in communities study. Diabetes Metab Syndr 2021; 15:479-485. [PMID: 33662834 DOI: 10.1016/j.dsx.2021.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS To elucidate the effect modification of general and central obesity by sex and age on the risk of cardiovascular events. METHODS The analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities study. Obesity was defined with body mass index (BMI), waist-to-hip ratio (WHR) and body shape index (BSI) which categorized the participants as obese and non-obese. Targeted maximum likelihood estimation was used to estimate the risk ratio (RR) with the tmle package in R software. RESULTS After adjustment, the strongest effect of BMI on CHD was in females (RR (95%CI): 1.26 (1.11, 1.42)) and in age>54 (RR (95%CI): 1.16 (1.06, 1.27)) and for HF it was in age>54 (RR (95%CI): 1.18 (1.10, 1.26)) and in females (RR (95%CI): 1.17 (1.08, 1.28)). Regarding central obesity, WHR (RR (95%CI): 1.19 (1.05, 1.34)) had the strongest effects on CHD for males and BSI (RR (95%CI): 1.140 (1.02, 1.26)) for age ≤ 54, and for HF the WHR (RR (95%CI): 1.22 (1.10, 1.36)) and BSI (RR (95%CI): 1.18 (1.07, 1.30)) had the strongest effects for age≤54, respectively. CONCLUSION Among males and age≤54, WHR index was associated with a higher risk of CHD and HF while BMI was so for females and age>54.
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Affiliation(s)
- Hossein Mozafar Saadati
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Siamak Sabour
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Seyed Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Liu Z, Sanossian N, Starkman S, Avila-Rinek G, Eckstein M, Sharma LK, Liebeskind D, Conwit R, Hamilton S, Saver JL. Adiposity and Outcome After Ischemic Stroke: Obesity Paradox for Mortality and Obesity Parabola for Favorable Functional Outcomes. Stroke 2020; 52:144-151. [PMID: 33272129 DOI: 10.1161/strokeaha.119.027900] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE A survival advantage among individuals with higher body mass index (BMI) has been observed for diverse acute illnesses, including stroke, and termed the obesity paradox. However, prior ischemic stroke studies have generally tested only for linear rather than nonlinear relations between body mass and outcome, and few studies have investigated poststroke functional outcomes in addition to mortality. METHODS We analyzed consecutive patients with acute ischemic stroke enrolled in a 60-center acute treatment trial, the NIH FAST-MAG acute stroke trial. Outcomes at 3 months analyzed were (1) death; (2) disability or death (modified Rankin Scale score, 2-6); and (3) low stroke-related quality of life (Stroke Impact Scale<median). Relations with BMI were analyzed univariately and in multivariate models adjusting for 14 additional prognostic variables. RESULTS Among 1033 patients with acute ischemic stroke, average age was 71 years (±13), 45.1% female, National Institutes of Health Stroke Scale 10.6 (±8.3), and BMI 27.5 (±5.6). In both unadjusted and adjusted analysis, increasing BMI was linearly associated with improved 3-month survival (P=0.01) odds ratios in adjusted analysis for mortality declined across the BMI categories of underweight (odds ratio, 1.7 [CI, 0.6-4.9]), normal (odds ratio, 1), overweight (0.9 [CI, 0.5-1.4]), obese (0.5, [CI, 0.3-1.0]), and severely obese (0.4 [CI, 0.2-0.9]). In unadjusted analysis, increasing BMI showed a U-shaped relation to poststroke disability or death (modified Rankin Scale score, 2-6), with odds ratios of modified Rankin Scale score, 2 to 6 for underweight, overweight, and obese declined initially when compared with normal weight patients, but then increased again in severely obese patients, suggesting a U-shaped or J-shaped relation. After adjustment, including for baseline National Institutes of Health Stroke Scale, modified Rankin Scale score 2 to 6 was no longer related to adiposity. CONCLUSIONS Mortality and functional outcomes after acute ischemic stroke have disparate relations with patients' adiposity. Higher BMI is linearly associated with increased survival; and BMI has a U-shaped or J-shaped relation to disability and stroke-related quality of life. Potential mechanisms including nutritional reserve aiding survival during recovery and greater frequency of atherosclerotic than thromboembolic infarcts in individuals with higher BMI.
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Affiliation(s)
- Zuolu Liu
- Sutter Health, CPMC Comprehensive Stroke Care Center (Z.L.)
| | | | - Sidney Starkman
- University of California, Los Angeles (S.S., G.A.-R., L.K.S., D.L., J.L.S.)
| | - Gilda Avila-Rinek
- University of California, Los Angeles (S.S., G.A.-R., L.K.S., D.L., J.L.S.)
| | | | - Latisha K Sharma
- University of California, Los Angeles (S.S., G.A.-R., L.K.S., D.L., J.L.S.)
| | - David Liebeskind
- University of California, Los Angeles (S.S., G.A.-R., L.K.S., D.L., J.L.S.)
| | - Robin Conwit
- National Institute of Neurological Disorders and Stroke (R.C.)
| | | | - Jeffrey L Saver
- University of California, Los Angeles (S.S., G.A.-R., L.K.S., D.L., J.L.S.)
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Tabucanon T, Wilcox J, Tang WHW. Does Weight Loss Improve Clinical Outcomes in Overweight and Obese Patients with Heart Failure? Curr Diab Rep 2020; 20:75. [PMID: 33231788 DOI: 10.1007/s11892-020-01367-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Obesity increases the risk of new onset heart failure (HF), and particularly HF with preserved ejection fraction (HFpEF). Despite the observations of favorable clinical outcomes in HF patients with obesity in general, sometimes referred to as the "obesity paradox," it is important to recognize that severe obesity is associated with worse clinical outcomes. This review summarizes the effects of obesity treatment on cardiovascular health and HF clinical outcomes. RECENT FINDINGS Treatment for obesity utilizes a variety of modalities to achieve purposeful weight loss including lifestyle intervention, medications, and bariatric surgery. There are a cluster of benefits of obesity treatment in terms of clinical outcomes in HF. The mechanisms of these benefits include both weight loss-dependent and weight loss-independent mechanisms. Obesity treatment is safe and associated with favorable clinical outcomes across the spectrum of the HF population. The potential benefits are facilitated through multiple mechanisms.
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Affiliation(s)
- Thida Tabucanon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
- Thammasat Heart Center, Thammasat University Hospital, Khlong Luang, Pathum Thani, Thailand
| | - Jennifer Wilcox
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA.
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
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Min J, Feng R, Badesch D, Berman-Rosenzweig E, Burger C, Chakinala M, De Marco T, Feldman J, Hemnes A, Horn EM, Lammi MR, Mathai S, McConnell JW, Presberg K, Robinson J, Sager J, Shlobin OA, Simon M, Thenappan T, Ventetuolo C, Al-Naamani N. Obesity in Pulmonary Arterial Hypertension (PAH): The Pulmonary Hypertension Association Registry (PHAR). Ann Am Thorac Soc 2020; 18:229-237. [PMID: 33085915 PMCID: PMC7869778 DOI: 10.1513/annalsats.202006-612oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Obesity is associated with pulmonary arterial hypertension (PAH), but its impact on outcomes such as health-related quality of life (HRQoL), hospitalizations and survival is not well understood. OBJECTIVES To assess the effect of obesity on health-related quality of life (HRQoL), hospitalizations and survival in patients with PAH. METHODS We performed a cohort study of adults with PAH from the Pulmonary Hypertension Association Registry, a prospective multicenter registry. Multivariate linear mixed effects regression was used to examine the relationship between weight categories and HRQoL using the Short Form-12 (SF-12) and emPHasis-10 (e10). We used multivariable negative binomial regression to estimate hospitalization incidence rate ratios (IRRs) and Cox regression to estimate hazard ratios (HRs) for transplant-free survival by weight status. RESULTS 767 subjects were included: mean age of 57 years, 74% female, 33% overweight and 40% obese, with median follow-up duration of 527 days. Overweight and obese patients had higher baseline e10 scores (worse HRQoL), which persisted over time (p<0.001). The overweight and obese have a trend towards increased incidence of hospitalizations compared to normal weight (IRR 1.34, 95% confidence interval (95%CI) 0.94-1.92 and 1.33, 95%CI 0.93-1.89, respectively). Overweight and obese patients had lower risk of transplant or death as compared to normal weight patients (HR 0.45, 95%CI 0.25-0.80 and 0.39, 95%CI 0.22-0.70, respectively). CONCLUSIONS In a large multicenter, prospective cohort of PAH, overweight and obese patients had worse disease-specific HRQoL despite better transplant-free survival compared to normal weight patients. Future interventions should address the specific needs of these patients.
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Affiliation(s)
- Jeff Min
- University of Pennsylvania, 6572, Pulmonary and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Rui Feng
- University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States
| | - David Badesch
- University of Colorado, Medicine, Aurora, Colorado, United States
| | | | - Charles Burger
- Mayo Clinic, Pulmonary and Critical Care, Jacksonville, Florida, United States
| | - Murali Chakinala
- Washington University, Internal Medicine, Saint Louis, Missouri, United States
| | - Teresa De Marco
- University of California San Francisco, Medicine, San Francisco, California, United States
| | - Jeremy Feldman
- Arizona Pulmonary Specialists, Phoenix, Arizona, United States
| | - Anna Hemnes
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Evelyn M Horn
- Weill-Cornell Medical School, New York, New York, United States
| | - Matthew R Lammi
- Louisiana State University Health Sciences Center, Pulmonary/Critical Care and Allergy/Immunology, New Orleans, Louisiana, United States
| | - Stephen Mathai
- Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Medicine, Baltimore, United States
| | - John W McConnell
- Kentuckiana Pulmonary Associates, Louisville, Kentucky, United States
| | - Kenneth Presberg
- Froedtert and the Medical College of Wisconsin Froedtert Hospital, 20721, Milwaukee, Wisconsin, United States
| | | | - Jeffrey Sager
- Santa Barbara Pulmonary Associates, Santa Barbara, California, United States
| | - Oksana A Shlobin
- Inova Fairfax Hospital, Advanced Lung Disease and Transplant, Falls Church, Virginia, United States
| | - Marc Simon
- UPMC and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | | | - Corey Ventetuolo
- Brown University, Medicine , Providence, Rhode Island, United States
| | - Nadine Al-Naamani
- University of Pennsylvania, 6572, Philadelphia, Pennsylvania, United States;
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Obesity paradox in Korean male and female patients with heart failure: A report from the Korean Heart Failure Registry. Int J Cardiol 2020; 325:82-88. [PMID: 33045277 DOI: 10.1016/j.ijcard.2020.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/06/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although the survival benefit of obesity has been suggested in patients with heart failure (HF), the impact of sex on obesity paradox is less clear. This study was performed to investigate whether there is a sex difference in the association between body mass index (BMI) and long-term clinical outcomes in patients hospitalized for HF. METHOD A total of 2616 patients hospitalized for HF (Mean age 66 years and 52% males) from the nation-wide registry database were analyzed. Patients were categorized using baseline BMI as normal (18.5 to 22.9 kg/m2), overweight (23 to 27.4 kg/m2) and obese (≥ 27.5 kg/m2). Their all-cause mortality and long-term composite events, including all-cause mortality and HF readmission, were assessed according to the BMI groups. RESULTS During the median follow-up period of 1499 days, there were 662 patients (25.3%) with all-cause mortality and 1071 patients (40.9%) with composite events. Compared to the normal weight group, the overweight (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.51-0.99; P = 0.045) and obese (HR, 0.53; 95% CI, 0.29-0.95; P = 0.032) group showed lower all-cause mortality rates even after adjusting for confounding factors in the male patients. Otherwise, BMI was not associated with composite events in males; it was not associated with all-cause mortality or composite events in females in the multivariable analyses (P > 0.05 for each). CONCLUSIONS Among patients with HF, a greater BMI was associated with low all-cause mortality in males, but not in females. Obesity paradox should be considered in the management of HF patients.
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Bariatric Surgery and Hospitalization for Heart Failure in Morbidly Obese Patients. Obes Surg 2020; 30:4218-4225. [DOI: 10.1007/s11695-020-04787-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
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The health outcomes of inflammation and obesity in patients with heart failure. Heart Lung 2020; 49:896-901. [PMID: 32507469 DOI: 10.1016/j.hrtlng.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although obesity is a risk factor for cardiovascular disease, higher body mass index is related to longer event-free survival in patients with heart failure (HF). While previous research demonstrated that higher levels of inflammatory mediators were associated with shorter event-free survival, the effect of inflammation on the association between obesity and outcomes of HF have not been considered. HYPOTHESIS Based on the obesity paradox, we hypothesized that patients with higher baseline body mass index (BMI) would experience better event-free survival than those with lower BMI regardless of inflammatory status. METHOD A sample of 415 patients with HF (age 61 ± 11.5 years; 31% female) provided blood to measure soluble tumor necrosis factor receptor1 (sTNFR1), a biomarker of inflammation. Patients were divided into 4 groups based on BMI and a median split of sTNFR1 levels: (1) high BMI ≥ 30 and sTNFR1 > 1804 pg/ml, (2) high BMI ≥ 30 and low sTNFR1 ≤ 1804 pg/ml, and (3) low BMI < 30 and high sTNFR1 > 1804 pg/ml vs. (4) low BMI < 30 and sTNFR1 ≤ 1804 pg/ml. Patients were followed for an average of 365 days to determine the time to first event of either all-cause hospitalization or death. RESULTS There were 177 patients (43%) who experienced either an all-cause hospitalization or death. In a Cox regression, high BMI and high sTNFR1 category predicted time to event (hazard ratio = 1.7, 95% confidence interval = 1.01-2.9) with age, gender, race, left ventricular ejection fraction, New York Heart Association functional class (I/II versus III/IV), log-transformed N-terminal Pro-B-type natriuretic peptide levels, prescribed statin (yes/no), and comorbidity as covariates. CONCLUSION Being in a higher inflammation group was associated with shorter event-free survival regardless of BMI. This study provides evidence that inflammation is an important consideration in the association between obesity and better outcomes in patients with HF.
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Miklisanskaya SV, Mazur NA, Solomasova LV, Chigineva VV. [The «obesity paradox» and its degree of proof]. TERAPEVT ARKH 2020; 92:84-90. [PMID: 32598704 DOI: 10.26442/00403660.2020.04.000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/22/2022]
Abstract
The article gives a critical assessment of the so-called obesity paradox. Methodological errors that occur in the organization of studies that studied the obesity paradox and the formation of comparison groups are highlighted. There are also examples of the disappearance of the obesity paradox when taking into account additional risk factors. The organization of prospective studies or more careful consideration of all currently known risk factors for cardiovascular diseases (CVD) will significantly improve the results of the study of the effect of overweight and obesity on mortality in patients with CVD. Thus, despite the biological possibility of the existence of a positive effect of adipose tissue in CVD, the presence of a large number of errors identified in the analysis of the work of researchers obesity paradox require to reconsider the existence of this phenomenon, it should be taken into account the possibility that the obesity paradox may be a consequence of improper design studies to investigate this phenomenon.
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Affiliation(s)
| | - N A Mazur
- Russian Medical Academy of Continuous Professional Education
| | - L V Solomasova
- Russian Medical Academy of Continuous Professional Education
| | - V V Chigineva
- Russian Medical Academy of Continuous Professional Education
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35
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Nanna MG, Sullivan AE, Bazylevska V, L Wong R, Murphy TE, Bellumkonda L, McNamara RL. Weight change in heart failure inpatients not associated with 30-day readmission. Future Cardiol 2020; 16:289-296. [PMID: 32286858 DOI: 10.2217/fca-2019-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The association of weight change and short-term readmission in patients hospitalized for heart failure (HF) has not been well studied. Methods: We collected clinical and weight data from patients admitted with decompensated HF to a single center (2012-2013). We performed logistic regression to determine the association between weight change and two outcomes: a total of 30-day HF-specific readmission and 30-day all-cause readmission. Results: Admission and discharge weights were documented in 479/658 patients (73%). Weight loss >2 kg was not associated with 30-day all-cause or HF-specific readmission when compared with more modest inpatient weight change (-2 kg to +2 kg; all-cause readmission odds ratio: 0.86; CI: 0.56-1.37; HF-specific readmission odds ratio: 1.15; CI: 0.61-2.16). Conclusion: Among HF inpatients, in-hospital weight loss was not associated with 30-day all-cause or HF-specific readmission.
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Affiliation(s)
- Michael G Nanna
- Duke Clinical Research Institute, Research Fellowship Training Program, Durham, North Carolina 27713, USA.,Duke University School of Medicine, Division of Cardiology, Durham, NC 27713, USA
| | - Alexander E Sullivan
- Duke University School of Medicine, Division of Cardiology, Durham, NC 27713, USA
| | - Vlada Bazylevska
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX 79430, USA
| | - Risa L Wong
- University of Washington & Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Terrence E Murphy
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Lavanya Bellumkonda
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT 06510, USA
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Abstract
Obesity has reached worldwide epidemic proportions, adversely impacting health on a global scale. Overweight and obesity adversely impact cardiac structure and function, affecting systolic and diastolic ventricular function. Studies and meta-analyses have documented an obesity paradox in large heart failure cohorts, where overweight and obese individuals with established heart failure have a better short- and medium-term prognosis compared with lean patients; this relationship is strongly impacted by level of cardiorespiratory fitness. There are implications for therapies aimed at increasing lean and muscle mass, and weight loss, for the prevention and treatment of compared with in patients with concomitant obesity.
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Gao F, Wan J, Xu B, Wang X, Lin X, Wang P. Trajectories of Waist-to-Hip Ratio and Adverse Outcomes in Heart Failure with Mid-Range Ejection Fraction. Obes Facts 2020; 13:344-357. [PMID: 32570251 PMCID: PMC7445556 DOI: 10.1159/000507708] [Citation(s) in RCA: 4] [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: 07/30/2019] [Accepted: 04/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Waist-to-hip ratio (WHR) is a strong predictor of mortality in patients with heart failure (HF). However, common WHR trajectories are not well established in HF with mid-range ejection fraction (HFmrEF) persons, and their relationship to clinical outcomes remains uncertain. METHOD We prospectively enrolled 1,396 participants with HFmrEF (left ventricular ejection fraction 40-49%) from April 2013 through April 2017. The waist and hip circumferences of the subjects were measured at regular intervals, and the WHR was calculated as waist circumference divided by hip circumference. Latent mixture modeling was performed to identify WHR trajectories. We then used Cox proportional-hazard models to examine the association between WHR trajectory patterns and incident HF, incident cardiovascular disease (CVD), and all-cause mortality. RESULTS We identified four distinct WHR trajectory patterns: lean-moderate increase (9.2%), medium-stable/increase (32.7%), heavy-stable/increase (48.0%), and heavy-moderate decrease (10.1%). After multivariable adjustment, the heavy-stable/increase and heavy-moderate decrease patterns were associated with an increased all-cause mortality risk (heavy-stable/increase: adjusted hazard ratio [HR] 3.18, 95% confidence interval [CI] 2.75-4.62; heavy-moderate decrease: adjusted HR 2.32, 95% CI 1.71-3.04), incident CVD risk (heavy-stable/increase: adjusted HR 4.03, 95% CI 2.39-4.91; heavy-moderate decrease: adjusted HR 3.05, 95% CI 2.34-4.09), and incident HF risk (heavy-stable/increase: adjusted HR 2.72, 95% CI 2.05-3.28; heavy-moderate decrease: adjusted HR 2.39, 95% CI 1.80-3.03) with reference to the lean-moderate increase pattern. CONCLUSION Among patients with HFmrEF, the trajectories of WHR gain are associated with poor outcomes. These findings highlight the importance of abdominal fat accumulation management during the progression of HFmrEF.
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Affiliation(s)
- Feng Gao
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jindong Wan
- Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China
| | - Banglong Xu
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaochen Wang
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianhe Lin
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- **Xianhe Lin, Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022 (PR China),
| | - Peijian Wang
- Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China
- *Peijian Wang, Department of Cardiology, The First Affiliated Hospital of, Chengdu Medical College, 278 Baoguang Avenue, Xindu District, Chengdu, Sichuan 610500 (PR China),
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Javalkar V, Kuybu O, Davis D, Kelley RE. Factors Associated with Inpatient Mortality after Intracerebral Hemorrhage: Updated Information from the United States Nationwide Inpatient Sample. J Stroke Cerebrovasc Dis 2019; 29:104583. [PMID: 31862153 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104583] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To use a nationwide database of hospital admissions to assess for trends in inpatient mortality from acute spontaneous intracerebral hemorrhage as well as associated potentially contributing factors. METHODS Adults with intracerebral hemorrhage in the US National Inpatient Sample database from 2012 to 2015 were included in this study. We assessed for mortality rate as well as potential impact of various comorbidities and demographic factors such as ethnicity and median house hold income on inpatient mortality rate. RESULTS A total of 47,700 patients were identified with a mean age of 68 years. The overall mortality rate was 24%. Hypertension was the commonest comorbidity (84%) followed by diabetes mellitus (28%). Positive associated factors for mortality rate were coagulopathy (OR 1.28, 95% CI 1.19-1.38, P < .001), female gender (OR 1.12, 95% CI 1.08-1.17, P < .001), and congestive heart failure (OR 1.16, 95% CI 1.08-1.24, P < .001). Age greater than 75 was also associated with higher mortality (P < .001). Factors associated with reduced mortality were hypertension (OR .76, 95% CI .72-0.81, P < .001), hypothyroidism (OR .87, 95% CI .81-.93, P < .001) and obesity (OR .64, 95% CI .59-.69, P < .001). CONCLUSIONS The inpatient mortality of 24% represents a decline when compared to previous years. Attention to the associated factors with mortality, that we report, could have some potential impact on management. Of interest, we found support for obesity paradox in which obesity may have an actual salutary effect on vascular disease outcome. Our observed paradoxical effects, not only for obesity, but also hypertension and hypothyroidism, warrant further study.
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Affiliation(s)
| | - Okkes Kuybu
- LSU Health Sciences Center-Shreveport, Shreveport
| | - Debra Davis
- LSU Health Sciences Center-Shreveport, Shreveport
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Lavie CJ, Carbone S, Kachur S, OʼKeefe EL, Elagizi A. Effects of Physical Activity, Exercise, and Fitness on Obesity-Related Morbidity and Mortality. Curr Sports Med Rep 2019; 18:292-298. [PMID: 31389871 DOI: 10.1249/jsr.0000000000000623] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Obesity is associated with increased prevalence of cardiovascular (CV) disease (CVD) risk factors, which may adversely impact CV structure and function and may increase the prevalence of most CVD, particularly heart failure (HF) and coronary heart disease (CHD). Physical activity (PA), exercise training (ET) and cardiorespiratory fitness (CRF) are all associated with marked reductions in most CVD, including HF and CHD. Additionally, PA/ET and, especially CRF, markedly alter the relationship between adiposity and subsequent major CVD outcomes and dramatically impact the "obesity paradox," which are all reviewed, including attention to the debate regarding "fitness versus fatness" for long-term prognosis, including in patients with established CVD.
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Salvatore Carbone
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, VA
| | - Sergey Kachur
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Evan L OʼKeefe
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Andrew Elagizi
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
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Gurunathan U, Pym A, Anderson C, Marshall A, Whitehouse SL, Crawford RW. Higher body mass index is not a risk factor for in-hospital adverse outcomes following total knee arthroplasty. J Orthop Surg (Hong Kong) 2019; 26:2309499018802429. [PMID: 30270748 DOI: 10.1177/2309499018802429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To investigate the association between body mass index (BMI) and perioperative complications until hospital discharge, following primary total knee arthroplasty (TKA). METHODS This retrospective study reviewed 1665 cases of elective primary unilateral TKA performed between 2006 and 2010, from a prospective secure electronic database. Types of complications, length of operating time, and duration of hospital stay were analyzed in both adjusted (for known confounders) and unadjusted analyses. A further matched analysis was also performed. RESULTS In terms of overall complications, there was no statistically significant difference between the BMI categories. When individual obesity category was considered, obese 2 had the lowest odds of developing complications, both with unadjusted (odds ratio (OR): 0.61, 95% confidence interval (CI) 0.41-0.91, p < 0.015) and adjusted regression analysis (OR: 0.65, 95% CI: 0.43-0.99, p = 0.044). Compared to normal weight category, obese class 3 (≥40 kg/m2) individuals were at 66% (OR: 0.34, 95% CI: 0.21-0.55) lower (unadjusted) odds of developing cardiac complications (overall p < 0.001). With the matched analysis, compared to normal weight category, obese class 3 (≥40 kg/m2) individuals were at a 60% (OR: 0.40, 95% CI: 0.23-0.68) lower (unadjusted) odds of developing cardiac complications (overall p = 0.004). Obese 3 patients had significantly higher operating time compared with other groups ( p < 0.001). CONCLUSION This study did not find a significant association between BMI and increased overall in-hospital medical or surgical complications following primary TKA. Obesity significantly increased the length of operating time.
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Affiliation(s)
- Usha Gurunathan
- 1 The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Australia
- 2 University of Queensland, Brisbane, Australia
| | - Aaron Pym
- 1 The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Australia
- 3 St. Vincent's Hospital, Sydney, Australia
| | - Cameron Anderson
- 1 The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Australia
| | - Amanda Marshall
- 1 The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Australia
- 4 Princess Alexandra Hospital, Brisbane, Australia
| | - Sarah L Whitehouse
- 1 The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Australia
- 5 Queensland University of Technology, Brisbane, Australia
| | - Ross W Crawford
- 1 The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Australia
- 5 Queensland University of Technology, Brisbane, Australia
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Karwi QG, Zhang L, Altamimi TR, Wagg CS, Patel V, Uddin GM, Joerg AR, Padwal RS, Johnstone DE, Sharma A, Oudit GY, Lopaschuk GD. Weight loss enhances cardiac energy metabolism and function in heart failure associated with obesity. Diabetes Obes Metab 2019; 21:1944-1955. [PMID: 31050157 DOI: 10.1111/dom.13762] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 01/06/2023]
Abstract
AIMS Obesity is associated with high rates of cardiac fatty acid oxidation, low rates of glucose oxidation, cardiac hypertrophy and heart failure. Whether weight loss can lessen the severity of heart failure associated with obesity is not known. We therefore determined the effect of weight loss on cardiac energy metabolism and the severity of heart failure in obese mice with heart failure. MATERIALS AND METHODS Obesity and heart failure were induced by feeding mice a high-fat (HF) diet and subjecting them to transverse aortic constriction (TAC). Obese mice with heart failure were then switched for 8 weeks to either a low-fat (LF) diet (HF TAC LF) or caloric restriction (CR) (40% caloric intake reduction, HF TAC CR) to induce weight loss. RESULTS Weight loss improved cardiac function (%EF was 38 ± 6% and 36 ± 6% in HF TAC LF and HF TAC CR mice vs 25 ± 3% in HF TAC mice, P < 0.05) and it decreased cardiac hypertrophy post TAC (left ventricle mass was 168 ± 7 and 171 ± 10 mg in HF TAC LF and HF TAC CR mice, respectively, vs 210 ± 8 mg in HF TAC mice, P < 0.05). Weight loss enhanced cardiac insulin signalling, insulin-stimulated glucose oxidation rates (1.5 ± 0.1 and 1.5 ± 0.1 μmol/g dry wt/min in HF TAC LF and HF TAC CR mice, respectively, vs 0.2 ± 0.1 μmol/g dry wt/min in HF TAC mice, P < 0.05) and it decreased pyruvate dehydrogenase phosphorylation. Cardiac fatty acid oxidation rates, AMPKTyr172 /ACCSer79 signalling and the acetylation of ß-oxidation enzymes, were attenuated following weight loss. CONCLUSIONS Weight loss is an effective intervention to improve cardiac function and energy metabolism in heart failure associated with obesity.
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Affiliation(s)
- Qutuba G Karwi
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Pharmacology, College of Medicine, University of Diyala, Diyala, Iraq
| | - Liyan Zhang
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Tariq R Altamimi
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Cory S Wagg
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Vaibhav Patel
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Golam M Uddin
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Alice R Joerg
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - David E Johnstone
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Arya Sharma
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gary D Lopaschuk
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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Mori T, Oku K, Miyagawa Y, Nukaga S, Kanto S, Kudo E, Imagita H, Kawahara I. Association between changes in subcutaneous fat mass and heart failure-induced cachexia: a case report. J Phys Ther Sci 2019; 31:462-465. [PMID: 31164786 PMCID: PMC6511507 DOI: 10.1589/jpts.31.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/19/2019] [Indexed: 11/29/2022] Open
Abstract
[Purpose] We investigated whether an increase or decrease in subcutaneous fat mass
secondary to cardiac cachexia can be evaluated using diagnostic ultrasonography in
patients with heart failure. [Participant and Methods] We report a case of cardiac
cachexia in a patient in whom cachexia was confirmed by weight loss, decreased dietary
intake, and biochemical indicators measured by blood tests. We measured the subcutaneous
fat mass in the patient’s thigh using ultrasonic diagnostic equipment during the cachectic
state, as well as 1 and 2 months later. [Results] An increase in weight and
ultrasonographically documented femoral subcutaneous fat mass was confirmed by improvement
in heart failure-induced cachexia. [Conclusion] Clinically convenient ultrasonic
diagnostic equipment is useful to assess subcutaneous fat mass, which serves as an
indicator of the degree of cachexia.
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Affiliation(s)
- Takuya Mori
- Hanna Central Hospital: 741 Tawaraguchi-cho, Ikoma-shi, Nara 630-0243, Japan.,Department of Molecular Pathology, Nara Medical University, Japan.,Department of Physical Therapy, Faculty of Health Science, Kio University, Japan
| | - Kousuke Oku
- Department of Sports Orthopedic, Nara Medical University, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Shijonawate Gakuen University, Japan
| | - Yoshihiro Miyagawa
- Hanna Central Hospital: 741 Tawaraguchi-cho, Ikoma-shi, Nara 630-0243, Japan.,Department of Molecular Pathology, Nara Medical University, Japan
| | - Shota Nukaga
- Hanna Central Hospital: 741 Tawaraguchi-cho, Ikoma-shi, Nara 630-0243, Japan
| | - Saeko Kanto
- Hanna Central Hospital: 741 Tawaraguchi-cho, Ikoma-shi, Nara 630-0243, Japan
| | - Eriko Kudo
- Hanna Central Hospital: 741 Tawaraguchi-cho, Ikoma-shi, Nara 630-0243, Japan
| | - Hidetaka Imagita
- Department of Physical Therapy, Faculty of Health Science, Kio University, Japan
| | - Isao Kawahara
- Hanna Central Hospital: 741 Tawaraguchi-cho, Ikoma-shi, Nara 630-0243, Japan.,Department of Molecular Pathology, Nara Medical University, Japan
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Lavie CJ, Milani RV, Ventura HO. Adipose Composition and Heart Failure Prognosis: Paradox or Not? J Am Coll Cardiol 2019; 70:2750-2751. [PMID: 29191322 DOI: 10.1016/j.jacc.2017.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.
| | - Richard V Milani
- Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Hector O Ventura
- Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
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Abstract
PURPOSE Arterial stiffness is an inevitable consequence of the aging process and is considered an early stage in the development of cardiovascular diseases. The perivascular adipose tissue (PVAT) is a distinct functional integral layer of the vasculature actively involved in blood pressure regulation and atherosclerosis development via PVAT-derived paracrine/autocrine factors. However, there is little knowledge regarding the relationship between PVAT and arterial stiffness. METHODS Using unique mice lacking PVAT, high-fat diet-induced obesity, and in mice overexpressing brown adipocyte selective mitoNEET, we investigated the relationship between PVAT and arterial stiffness in mice. RESULTS We found that lack of PVAT enhanced arterial stiffness in aging mice. High-fat diet feeding of aging C57BL/6J wild-type mice significantly induced hypertrophic PVAT and enhanced arterial stiffness. Furthermore, the expression of mitoNEET, a mitochondrial membrane protein related to energy expenditure, was significantly increased by pioglitazone treatment, while reduced in the hypertrophic PVAT induced by high-fat diet. Overexpression of mitoNEET in PVAT reduced the expression of inflammatory genes and was associated with lower pulse wave velocity in aging mice. CONCLUSIONS These data indicate that local PVAT homeostasis especially inflammation in PVAT is associated with arterial stiffness development. Pioglitazone-induced mitoNEET in PVAT prevents PVAT inflammation and is negatively associated with arterial stiffness. These findings provide new experimental insight into the roles of pioglitazone on PVAT in arterial stiffness and indicate that PVAT might be a target to treat or prevent cardiovascular disease.
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Ortega-Loubon C, Fernández-Molina M, Singh G, Correa R. Obesity and its cardiovascular effects. Diabetes Metab Res Rev 2019; 35:e3135. [PMID: 30715772 DOI: 10.1002/dmrr.3135] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/21/2022]
Abstract
Obesity is described in terms of body fat percentage or body mass index (BMI), despite the fact that these measures do not give full insight about the body fat distribution. It is presently a consistently growing universal challenge since it has tripled in the last 10 years, killing approximately 28 million people each year. In this review, we aim to clarify the different results of obesity on the working and physiology of the cardiovascular system and to reveal changes in the obesity "paradox"-a variety of cardiovascular outcomes in typical/overweight people. Central fat build-up in ordinary/overweight populaces has been related to expanded occurrences of myocardial infarction, heart failure, or all-cause mortality when contrasted with the obese populace. These discoveries are additionally clarified as the abundance and prolonged vulnerability to free fatty acids (FFAs) in obesity. This has been believed to cause the myocardial substrate to move from glucose to FFAs digestion, which causes lipid gathering in cardiomyocytes, spilling over to other lean tissues, and prompting a general atherogenic impact. This cardiomyocyte lipid aggregation has been demonstrated to cause insulin resistance and cardiovascular hypertrophy, and to lessen the heart functions in general. There is a proof backing the fact that fat tissue is not only an energy reservoir, it also coordinates hormones and proinflammatory cytokines and deals with the energy transition of the body by putting away abundant lipids in diverse tissues.
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Affiliation(s)
- Christian Ortega-Loubon
- Department of Pediatric Cardiac Surgery, Universidad Autonoma de Barcelona, Barcelona, Spain
| | | | - Gauri Singh
- Department of Medicine, University of Miami, Miller School of Medicine, Miami, Florida
| | - Ricardo Correa
- Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
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Chrysant SG, Chrysant GS. The single use of body mass index for the obesity paradox is misleading and should be used in conjunction with other obesity indices. Postgrad Med 2019; 131:96-102. [DOI: 10.1080/00325481.2019.1568019] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Steven G. Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - George S. Chrysant
- Department of Cardiology, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
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Han H, Zhu T, Guo Y, Ruan Y, Herzog E, He J. Impact of prior bariatric surgery on outcomes of hospitalized patients with heart failure: a population-based study. Surg Obes Relat Dis 2019; 15:469-477. [PMID: 30713121 DOI: 10.1016/j.soard.2018.12.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/30/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies have suggested that obesity could improve prognosis in patients with heart failure (HF), known as the "obesity paradox." However, the association between bariatric surgery (BS) and HF outcomes is not well established. OBJECTIVE This study aimed to assess the effects of prior BS on outcomes of HF patients. SETTING Inpatient hospital admissions from the Nationwide Inpatient Sample. METHODS The Nationwide Inpatient Sample database for years 2006 to 2014 was queried for adults with a primary diagnosis of HF. We performed multivariable regression analyses to compare outcomes including in-hospital mortality, complications, cost, and length of stay between prior BS (body mass index <35 and ≥35 kg/m2) and morbid obesity. RESULTS Of 164,220 patients with HF, 3617 were with prior BS and 160,603 were diagnosed with morbid obesity. Prior BS patients were younger, tended to be female, and had fewer co-morbidities and complications. Multivariate regression analyses adjusting for baseline patient and hospital characteristics revealed that compared with morbid obesity, prior BS with successful weight loss (body mass index <35 kg/m2) was associated with decreased mortality (odds ratio: .47; 95% confidence interval: .37-.74), urinary tract infection (odds ratio: .72; 95% confidence interval: .62-.84), 17% shorter hospitalization (median length of stay: 2.99 and 3.95 days), and 7% lower cost (median cost: $6984 and $7775). Propensity score-matching analysis validated main findings with permissible similarity regarding covariates between groups. CONCLUSION Among HF hospitalized patients, prior BS is associated with better in-hospital outcomes, mainly in those who had successful weight loss. Our findings emphasize potential clinical and economic impact of BS on HF patients.
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Affiliation(s)
- Hedong Han
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Tiantian Zhu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Yibin Guo
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Yiming Ruan
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Eyal Herzog
- Mount Sinai St. Luke's and West Medical Center, New York, New York
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai, China; Tongji University School of Medicine, Shanghai, China.
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Lundberg G, Walsh MN, Mehta LS. Sex-Specific Differences in Risk Factors for Development of Heart Failure in Women. Heart Fail Clin 2019; 15:1-8. [DOI: 10.1016/j.hfc.2018.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Obesity and Type 2 Diabetes mellitus induce lipopolysaccharide tolerance in rat neutrophils. Sci Rep 2018; 8:17534. [PMID: 30510205 PMCID: PMC6277411 DOI: 10.1038/s41598-018-35809-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 11/09/2018] [Indexed: 12/14/2022] Open
Abstract
Obesity and diabetes implicate in various health complications and increased mortality caused by infection. Innate immune system is broadly affected by these diseases, leading the patients to an immunosuppressive state. A mechanism that leads innate immune cells to a less capacity of killing microorganism is the impaired TLR4 activation. TLR4 recognizes a component of the outer membrane of Gram-negative bacteria, lipopolysaccharide (LPS), and when activated increases the production of inflammatory substances. Neutrophils are components of the innate immune system and are the first responders to an invading agent. The correct activation of TLR4 in these cells is required for the initiation of the inflammatory process and elimination of the microorganisms. The aim of this study was to evaluate the influence of type 2 diabetes and obesity in the TLR4 pathway in rat neutrophils. Two experimental models were used: Goto-Kakizaki rats and high-fat-diet induced obese Wistar rats. To evaluate neutrophil response to LPS, intratracheal LPS instillation was used. Neutrophils from obese and diabetic animals exhibited tolerance to LPS, mainly by the impaired production of cytokines and chemokines and the low content of phospho-NFκB and phospho-IKBα. Neutrophils from both experimental models had increased cell death, impaired in vivo migration and myeloperoxidase activity.
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50
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Observational Evidence for Unintentional Weight Loss in All-Cause Mortality and Major Cardiovascular Events: A Systematic Review and Meta-Analysis. Sci Rep 2018; 8:15447. [PMID: 30337578 PMCID: PMC6194006 DOI: 10.1038/s41598-018-33563-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
The obesity paradox has been described in several observational cohorts and meta-analysis. However, evidence of the intentionality of weight loss in all-cause deaths and major cardiovascular events (MACE) in prospective cohorts is unclear. We analysed whether involuntary weight loss is associated with increased cardiovascular events and mortality. In a systematic review, we searched multiple electronic databases for observational studies published up to October 2016. Studies reporting risk estimates for unintentional weight loss compared with stable weight in MACE and mortality were included. Fifteen studies met the selection criteria, with a total of 178,644 participants. For unintentional weight loss, we found adjusted risk ratios (RRs) with confidence intervals (CIs) of 1.38 (95% CI: 1.23, 1.53) and 1.17 (95% CI: 0.98, 1.37) for all-cause mortality and MACE, respectively. Participants with comorbidities, overweight and obese populations, and older adults yielded RRs (95% CI) of 1.49 (1.30, 1.68), 1.11 (1.04, 1.18), and 1.81 (1.59, 2.03), respectively. Unintentional weight loss had a significant impact on all-cause mortality. We found no protective effect of being overweight or obese for unintentional weight loss and MACE.
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