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Singh A, Chattopadhyay A. Age-appropriate BMI cut-offs for malnutrition among older adults in India. Sci Rep 2024; 14:15072. [PMID: 38956083 PMCID: PMC11219785 DOI: 10.1038/s41598-024-63421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
With the increasing prevalence of obesity in India, body mass index (BMI) has garnered importance as a disease predictor. The current World Health Organization (WHO) body mass index (BMI) cut-offs may not accurately portray these health risks in older adults aged 60 years and above. This study aims to define age-appropriate cut-offs for older adults (60-74 years and 75 years and above) and compare the performance of these cut-offs with the WHO BMI cut-offs using cardio-metabolic conditions as outcomes. Using baseline data from the Longitudinal Ageing Study in India (LASI), classification and regression tree (CART) cross-sectional analysis was conducted to obtain age-appropriate BMI cut-offs based on cardio-metabolic conditions as outcomes. Logistic regression models were estimated to compare the association of the two sets of cut-offs with cardio-metabolic outcomes. The area under the receiver operating characteristic curve (AUC), sensitivity and specificity were estimated. Agreement with waist circumference, an alternate measure of adiposity, was conducted. For older adults aged 60-74 years and 75 years and above, the cut-off for underweight reduced from < 18.5 to < 17.4 and < 13.3 respectively. The thresholds for overweight and obese increased for older adults aged 60-74 years old from > = 25 to > 28.8 and > = 30 to > 33.7 respectively. For older adults aged 75 years and above, the thresholds decreased for both categories. The largest improvement in AUC was observed in older adults aged 75 years and above. The newly derived cut-offs also demonstrated higher sensitivity and specificity among all age-sex stratifications. There is a need to adopt greater rigidity in defining overweight/obesity among older adults aged 75 years and above, as opposed to older adults aged 60-74 years old among whom the thresholds need to be less conservative. Further stratification in the low risk category could also improve BMI classification among older adults. These age-specific thresholds may act as improved alternatives of the current WHO BMI thresholds and improve classification among older adults in India.
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Affiliation(s)
- Akancha Singh
- International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India.
| | - Aparajita Chattopadhyay
- Department of Population and Development, and Associate Head, Centre for Demography of Gender (CDG), International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India
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Singh YS, Wada H, Ogita M, Takamura Y, Onozato T, Fujita W, Abe K, Shitara J, Endo H, Tsuboi S, Suwa S, Miyauchi K, Minamino T. Clinical outcomes of ST elevation myocardial infarction patients without standard modifiable risk factors. J Cardiol 2024; 84:41-46. [PMID: 38043707 DOI: 10.1016/j.jjcc.2023.11.007] [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: 08/21/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes mellitus, dyslipidemia, and smoking) are widely recognized as risk factors for coronary artery disease. However, the associations between absence of SMuRFs and long-term clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients are unclear. METHODS Consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) between 1999 and 2015 were retrospectively analyzed. The primary endpoint was up to 5-year all-cause mortality. Clinical characteristics and outcomes were compared between patients with at least one of the SMuRFs and those without any SMuRFs. RESULTS Of 1963 STEMI patients, 126 (6.4 %) did not have any SMuRFs. Patients without SMuRFs were significantly older, had lower body mass index, and were more likely to be female. During a median follow-up period of 4.9 years, the cumulative incidence of death was significantly higher in patients without SMuRFs than in those with SMuRFs (log-rank p < 0.0001). Landmark analysis showed that patients without SMuRFs had higher mortality within 30 days of STEMI onset (log-rank p = 0.0045) and >30 days after STEMI onset (log-rank p = 0.0004). Multivariable Cox hazards analysis showed that absence of SMuRFs was associated with a higher risk of mortality (hazard ratio, 1.59; 95 % confidence interval, 1.14-2.21; p = 0.006). CONCLUSIONS Of STEMI patients undergoing primary PCI, patients without any SMuRFs had higher mortality than those with at least one of the SMuRFs. Patients without any SMuRFs have a poor prognosis and require more attention.
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Affiliation(s)
- Yu Suresvar Singh
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Manabu Ogita
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Yuta Takamura
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Takuya Onozato
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Wataru Fujita
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Keiki Abe
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine and Biology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Medicine and Biology, Juntendo University Graduate School of Medicine, Tokyo, 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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Lowenstern A, Ng N, Takagi H, Rymer JA, Koweek LM, Douglas PS, Duran JM, Rabbat M, Pontone G, Fairbairn T, Chinnaiyan K, Berman DS, De Bruyne B, Bax JJ, Akasaka T, Amano T, Nieman K, Rogers C, Kitabata H, Sand NPR, Kawasaki T, Mullen S, Matsuo H, Norgaard BL, Patel MR, Leipsic J, Daubert MA. Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry. Circ Cardiovasc Imaging 2023; 16:e014850. [PMID: 37192296 DOI: 10.1161/circimaging.122.014850] [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: 09/12/2022] [Accepted: 04/11/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The relationship between body size and cardiovascular events is complex. This study utilized the ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) Registry to investigate the association between body mass index (BMI), coronary artery disease (CAD), and clinical outcomes. METHODS The ADVANCE registry enrolled patients undergoing evaluation for clinically suspected CAD who had >30% stenosis on cardiac computed tomography angiography. Patients were stratified by BMI: normal <25 kg/m2, overweight 25-29.9 kg/m2, and obese ≥30 kg/m2. Baseline characteristics, cardiac computed tomography angiography and computed tomography fractional flow reserve (FFRCT), were compared across BMI groups. Adjusted Cox proportional hazards models assessed the association between BMI and outcomes. RESULTS Among 5014 patients, 2166 (43.2%) had a normal BMI, 1883 (37.6%) were overweight, and 965 (19.2%) were obese. Patients with obesity were younger and more likely to have comorbidities, including diabetes and hypertension (all P<0.001), but were less likely to have obstructive coronary stenosis (65.2% obese, 72.2% overweight, and 73.2% normal BMI; P<0.001). However, the rate of hemodynamic significance, as indicated by a positive FFRCT, was similar across BMI categories (63.4% obese, 66.1% overweight, and 67.8% normal BMI; P=0.07). Additionally, patients with obesity had a lower coronary volume-to-myocardial mass ratio compared with patients who were overweight or had normal BMI (obese BMI, 23.7; overweight BMI, 24.8; and normal BMI, 26.3; P<0.001). After adjustment, the risk of major adverse cardiovascular events was similar regardless of BMI (all P>0.05). CONCLUSIONS Patients with obesity in the ADVANCE registry were less likely to have anatomically obstructive CAD by cardiac computed tomography angiography but had a similar degree of physiologically significant CAD by FFRCT and similar rates of adverse events. An exclusively anatomic assessment of CAD in patients with obesity may underestimate the burden of physiologically significant disease that is potentially due to a significantly lower volume-to-myocardial mass ratio.
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Affiliation(s)
| | - Nicholas Ng
- HeartFlow, Redwood City, CA (N.N., C.R., S.M., J.L.)
| | | | - Jennifer A Rymer
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
| | - Lynne M Koweek
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
| | - Pamela S Douglas
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
| | - Jessica M Duran
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
| | - Mark Rabbat
- Loyola University Medical Center, Maywood, IL (M.R.)
| | | | | | | | | | | | - Jeroen J Bax
- Leiden University Medical Center, the Netherlands (J.J.B.)
| | | | | | | | | | | | - Niels P R Sand
- University of Southern Denmark, Odense, Denmark (N.P.R.S.)
| | | | - Sarah Mullen
- HeartFlow, Redwood City, CA (N.N., C.R., S.M., J.L.)
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (H.M.)
| | | | - Manesh R Patel
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
| | - Jonathan Leipsic
- HeartFlow, Redwood City, CA (N.N., C.R., S.M., J.L.)
- Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.)
| | - Melissa A Daubert
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)
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Saygi M, Uzman O, Birdal O, Karagoz A, Yumurtas AC, Tezen O, Tanboga IH, Karabay CY. The Relation of Body Mass Index with In-Hospital Mortality in Patients with ST-Segment Elevation Myocardial Infarction. Metab Syndr Relat Disord 2023; 21:94-100. [PMID: 36459115 DOI: 10.1089/met.2022.0070] [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: 12/05/2022] Open
Abstract
Objectives: In this study, we aimed to determine whether body mass index (BMI) is an independent predictor of in-hospital mortality in ST-segment elevation myocardial infarction (STEMI) patients and to assess the relationship between BMI and mortality. Methods: One thousand three hundred fifty-seven patients with STEMI were included to the study. Primary outcome was in-hospital mortality. The multivariable logistic regression was used to assess the relationship between BMI and in-hospital mortality using age, gender, diabetes mellitus, systolic blood pressure, heart rate, smoking status, serum creatinine and hemoglobin, type of STEMI, and Killip class as adjustment variables. Results: The frequency of in-hospital mortality was 14.7%. The mean BMI was found to be 28.2 ± 4.8 kg/m2. Considering the in-hospital mortality frequencies between the groups, mortality was observed in 61.7% of the BMI <20 kg/m2 group, 15.5% of the 20-25 kg/m2 group, 8.5% of the 25-30 kg/m2 group, and 9.5% of the >30 kg/m2 group (chi-square P value <0.001). In the multivariable logistic regression analysis, a change in BMI from 20 to 30 kg/m2 was associated with a reduced risk of in-hospital mortality (odds ratio: 0.39, 95% confidence interval: 0.23-0.67, P < 0.001). Conclusion: Our study results revealed that there was inverse significant association between BMI and in-hospital mortality in STEMI patients.
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Affiliation(s)
- Mehmet Saygi
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Osman Uzman
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul, Turkey
| | - Oguzhan Birdal
- Department of Cardiology, Ataturk University Medical School, Erzurum, Turkey
| | - Ali Karagoz
- Department of Cardiology, Kosuyolu Education Research Hospital, Istanbul, Turkey
| | - Ahmet Cagdas Yumurtas
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul, Turkey
| | - Ozan Tezen
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul, Turkey
| | - Ibrahim Halil Tanboga
- Department of Biostatistics and Cardiology, Nisantasi University Medical School, Istanbul, Turkey
| | - Can Yucel Karabay
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul, Turkey
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Zeng S, Cai X, Zheng Y, Liu X, Ye M. Associations of body mass index with mortality in heart failure with preserved ejection fraction patients with ischemic versus non-ischemic etiology. Front Cardiovasc Med 2022; 9:966745. [PMID: 35990945 PMCID: PMC9386382 DOI: 10.3389/fcvm.2022.966745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundObesity could paradoxically improve prognosis in patients with heart failure (HF), termed the “obesity paradox.” Whether HF etiology could modify the “obesity paradox” is still controversial. In the present study, we aimed to assess the relationship between obesity and death in patients with heart failure with preserved ejection fraction (HFpEF) with non-ischemic versus ischemic etiologies.MethodsWe analyzed 3,360 HFpEF patients from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. Cox regression models were used to assess the association of obesity assessed by body mass index (BMI) with short-term and long-term death risk.ResultsOverweight and obesity were associated with a lower risk of long-term all-cause death in patients with non-ischemic HFpEF, even in those with class III obesity (adjusted HR: 0.61, 95% CI 0.38–0.97). However, in the ischemic subgroup, as obesity advanced, this paradoxical relationship was gradually attenuated and disappeared in class III obesity (adjusted HR: 0.93, 95% CI 0.56–1.57). Restricted cubic spline analyses confirmed the differential relationship of baseline BMI with risk of long-term death with a BMI higher than 30 kg/m2 in non-ischemic versus ischemic HFpEF. In the short-term follow-up, the beneficial effects of overweight and obesity on survival were consistently observed in all the BMI categories, with the nadirs of all-cause death risk at class III obesity category both in non-ischemic and ischemic subgroups.Conclusion“Obesity paradox” was evident both in non-ischemic and ischemic HFpEF during short-term follow-up, even in those with class III obesity. However, the beneficial effect of class III obesity disappeared during long-term follow-up in ischemic HFpEF.Clinical Trial Registration[https://clinicaltrials.gov], identifier [NCT00094302].
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Affiliation(s)
- Shan Zeng
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Department of Cardiology, First Affiliated Hospital, Ministry of Education, Gannan Medical University, Ganzhou, China
| | - Xingming Cai
- Department of Geriatric, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuxiang Zheng
- Second Clinical Medical College, Nanchang University, Nanchang, China
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Xiao Liu,
| | - Min Ye
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Min Ye,
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Huang Y, Ruan Z, Lin W, Chen Z, Zhang L, Li Z. Association Between Weight Change and Increased Likelihood of Abdominal Aortic Calcification Among Men. J Endocr Soc 2022; 6:bvac067. [PMID: 35528824 PMCID: PMC9071313 DOI: 10.1210/jendso/bvac067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We aimed to explore the effect of weight change on abdominal aortic calcification (AAC) among men. METHODS Data were obtained from the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES). Self-reported cardiovascular disease patients were excluded. Lateral spine images were used to quantify AAC score and severe AAC was defined as a AAC score greater than 6. Weight change over a 10-year period was defined as long-term weight change, and weight change over a 1-year period was defined as short-term weight change. The relationship between long-term and short-term weight change with AAC grade was estimated by using multivariable regression analysis and subgroup analysis. RESULTS After adjusting for covariates, weight gain, especially severe weight gain (> 10 kg), was associated with increased likelihood of AAC and severe AAC both in the short term (1 year) and long term (10 years) among men when compared to stable weight change, while long-term weight loss could also lead to an increased likelihood of AAC and severe AAC. CONCLUSION Stable body weight might be a predictor of a lower risk of AAC and severe AAC among men in the long term and short term.
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Affiliation(s)
- Yanting Huang
- Shantou University Medical College, Shantou, Guangdong 515041, P. R. China
| | - Zhijie Ruan
- Shantou University Medical College, Shantou, Guangdong 515041, P. R. China
| | - Weizhao Lin
- Shantou University Medical College, Shantou, Guangdong 515041, P. R. China
- Department of Cardiology, the Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Zhichao Chen
- Shantou University Medical College, Shantou, Guangdong 515041, P. R. China
- Department of Cardiology, the Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Liling Zhang
- Shantou University Medical College, Shantou, Guangdong 515041, P. R. China
- Endocrinology Department, the Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Zhi Li
- Shantou University Medical College, Shantou, Guangdong 515041, P. R. China
- Department of Cardiology, the Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P. R. China
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Pellegrini JR, Munshi RF, Farraj K, Russe-Russe JR, Abdou A, Shah K, Lannom M, Rizvon K, Mustacchia P. A Comprehensive Analysis of the Impact of Acute Myocardial Infarction in Patients With Celiac Disease. GASTRO HEP ADVANCES 2022; 1:770-774. [PMID: 39131845 PMCID: PMC11308801 DOI: 10.1016/j.gastha.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/25/2022] [Indexed: 08/13/2024]
Abstract
Background and Aims We aimed to study the impact of acute myocardial infarction (AMI) in patients with celiac disease (CD). Methods We used the National Inpatient Sample 2011-2018 to identify patients aged 18 years and older with a history of CD who presented with AMI using International Classification of Disease Nineth and Tenth Revision codes. Primary outcome of interest was mortality differences in AMI patients with and without CD. Secondary outcomes were in-hospital length of stay, hospital costs, and coronary revascularization. Results A total of 2,287,840 weighted patients were included in this study with a principal diagnosis of AMI. Among this population, 183,027 weighted patients had a history of CD (0.08%), and 2,286,010 weighted patients had AMI without a history of CD (99.92%). Most AMI patients with and without CD were older (69.57 ± 13.21 vs 67.08 ± 13.87 years, respectively) and white (92.55% vs 75.39%, respectively). Patients with AMI and CD were more likely to be female than patients without CD (53.76% vs 38.47%; P < .05). In our study, we found that the difference in hospital charges (adjusted mean difference $2644.7) was lower among AMI and CD; however, length of stay was higher among patients with CD (adjusted mean difference 0.36 day) although they were not statistically significant (P > .05). Both cohorts had higher number of Medicare recipients and lower number of patients who self-pay. Our study also found that smoking was more prevalent among patients with CD, 12.14%, vs patients without CD, 2.51%. Moreover, patients with CD who developed AMI had a lower adjusted odds of mortality than those without CD (adjusted odds ratio [aOR] 0.41; P < .05). Patients with CD and AMI also had lower odds of coronary revascularization (aOR 0.80; P < .05). In addition, we found that adults with CD had a lower odds of developing AMI (aOR 0.78; P < .05). Conclusion CD is a chronic disease leading to chronic inflammation and various nutrition-related problems which can lead to increased morbid conditions. However, we found lower odds of AMI among patients with CD, as well as lower mortality and comorbidities related to AMI, thus contradicting previous assumptions.
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Affiliation(s)
- James R. Pellegrini
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York
| | - Rezwan F. Munshi
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York
| | - Kristen Farraj
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York
| | - Jose R. Russe-Russe
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York
| | - Amr Abdou
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York
| | - Kashyap Shah
- Department of Internal Medicine, St. Lukes University Health Network, Bethlehem, Pennsylvania
| | - Madison Lannom
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York
| | - Kaleem Rizvon
- Divison of Gastroenterology, Nassau University Medical Center, East Meadow, New York
| | - Paul Mustacchia
- Divison of Gastroenterology, Nassau University Medical Center, East Meadow, New York
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Bae EH, Lim SY, Yang EM, Oh TR, Choi HS, Kim CS, Ma SK, Kim B, Han KD, Kim SW. Low waist circumference prior to percutaneous coronary intervention predict the risk for end-stage renal disease: a nationwide Korean population based-cohort study. Korean J Intern Med 2022; 37:639-652. [PMID: 35143719 PMCID: PMC9082428 DOI: 10.3904/kjim.2021.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/AIMS The obesity paradox has been known in end-stage renal disease (ESRD). However, the effect of body mass index (BMI) or waist circumference (WC) prior to percutaneous coronary intervention (PCI) on the development of ESRD is not clear. METHODS Using nationally representative data from the Korean National Health Insurance System, we enrolled 140,164 subjects without ESRD at enrolment who underwent PCI between 2010 and 2015, and were followed-up until 2017. Patients were stratified into five levels based on their baseline BMI and six levels based on their WC with 5-cm increments. BMI and WC were measured at least 2 years prior to PCI. The primary outcome was the development of ESRD. RESULTS During a median follow-up of 5.4 years, 2,082 (1.49%) participants developed ESRD. The underweight group (hazard ratio [HR], 1.331; 95% confidence interval [CI], 0.955 to 1.856) and low WC (< 80/< 75) (HR, 1.589; 95% CI, 1.379 to 1.831) showed the highest ESRD risk and the BMI 25 to 30 group showed the lowest ESRD risk (HR, 0.604; 95% CI, 0542 to 0.673) in all participants after adjusting for all covariates. In the subgroup analysis for diabetes mellitus (DM) duration, WC < 85/80 cm (men/women) increased ESRD risk in only the DM group (DM < 5 years and DM ≥ 5 years) compared to the reference group (85-90/80-85 of WC), but not the normal or impaired fasting glucose group. CONCLUSION Low WC prior to PCI showed an increased ESRD risk in patients with DM undergoing PCI as compared to those without DM.
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Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Sang Yup Lim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan,
Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Hospital, Gwangju,
Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul,
Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul,
Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
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10
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Held C, Hadziosmanovic N, Aylward PE, Hagström E, Hochman JS, Stewart RAH, White HD, Wallentin L. Body Mass Index and Association With Cardiovascular Outcomes in Patients With Stable Coronary Heart Disease – A STABILITY Substudy. J Am Heart Assoc 2022; 11:e023667. [PMID: 35060389 PMCID: PMC9238503 DOI: 10.1161/jaha.121.023667] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The obesity paradox states that patients with higher body mass index (BMI) and cardiovascular disease may experience better prognosis. However, this is less clear in patients with coronary heart disease. METHODS AND RESULTS The prospective STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial included 15 828 patients with stable coronary heart disease with 3 to 5 years’ follow‐up on optimal secondary preventive treatment. BMI was measured at baseline (n=15 785). Associations between BMI and cardiovascular outcomes were evaluated by Cox regression analyses with multivariable adjustments. Mean age was 64±9 years and 19% women. Most risk markers (diabetes, hypertension, inflammatory biomarkers, triglycerides) showed a graded association with higher BMI. The frequency of smoking, levels of high‐density lipoprotein, growth differentiation factor 15, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) were higher at lower BMI. Low BMI (<20 kg/m2; n=244 [1.5%]) was associated with doubled risk of total death (hazard ratio [HR], 2.27; 95% CI, 1.60–3.22), cardiovascular death (HR, 2.26; 95% CI, 1.46–3.49), and heart failure (HR, 2.51; 95% CI, 1.35–4.68) compared with BMI of 25 to <30 kg/m2 (n=6752 [42.8%]) as reference. Similarly, high BMI of ≥35 kg/m2 (n=1768 [11.2%]) was associated with increased risk of the same outcomes. A BMI between 20 and <25 kg/m2 was associated with increased risk of cardiovascular death (HR, 1.26; 95% CI, 1.03–1.54) and total death (HR, 1.21; 95% CI, 1.03–1.42). CONCLUSIONS Patients with stable coronary heart disease showed a graded increase in cardiometabolic and inflammatory risk factors with increasing BMI category >25 kg/m2. All‐cause and cardiovascular mortality were lowest at BMI of 25 to 35 kg/m2. Underweight with BMI of <20 kg/m2 and very high BMI of ≥35 kg/m2 were strong risk markers for poor prognosis. REGISTRATION URL: https://clinicaltrials.gov/; Unique identifier NCT00799903.
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Affiliation(s)
- Claes Held
- Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Nermin Hadziosmanovic
- Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Philip E. Aylward
- South Australian Health and Medical Research InstituteFlinders University and Medical Centre Adelaide SA Australia
| | - Emil Hagström
- Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Judith S. Hochman
- Department of Medicine New York University Langone Medical Center New York NY
| | - Ralph A. H. Stewart
- Green Lane Cardiovascular ServiceAuckland City Hospital and University of Auckland Auckland New Zealand
| | - Harvey D. White
- Green Lane Cardiovascular ServiceAuckland City Hospital and University of Auckland Auckland New Zealand
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
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11
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Wang J, Wang C, Zeng Z, Zuo H. Impact of BMI on Long-Term Outcomes in Patients with ST-Segment Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention. Int J Clin Pract 2022; 2022:6210204. [PMID: 35685592 PMCID: PMC9159228 DOI: 10.1155/2022/6210204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022] Open
Abstract
AIM Obesity paradox remains a point of debate in ST-segment elevation myocardial infarction (STEMI) patients. The aim of this study was to examine the relationship between body mass index (BMI) and clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). METHODS Outcomes were assessed in 1429 STEMI patients undergoing PPCI between January 2009 and January 2010 in Beijing. Patients were classified into 6 groups according to age (the younger and elderly groups consisting of patients ≤65 and > 65 years old) and baseline BMI (normal weight, BMI < 24 kg/m2; overweight, 24 kg/m2 ≤BMI < 28 kg/m2; obese, BMI ≥ 28 kg/m2). The primary outcome was death, acute myocardial infarction (AMI), or revascularization. RESULTS On long-term follow-up (mean follow-up of 59 months), 13.9% of patients experienced the adverse event. Multivariate logistic regression analyses showed that low BMI was a significant predictor of the primary outcome only in the younger group. The odds ratio for overweight in comparison with normal weight was 0.741 (95% CI: 0.413-0.979; p = 0.038), the odds radio for obesity in comparison with normal-weight patients was 0.508 (95% CI: 0.344-0.750; p = 0.016) in the younger group. In the elderly group, diabetes, hypertension, triple disease, regular exercise, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blockers (ARBs) use after discharge, and bleeding complication were associated with primary outcome. CONCLUSION The obesity paradox was recognized only in the younger age group in STEMI patients undergoing PPCI.
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Affiliation(s)
- Jinwen Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
| | - Changhua Wang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhechun Zeng
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
| | - Huijuan Zuo
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
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12
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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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13
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Rozenbaum Z, Klein E, Cohen T, Shlomo N, Pereg D, Shuvy M. Temporal trends in management and outcomes of patients with acute coronary syndrome according to body mass index. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:170-175. [PMID: 30663317 DOI: 10.1177/2048872619825569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Obesity is a major public health concern. We sought to investigate temporal trends in characteristics and outcomes of acute coronary syndrome patients according to body mass index. METHODS The study population consisted of patients who were included in the Acute Coronary Syndromes Israeli Surveys during 2000-2016. Patients were categorised into three groups according to body mass index: below 25 kg/m2, 25-30 kg/m2 (overweight) and above 30 kg/m2 (obese). Among each body mass index group the outcomes of two time frames were compared - early (2000-2006) versus late (2008-2016). RESULTS Overall 12,167 patients were included. Between the years 2000 and 2016, the percentage of obese patients increased from 20% to 30%. Obese patients were more frequently selected for an invasive approach, and had the lowest all-cause mortality rates. A significant reduction in 1-year mortality in recent compared to early surveys among patients with body mass index less than 25 kg/m2 and in obese patients but not for overweight patients was shown. Multivariable analysis showed that body mass index greater than 25 kg/m2 was associated with 30% lower 1-year mortality (hazard ratio 0.70, 95% confidence interval 0.55-0.90, P=0.005). CONCLUSION The prevalence of obesity among acute coronary syndrome patients has increased over the past two decades. A reduction of all-cause mortality was mainly seen in lean and obese patients.
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Affiliation(s)
- Zach Rozenbaum
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Eyal Klein
- Heart Institute, Hadassah Hebrew University Medical Center, Israel
| | - Tal Cohen
- Department of Cardiology, Sheba Medical Center, Israel
| | - Nir Shlomo
- Department of Cardiology, Sheba Medical Center, Israel
| | - David Pereg
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
- Department Cardiology, Meir Medical Center, Israel
| | - Mony Shuvy
- Heart Institute, Hadassah Hebrew University Medical Center, Israel
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14
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Zhao S, Cao R, Zhang S, Kang Y. Explore the Protective Role of Obesity in the Progression of Myocardial Infarction. Front Cardiovasc Med 2021; 8:629734. [PMID: 33842562 PMCID: PMC8026861 DOI: 10.3389/fcvm.2021.629734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/03/2021] [Indexed: 01/15/2023] Open
Abstract
Obesity has been shown as a risk factor to increase the incidence of myocardial infarction (MI). However, obesity has also been linked to the decreased mortality of acute MI with unknown mechanisms. Here, we firstly used large-scale literature data mining to identify obesity downstream targets and MI upstream regulators with polarity, based on which an obesity-MI regulatory network was constructed. Then, a gene set enrichment analysis was conducted to explore the functional profile of the genes involved in the obesity-MI regulatory networks. After that, a mega-analysis using MI RNA expression datasets was conducted to test the expression of obesity-specific genes in MI patients, followed by a shortest-path analysis to explore any potential gene-MI association. Our results suggested that obesity could inhibit 11 MI promoters, including NPPB, NPPA, IRS1, SMAD3, MIR155, ADRB1, AVP, MAPK14, MC3R, ROCK1, and COL3A1, which were mainly involved in blood pressure-related pathways. Our study suggested that obesity could influence MI progression by driving multiple genes associated with blood pressure regulation. Moreover, PTH could be a novel obesity driven gene associated with the pathogenesis of MI, which needs further validation.
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Affiliation(s)
- Siyuan Zhao
- Department of Cardiology, Second People's Hospital of Lianyungang, Lianyungang, China
| | - Rongyuan Cao
- Department of Cardiology, Second People's Hospital of Lianyungang, Lianyungang, China
| | - Shuhua Zhang
- Department of Cardiology, Second People's Hospital of Lianyungang, Lianyungang, China
| | - Yan Kang
- Human Biochemical Genetics Section, National Institutes of Health, Bethesda, MD, United States
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15
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Song WH, Bae EH, Ahn JC, Oh TR, Kim YH, Kim JS, Kim SW, Kim SW, Han KD, Lim SY. Effect of body mass index and abdominal obesity on mortality after percutaneous coronary intervention: a nationwide, population-based study. Korean J Intern Med 2021; 36:S90-S98. [PMID: 32972124 PMCID: PMC8009155 DOI: 10.3904/kjim.2020.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We investigated the impact of obesity on the clinical outcomes following percutaneous coronary intervention (PCI). METHODS We included South Koreans aged > 20 years who underwent the Korean National Health Screening assessment between 2009 and 2012. Obesity was defined using the body mass index (BMI), according to the World Health Organization's recommendations. Abdominal obesity was defined using the waist circumference (WC), as defined by the Korean Society for Obesity. The odds and hazard ratios in all-cause mortality were calculated after adjustment for multiple covariates. Patients were followed up to the end of 2017. RESULTS Among 130,490 subjects who underwent PCI, the mean age negatively correlated with BMI. WC, hypertension, diabetes, dyslipidemia, fasting glucose, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels correlated with the increased BMI. The mortality rates were higher in the lower BMI and WC groups than the higher BMI and WC groups. The non-obese with abdominal obesity group showed a mortality rate of 2.11 per 1,000 person-years. Obese with no abdominal obesity group had the lowest mortality rate (0.88 per 1,000 person-years). The mortality showed U-shaped curve with a cut-off value of 29 in case of BMI and 78 cm of WC. CONCLUSION The mortality showed U-shaped curve and the cut-off value of lowest mortality was 29 in case of BMI and 78 cm of WC. The abdominal obesity may be associated with poor prognosis in Korean patients who underwent PCI.
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Affiliation(s)
- Woo-Hyuk Song
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong Cheon Ahn
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Hyun Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jin Seok Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sun-Won Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Sang Yup Lim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
- Correspondence to Sang Yup Lim, M.D. Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea Tel: +82-31-8099-6352 Fax: +82-31-412-6755 E-mail:
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16
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Huang W, Chen X, Zhang Y, Wang L, Wang J, Zhang Y, Wei D, Zhou Z. Acupoint catgut embedding for obesity: A protocol of systematic review. Medicine (Baltimore) 2020; 99:e23728. [PMID: 33371124 PMCID: PMC7748162 DOI: 10.1097/md.0000000000023728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Obesity is a chronic metabolic disease in which patients are overweight due to the excessive accumulation of fat in the body. As a subtype of acupuncture, catgut embedding at acupoints has increased in clinical application for obesity. The aim of this study is to evaluate the effectiveness and safety of acupoint catgut embedding therapy for simple obesity. METHODS AND ANALYSIS Electronic searches of the Cochrane Library, PubMed, Springer Medline, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wan-Fang Data (WANFANG), Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP databases) will be performed. The Chinese Clinical Trial Registry Center and the ClinicalTrials.gov registry will also be searched for ongoing trials. Databases will be searched from inception to August 2020.Randomized controlled clinical trials (RCTs) will be included if acupoint catgut embedding was evaluated as the sole treatment (diet or exercise therapy as the control group will be allowed) for simple obesity. The primary outcomes will consist of the improvement rate and reduction in body weight (BW). The secondary outcomes will include body mass index (BMI), waist circumference (WC), fat percentage (F %) and adverse effects. Two reviewers will undertake the study selection, data extraction and assessments of study quality. After screening the studies, the quality of the included studies will be assessed according to the quality criteria specified by the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). Meta-analysis will be performed by RevMan 5.3 software. RESULTS According to the data of improvement rate and reduction in BW, BMI, WC, and F %, this study will provide an evidence-based review of acupoint catgut embedding therapy for simply. CONCLUSIONS This systematic review will present the current evidence for acupoint catgut embedding therapy for obesity. ETHICS AND DISSEMINATION Ethical approval is not necessary since this protocol is only for systematic review and does not involve privacy data. The findings of this study will be disseminated electronically through a peer-review publication or presented at a relevant conference. TRIAL REGISTRATION NUMBER INPLASY2020110045.
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Affiliation(s)
- Wei Huang
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Xia Chen
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Yanji Zhang
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province
| | - Lihua Wang
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province
| | - Jiajie Wang
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Yingrong Zhang
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province
| | - Dan Wei
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Zhongyu Zhou
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
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17
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Velazquez G, Gomez TMA, Asemota I, Akuna E, Ojemolon PE, Eseaton P. Obesity Impacts Mortality and Rate of Revascularizations Among Patients With Acute Myocardial Infarction: An Analysis of the National Inpatient Sample. Cureus 2020; 12:e11910. [PMID: 33425499 PMCID: PMC7785489 DOI: 10.7759/cureus.11910] [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] [Accepted: 12/04/2020] [Indexed: 11/05/2022] Open
Abstract
Background Obesity is now a recognized chronic comorbid condition which is highly prevalent in the United States. Obesity poses several health risks, affecting multiple organ systems. The cardiovascular system is particularly affected by obesity including its role in atherosclerotic disease and hence myocardial infarction (MI) from atheromatous plaque events. However, multiple population-based studies have shown mixed outcomes in obese patients who have acute MI. This study aimed to determine if obesity paradoxically improved outcomes in patients with acute myocardial infarction (AMI) as well as compare outcomes of mild to moderately obese patients and morbidly obese patients to non-obese patients. Materials and methods Data was obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study included adult patients with a principal discharge diagnosis of AMI. This group was divided into ST segment elevation myocardial infarction (STEMI) and non-ST segment myocardial infarction (NSTEMI). Obese patients were subdivided into two groups: mild-moderate obesity and morbid obesity. Primary outcome compared inpatient mortality. Secondary outcomes included rate of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), composite revascularization, mean length of hospitalization, total hospital charges, and rates of complications. Results In patients with STEMI, mild to moderately obese patients had lower odds of mortality (aOR: 0.80, 95% CI: 0.715-0.906, p < 0.001) compared to non-obese patients. However, morbidly obese patients had higher odds of mortality (aOR: 1.26, 95% CI: 1.100-1.446, p < 0.001) compared to non-obese patients. Mild to moderately obese patients had higher odds of composite revascularization (aOR: 1.24, 95% CI: 1.158-1.334, p < 0.001), PCI (aOR: 1.08, 95% CI: 1.054-1.150, p = 0.014), and CABG (aOR: 1.46, 95% CI: 1.313-1.626, p < 0.001). Conclusion The degree of obesity affects outcome of patients with AMI. Cardiovascular interventions during hospitalizations for AMI also varied with degree of obesity. This may have affected the outcome, especially among morbidly obese patients.
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Affiliation(s)
- Genaro Velazquez
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | | | - Iriagbonse Asemota
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Emmanuel Akuna
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Pius E Ojemolon
- Anatomical Sciences, St. George's University, St. George's, GRD
| | - Precious Eseaton
- Internal Medicine, College of Medicine, University of Benin, Benin City, NGA
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18
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Chen X, Huang W, Wei D, Ding DG, Jiao Y, Pan HL, Jin YT, Zheng YW, Zhang YJ, Zhang YR, Liu YR, Zhou ZY. Clinical effect of catgut implantation at acupoints for the treatment of simple obesity: A multicentre randomized controlled trial. Medicine (Baltimore) 2020; 99:e23390. [PMID: 33235115 PMCID: PMC7710253 DOI: 10.1097/md.0000000000023390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Catgut implantation at acupoints (CIA) is a subtype of acupuncture that has been widely used to treat simple obesity, but evidence for its effectiveness remains scarce. The aim of this study is to evaluate the efficacy and safety of treating simple obesity with CIA. OBJECTIVE This clinical trial aims to evaluate the effectiveness and safety of CIA used for treatment of simple obesity. METHODS This is a multicentre, randomized, parallel, sham-controlled clinical trial. A total of 216 patients with simple obesity will be recruited. They will be randomly assigned in a 1:1 ratio to either the CIA group or the sham control group. All treatments will be given once every 2 weeks. The primary outcome measure is the rate of waistline reduction. Secondary outcome measures are the rates of reduction of body measurements, including weight, body mass index (BMI), hipline, waist-hip-ratio (WHR) and body fat percentage (BFP), the changes in scores on scales, including the Impact of Weight on Quality of Life Questionnaire (IWQOL-Lite), Short Form 36 (SF-36), the Hospital Anxiety and Depression Scale (HAD) and the Self-Esteem Scale (SES), Outcomes will be evaluated at baseline and at weeks 4, 8, 12, 16, 28, and 40, respectively. All adverse events that occur during this study will be recorded. If any participant withdraws from the trial, an intention-to-treat analysis (ITT) will be performed. CONCLUSION This is a randomized, sham-controlled trial of CIA treatment for simple obesity. The results of this trial will provide more evidence on whether CIA is efficacious and safe for treating obesity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02936973. Registered on October 18, 2016.
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Affiliation(s)
- Xia Chen
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine
| | - Wei Huang
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province, Wuhan, China
| | - Dan Wei
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine
| | - De-Guang Ding
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine
| | - Yang Jiao
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine
| | - Hong-Ling Pan
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine
| | - Yi-Ting Jin
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province, Wuhan, China
| | - Yi-Wei Zheng
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine
| | - Yan-Ji Zhang
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province, Wuhan, China
| | - Ying-Rong Zhang
- Hubei University of Chinese Medicine/The Co-innovation Center for Preventive Treatment of Disease of Acupuncture-moxibustion in Hubei Province, Wuhan, China
| | - Yi-Ran Liu
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine
| | - Zhong-Yu Zhou
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine
- Hubei Province Academy of Traditional Chinese Medicine
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Abstract
Background: Cardiac rupture (CR) is a major lethal complication of acute myocardial infarction (AMI). However, no valid risk score model was found to predict CR after AMI in previous researches. This study aimed to establish a simple model to assess risk of CR after AMI, which could be easily used in a clinical environment. Methods: This was a retrospective case-control study that included 53 consecutive patients with CR after AMI during a period from January 1, 2010 to December 31, 2017. The controls included 524 patients who were selected randomly from 7932 AMI patients without CR at a 1:10 ratio. Risk factors for CR were identified using univariate analysis and multivariate logistic regression. Risk score model was developed based on multiple regression coefficients. Performance of risk model was evaluated using receiver-operating characteristic (ROC) curves and internal validity was explored using bootstrap analysis. Results: Among all 7985 AMI patients, 53 (0.67%) had CR (free wall rupture, n = 39; ventricular septal rupture, n = 14). Hospital mortalities were 92.5% and 4.01% in patients with and without CR (P < 0.001). Independent variables associated with CR included: older age, female gender, higher heart rate at admission, body mass index (BMI) <25 kg/m2, lower left ventricular ejection fraction (LVEF) and no primary percutaneous coronary intervention (pPCI) treatment. In ROC analysis, our CR risk assess model demonstrated a very good discriminate power (area under the curve [AUC] = 0.895, 95% confidence interval: 0.845–0.944, optimism-corrected AUC = 0.821, P < 0.001). Conclusion: This study developed a novel risk score model to help predict CR after AMI, which had high accuracy and was very simple to use.
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Younis A, Younis A, Goldkorn R, Goldenberg I, Peled Y, Tzur B, Klempfner R. The Association of Body Mass Index and 20-Year All-Cause Mortality Among Patients With Stable Coronary Artery Disease. Heart Lung Circ 2019; 28:719-726. [DOI: 10.1016/j.hlc.2018.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 12/19/2017] [Accepted: 02/18/2018] [Indexed: 10/17/2022]
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Shah M, Patil S, Patnaik S, Agrawal M, Patel B, Tripathi B, Jorde U, Lavie C. Outcomes in Cardiogenic Shock from Acute Coronary Syndrome Depending on Severity of Obesity. Am J Cardiol 2019; 123:1267-1272. [PMID: 30773250 DOI: 10.1016/j.amjcard.2019.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 01/23/2023]
Abstract
We reviewed 54,044 adult cases of cardiogenic shock (CS) accompanying acute coronary syndrome from the 2005 to 2014 Nationwide Inpatient Sample. We evaluated outcomes among patients who were nonobese, obese (body mass index 30.0 to 39.9 kg/m2) and extremely-obese (body mass index ≥40 kg/m2). A multivariate analysis was performed to assess their impact on in-hospital mortality. There were 3,602 (6.6%) and 1,610 (2.9%) admissions among patients who were obese and extremely-obese. Those obese and extremely-obese were younger compared with the nonobese (62.7 vs 61.2 vs 68.8 years, respectively; p <0.01) but had significantly greater comorbidity burden. CS patients who were not-obese were most likely to have an associated ST elevation myocardial infarction, compared with the obese and extremely-obese (67.7% vs 65.9% vs 60.7%; p <0.01). Compared to the nonobese, patients who were obese had higher rates of percutaneous coronary intervention (55.8% vs 51.5%; p <0.01) and coronary artery bypass grafting (24.0% vs 16.0%; p <0.01) whereas those extremely-obese had higher coronary artery bypass grafting rates (23.9% vs 16.0%; p <0.01) but similar percutaneous coronary intervention rates (51.1% vs 51.5%; p = 0.74). Short-term mechanical support use was lowest among the nonobese followed by the extremely-obese and obese. Adjusted analysis revealed that obesity predicted less (adjusted odd ratio 0.82, 95% confidence interval 0.76 to 0.90) and extreme-obesity predicted higher in-hospital mortality (adjusted odds ratio 1.17, 95% confidence interval 1.05 to 1.32) compared with the nonobese. In conclusion, obesity and extreme-obesity are associated with greater comorbidity burden among ACS related CS admissions. Obesity predicted less in-hospital mortality, whereas extreme obesity was associated with elevated in-hospital mortality.
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Affiliation(s)
- Mahek Shah
- Division of Cardiology, Montefiore Medical Center, Bronx, New York.
| | - Shantanu Patil
- Department of Medicine, SSM Health, St Mary's Hospital, St. Louis, Missouri
| | - Soumya Patnaik
- Department of Cardiology, UT Health Science Center at Houston, Houston, Texas
| | - Manyoo Agrawal
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brijesh Patel
- Division of Cardiology, Henry Ford Allegiance Cardiology, Jackson, Michigan
| | - Byomesh Tripathi
- Department of Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
| | - Ulrich Jorde
- Division of Cardiology, Montefiore Medical Center, Bronx, New York
| | - Carl Lavie
- Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana
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Wang LH, Huang W, Wei D, Ding DG, Liu YR, Wang JJ, Zhou ZY. Mechanisms of Acupuncture Therapy for Simple Obesity: An Evidence-Based Review of Clinical and Animal Studies on Simple Obesity. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:5796381. [PMID: 30854010 PMCID: PMC6378065 DOI: 10.1155/2019/5796381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/25/2018] [Indexed: 12/15/2022]
Abstract
Simple obesity is a worldwide epidemic associated with rapidly growing morbidity and mortality which imposes an enormous burden on individual and public health. As a part of Traditional Chinese Medicine (TCM), acupuncture has shown the positive efficacy in the management of simple obesity. In this article, we comprehensively review the clinical and animal studies that demonstrated the potential mechanisms of acupuncture treatment for simple obesity. Clinical studies suggested that acupuncture regulates endocrine system, promotes digestion, attenuates oxidative stress, and modulates relevant molecules of metabolism in patients of simple obesity. Evidence from laboratory indicated that acupuncture regulates lipid metabolism, modulates inflammatory responses, and promotes white adipose tissue browning. Acupuncture also suppresses appetite through regulating appetite regulatory hormones and the downstream signaling pathway. The evidence from clinical and animal studies indicates that acupuncture induces multifaceted regulation through complex mechanisms and moreover a single factor may not be enough to explain the beneficial effects against simple obesity.
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Affiliation(s)
- Li-Hua Wang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine/Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Wuhan, China
| | - Wei Huang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine/Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Wuhan, China
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Dan Wei
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - De-Guang Ding
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Yi-Ran Liu
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Jia-Jie Wang
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Zhong-Yu Zhou
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
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Cui Z, Qin Q, Chen P, Wang J, Zhang S, Mei X, Xie B, Wang S. EFFECT OF DORSOMEDIAL HYPOTHALAMUS NEUROPEPTIDE Y KNOCKDOWN ON HEPATIC INSULIN SENSITIVITY. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; -5:25-31. [PMID: 31149056 DOI: 10.4183/aeb.2019.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective In this study we investigated the effect of dorsomedial hypothalamus (DMH) neuropeptide Y (NPY) knock-down on hepatic insulin sensitivity in high-fat (HF) diet-fed rats. Methods Forty-eight Sprague-Dawley rats were randomly assigned to receive bilateral DMH injections of adeno-associated virus AAVshNPY or AAVshCTL and then accessed to regular chow. Five weeks after viral injection, half rats in each group were given access to the HF diet. At 16 weeks, rat livers were collected. Insulin receptor substrate-1 (IRS-1) and phosphoinositide 3-kinase (PI3K) mRNA expression was measured by qRT-PCR. Blood glucose levels were measured by the oxidase method, serum insulin, triglyceride, and TC levels were measured by Elisa. Pathological changes in the liver were assessed by hematoxylin-eosin (HE) staining. AKT, p-AKT, and GSK-3 levels were measured by western blotting. Results Compared with AAVshCTL-injected rats, AAVshNPY-injected rats showed a significant decrease in blood glucose concentrations; serum insulin, triglyceride, and TC; HOMA-IR; and IRS-1 and PI3K mRNA levels (P<0.05). ISI, GSK-3, and p-AKT levels were significantly increased (P<0.05). HE staining showed that AAVshNPY-injected rats fed the HF diet had mild fatty degeneration. Conclusion These results suggest that DMH NPY knock-down improves hepatic insulin sensitivity in HF diet-fed rats by activating the hepatic PI3K/AKT insulin signalling pathway.
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Affiliation(s)
- Z Cui
- First Affiliated Hospital of Zhengzhou University, Department of Endocrinology and Metabolism, Zhengzhou, China
| | - Q Qin
- First Affiliated Hospital of Zhengzhou University, Department of Endocrinology and Metabolism, Zhengzhou, China
| | - P Chen
- First Affiliated Hospital of Zhengzhou University, Department of Endocrinology and Metabolism, Zhengzhou, China
| | - J Wang
- First Affiliated Hospital of Zhengzhou University, Department of Endocrinology and Metabolism, Zhengzhou, China
| | - S Zhang
- First Affiliated Hospital of Zhengzhou University, Department of Endocrinology and Metabolism, Zhengzhou, China
| | - X Mei
- First Affiliated Hospital of Zhengzhou University, Department of Endocrinology and Metabolism, Zhengzhou, China
| | - B Xie
- First Affiliated Hospital of Zhengzhou University, Department of Endocrinology and Metabolism, Zhengzhou, China
| | - S Wang
- First Affiliated Hospital of Zhengzhou University, Department of Endocrinology and Metabolism, Zhengzhou, China
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Lin MT, Lai CL, Lee PL, Shen MH, Yu CJ, Fang CT, Chen CL. Timely diagnosis and treatment of sleep apnea reduce cardiovascular sequelae in patients with myocardial infarction. PLoS One 2018; 13:e0201493. [PMID: 30059554 PMCID: PMC6066237 DOI: 10.1371/journal.pone.0201493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/16/2018] [Indexed: 02/04/2023] Open
Abstract
Background The present study aimed to test if the temporal sequence between sleep apnea (SA) diagnosis and incident myocardial infarction (MI) was associated with the long-term mortality and cardiovascular event in a community-based cohort. Methods We retrieved data from 9,453 incident MI patients between Jan. 1st 2000 and Dec. 31st 2012 from the Taiwan National Health Insurance Research Database. The study subjects included 207 MI patients with SA (SA-MI), further stratified into 110 with pre-existing SA before MI (SA-bMI) and 96 diagnosed with SA after MI (SA-pMI). The median follow-up period was 4.2 years. Propensity-score-matched controls were selected from 9,246 non-SA MI patients (non-SA-MI). The association of SA and outcomes including all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed by a Cox proportional hazards model. Results The result showed that SA was not associated with mortality regardless of the timing of SA diagnosis. SA-pMI was associated with increased risk of MACCEs (Hazard ratio [HR]: 1.412, 95% confidence interval [CI]: 1.037~1.923, p = 0.029) including re-MI or revascularization and ischemic heart disease hospitalization. Such an association was most significant for SA diagnosed within one year after MI (HR: 2.029, 95% CI: 1.265~3.254, p = 0.003), which was not seen in patients treated with continuous positive airway pressure (CPAP). Conclusion The temporal sequence and the time interval between SA diagnosis and incident MI was associated with the cardiovascular events after MI, especially within one year after MI. Early assessment for the presence of SA after incident MI and early CPAP intervention may reduce the risk of further adverse cardiovascular events.
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Affiliation(s)
- Ming-Tzer Lin
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Lun Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
- Center for Critical Care Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Pei-Lin Lee
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Center for electronics technology integration, National Taiwan University, Taipei, Taiwan
- * E-mail: (CLC); (PLL)
| | - Min-Huei Shen
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Ling Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Center for electronics technology integration, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail: (CLC); (PLL)
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Influence of obesity and metabolic syndrome on clinical outcomes of ST-segment elevation myocardial infarction in men undergoing primary percutaneous coronary intervention. J Cardiol 2018; 72:328-334. [PMID: 29709405 DOI: 10.1016/j.jjcc.2018.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/13/2018] [Accepted: 03/22/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The correlation between obesity and metabolic syndrome (MetS) and its impact on cardiovascular disease remains unclear. This study aims to investigate the impact of metabolic status and obesity on clinical outcomes of male patients with ST-segment elevation myocardial infarction (STEMI). METHODS Data from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry were used to evaluate the impact of obesity and MetS on patients undergoing primary percutaneous coronary intervention (PPCI) from November 2005 to November 2015. Patients were grouped according to the presence or absence of obesity and MetS ('obese-/MetS-', 'obese-/MetS+', 'obese+/MetS-', or 'obese+/MetS+', respectively). All-cause death and major adverse cardiac events (MACE) were recorded during 12 months of follow-up. RESULTS A total of 14,357 patients were included. Multivariate analysis showed that the presence of MetS was an independent risk factor for all-cause death (HR 2.08, 95% CI 1.30-3.31, p=0.002) and cardiovascular death (HR 2.44, 95% CI 1.33-4.46, p=0.004) at 12 months among normal weight patients. The protective effect of obesity was observed, compared with the obese-/MetS+ group, in terms of all-cause death (HR 0.50, 95% CI 0.31-0.81, p=0.005) and cardiovascular death (HR 0.52, 95% CI 0.28-0.96, p=0.038; vs. total obese individuals), but it might have disappeared compared with the obese-/MetS- group. The rate of MACE did not differ significantly according to category by obesity and MetS. CONCLUSIONS The obesity paradox has not been observed between obese and normal weight patients without MetS. Risk stratification on the basis of the presence or absence of MetS is not a clinically useful indicator of outcome in obese male patients with STEMI after PPCI.
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Vecchié A, Dallegri F, Carbone F, Bonaventura A, Liberale L, Portincasa P, Frühbeck G, Montecucco F. Obesity phenotypes and their paradoxical association with cardiovascular diseases. Eur J Intern Med 2018; 48:6-17. [PMID: 29100895 DOI: 10.1016/j.ejim.2017.10.020] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 12/15/2022]
Abstract
The pro-inflammatory state of the visceral adipose tissue (VAT) is supposed to accelerate cardiovascular (CV) and metabolic diseases in obese subjects. Some studies have recently reported an improved CV prognosis in certain obese and overweight patients as compared with leaner ones. This phenomenon, known as the "obesity paradox" (OP), has been described in many chronic diseases. This narrative review is based on the material searched for and obtained via PubMed and Web of Science up to May 2017. The search terms we used were: "obesity, paradox, adipose tissue" in combination with "cardiovascular, coronary heart disease, heart failure, arrhythmias". Using the current Body Mass Index (BMI)-based obesity definition, individuals with different clinical and biochemical characteristics are gathered together in the same category. Emerging evidence point to the existence of many "Obesity phenotypes" with different association with CV risk, accordingly to physical and life-style features. In this narrative review, we discussed if obesity phenotypes may be associated with a different CV risk, potentially explaining the OP. As a globally accepted definition of obesity is still lacking, we emphasized the need of a new approach, which should consider the heterogeneity of obesity. Better defining "obesities" and related CV risk is critical to markedly improve the classical BMI-based definition of obesity.
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Affiliation(s)
- Alessandra Vecchié
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, 10 Largo Benzi, 16132 Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Centre for Molecular Cardiology, University of Zürich, 12 Wagistrasse, 8952 Schlieren, Switzerland
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Gema Frühbeck
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, 10 Largo Benzi, 16132 Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132 Genoa, Italy.
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Sex-specific differences in mortality and the obesity paradox of patients with myocardial infarction ages >70 y. Nutrition 2017; 46:124-130. [PMID: 29108730 DOI: 10.1016/j.nut.2017.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 06/26/2017] [Accepted: 09/18/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Recent studies suggest an obesity survival paradox in patients with acute myocardial infarction (MI). The aim of this study was to investigate the in-hospital mortality of patients aged ≥70 y with acute MI relative to sex and obesity. METHODS We selected patients ≥70 y of age with a diagnosis of acute MI based on the International Classification of Diseases (ICD) code I21 in the nationwide database of the Federal Statistical Office of Germany in 2014. We stratified the patients for sex and obesity versus nonobesity, and obesity classes I, II, and III. We compared the in-hospital mortality of these groups. RESULTS In 2014, 122 607 patients ≥70 y of age were diagnosed with acute MI in Germany. Among these inpatients 14 342 (11.7%) died during their in-hospital stay. The calculated incidence was 938.46 per 100 000 citizens. Overall, 7874 MI patients (6.4%) had an additional coded diagnosis of obesity; 513 of these patients (6.5%) died while in the hospital. The number of MI events was higher in men than in women (56.2 versus 43.8%), whereas mortality rate of the women exceeded that of the men (12.7 versus 10.9%). Obesity mitigated sex differences in mortality after MI. Overall mortality after acute MI was distinctly lower in all obesity classes relative to MI patients without coded obesity. Relative mortality risk was 0.45, 0.62, and 0.75 in obesity classes I, II, and III, respectively. The present results point to a pronounced obesity paradox in women. CONCLUSIONS Obesity is associated with lower in-hospital mortality in patients ≥70 y with MI relative to MI patients without coded obesity. Although women showed higher in-hospital mortality, sex differences were significantly attenuated by obesity. Women showed a pronounced obesity paradox in the higher obesity classes.
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Champagne-Langabeer T, Kim J, Bower JK, Gardner A, Fowler R, Langabeer JR. Obesity, Treatment Times, and Cardiovascular Outcomes After ST-Elevation Myocardial Infarction: Findings From Mission: Lifeline North Texas. J Am Heart Assoc 2017; 6:JAHA.117.005827. [PMID: 28939712 PMCID: PMC5634256 DOI: 10.1161/jaha.117.005827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND With increasing rates of obesity and its link with cardiovascular disease, there is a need for better understanding of the obesity-outcome relationship. This study explores the association between categories of obesity with treatment times and mortality for patients experiencing ST-segment elevation myocardial infarction. METHODS AND RESULTS We examined 8725 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and used regression models to analyze the relationship between 6 categories of body mass index with key door-to-balloon time, total ischemic time, and in-hospital mortality. We relied on data from the Mission: Lifeline North Texas program, consisting of 33 percutaneous coronary intervention-capable hospitals in 6 counties surrounding Dallas, Texas. Data were extracted from the National Cardiovascular Data Registry for each participating hospital. Of the samples, 76% were overweight or obese. Comparing the univariate differences between the normal-weight group and the pooled sample, we observed a U-shaped association between body mass index and both mortality and door-to-balloon times. The most underweight and severely obese had the highest mortality and median door-to-balloon time, respectively. These differences persisted after multivariate adjustments for door-to-balloon time, but not for mortality. CONCLUSIONS Extremely obese patients have longer treatment time delays than other body mass index categories. However, this did not extend to significant differences in mortality in the multivariate models. We conclude that clinicians should incorporate body mass assessments into their diagnosis and treatment plans to mitigate observed disparities.
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Affiliation(s)
| | - Junghyun Kim
- The University of Texas Health Sciences Center, Houston, TX
| | | | - Angela Gardner
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Raymond Fowler
- The University of Texas Southwestern Medical Center, Dallas, TX
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Paratz ED, Wilkinson LE, MacIsaac AI. Outcomes of Obese and Morbidly Obese Patients Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2017; 27:785-791. [PMID: 29428203 DOI: 10.1016/j.hlc.2017.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/26/2017] [Accepted: 08/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The risks of percutaneous coronary intervention (PCI) in obese and particularly morbidly obese patients remain uncertain. METHODS 1082 consecutive patients were categorised as non-obese (NO, body mass index (BMI) <30kg/m2, n=688), obese (O, BMI 30-40kg/m2, n=354) or morbidly obese (MO, BMI ≥40kg/m2, n=40). Demographic and procedural information was collated. Monte Carlo simulations modelled radiation dosimetric data. RESULTS Obese and morbidly obese patients were younger (p=0.016), more frequently female (p=0.036), more frequently diabetic (p<0.0001), with better renal function (p<0.0001), and prior PCI (p=0.01). There was no difference in major adverse cardiovascular or cerebrovascular events (MACCE) (NO=1.2%, O=0.8%, MO=2.5%, p=NS), acute kidney injury, bleeding, length of stay, 30-day readmission or 30-day mortality. Obese and morbidly obese patients received increased contrast (NO=180 [150-230]mL, O=190 [160-250]mL, MO=200 [165-225]mL, p=0.016), dose area product (NO=75.56 [50.61-113.69]Gycm2, O=116.4 [76.11-157.82]Gycm2, MO=125.62 [92.22-158.81]Gycm2, p<0.0001), entrance air kerma (NO=1439.42 [977.0-2075.5]mGy, O=2111.63 [1492.0-3011.0]mGy, MO=2376.0 [1700.0-3234.42]mGy, p<0.0001), and peak skin dose (NO=1439.42 [977.0-2075.5], O=2111.63 [1492.0-3011.0], MO=2376.0 [1700.0-3234.42], p<0.0001). Effective radiation dose increased in obese patients (NO=20.9±14.9mSv, O=27.4±17.1mSv, MO=24.1±12.6mSv, p<0.0001 for NO vs O, p=0.449 for NO vs MO). CONCLUSIONS Percutaneous coronary intervention can be performed in obese and morbidly obese patients without elevated risk for most clinical outcomes. However, radiation increases above levels that could cause both transient and late effects. Strategies should be pursued to minimise radiation dose.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia.
| | - Luke E Wilkinson
- Department of Medical Engineering and Physics, St Vincent's Hospital Melbourne, Vic, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
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Chatterjee K, Gupta T, Goyal A, Kolte D, Khera S, Shanbhag A, Patel K, Villablanca P, Agarwal N, Aronow WS, Menegus MA, Fonarow GC, Bhatt DL, Garcia MJ, Meena NK. Association of Obesity With In-Hospital Mortality of Cardiogenic Shock Complicating Acute Myocardial Infarction. Am J Cardiol 2017; 119:1548-1554. [PMID: 28363355 DOI: 10.1016/j.amjcard.2017.02.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 01/20/2023]
Abstract
Several previous studies have shown obesity to be counterintuitively associated with more favorable mortality in patients with acute myocardial infarction (AMI); however, the association of obesity with in-hospital mortality of cardiogenic shock complicating AMI has not been previously examined. We queried the 2004 to 2013 National Inpatient Sample databases to identify all patients ≥18 years hospitalized with the principal diagnosis of AMI. Multivariable regression models adjusting for demographics, hospital characteristics, and co-morbidities were used to examine differences in incidence and in-hospital mortality of cardiogenic shock complicating AMI between obese and nonobese patients. Of 6,097,817 patients with AMI, 290,894 (4.8%) had cardiogenic shock. There was no difference in risk-adjusted incidence of cardiogenic shock between obese and nonobese patients (adjusted odds ratio 1.00, 95% CI 0.98 to 1.01; p = 0.46). Of the patients with cardiogenic shock complicating AMI, 8.9% had a documented diagnosis of obesity. Obese patients were on average 6 years younger and had higher prevalence of most cardiovascular co-morbidities. Obese patients were more likely to receive revascularization (73.0% vs 63.4%, p <0.001) and had lower risk-adjusted in-hospital mortality compared with nonobese patients (28.2% vs 36.5%; adjusted odds ratio 0.89, 95% CI 0.86 to 0.92; p <0.001). Similar findings were seen in subgroups of patients with cardiogenic shock complicating ST elevation or non-ST elevation MI. In conclusion, this large retrospective analysis of a nationwide cohort of patients with cardiogenic shock complicating AMI demonstrated that obese patients were younger, more likely to receive revascularization, and had modestly lower risk-adjusted in-hospital mortality compared with nonobese patients.
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Singh RK, Kumar P, Mahalingam K. Molecular genetics of human obesity: A comprehensive review. C R Biol 2017; 340:87-108. [PMID: 28089486 DOI: 10.1016/j.crvi.2016.11.007] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/03/2016] [Accepted: 11/10/2016] [Indexed: 12/25/2022]
Abstract
Obesity and its related health complications is a major problem worldwide. Hypothalamus and their signalling molecules play a critical role in the intervening and coordination with energy balance and homeostasis. Genetic factors play a crucial role in determining an individual's predisposition to the weight gain and being obese. In the past few years, several genetic variants were identified as monogenic forms of human obesity having success over common polygenic forms. In the context of molecular genetics, genome-wide association studies (GWAS) approach and their findings signified a number of genetic variants predisposing to obesity. However, the last couple of years, it has also been noticed that alterations in the environmental and epigenetic factors are one of the key causes of obesity. Hence, this review might be helpful in the current scenario of molecular genetics of human obesity, obesity-related health complications (ORHC), and energy homeostasis. Future work based on the clinical discoveries may play a role in the molecular dissection of genetic approaches to find more obesity-susceptible gene loci.
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Affiliation(s)
- Rajan Kumar Singh
- Department of Bio-Medical Sciences, School of Biosciences and Technology, VIT University, 632014 Vellore, India
| | - Permendra Kumar
- Department of Bio-Medical Sciences, School of Biosciences and Technology, VIT University, 632014 Vellore, India
| | - Kulandaivelu Mahalingam
- Department of Bio-Medical Sciences, School of Biosciences and Technology, VIT University, 632014 Vellore, India.
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Abstract
Obesity is a major burden on healthcare systems worldwide due to the association with numerous complications, arguably the most important of which are the development of type 2 diabetes and cardiovascular disease. Both are thought to develop from similar origins and occur at variable rates in obese individuals, including those with similar body mass indices. This phenomenon is likely a result of an increased susceptibility for the storage of excess fat in the wrong place, namely, ectopic fat surrounding the liver, pancreas and muscles. This triggers a concatenation of events leading to insulin resistance and inflammation which culminate in an increased atherothrombotic potential due to the dysfunction of vascular endothelial cells causing accelerated atherosclerotic plaque formation and a pro-thrombotic phenotype. The degree of weight loss following different interventions is well documented but it is less widely known what effect weight loss by various means has on the deleterious process mentioned above, in particular their effects on cardiovascular events. This review summarises the processes leading to increased vascular risk in obesity and examines the effects of currently available weight loss strategies on reversing these processes and how this translates to cardiovascular disease.
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Affiliation(s)
- Rhodri J King
- Leeds Institute for Cardiovascular and Metabolic Medicine, LIGHT Laboratories, University of Leeds, Leeds, UK
| | - Ramzi A Ajjan
- Leeds Institute for Cardiovascular and Metabolic Medicine, LIGHT Laboratories, University of Leeds, Leeds, UK
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Klatsky AL, Zhang J, Udaltsova N, Li Y, Tran HN. Body Mass Index and Mortality in a Very Large Cohort: Is It Really Healthier to Be Overweight? Perm J 2017; 21:16-142. [PMID: 28678695 PMCID: PMC5499607 DOI: 10.7812/tpp/16-142] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Controversy persists about optimal body weight. Many experts define "normal" (healthy) body mass index (BMI) as 18.5 to 24.9 kg/m2, 25 to 29.9 kg/m2 as overweight, and 30 kg/m2 or greater as obese. Obesity is subdivided into 30 to 34.9 kg/m2 (Grade 1), 35 to 39.9 kg/m2 (Grade 2), and 40 kg/m2 and above (Grade 3). Studies consistently show higher mortality for underweight and Grade 2 or 3 obesity, but results conflict for the overweight category and Grade 1 obesity. OBJECTIVE To study 30-year risk of death related to baseline BMI. DESIGN Retrospective cohort study in a multiracial population of 273,843 persons using logistic regression with 7 covariates (sex, age, race-ethnicity, education, marital status, smoking, alcohol intake). MAIN OUTCOME MEASURES Mortality risk by baseline BMI. RESULTS With average follow-up exceeding 30 years, there were 103,218 deaths: 41,215 attributed to cardiovascular causes and 62,003 to noncardiovascular causes. Odds ratios (and 95% confidence intervals) for all deaths in BMI categories, with a BMI of 18.5 to 24.9 kg/m2 as the referent, were BMI below 18.5 kg/m2 = 1.1 (1.0-2.0), BMI 25 to 29 kg/m2 = 1.1 (1.1-1.2), BMI 30 to 34 kg/m2 = 1.5 (1.4-1.5), BMI 35 to 39 kg/m2 = 2.1 (1.9-2.3), and BMI 40 kg/m2 or higher = 2.7 (2.4-3.0). Disparities existed regarding age, race/ethnicity, cause of death, and interval to death. CONCLUSION Compared with persons with BMI defined as normal, persons who were underweight, overweight, and obese were at increased risk of death over 30 years.
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Affiliation(s)
- Arthur L Klatsky
- Senior Consultant in Cardiology and an Adjunct Investigator in the Division of Research, Kaiser Permanente Medical Care Program in Oakland, CA.
| | | | | | - Yan Li
- Hematologist and Oncologist at the Oakland Medical Center in CA.
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Antonopoulos AS, Oikonomou EK, Antoniades C, Tousoulis D. From the BMI paradox to the obesity paradox: the obesity-mortality association in coronary heart disease. Obes Rev 2016; 17:989-1000. [PMID: 27405510 DOI: 10.1111/obr.12440] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/15/2016] [Accepted: 05/23/2016] [Indexed: 12/13/2022]
Abstract
Despite a strong association between body weight and mortality in the general population, clinical evidence suggests better clinical outcome of overweight or obese individuals with established coronary heart disease. This finding has been termed the 'obesity paradox', but its existence remains a point of debate, because it is mostly observed when body mass index (BMI) is used to define obesity. Inherent limitations of BMI as an index of adiposity, as well as methodological biases and the presence of confounding factors, may account for the observed findings of clinical studies. In this review, our aim is to present the data that support the presence of a BMI paradox in coronary heart disease and then explore whether next to a BMI paradox a true obesity paradox exists as well. We conclude by attempting to link the obesity paradox notion to available translational research data supporting a 'healthy', protective adipose tissue phenotype. © 2016 World Obesity.
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Affiliation(s)
- A S Antonopoulos
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece. .,Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
| | - E K Oikonomou
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece.,Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - C Antoniades
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - D Tousoulis
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece
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Kim SH, Després JP, Koh KK. Obesity and cardiovascular disease: friend or foe? Eur Heart J 2015; 37:3560-3568. [DOI: 10.1093/eurheartj/ehv509] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/26/2015] [Accepted: 09/07/2015] [Indexed: 01/14/2023] Open
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Ellimoottil C, Roghmann F, Blackwell R, Kadlec A, Greco K, Quek ML, Sun M, Trinh QD, Gupta G. Open Versus Robotic Radical Prostatectomy in Obese Men. Curr Urol 2015; 8:156-61. [PMID: 26889136 DOI: 10.1159/000365708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/29/2014] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Robotic-assisted radical prostatectomy (RARP) has been shown to reduce blood loss, peri-operative complications and length of stay when compared to open radical prostatectomy (ORP). We sought to determine whether the reported benefits of RARP over ORP translate to obese patients. PATIENTS AND METHODS We utilized the 2009-2010 Nationwide Inpatient Sample to identify all obese men with prostate cancer who underwent ORP and RARP. Our primary outcome was the presence of a peri-operative adverse event (i.e. blood transfusion, complication, prolonged length of stay). We fit multivariable logistic regression models to examine whether RARP in obese patients was independently associated with decreased odds of all three outcomes. RESULTS We identified 9,108 obese patients who underwent radical prostatectomy. On multivariable analysis, the use of RARP in the obese population was not independently associated with decreased odds of developing a peri-operative complication (OR = 0.81, CI: 0.58-1.13, p = 0.209). RARP was, however, associated with decreased odds of blood transfusion (OR = 0.17, CI: 0.10-0.30, p < 0.001) and prolonged length of stay (OR = 0.28, CI: 0.20-0.40, p < 0.001). CONCLUSION Our findings suggest that in obese patients, the use of RARP may reduce length of stay and blood transfusions compared to ORP. Both approaches, however, are associated with similar odds of developing a complication.
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Affiliation(s)
| | - Florian Roghmann
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany
| | | | - Adam Kadlec
- Loyola University Medical Center, Maywood, IL., USA
| | | | | | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Quoc-Dien Trinh
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA., USA
| | - Gopal Gupta
- Loyola University Medical Center, Maywood, IL., USA
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Colombo MG, Meisinger C, Amann U, Heier M, von Scheidt W, Kuch B, Peters A, Kirchberger I. Association of obesity and long-term mortality in patients with acute myocardial infarction with and without diabetes mellitus: results from the MONICA/KORA myocardial infarction registry. Cardiovasc Diabetol 2015; 14:24. [PMID: 25885918 PMCID: PMC4396021 DOI: 10.1186/s12933-015-0189-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/04/2015] [Indexed: 02/06/2023] Open
Abstract
Background Paradoxically, beneficial effects of overweight and obesity on survival have been found in patients after cardiovascular events such as acute myocardial infarction (AMI). This obesity paradox has not been analyzed in AMI patients with diabetes even though their cardiovascular morbidity and mortality is increased compared to their counterparts without diabetes. Therefore, the objective of this long-term study was to analyze the association between body mass index (BMI) and all-cause mortality in AMI patients with and without diabetes mellitus. Methods Included in the study were 1190 patients with and 2864 patients without diabetes, aged 28-74 years, recruited from a German population-based AMI registry. Patients were consecutively hospitalized between 1 January 2000 and 31 December 2008 with a first ever AMI and followed up until December 2011. Data collection comprised standardized interviews and chart reviews. To assess the association between BMI and long-term mortality from all causes, Cox proportional hazards models were calculated adjusted for risk factors, co-morbidities, clinical characteristics, in-hospital complications as well as medical and drug treatment. Results AMI patients of normal weight (BMI 18.5-24.9 kg/m2) had the highest long-term mortality rate both in patients with and without diabetes with 50 deaths per 1000 person years and 26 deaths per 1000 person years, respectively. After adjusting for a selection of covariates, a significant, protective effect of overweight and obesity on all-cause mortality was found in AMI patients without diabetes (overweight: hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.58-0.93; p=0.009; obesity: HR 0.64, 95% CI 0.47-0.87; p=0.004). In contrast, an obesity paradox was not found in AMI patients with diabetes. However, stratified analyses showed survival benefits in overweight AMI patients with diabetes who had been prescribed statins prior to AMI (HR 0.51, 95% CI 0.29-0.89, p=0.018) or four evidence-based medications at hospital-discharge (HR 0.52, 95% CI 0.34-0.80, p=0.003). Conclusion In contrast to AMI patients without diabetes, AMI patients with diabetes do not experience a survival benefit from an elevated BMI. To investigate the underlying reasons for these findings, further studies stratifying their samples by diabetes status are needed. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0189-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miriam Giovanna Colombo
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, 86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Christa Meisinger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, 86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Ute Amann
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, 86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Margit Heier
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, 86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Wolfgang von Scheidt
- Central Hospital of Augsburg, Department of Internal Medicine I-Cardiology, Stenglinstr. 2, 86156, Augsburg, Germany.
| | - Bernhard Kuch
- Central Hospital of Augsburg, Department of Internal Medicine I-Cardiology, Stenglinstr. 2, 86156, Augsburg, Germany. .,Hospital of Nördlingen, Department of Internal Medicine/Cardiology, Stoffelsberg 4, 86720, Nördlingen, Germany.
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Inge Kirchberger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, 86156, Augsburg, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
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Alidoosti M, Salarifar M, Hajizeinali AM, Kassaian SE, Nematipour E, Aghajani H, Lotfi-Tokaldany M, Kazazi EH. Relationship between Body Mass Index and Outcome of Elective Percutaneous Coronary Intervention. J Tehran Heart Cent 2015; 10:18-23. [PMID: 26157459 PMCID: PMC4494515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/09/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Studies have shown controversial effects of obesity on major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI). We sought to investigate the impact of the body mass index (BMI) on the mid-term outcome following successful PCI. METHODS Between March 2006 and August 2008, 3948 patients underwent successful elective PCI in Tehran Heart Center, Tehran, Iran, and were retrospectively included in this study. Patients who underwent PCI on the same day as the occurrence of myocardial infarction were excluded. The demographic, procedural, in-hospital, and follow-up information of these patients was extracted from the PCI Data Registry of our institution. The patients were divided into three groups: normal weight (No. 1058, BMI < 25 kg/m(2) age = 58 ± 10 years); overweight (No. 1867, 25 ≤ BMI < 30 kg/m(2), age = 57 ± 10 years); and obese (No. 1023, BMI ≥ 30 kg/m(2), age = 56 ± 10 years). MACE included death, myocardial infarction, target vessel revascularization, and target lesion revascularization. RESULTS Compared with the other patients, the obese individuals were significantly younger and more frequently female, had a higher ejection fraction, and more frequently presented with hypertension, diabetes, and hyperlipidemia. There was no association between the BMI and the angiographic and procedural findings in the univariate analysis. While no difference was found in the rate of in-hospital death between the groups, the number of the obese patients undergoing emergent cardiac surgery was marginally different in the univariate analysis (p value = 0.06). At 9 months' follow-up, MACE had occurred in 92 (2.3%) patients and cardiac mortality was 9 (0.2%). After adjustments for confounders, no significant difference was observed in terms of MACE between the BMI groups. CONCLUSION The BMI had no significant effect on the rate of MACE at 9 months' follow-up in our study population. Interventionists' recommendations for patients undergoing PCI should, therefore, not be significantly influenced by the BMI status.
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Affiliation(s)
- Mohammad Alidoosti
- Corresponding Author: Mohammad Alidoosti, Associate Professor in Cardiology, Interventional Cardiology Department, Tehran Heart Center, North Kargar Street, Tehran, Iran. 1411713138. Tel: + 98 21 88089256. Fax: + 98 21 88089256. E-mail:
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Zhu J, Su X, Li G, Chen J, Tang B, Yang Y. The incidence of acute myocardial infarction in relation to overweight and obesity: a meta-analysis. Arch Med Sci 2014; 10:855-62. [PMID: 25395935 PMCID: PMC4223131 DOI: 10.5114/aoms.2014.46206] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/05/2014] [Accepted: 02/10/2014] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Epidemiological evidence suggests that overweight and obesity have been associated with acute myocardial infarction (AMI). However, data on this issue are controversial. This study aims to use meta-analysis to determine whether overweight and obesity are related to AMI. MATERIAL AND METHODS We searched PubMed and Embase databases up to October 23(rd), 2013 for related literature. The association of overweight and obesity with AMI was assessed by odd ratio (OR) with 95% confidence interval (CI) as the effect size. Then subgroup analysis was performed according to gender, area and study type. RESULTS Five primary studies (one cohort study and four case-control studies) were included in this meta-analysis involving 36 803 participants, 14 883 of whom had an AMI. There was a significant association between overweight and AMI (OR = 1.27, 95% CI: 1.21-1.33, p < 0.001). Similar results revealed a relation between obesity and AMI (OR = 1.22, 95% CI: 1.07-1.40, p = 0.003). Subgroup analysis showed that overweight and obesity were positively associated with AMI risk except for obese subjects in Europe. There was no publication bias (Begg's test p = 0.972, Egger's test p = 0.858). CONCLUSIONS Both overweight and obesity increased the incidence of AMI, and it is necessary to control weight to prevent AMI. A large number of studies is needed to explore the mechanisms that link overweight and obesity with AMI.
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Affiliation(s)
- Jun Zhu
- Department of Cardiology, General Hospital of PLA, Chengdu Military Area Command, Tianhui Town, Jinniu District, Chengdu, China
| | - Xiaohua Su
- Department of Cardiology, General Hospital of PLA, Chengdu Military Area Command, Tianhui Town, Jinniu District, Chengdu, China
| | - Gang Li
- Department of Cardiology, General Hospital of PLA, Chengdu Military Area Command, Tianhui Town, Jinniu District, Chengdu, China
| | - Jingsong Chen
- Department of Cardiology, General Hospital of PLA, Chengdu Military Area Command, Tianhui Town, Jinniu District, Chengdu, China
| | - Bing Tang
- Department of Cardiology, General Hospital of PLA, Chengdu Military Area Command, Tianhui Town, Jinniu District, Chengdu, China
| | - Yongjian Yang
- Department of Cardiology, General Hospital of PLA, Chengdu Military Area Command, Tianhui Town, Jinniu District, Chengdu, China
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Jahangir E, De Schutter A, Lavie CJ. The relationship between obesity and coronary artery disease. Transl Res 2014; 164:336-44. [PMID: 24726461 DOI: 10.1016/j.trsl.2014.03.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/07/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
Obesity continues to be a growing issue in the United States, with an estimated prevalence of 72 million people. There are major health implications associated with obesity, including its relationship with hypertension, diabetes mellitus type 2, metabolic syndrome, and dyslipidemia, all independent risk factors for coronary artery disease (CAD). Despite the increased risk of developing CAD, in recent years an "obesity paradox" has been described in which moderately obese individuals with established cardiovascular disease, including CAD, appear to have mortality similar to their normal-weight counterparts. This review examines the relationship between obesity and CAD, including the increased risk of hypertension, diabetes mellitus, metabolic syndrome, and dyslipidemia, along with a discussion of the obesity paradox and the benefits of weight reduction.
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Affiliation(s)
- Eiman Jahangir
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, La.
| | - Alban De Schutter
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, La
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, La; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, La
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De Schutter A, Lavie CJ, Kachur S, Patel DA, Milani RV. Body composition and mortality in a large cohort with preserved ejection fraction: untangling the obesity paradox. Mayo Clin Proc 2014; 89:1072-9. [PMID: 25039037 DOI: 10.1016/j.mayocp.2014.04.025] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 03/11/2014] [Accepted: 04/16/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effects of body composition as a function of lean mass index (LMI) and body fat (BF) on the correlation between increasing body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) and decreasing mortality, which is known as the obesity paradox. PATIENTS AND METHODS We retrospectively assessed 47,866 patients with preserved left ventricular ejection fraction (≥50%). We calculated BF by using the Jackson-Pollock equation and LMI using (1 - BF) × BMI. The population was divided according to the sex-adjusted BMI classification, sex-adjusted LMI classification, and sex-adjusted BF tertiles. The population was analyzed by using multivariate analysis for total mortality over a mean follow-up duration of 3.1 years by using the National Death Index, adjusting for left ventricular ejection fraction, left ventricular mass index, age, sex, and relative wall thickness. RESULTS In the entire population, higher BMI was narrowly associated (hazard ratio [HR], 0.99; P<.001) with lower mortality. The higher LMI group was clearly protective (HR, 0.71; P<.001), whereas BF tertile was associated with lower mortality only if no adjustment was made for LMI (HR, 0.87; P<.001 without LMI; HR, 0.97; P=.23 with LMI). In the lean patients, low BMI was clearly associated with higher mortality (HR, 0.92; P<.001) and lower BF tertile was associated with lower mortality only if no adjustment was made for LMI (HR, 0.80; P<.001 without LMI; HR, 1.01; P=.83 with LMI). The underweight patients stratified by BF seemed to have an increased mortality (HR, 1.91; 95% CI, 1.56-2.34) that was independent of LMI. However, in obese patients, both BMI (HR, 1.03; P<.001) and BF (HR, 1.18; P=.003) were associated with higher mortality, even after adjusting for LMI, which remained protective (HR, 0.57; P<.001) independently of BF. CONCLUSION Body composition could explain the inverse J shape of the mortality curve noted with increasing BMI. Body fat seems to be protective in this cohort only if no adjustment was made for LMI, although being underweight stratified by BF seems to be an independent risk factor. Lean mass index seems to remain protective in obese patients even when BMI is not.
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Affiliation(s)
- Alban De Schutter
- John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Medicine, Cleveland Clinic Florida, Weston
| | - Carl J Lavie
- John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge.
| | - Sergey Kachur
- Department of Medicine, Cleveland Clinic Florida, Weston
| | - Dharmendrakumar A Patel
- John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Richard V Milani
- John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
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Ogasawara T, Umezawa H, Naito Y, Takeuchi T, Kato S, Yano T, Kasamatsu N, Hashizume I. Procalcitonin-guided antibiotic therapy in aspiration pneumonia and an assessment of the continuation of oral intake. Respir Investig 2014; 52:107-113. [PMID: 24636266 DOI: 10.1016/j.resinv.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/15/2013] [Accepted: 08/01/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Procalcitonin-guided antibiotic therapy for community-acquired pneumonia is effective and safe. However, the usefulness of procalcitonin for aspiration pneumonia and its nutrition-related outcomes are unknown. METHODS We conducted a noninferiority randomized controlled study in patients with aspiration pneumonia who were admitted to our hospital between September 2010 and January 2012. We randomly assigned 105 patients to groups with different durations of antibiotic therapy based on the procalcitonin levels upon admission (procalcitonin group) or according to the standard guidelines (control group). The primary endpoints were relapse of aspiration pneumonia and death within 30 days, with a predefined noninferiority boundary of 10%. Secondary endpoints included duration of antibiotic exposure. Furthermore, we conducted a retrospective analysis of the prognostic factors that determined continuation of oral nutritional intake, relapse of pneumonia, and in-hospital death. RESULTS The rate of relapse and death within 30 days were similar in the procalcitonin and control groups (25% versus 37.5%; difference, -12.5%; 95% confidence interval, -30.9% to 5.9%). Procalcitonin-guided antibiotic therapy significantly shortened the median duration of antibiotic exposure (5 versus 8 days; p<0.0001); however, the continuation of oral intake was not increased (56% versus 50%; p=0.54). A multivariable analysis showed a significant association between the continuation of oral nutritional intake and the body mass index upon admission. CONCLUSIONS Procalcitonin-guided antibiotic therapy for aspiration pneumonia can shorten the duration of antibiotic exposure, but it does not increase the continuation of oral intake (UMIN000004800).
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Affiliation(s)
- Takashi Ogasawara
- Department of Respiratory Medicine, Hamamatsu Medical Center, 328 Tomitsuka, Hamamatsu, Shizuoka 432-8580, Japan.
| | - Hiroki Umezawa
- Department of Respiratory Medicine, Hamamatsu Medical Center, 328 Tomitsuka, Hamamatsu, Shizuoka 432-8580, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yusuke Naito
- Department of Respiratory Medicine, Hamamatsu Medical Center, 328 Tomitsuka, Hamamatsu, Shizuoka 432-8580, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Takao Takeuchi
- Department of Respiratory Medicine, Hamamatsu Medical Center, 328 Tomitsuka, Hamamatsu, Shizuoka 432-8580, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Shinpei Kato
- Department of Respiratory Medicine, Hamamatsu Medical Center, 328 Tomitsuka, Hamamatsu, Shizuoka 432-8580, Japan
| | - Toshiaki Yano
- Department of Respiratory Medicine, Hamamatsu Medical Center, 328 Tomitsuka, Hamamatsu, Shizuoka 432-8580, Japan
| | - Norio Kasamatsu
- Department of Respiratory Medicine, Hamamatsu Medical Center, 328 Tomitsuka, Hamamatsu, Shizuoka 432-8580, Japan
| | - Ikko Hashizume
- Department of Respiratory Medicine, Hamamatsu Medical Center, 328 Tomitsuka, Hamamatsu, Shizuoka 432-8580, Japan
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Ghoorah K, Campbell P, Kent A, Maznyczka A, Kunadian V. Obesity and cardiovascular outcomes: a review. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 5:77-85. [PMID: 24526749 DOI: 10.1177/2048872614523349] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/08/2014] [Indexed: 11/16/2022]
Abstract
The prevalence of obesity is increasing at an epidemic rate globally with more than 1 billion adults overweight and at least 300 million of them clinically obese. This is expected to rise further in the next 20 to 30 years. Obesity is known to be an independent risk factor for serious health conditions, including hypertension, type 2 diabetes, and cardiovascular diseases. Given the association of obesity with cardiovascular disease, it could be speculated that obese individuals would have adverse outcomes after a cardiovascular event compared to those with normal body mass index (BMI). However, various studies have reported a paradoxical U-shaped relationship between obesity and mortality from various diseases, including myocardial infarction and heart failure, suggesting that patients with higher BMI have similar or lower short- and long-term mortality rates. This phenomenon has been termed the 'obesity paradox' or 'reverse epidemiology'. The goal of this review is to evaluate the potential mechanisms behind the obesity paradox and its implications.
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Affiliation(s)
- Kuldeepa Ghoorah
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Alexandra Kent
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Vijay Kunadian
- Newcastle University, Newcastle, UK Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
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Goel K, Lopez-Jimenez F, De Schutter A, Coutinho T, Lavie CJ. Obesity paradox in different populations: evidence and controversies. Future Cardiol 2014; 10:81-91. [DOI: 10.2217/fca.13.84] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
ABSTRACT: An inverse association between BMI and mortality has been reported in patients with coronary heart disease and heart failure. This ‘obesity paradox‘ has recently been reported in other disease states, including stroke, hypertension, incident diabetes, atrial fibrillation, hemodialysis and transcatheter aortic valve replacement. Cardiorespiratory fitness influences the obesity paradox and this inverse association may be present only in individuals with low fitness levels. Intentional weight loss, exercise training and improving lean mass are important and should be advised to all patients. Recent studies have also explored the association between measures of central obesity and direct measures of body fat with mortality. This review will summarize the evidence, controversies and mechanisms associated with the puzzling obesity paradox.
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Affiliation(s)
- Kashish Goel
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Francisco Lopez-Jimenez
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Alban De Schutter
- Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute & Ochsner Clinical School–The University of Queensland School of Medicine, 1514 Jefferson Hwy, New Orleans, LA 70121, USA
| | - Thais Coutinho
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Carl J Lavie
- The Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
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Bozorgmanesh M, Arshi B, Sheikholeslami F, Azizi F, Hadaegh F. No Obesity Paradox-BMI Incapable of Adequately Capturing the Relation of Obesity with All-Cause Mortality: An Inception Diabetes Cohort Study. Int J Endocrinol 2014; 2014:282089. [PMID: 25180034 PMCID: PMC4142289 DOI: 10.1155/2014/282089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/09/2014] [Indexed: 01/12/2023] Open
Abstract
Background. To reconcile "the obesity paradox," we tested if (1) the contribution of anthropometric measures to mortality was nonlinear and (2) the confounding of hip circumference contributed to the obesity paradox recently observed among diabetic patients. Methods. We analyzed data of diabetic patients attending a community-based prospective, "Tehran lipid and glucose study." In the mortality analysis, anthropometric measures-body mass index (BMI), waist, and hip circumference-were assessed using Cox models incorporating cubic spline functions. Results. During 12 990 person-years follow-up, BMI levels below 27 and those above 40 kg·m(-2) were associated with increased mortality. When we added waist circumference to the BMI in the multivariate-adjusted model, the steepness of BMI-mortality association curve slope for values below 27 kg·m(-2) increased, whereas the steepness of BMI-mortality association curve slope for values above this threshold decreased. Further adjusting the model for hip circumference, the steepness of the slopes of the association curve moved towards null on both extremes and no associations between BMI and all-cause mortality remained. Conclusion. BMI harbors intermixed positive and negative confounding effects on mortality of waist and hip circumference. Failing to control for the confounding effect of hip circumference may stymie unbiased hazard estimation and render conclusions paradoxical.
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Affiliation(s)
- Mohammadreza Bozorgmanesh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Banafsheh Arshi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Farhad Sheikholeslami
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
- *Farzad Hadaegh:
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De Schutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. Prog Cardiovasc Dis 2013; 56:401-8. [PMID: 24438731 DOI: 10.1016/j.pcad.2013.08.003] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Obesity is associated with a host of cardiovascular risk factors and its prevalence is rising rapidly. Despite strong evidence that obesity predisposes to the development and progression of coronary heart disease (CHD), numerous studies have shown an inverse relationship between various measures of obesity (most commonly body mass index) and outcomes in established CHD. In this article we review the evidence surrounding the ≪obesity paradox≫ in the secondary care of CHD patients and the CHD presentations where a paradox has been found. Finally we discuss the impact of cardiorespiratory fitness and a number of mechanisms which may offer potential explanations for this puzzling phenomenon.
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Affiliation(s)
- Alban De Schutter
- Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
| | - Carl J Lavie
- Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA; The Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA.
| | - Richard V Milani
- Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
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De Schutter A, Lavie CJ, Patel DA, Milani RV. Obesity paradox and the heart: which indicator of obesity best describes this complex relationship? Curr Opin Clin Nutr Metab Care 2013; 16:517-24. [PMID: 23892506 DOI: 10.1097/mco.0b013e328363bcca] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Despite the detrimental effects of obesity on coronary heart disease (CHD) and heart failure, obesity is found to be paradoxically associated with improved survival in secondary care of CHD and heart failure. This 'obesity paradox' is an area of active research, and it might be the result of an inaccurate working definition of obesity, which is traditionally defined in terms of BMI. We reviewed the recent literature on the paradox and examined different anthropomorphic measurements and their association with prognosis in cardiovascular diseases. RECENT FINDINGS In CHD, obesity is associated with improved prognosis when defined by high BMI and body fat, independent of fat-free mass (FFM). High waist circumference seems to be associated with worse prognosis in some studies, but is associated with protection and an obesity paradox in those with poor cardiorespiratory fitness (CRF). In patients with heart failure, BMI, body fat and waist circumference, and possibly FFM, have been associated with improved survival. Despite these findings, intentional weight loss remains protective. In both CHD and heart failure, CRF seems to significantly impact the relationship between adiposity and subsequent prognosis, and an obesity paradox is only present with low CRF. SUMMARY Body composition, including waist circumference, body fat and FFM have a role in clinical practice. Emphasis should be placed on improving CRF, regardless of weight status. Intentional weight loss, particularly while maintaining FFM, should be encouraged in obese individuals.
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Affiliation(s)
- Alban De Schutter
- Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA
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Cheng CC, Huang WC, Chiou KR, Kuo FY, Chiang CH, Yang JS, Lin KL, Hsiao SH, Hwang HR, Mar GY, Lin SL, Chiou CW, Liu CP. Body Mass Index and Outcome of Acute Myocardial Infarction - Is There an Obesity Paradox? ACTA CARDIOLOGICA SINICA 2013; 29:413-420. [PMID: 27122738 PMCID: PMC4804790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 07/24/2013] [Indexed: 06/05/2023]
Abstract
BACKGROUND Although there have been some studies focusing on the relationship between body mass index (BMI), coronary artery disease (CAD) and acute coronary syndrome, the clinical effects of BMI on outcomes after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) are not well known in a Taiwanese population. METHODS From January 2005 to December 2011, 1298 AMI patients who received PCI were enrolled from a single center in Taiwan. The patients were divided into 4 groups according to their BMI: underweight (BMI < 18.5 kg/m(2)); normal weight (18.5 ≤ BMI < 24 kg/m(2)); overweight (24 ≤ BMI < 27 kg/m(2)) and obese (BMI ≥ 27). All patients had been followed up for at least 12 months, and 30-day and 5-year all-cause and cardiovascular-cause mortality were compared among the study groups. RESULTS The patients in the underweight group had a lower 30-day survival rate than the other 3 groups, and the underweight and normal weight patients had a lower 5-year survival rate than the overweight and obese patients. The multivariate regression analysis showed that Killip class ≥ 2, non-use of statin, older age, hemoglobin < 12 g/dl and chronic kidney disease, but not BMI, are independent predictors of all-cause mortality. CONCLUSIONS In this present study, the major factors affecting long-term survival are lack of using statin and older age, but not obese paradox. KEY WORDS Acute myocardial infarction; Mortality; Obesity; Percutaneous coronary intervention; Survival.
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Affiliation(s)
- Chin-Chang Cheng
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
- Institute of Clinical Medicine
- School of Medicine, National Yang-Ming University, Taipei
| | - Wei-Chun Huang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
- School of Medicine, National Yang-Ming University, Taipei
- Department of Physical Therapy, Fooyin University
| | - Kuan-Rau Chiou
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
- School of Medicine, National Yang-Ming University, Taipei
| | - Feng-Yu Kuo
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
| | - Cheng-Hung Chiang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
| | | | - Ko-Long Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shin-Hung Hsiao
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
- School of Medicine, National Yang-Ming University, Taipei
| | - Hwong-Ru Hwang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
| | - Guang-Yuan Mar
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
| | - Shoa-Lin Lin
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
- School of Medicine, National Yang-Ming University, Taipei
| | - Chuen-Wang Chiou
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
- School of Medicine, National Yang-Ming University, Taipei
| | - Chun-Peng Liu
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung City
- School of Medicine, National Yang-Ming University, Taipei
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Khera S, Kolte D, Palaniswamy C, Mujib M, Aronow WS, Singh T, Gotsis W, Silverman G, Frishman WH. ST-elevation myocardial infarction in the elderly--temporal trends in incidence, utilization of percutaneous coronary intervention and outcomes in the United States. Int J Cardiol 2013; 168:3683-90. [PMID: 23838593 DOI: 10.1016/j.ijcard.2013.06.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/06/2013] [Accepted: 06/15/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND Elderly patients with ST-elevation myocardial infarction (STEMI) are often underrepresented in major percutaneous coronary intervention (PCI) trials. Use of PCI for STEMI, and associated outcomes in patients aged ≥65 years with STEMI needed further investigation. METHODS We used the 2001-2010 United States Nationwide Inpatient Sample (NIS) database to examine the temporal trends in STEMI, use of PCI for STEMI, and outcomes among patients aged 65-79 and ≥80 years. RESULTS During 2001-2010, of 4,017,367 patients aged ≥65 years with acute myocardial infarction (AMI), 1,434,579 (35.7%) had STEMI. Over this period, among patients aged 65-79 and ≥80 years, STEMI decreased by 16.4% and 19%, whereas the use of PCI for STEMI increased by 33.5% and 22%, respectively (Ptrend<0.001). There was a significant decrease in age-adjusted in-hospital mortality (per 1000) in patients aged ≥80 years (150 versus 116, Ptrend=0.02) but not in patients aged 65-79 years (63 versus 59, Ptrend=0.886). Stepwise logistic regression identified intra-aortic balloon pump use, acute renal failure, acute cerebrovascular disease, age ≥80 years, peripheral vascular disease, gastrointestinal bleeding, female gender, congestive heart failure, chronic lung disease, weekend admission and multivessel PCI as independent predictors of in-hospital mortality among all patients ≥65 years of age who underwent PCI for STEMI. CONCLUSIONS In this large, multi-institutional cohort of elderly patients, a decreasing trend in STEMI, an increasing trend in PCI utilization for STEMI, and reduction in in-hospital mortality were observed from 2001 to 2010.
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Affiliation(s)
- Sahil Khera
- Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, NY, USA.
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