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Oesterle A, Buzkova P, Pellegrini CN, Hirsch C, Tracy R, Siscovick D, Djousse L, Mukamal K, Kizer J. Fasting and Post-Load Glucose and Non-Esterified Fatty Acids and Risk of Heart Failure and Its Subtypes in Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:1164-1171. [PMID: 36373954 PMCID: PMC10329227 DOI: 10.1093/gerona/glac229] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Glucose and non-esterified fatty acids (NEFA) are myocardial fuels whose fasting and post-prandial levels are under different homeostatic regulation. The relationships of fasting and post-load glucose and NEFA with incident heart failure (HF) remain incompletely defined. METHODS Serum glucose and NEFA were measured during fasting and 2 hours post-oral glucose tolerance test, performed in Cardiovascular Health Study participants not receiving hypoglycemic medication. Participants with prevalent HF or lacking relevant data were excluded. Outcomes were incident HF (primary), and HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction (secondary). RESULTS Among 2 238 participants (age 78 ± 4) with a median follow-up of 9.9 years, there were 737 HF events. After adjustment for demographic and lifestyle factors, both fasting (hazard ratio [HR] = 1.11 per SD [95% confidence interval {CI} = 1.01-1.23], p = .040) and post-load (HR = 1.14 per SD [1.05-1.24], p = 0.002) glucose were significantly associated with incident HF. No association was seen for fasting or post-load NEFA. Upon mutual adjustment, only post-load glucose (HR = 1.11 [1.003-1.22], p = .044), but not fasting glucose (HR = 1.06 [0.94-1.20], p = .340), remained associated with HF. Further adjustment for cardiovascular disease and other risk factors in the causal pathway did not affect the association for post-load glucose, but eliminated that for fasting glucose. Associations for fasting and post-load glucose appeared stronger with higher adiposity and were observed specifically for HFrEF but not HFpEF. CONCLUSIONS Fasting and post-load glucose, but not NEFA, were associated with incident HF. The association was especially robust for post-load glucose, suggesting that pathways involved in post-prandial dysglycemia could offer new targets for HF prevention late in life.
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Affiliation(s)
- Adam Oesterle
- Department of Medicine, Division of Cardiology San Francisco VA & University of California San Francisco, San Francisco, California, USA
| | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Cara N Pellegrini
- Department of Medicine, Division of Cardiology San Francisco VA & University of California San Francisco, San Francisco, California, USA
| | - Calvin Hirsch
- Department of Medicine, University of California Davis, Davis, California, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Luc Djousse
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ken J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jorge R Kizer
- Department of Medicine, Division of Cardiology San Francisco VA & University of California San Francisco, San Francisco, California, USA
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2
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Oguntade AS, Islam N, Malouf R, Taylor H, Jin D, Lewington S, Lacey B. Body Composition and Risk of Incident Heart Failure in 1 Million Adults: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc 2023; 12:e029062. [PMID: 37345755 PMCID: PMC10356078 DOI: 10.1161/jaha.122.029062] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/15/2023] [Indexed: 06/23/2023]
Abstract
Background The aim of this systematic review was to quantify the associations between body composition measures and risk of incident heart failure (HF) and its subtypes in the general population. Methods and Results We searched Medline, Embase, and Global Health databases from each database inception to January 19, 2023 for prospective studies reporting on body composition and HF risk. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Newcastle-Ottawa scale was used to assess the risk of bias of included studies. Fixed-effects models were used for meta-analysis. Thirty-five studies were included (ntotal=1 137 044; ncases=34 422). Summary relative risk (RR) per 5-kg/m2 higher body mass index was 1.42 (95% CI, 1.40-1.42; 𝜁2=0.02, I2=94.4%), 1.28 (95% CI, 1.26-1.31; 𝜁2=0.01, I2=75.8%) per 10-cm higher waist circumference, and 1.33 (95% CI, 1.28-1.37; 𝜁2=0.04, I2=94.9%) per 0.1-unit higher waist-hip ratio. Pooled estimates of the few studies that reported on regional fat suggested significant positive association between HF risk and both visceral fat (RR, 1.08 [95% CI, 1.04-1.12]) and pericardial fat (RR, 1.08 [95% CI, 1.06-1.10]). Among HF subtypes, associations were stronger for HF with preserved ejection fraction than HF with reduced ejection fraction. No study reported on lean mass. Conclusions Pooled data suggested strong associations between adiposity and HF. The association with adiposity is stronger for HF with preserved ejection fraction than HF with reduced ejection fraction, indicating that different mechanisms may be at play in etiopathogenesis of HF subtypes. Future studies are needed to investigate role of regional fat mass and lean mass in HF risk. Registration Information REGISTRATION: URL: www.crd.york.ac.uk/prospero/. Unique identifier: CRD42020224584.
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Affiliation(s)
- Ayodipupo S. Oguntade
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
| | - Nazrul Islam
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
- School of Primary Care, Population Sciences and Medical Education, Faculty of MedicineUniversity of SouthamptonUK
| | - Reem Malouf
- National Perinatal Epidemiological Unit, Nuffield Department of Population HealthUniversity of OxfordUK
| | - Hannah Taylor
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
| | - Danyao Jin
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
| | - Sarah Lewington
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
- MRC Population Health Research Unit, NDPHUniversity of OxfordUK
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Ben Lacey
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH)University of OxfordUK
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3
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Burger PM, Koudstaal S, Dorresteijn JAN, Savarese G, van der Meer MG, de Borst GJ, Mosterd A, Visseren FLJ. Metabolic syndrome and risk of incident heart failure in non-diabetic patients with established cardiovascular disease. Int J Cardiol 2023; 379:66-75. [PMID: 36907452 DOI: 10.1016/j.ijcard.2023.03.024] [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: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND In patients with established cardiovascular disease (CVD), the relation between metabolic syndrome (MetS) and incident heart failure (HF) in the absence of diabetes mellitus (DM) is largely unknown. This study assessed this relation in non-diabetic patients with established CVD. METHODS Patients from the prospective UCC-SMART cohort with established CVD, but without DM or HF at baseline were included (n = 4653). MetS was defined according to the Adult Treatment Panel III criteria. Insulin resistance was quantified using the homeostasis model of insulin resistance (HOMA-IR). The outcome was a first hospitalization for HF. Relations were assessed using Cox proportional hazards models adjusted for established risk factors: age, sex, prior myocardial infarction (MI), smoking, cholesterol, and kidney function. RESULTS During a median follow-up of 8.0 years, 290 cases of incident HF were observed (0.81/100 person years). MetS was significantly related to an increased risk of incident HF independent of established risk factors (hazard ratio [HR] 1.32; 95% confidence interval [CI] 1.04-1.68, HR per criterion 1.17; 95% CI 1.06-1.29), as was HOMA-IR (HR per standard deviation [SD] 1.15; 95% CI 1.03-1.29). Of the individual MetS components, only higher waist circumference independently increased the risk of HF (HR per SD 1.34; 95% CI 1.17-1.53). Relations were independent of the occurrence of interim DM and MI, and were not significantly different for HF with reduced vs preserved ejection fraction. CONCLUSION In CVD patients without a current diagnosis of DM, MetS and insulin resistance increase the risk of incident HF independent of established risk factors.
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Affiliation(s)
- Pascal M Burger
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Stefan Koudstaal
- Department of Cardiology, Green Heart Hospital, Gouda, the Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
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Hsu JC, Yang YY, Chuang SL, Lin LY, Chen THH. Prediabetes as a risk factor for new-onset atrial fibrillation: the propensity-score matching cohort analyzed using the Cox regression model coupled with the random survival forest. Cardiovasc Diabetol 2023; 22:35. [PMID: 36804876 PMCID: PMC9940357 DOI: 10.1186/s12933-023-01767-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The glycemic continuum often indicates a gradual decline in insulin sensitivity leading to an increase in glucose levels. Although prediabetes is an established risk factor for both macrovascular and microvascular diseases, whether prediabetes is independently associated with the risk of developing atrial fibrillation (AF), particularly the occurrence time, has not been well studied using a high-quality research design in combination with statistical machine-learning algorithms. METHODS Using data available from electronic medical records collected from the National Taiwan University Hospital, a tertiary medical center in Taiwan, we conducted a retrospective cohort study consisting 174,835 adult patients between 2014 and 2019 to investigate the relationship between prediabetes and AF. To render patients with prediabetes as comparable to those with normal glucose test, a propensity-score matching design was used to select the matched pairs of two groups with a 1:1 ratio. The Kaplan-Meier method was used to compare the cumulative risk of AF between prediabetes and normal glucose test using log-rank test. The multivariable Cox regression model was employed to estimate adjusted hazard ratio (HR) for prediabetes versus normal glucose test by stratifying three levels of glycosylated hemoglobin (HbA1c). The machine-learning algorithm using the random survival forest (RSF) method was further used to identify the importance of clinical factors associated with AF in patients with prediabetes. RESULTS A sample of 14,309 pairs of patients with prediabetes and normal glucose test result were selected. The incidence of AF was 11.6 cases per 1000 person-years during a median follow-up period of 47.1 months. The Kaplan-Meier analysis revealed that the risk of AF was significantly higher in patients with prediabetes (log-rank p < 0.001). The multivariable Cox regression model indicated that prediabetes was independently associated with a significant increased risk of AF (HR 1.24, 95% confidence interval 1.11-1.39, p < 0.001), particularly for patients with HbA1c above 5.5%. The RSF method identified elevated N-terminal natriuretic peptide and altered left heart structure as the two most important risk factors for AF among patients with prediabetes. CONCLUSIONS Our study found that prediabetes is independently associated with a higher risk of AF. Furthermore, alterations in left heart structure make a significant contribution to this elevated risk, and these structural changes may begin during the prediabetes stage.
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Affiliation(s)
- Jung-Chi Hsu
- Division of Cardiology, Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No.7, Chung-Chan South Road, Taipei, 100, Taiwan
| | - Yen-Yun Yang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Lin Chuang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No.7, Chung-Chan South Road, Taipei, 100, Taiwan. .,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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5
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Gargiulo P, Acampa W, Asile G, Abbate V, Nardi E, Marzano F, Assante R, Nappi C, Parlati ALM, Basile C, Dellegrottaglie S, Paolillo S, Cuocolo A, Perrone-Filardi P. 123I-MIBG imaging in heart failure: impact of comorbidities on cardiac sympathetic innervation. Eur J Nucl Med Mol Imaging 2023; 50:813-824. [PMID: 36071220 PMCID: PMC9852124 DOI: 10.1007/s00259-022-05941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Heart failure (HF) is a primary cause of morbidity and mortality worldwide, with significant impact on life quality and extensive healthcare costs. Assessment of myocardial sympathetic innervation function plays a central role in prognosis assessment in HF patients. The aim of this review is to summarize the most recent evidence regarding the clinical applications of iodine-123 metaiodobenzylguanidine (123I-MIBG) imaging in patients with HF and related comorbidities. METHODS A comprehensive literature search was conducted on PubMed and Web of Science databases. Articles describing the impact of 123I-MIBG imaging on HF and related comorbidities were considered eligible for the review. RESULTS We collected several data reporting that 123I-MIBG imaging is a safe and non-invasive tool to evaluate dysfunction of cardiac sympathetic neuronal function and to assess risk stratification in HF patients. HF is frequently associated with comorbidities that may affect cardiac adrenergic innervation. Furthermore, HF is frequently associated with comorbidities and chronic conditions, such as diabetes, obesity, kidney disease and others, that may affect cardiac adrenergic innervation. CONCLUSION Comorbidities and chronic conditions lead to more severe impairment of sympathetic nervous system in patients with HF, with a negative impact on disease progression and outcome. Cardiac imaging with 123I-MIBG can be a useful tool to reduce morbidity and prevent adverse events in HF patients.
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Affiliation(s)
- Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Gaetano Asile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenza Abbate
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Ermanno Nardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Perrone-Filardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ,Mediterranea Cardiocentro, Naples, Italy
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6
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Lind V, Hammar N, Lundman P, Friberg L, Talbäck M, Walldius G, Norhammar A. Impaired fasting glucose: a risk factor for atrial fibrillation and heart failure. Cardiovasc Diabetol 2021. [PMID: 34819087 DOI: 10.1186/s12933-021-01422-3/figures/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Dysglycaemia is associated with overall cardiovascular disease even at prediabetes levels. The aim of this study was to explore the association between glucose levels and future risk of developing atrial fibrillation and heart failure, respectively. METHODS In this prospective cohort study subjects from the Swedish AMORIS-cohort with fasting glucose from health examinations 1985-1996 without previous cardiovascular disease (N = 294,057) were followed to 31 December 2011 for incident atrial fibrillation or heart failure. Cox proportional hazard models with attained age as timescale and adjustments for sex, cholesterol, triglycerides, and socioeconomic status were used to estimate hazard ratios by glucose categorized groups (normal glucose 3.9-6.0 mmol/L, impaired fasting glucose; 6.1-6.9 mmol/L, undiagnosed diabetes ≥ 7.0 mmol/L, and diagnosed diabetes). RESULTS During a mean follow-up time of 19.1 years 28,233 individuals developed atrial fibrillation and 25,604 developed heart failure. The HR for atrial fibrillation was 1.19 (95% confidence interval 1.13-1.26) for impaired fasting glucose, 1.23 (1.15-1.32) for undiagnosed diabetes and 1.30 (1.21-1.41) for diagnosed diabetes. Corresponding figures for heart failure were; 1.40 (1.33-1.48), 2.11 (1.99-2.23), 2.22 (2.08-2.36) respectively. In a subset with BMI data (19%), these associations were attenuated and for atrial fibrillation only remained statistically significant among subjects with diagnosed diabetes (HR 1.25; 1.02-1.53). CONCLUSIONS Fasting glucose at prediabetes levels is associated with development of atrial fibrillation and heart failure. To some extent increased BMI may drive this association.
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Affiliation(s)
- Viktor Lind
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden. .,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pia Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Leif Friberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Göran Walldius
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.,Capio S:T Görans Hospital, Stockholm, Sweden
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7
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Lind V, Hammar N, Lundman P, Friberg L, Talbäck M, Walldius G, Norhammar A. Impaired fasting glucose: a risk factor for atrial fibrillation and heart failure. Cardiovasc Diabetol 2021; 20:227. [PMID: 34819087 PMCID: PMC8614025 DOI: 10.1186/s12933-021-01422-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Dysglycaemia is associated with overall cardiovascular disease even at prediabetes levels. The aim of this study was to explore the association between glucose levels and future risk of developing atrial fibrillation and heart failure, respectively. METHODS In this prospective cohort study subjects from the Swedish AMORIS-cohort with fasting glucose from health examinations 1985-1996 without previous cardiovascular disease (N = 294,057) were followed to 31 December 2011 for incident atrial fibrillation or heart failure. Cox proportional hazard models with attained age as timescale and adjustments for sex, cholesterol, triglycerides, and socioeconomic status were used to estimate hazard ratios by glucose categorized groups (normal glucose 3.9-6.0 mmol/L, impaired fasting glucose; 6.1-6.9 mmol/L, undiagnosed diabetes ≥ 7.0 mmol/L, and diagnosed diabetes). RESULTS During a mean follow-up time of 19.1 years 28,233 individuals developed atrial fibrillation and 25,604 developed heart failure. The HR for atrial fibrillation was 1.19 (95% confidence interval 1.13-1.26) for impaired fasting glucose, 1.23 (1.15-1.32) for undiagnosed diabetes and 1.30 (1.21-1.41) for diagnosed diabetes. Corresponding figures for heart failure were; 1.40 (1.33-1.48), 2.11 (1.99-2.23), 2.22 (2.08-2.36) respectively. In a subset with BMI data (19%), these associations were attenuated and for atrial fibrillation only remained statistically significant among subjects with diagnosed diabetes (HR 1.25; 1.02-1.53). CONCLUSIONS Fasting glucose at prediabetes levels is associated with development of atrial fibrillation and heart failure. To some extent increased BMI may drive this association.
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Affiliation(s)
- Viktor Lind
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden. .,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pia Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Leif Friberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Göran Walldius
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.,Capio S:T Görans Hospital, Stockholm, Sweden
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8
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Gribble AK, Sayón-Orea C, Bes-Rastrollo M, Kales SN, Shirahama R, Martínez-González MÁ, Fernandez-Montero A. Risk of Developing Metabolic Syndrome Is Affected by Length of Daily Siesta: Results from a Prospective Cohort Study. Nutrients 2021; 13:nu13114182. [PMID: 34836438 PMCID: PMC8619148 DOI: 10.3390/nu13114182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Siesta has been associated with increased incidence of cardiovascular disease but the mechanism remains unclear. New studies into the relationship between siesta and metabolic syndrome have identified siesta length as a crucial differential, suggesting that siesta less than 40 min is associated with decreased risk of metabolic syndrome, while longer siesta is associated with increased risk. We aimed to investigate the effect of siesta duration on development of metabolic syndrome in a Mediterranean population using a prospective cohort study design. Methods: Our sample consisted of 9161 participants of the SUN cohort without components of metabolic syndrome at baseline. Siesta exposure was assessed at baseline and the development of metabolic syndrome components was assessed after an average 6.8 years of follow-up. We estimated odds ratios and fitted logistic regression models to adjust for potential cofounders including night-time sleep duration and quality, as well as other diet, health, and lifestyle factors. Results: We observed a positive association between average daily siesta >30 min and development of metabolic syndrome (aOR = 1.39 CI: 1.03–1.88). We found no significant difference in risk of developing metabolic syndrome between the group averaging ≤30 min of daily siesta and the group not taking siesta (aOR = 1.07 CI: 0.83–1.37). Further analysis suggested that average daily siesta <15 min may reduce risk of metabolic syndrome. Conclusions: Our study supports the J-curve model of the association between siesta and risk of metabolic syndrome, but suggests the protective effect is limited to a shorter range of siesta length than previously proposed.
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Affiliation(s)
- Anne Katherine Gribble
- School of Medicine, University of Sydney, Camperdown 2050, Australia;
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.S.-O.); (M.B.-R.); (M.Á.M.-G.)
- Illawarra and Shoalhaven Local Health District, NSW Health, Wollongong 2500, Australia
| | - Carmen Sayón-Orea
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.S.-O.); (M.B.-R.); (M.Á.M.-G.)
- Navarra Institute for Health Research (IdiSNa), 31008 Pamplona, Spain
- Navarra Public Health Institute, 31003 Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.S.-O.); (M.B.-R.); (M.Á.M.-G.)
- Navarra Institute for Health Research (IdiSNa), 31008 Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02115, USA; (S.N.K.); (R.S.)
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA
| | - Ryutaro Shirahama
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02115, USA; (S.N.K.); (R.S.)
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Faculty of Science and Technology, Keio University, Kanagawa 223-8522, Japan
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.S.-O.); (M.B.-R.); (M.Á.M.-G.)
- Navarra Institute for Health Research (IdiSNa), 31008 Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Nutrition, Harvard T.H Chan School of Public Health, Boston, MA 02115, USA
| | - Alejandro Fernandez-Montero
- Navarra Institute for Health Research (IdiSNa), 31008 Pamplona, Spain
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA 02115, USA; (S.N.K.); (R.S.)
- Department of Occupational Medicine, University of Navarra Clinic, Av. Pio XII, 36, 31008 Pamplona, Spain
- Correspondence: ; Tel.: +34-948-255400; Fax: +34-948-296500
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9
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Zhou Y, Fu L, Sun J, Zhu Z, Xing Z, Zhou S, Tai S, Wang Y. Association Between Metabolic Syndrome and an Increased Risk of Hospitalization for Heart Failure in Population of HFpEF. Front Cardiovasc Med 2021; 8:698117. [PMID: 34595217 PMCID: PMC8476762 DOI: 10.3389/fcvm.2021.698117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 01/14/2023] Open
Abstract
Background: The association between metabolic syndrome and the development of heart failure (HF) with preserved ejection fraction (HFpEF) has not been completely clarified. Aim: To evaluate the association between metabolic syndrome and the risk of HF hospitalization for patients with HFpEF. Methods: Patient data were obtained from the American cohort of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial database. Data for the primary outcome (hospitalization for HF) and secondary outcomes (all-cause mortality, cardiovascular mortality, and all-cause hospitalization) were collected, and hazard ratios (HRs) for the patients with and without metabolic syndrome were analyzed by applying a multivariable Cox proportional hazard model. Results: Among the 1,548 total participants, 1,197 had metabolic syndrome. The patients with metabolic syndrome exhibited worse heart function and a lower quality of life than those without metabolic syndrome. During the 3.3 years of follow-up, 351 patients were hospitalized for HF. After a multivariable adjustment, the risk of hospitalization for HF and all-cause hospitalization (adjusted HR = 1.42, 95% CI: 1.01–2.00; p = 0.042 and adjusted HR = 1.27; 95% CI: 1.04–1.54; p = 0.017, respectively) were independently associated with HFpEF for the patients with metabolic syndrome. In addition, the risks of HF hospitalization and all-cause hospitalization among 267 propensity score-matched patients were higher for patients with metabolic syndrome (HR = 1.53, 95% CI = 1.05–2.23, and p = 0.025 and HR = 1.34, 95% CI = 1.08–1.67, and p = 0.009, respectively). Conclusion: The risks of HF hospitalization and all-cause hospitalization were higher for patients with HFpEF having metabolic syndrome than for those without metabolic syndrome.
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Affiliation(s)
- Ying Zhou
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liyao Fu
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiaxing Sun
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhaowei Zhu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Tai
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yongjun Wang
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China
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10
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Cai X, Liu X, Sun L, He Y, Zheng S, Zhang Y, Huang Y. Prediabetes and the risk of heart failure: A meta-analysis. Diabetes Obes Metab 2021; 23:1746-1753. [PMID: 33769672 DOI: 10.1111/dom.14388] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/13/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023]
Abstract
AIM To determine the role of prediabetes in the incidence of heart failure (HF). MATERIALS AND METHODS We searched electronic databases (PubMed, Embase, Google Scholar and OpenGrey) for studies up to 31 December 2020. Studies were included for meta-analysis if they reported adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the risk of HF for prediabetes compared with normoglycaemia. Prediabetes was defined as impaired fasting glucose (IFG) according to the World Health Organization (WHO) criteria (IFG-WHO), or according to the American Diabetes Association (ADA) definition (IFG-ADA), impaired glucose tolerance (IGT), raised HbA1c according to the ADA criteria (HbA1c-ADA), or according to the International Expert Committee (IEC) recommendation (HbA1c-IEC). RESULTS A total of 15 studies comprising 9,827,430 individuals provided data for this analysis. The median follow-up duration of the included studies was 8.0 years. Compared with normoglycaemia, prediabetes was associated with an increased risk for HF: IFG-ADA (RR: 1.09, 95% CI: 1.05-1.13), IFG-WHO (RR: 1.18, 95% CI: 1.07-1.30), IGT (RR 1.58, 95% CI 1.04-2.39), HbA1c-ADA (RR 1.28, 95% CI 1.16-1.41) or HbA1c-IEC (RR 1.40, 95% CI 1.09-1.79), respectively. CONCLUSIONS Prediabetes is associated with an increased risk of HF. Future studies are needed to evaluate effective treatments for prediabetes to prevent the development and progression of HF.
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Affiliation(s)
- Xiaoyan Cai
- Department of Scientific Research and Education, Shunde Hospital, Southern Medical University, Foshan, China
| | - Xiong Liu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Lichang Sun
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yiting He
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Sulin Zheng
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yang Zhang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangdong, China
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11
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Biomarker-Based Risk Prediction of Incident Heart Failure in Pre-Diabetes and Diabetes. JACC-HEART FAILURE 2021; 9:215-223. [PMID: 33422434 DOI: 10.1016/j.jchf.2020.10.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study evaluated the application of a biomarker-based risk score to identify individuals with dysglycemia who are at high risk for incident heart failure (HF) and to inform allocation of effective preventive interventions. BACKGROUND Risk stratification tools to identify patients with diabetes and pre-diabetes at highest risk for HF are needed to inform cost-effective allocation of preventive therapies. Whether a biomarker score can meaningfully stratify HF risk is unknown. METHODS Participants free of cardiovascular disease from 3 cohort studies (ARIC [Atherosclerosis Risk In Communities], DHS [Dallas Heart Study], and MESA [Multi-Ethnic Study of Atherosclerosis]) were included. An integer-based biomarker score included high-sensitivity cardiac troponin T ≥6 ng/l, N-terminal pro-B-type natriuretic peptide ≥125 pg/ml, high-sensitivity C-reactive protein ≥3 mg/l, and left ventricular hypertrophy by electrocardiography, with 1 point for each abnormal parameter. The 5-year risk of HF was estimated among participants with diabetes and pre-diabetes across biomarker score groups (0 to 4). RESULTS The primary analysis included 6,799 participants with dysglycemia (diabetes: 33.2%; pre-diabetes: 66.8%). The biomarker score demonstrated good discrimination and calibration for predicting 5- and 10-year HF risk among pre-diabetes and diabetes cohorts. The 5-year risk of HF among subjects with a biomarker score of ≤1 was low and comparable to participants with euglycemia (0.78%). The 5-year risk for HF increased in a graded fashion with an increasing biomarker score, with the highest risk noted among those with scores of ≥3 (diabetes: 12.0%; pre-diabetes: 7.8%). The estimated number of HF events that could be prevented using a sodium-glucose cotransporter-2 inhibitor per 1,000 treated subjects over 5 years was 11 for all subjects with diabetes and ranged from 4 in the biomarker score zero group to 44 in the biomarker score ≥3 group. CONCLUSIONS Among adults with diabetes and pre-diabetes, a biomarker score can stratify HF risk and inform allocation of HF prevention therapies.
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12
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Ferreira JP, Verma S, Fitchett D, Ofstad AP, Lauer S, Zwiener I, George J, Wanner C, Zinman B, Inzucchi SE. Metabolic syndrome in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a post hoc analyses of the EMPA-REG OUTCOME trial. Cardiovasc Diabetol 2020; 19:200. [PMID: 33243221 PMCID: PMC7694291 DOI: 10.1186/s12933-020-01174-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/15/2020] [Indexed: 12/20/2022] Open
Abstract
Background Patients with type 2 diabetes (T2D) and metabolic syndrome (MetS) are at greater cardiovascular risk than those with T2D without MetS. In the current report we aim to study the characteristics, cardio-renal outcomes and the effect of empagliflozin in patients with MetS enrolled in the EMPA-REG OUTCOME trial. Methods A total of 7020 patients with T2D and atherosclerotic cardiovascular disease were treated with empagliflozin (10 mg or 25 mg) or placebo for a median of 3.1 years. The World Health Organization MetS criteria could be determined for 6985 (99.5%) patients. We assessed the association between baseline MetS and multiple cardio-renal endpoints using Cox regression models, and we studied the change in the individual component over time of the MetS using mixed effect models. Results MetS at baseline was present in 5740 (82%) patients; these were more often white and had more often albuminuria and heart failure, had lower eGFR and HDL-cholesterol, and higher blood pressure, body mass index, waist circumference, and triglycerides. In the placebo group, patients with MetS had a higher risk of all outcomes including cardiovascular death: HR = 1.73 (95% CI 1.01–2.98), heart failure hospitalization: HR = 2.64 (95% CI 1.22, 5.72), and new or worsening nephropathy: HR = 3.11 (95% CI 2.17–4.46). The beneficial effect of empagliflozin was consistent on all cardio-renal outcomes regardless of presence of MetS. Conclusions A large proportion of the EMPA-REG OUTCOME population fulfills the criteria for MetS. Those with MetS had increased risk of adverse cardio-renal outcomes. Compared with placebo, empagliflozin improved cardio-renal outcomes in patients with and without MetS. Trial registration Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT 01131676
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Affiliation(s)
- João Pedro Ferreira
- Centre d'Investigations Cliniques Plurithématique Inserm 1433, CHRU de Nancy, Inserm U1116, FCRIN INI- CRCT, Université de Lorraine, Nancy, France.
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - David Fitchett
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Sabine Lauer
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | | | - Jyothis George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | | - Bernard Zinman
- Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
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13
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Abstract
The presence of comorbidities significantly influences long-term morbidity and mortality of symptomatic and asymptomatic heart failure (HF) patients. Metabolic syndrome and diabetic cardiomyopathy are two clinical conditions that share multiple pathophysiological mechanisms and that might be both responsible for cardiac dysfunction. However, it is argued whether metabolic syndrome (MS) independently increases HF risk or the association between MS and HF merely reflects the impact of individual risk factors included in its definition on HF development. Similarly, in the context of diabetic cardiomyopathy, many aspects are still challenging starting from the definition up to the therapeutic management. In this clinical review, we focused the attention on molecular pathways, myocyte alterations, and specific patterns of metabolic syndrome and diabetic cardiomyopathy in order to better define the potential diagnostic and therapeutic approaches of these two pathological conditions.
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14
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Chiu LS, Pedley A, Massaro J, Benjamin EJ, Mitchell GF, McManus DD, Aragam J, Vasan RS, Cheng S, Long MT. The association of non-alcoholic fatty liver disease and cardiac structure and function-Framingham Heart Study. Liver Int 2020; 40:2445-2454. [PMID: 32654390 PMCID: PMC7669676 DOI: 10.1111/liv.14600] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease confers increased risk for cardiovascular disease, including heart failure (HF), for reasons that remain unclear. Possible pathways could involve an association of liver fat with cardiac structural or functional abnormalities even after accounting for body size. METHODS We analysed N = 2356 Framingham Heart Study participants (age 52 ± 12 years, 52% women) who underwent echocardiography and standardized computed tomography measures of liver fat. RESULTS In cross-sectional multivariable regression models adjusted for age, gender, cohort and cardiovascular risk factors, liver fat was positively associated with left ventricular (LV) mass (β = 1.45; 95% confidence interval (CI): 0.01, 2.88), LV wall thickness (β = 0.01; 95% CI: 0.00, 0.02), mass volume ratio (β = 0.02; 95% CI 0.01, 0.03), mitral peak velocity (E) (β = 0.83; 95% CI 0.31, 1.36) and LV filling pressure (E/e' ratio) (β = 0.16; 95% CI 0.09, 0.23); and inversely associated with global systolic longitudinal strain (β = 0.20, 95% CI 0.07, 0.33), diastolic annular velocity (e') (β = -0.12; 95% CI - 0.22, -0.03), and E/A ratio (β = -0.01; 95% CI - 0.02, -0.00). After additional adjustment for body mass index (BMI), statistical significance was attenuated for all associations except for that of greater liver fat with increased LV filling pressure, a possible precursor to HF (β = 0.11; 95% CI 0.03, 0.18). CONCLUSION Increased liver fat was associated with multiple subclinical cardiac dysfunction measures, with most of associations mediated by obesity. Interestingly, the association of liver fat and LV filling pressure was only partially mediated by BMI, suggesting a possible direct effect of liver fat on LV filling pressure. Further confirmatory studies are needed.
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Affiliation(s)
- Laura S. Chiu
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | | | - Joseph Massaro
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA.,Department of Mathematics and Statistics, Boston University, Boston, MA, United States
| | - Emelia J. Benjamin
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA.,Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA,Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | | | - David D. McManus
- Cardiology Division, Department of Medicine and the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worchester, MA
| | - Jayashri Aragam
- Cardiovascular Division, VA Boston Healthcare System, West Roxbury, MA,Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Ramachandran S. Vasan
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA.,Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA,Department of Epidemiology, Boston University School of Public Health, Boston, MA,Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston Medical Center, Boston, MA
| | - Susan Cheng
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michelle T. Long
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA
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15
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Gimeno-Miguel A, Gracia Gutiérrez A, Poblador-Plou B, Coscollar-Santaliestra C, Pérez-Calvo JI, Divo MJ, Calderón-Larrañaga A, Prados-Torres A, Ruiz-Laiglesia FJ. Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records. BMJ Open 2019; 9:e033174. [PMID: 31874886 PMCID: PMC7008407 DOI: 10.1136/bmjopen-2019-033174] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on the risk of hospitalisation and mortality. DESIGN Observational retrospective population study based on electronic health records. SETTING EpiChron Cohort (Aragón, Spain). PARTICIPANTS All the primary and hospital care patients of the EpiChron Cohort with a diagnosis of HF on 1 January 2011 (ie, 8488 women and 6182 men). We analysed all the chronic diseases registered in patients' electronic health records until 31 December 2011. PRIMARY OUTCOME We performed an exploratory factor analysis to identify the multimorbidity patterns in men and women, and logistic and Cox proportional-hazards regressions to investigate the association between the patterns and the risk of hospitalisation in 2012, and of 3-year mortality. RESULTS Almost all HF patients (98%) had multimorbidity, with an average of 7.8 chronic diseases per patient. We identified six different multimorbidity patterns, named cardiovascular, neurovascular, coronary, metabolic, degenerative and respiratory. The most prevalent were the degenerative (64.0%) and cardiovascular (29.9%) patterns in women, and the metabolic (49.3%) and cardiovascular (43.2%) patterns in men. Every pattern was associated with higher hospitalisation risks; and the cardiovascular, neurovascular and respiratory patterns significantly increased the likelihood of 3-year mortality. CONCLUSIONS Multimorbidity is the norm rather than the exception in patients with heart failure, whose comorbidities tend to cluster together beyond simple chance in the form of multimorbidity patterns that have different impact on health outcomes. This knowledge could be useful to better understand common pathophysiological pathways underlying this condition and its comorbidities, and the factors influencing the prognosis of men and women with HF. Further large scale longitudinal studies are encouraged to confirm the existence of these patterns as well as their differential impact on health outcomes.
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Affiliation(s)
- Antonio Gimeno-Miguel
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Anyuli Gracia Gutiérrez
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Carlos Coscollar-Santaliestra
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- Primary Care Health Centre San Pablo, SALUD, Zaragoza, Spain
| | - J Ignacio Pérez-Calvo
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
- University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Miguel J Divo
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Alexandra Prados-Torres
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Fernando J Ruiz-Laiglesia
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
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16
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Bonikowske AR, Barillas Lara MI, Koepp KE, Medina Inojosa JR, Squires RW, Lopez-Jimenez F, Olson TP. Fat Mass Index Better Identifies Metabolic Syndrome: Insights from Patients in Early Outpatient Cardiac Rehabilitation. J Clin Med 2019; 8:jcm8122147. [PMID: 31817309 PMCID: PMC6947316 DOI: 10.3390/jcm8122147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/22/2019] [Accepted: 12/02/2019] [Indexed: 12/29/2022] Open
Abstract
Body mass index (BMI) does not differentiate fat and lean mass or the distribution of adipose tissue. The purpose of this study was to examine the prevalence of metabolic syndrome (MetS) among patients entering outpatient cardiac rehabilitation (CR) across fat mass index (FMI) categories compared with BMI. This retrospective cross-sectional study evaluated dual-energy x-ray absorptiometry in 483 CR patients from 1 January 2014, through 31 December 2017. Clinical data were extracted from the electronic health record. Patients were grouped by FMI and BMI categories. Mean (SD) age of patients was 64.3 (14) years. The normal FMI category had 15 patients; excess fat, 74; and obese, 384. In contrast, 93, 174, and 216 were in the normal, overweight, and obese BMI categories, respectively. Prevalence of MetS was 0 (0%) in normal, 5 (1%) in excess fat, and 167 (54%) in obese FMI, with 97% in the obese category. MetS prevalence was 4 patients (0.8%) in normal, 39 (8%) in overweight, and 129 (27%) in obese BMI categories, with 75% of MetS in the obese category. FMI more accurately classified CR patients with metabolically abnormal fat (p < 0.001). FMI is a more sensitive index than BMI for metabolically abnormal fat of outpatient CR patients.
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17
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Arcopinto M, Schiavo A, Salzano A, Bossone E, D'Assante R, Marsico F, Demelo-Rodriguez P, Baliga RR, Cittadini A, Marra AM. Metabolic Syndrome in Heart Failure: Friend or Foe? Heart Fail Clin 2019; 15:349-358. [PMID: 31079693 DOI: 10.1016/j.hfc.2019.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The interplay between metabolic syndrome (MetS) and heart failure (HF) is intricate. Population studies show that MetS confers an increased risk to develop HF and this effect is mediated by insulin resistance (IR). However, obesity, a key component in MetS and common partner of IR, is protective in patients with established HF, although IR confers an increased risk of dying by HF. Such phenomenon, known as "obesity paradox," accounts for the complexity of the HF-MetS relationship. Because IR impacts more on outcomes than MetS itself, the former may be considered the actual target for MetS in HF patients.
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Affiliation(s)
- Michele Arcopinto
- Department of Translational Medical Sciences, "Federico II" University, Via Pansini 5, 80131 Naples, Italy
| | - Alessandra Schiavo
- Department of Translational Medical Sciences, "Federico II" University, Via Pansini 5, 80131 Naples, Italy
| | - Andrea Salzano
- Department of Translational Medical Sciences, "Federico II" University, Via Pansini 5, 80131 Naples, Italy; Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Eduardo Bossone
- Cardiology Division, A Cardarelli Hospital, Via Antonio Cardarelli 9, 80131 Naples, Italy
| | - Roberta D'Assante
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) SDN, Via Gianturco 113, 80142 Naples, Italy
| | - Fabio Marsico
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy; Center for Congenital Heart Disease, University Hospital "Inselspital," University of Bern, Bern, Switzerland
| | - Pablo Demelo-Rodriguez
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ragavendra R Baliga
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Davis Heart and Lung Research Institute, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Antonio Cittadini
- Department of Translational Medical Sciences, "Federico II" University, Via Pansini 5, 80131 Naples, Italy; Interdisciplinary Research Centre in Biomedical Materials (CRIB), Via Pansini 5, 80131 Naples, Italy
| | - Alberto M Marra
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) SDN, Via Gianturco 113, 80142 Naples, Italy.
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18
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Aune D, Schlesinger S, Neuenschwander M, Feng T, Janszky I, Norat T, Riboli E. Diabetes mellitus, blood glucose and the risk of heart failure: A systematic review and meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 2018; 28:1081-1091. [PMID: 30318112 DOI: 10.1016/j.numecd.2018.07.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM The strength of the association between diabetes and risk of heart failure has differed between previous studies and the available studies have not been summarized in a meta-analysis. We therefore quantified the association between diabetes and blood glucose and heart failure in a systematic review and meta-analysis. METHODS AND RESULTS PubMed and Embase databases were searched up to May 3rd 2018. Prospective studies on diabetes mellitus or blood glucose and heart failure risk were included. A random effects model was used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs). Seventy seven studies were included. Among the population-based prospective studies, the summary RR for individuals with diabetes vs. no diabetes was 2.06 (95% CIs: 1.73-2.46, I2 = 99.8%, n = 30 studies, 401495 cases, 21416780 participants). The summary RR was 1.23 (95% CI: 1.15-1.32, I2 = 78.2%, n = 10, 5344 cases, 91758 participants) per 20 mg/dl increase in blood glucose and there was evidence of a J-shaped association with nadir around 90 mg/dl and increased risk even within the pre-diabetic blood glucose range. Among the patient-based studies the summary RR was 1.69 (95% CI: 1.57-1.81, I2 = 85.5%, pheterogeneity<0.0001) for diabetes vs. no diabetes (n = 41, 100284 cases and >613925 participants) and 1.25 (95% CI: 0.89-1.75, I2 = 95.6%, pheterogeneity<0.0001) per 20 mg/dl increase in blood glucose (1016 cases, 34309 participants, n = 2). In the analyses of diabetes and heart failure there was low or no heterogeneity among the population-based studies that adjusted for alcohol intake and physical activity and among the patient-based studies there was no heterogeneity among studies with ≥10 years follow-up. CONCLUSIONS These results suggest that individuals with diabetes are at an increased risk of developing heart failure and there is evidence of increased risk even within the pre-diabetic range of blood glucose.
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Affiliation(s)
- D Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Department of Nutrition, Bjørknes University College, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | - S Schlesinger
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - M Neuenschwander
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - T Feng
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - I Janszky
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Regional Center for Health Care Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - T Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
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Vest AR, Young JB, Cho L. The Metabolic Syndrome, Cardiovascular Fitness and Survival in Patients With Advanced Systolic Heart Failure. Am J Cardiol 2018; 122:1513-1519. [PMID: 30172361 DOI: 10.1016/j.amjcard.2018.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 02/02/2023]
Abstract
The metabolic syndrome (MetS), which incorporates insulin resistance, visceral adiposity, and dyslipidemia, is an independent risk factor for incident heart failure (HF), but the impact on survival is uncertain. We sought to determine the relation between the metabolic syndrome and survival in ambulatory systolic HF patients and the impact of MetS on cardiopulmonary exercise test (CPET). We identified adults with ejection fraction ≤40% who underwent CPETs between 2000 and 2011. Baseline MetS status was defined by 3 or more of: (1) Triglycerides ≥150 mg/dl; (2) High density lipoprotein <40 mg/dl males or <50 mg/dl females; (3) Diabetes mellitus; (4) Hypertension; (5) Body mass index ≥35 kg/m2. Minimally-adjusted (for age, sex, transplantation and left ventricular assist device implantation) and fully-adjusted Cox proportional hazards models were constructed for all-cause mortality. MetS prevalence was 37% (716 of 1,953) and median follow-up 5 years. Mortality was 36% for +MetS and 29% for -MetS (p = 0.006), with highest mortality in the subgroup with both MetS plus diabetes (39%). The minimally-adjusted hazard ratio for mortality with MetS was 1.27 (95% confidence interval, 1.08 to 1.49, p = 0.004). After adjustment, MetS was no longer independently associated with mortality (hazard ratio 1.01, 95% confidence interval 0.85 to 1.19, p = 0.921). Patients with MetS achieved poorer CPET performance compared and MetS was independently associated with a lower peak VO2. MetS was associated with a higher hazard of mortality in the minimally-adjusted model, which was primarily driven by the unfavorable impact of diabetes on mortality, but this association was no longer significant after full adjustment. In conclusion, there was no independent association between MetS and survival in an ambulatory systolic HF population.
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Affiliation(s)
- Amanda Ruth Vest
- Division of Cardiology, The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
| | - James Bernard Young
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leslie Cho
- Department of Cardiovascular Medicine, Preventive Cardiology & Rehabilitation, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Meydan C, Bekenstein U, Soreq H. Molecular Regulatory Pathways Link Sepsis With Metabolic Syndrome: Non-coding RNA Elements Underlying the Sepsis/Metabolic Cross-Talk. Front Mol Neurosci 2018; 11:189. [PMID: 29922126 PMCID: PMC5996041 DOI: 10.3389/fnmol.2018.00189] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/15/2018] [Indexed: 01/04/2023] Open
Abstract
Sepsis and metabolic syndrome (MetS) are both inflammation-related entities with high impact for human health and the consequences of concussions. Both represent imbalanced parasympathetic/cholinergic response to insulting triggers and variably uncontrolled inflammation that indicates shared upstream regulators, including short microRNAs (miRs) and long non-coding RNAs (lncRNAs). These may cross talk across multiple systems, leading to complex molecular and clinical outcomes. Notably, biomedical and RNA-sequencing based analyses both highlight new links between the acquired and inherited pathogenic, cardiac and inflammatory traits of sepsis/MetS. Those include the HOTAIR and MIAT lncRNAs and their targets, such as miR-122, −150, −155, −182, −197, −375, −608 and HLA-DRA. Implicating non-coding RNA regulators in sepsis and MetS may delineate novel high-value biomarkers and targets for intervention.
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Affiliation(s)
- Chanan Meydan
- Department of Internal Medicine, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Uriya Bekenstein
- The Department of Biological Chemistry, The Edmond and Lilly Safra Center for Brain Sciences, The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hermona Soreq
- The Department of Biological Chemistry, The Edmond and Lilly Safra Center for Brain Sciences, The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
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Adeyanju OA, Soetan OA, Soladoye AO, Olatunji LA. Oral hormonal therapy with ethinylestradiol–levonorgestrel improves insulin resistance, obesity, and glycogen synthase kinase-3 independent of circulating mineralocorticoid in estrogen-deficient rats. Can J Physiol Pharmacol 2018; 96:577-586. [DOI: 10.1139/cjpp-2017-0630] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Estrogen deficiency has been associated with increased incidence of cardiovascular diseases , and recent clinical trials of standard formulations of hormonal therapies have not demonstrated consistent beneficial effects. Estrogen–progestin therapy has been used as exogenous estrogen to normalize depressed estrogen level during menopause. Ovariectomized rodents mimic an estrogen-deficient state in that they develop cardiometabolic dysfunction, including insulin resistance (IR). We therefore hypothesized that hormonal therapy with combined oral contraceptive steroids, ethinylestradiol–levonorgestrel (EEL), improves IR, obesity, and glycogen synthase kinase-3 (GSK-3) through reduction of circulating mineralocorticoid in ovariectomized rats. Twelve-week-old female Wistar rats were divided into 4 groups: sham-operated (SHM) and ovariectomized (OVX) rats were treated with or without EEL (1.0 μg ethinylestradiol and 5.0 μg levonorgestrel) daily for 8 weeks. Results showed that OVX or SHM + EEL treated rats had increased HOMA-IR (homeostatic model assessment of IR), 1 h postload glucose, HOMA-β, triglycerides (TG), total cholesterol (TC), TC/HDL cholesterol, TG/HDL cholesterol, plasma insulin, GSK-3, corticosterone, and aldosterone. On the other hand, OVX + EEL treatment ameliorated all these effects except that of aldosterone. Taken together, the results demonstrate that oral hormonal replacement with EEL improves IR and pancreatic β-cell function and suppresses GSK-3 and glucocorticoid independent of circulating aldosterone, suggesting a positive cardiometabolic effect of oral EEL therapy in estrogen-deficient rats.
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Affiliation(s)
- Oluwaseun A. Adeyanju
- Cardiovascular Research Laboratory, Department of Physiology, University of Ilorin, Ilorin, Nigeria
- Cardiometabolic Research Unit, Department of Physiology, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Olaniyi A. Soetan
- Cardiovascular Research Laboratory, Department of Physiology, University of Ilorin, Ilorin, Nigeria
| | - Ayodele O. Soladoye
- Cardiovascular Research Laboratory, Department of Physiology, University of Ilorin, Ilorin, Nigeria
| | - Lawrence A. Olatunji
- Cardiovascular Research Laboratory, Department of Physiology, University of Ilorin, Ilorin, Nigeria
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22
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Krittanawong C, Tunhasiriwet A, Wang Z, Zhang H, Prokop LJ, Chirapongsathorn S, Sun T, Kitai T, Tang WW. Meta-Analysis Comparing Frequency of Overweight Versus Normal Weight in Patients With New-Onset Heart Failure. Am J Cardiol 2018; 121:836-843. [PMID: 29397880 DOI: 10.1016/j.amjcard.2017.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/15/2017] [Accepted: 12/27/2017] [Indexed: 12/28/2022]
Abstract
Association between obesity and new-onset heart failure (HF) has repeatedly been established. Less is known about the risk of overweight with the development of HF. The aim of this systematic review and meta-analysis was to explore the association between overweight, obesity, and the incidence of new-onset HF. In this study, we systematically searched MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials from database inception through June 2017. Studies were included if they reported the association between overweight or obesity and new-onset HF compared with normal weight. DerSimonian and Laird random effect meta-analyses were used, and subgroup analyses were performed to explore the potential sources of heterogeneity. Of 2,184 retrieved articles, we identified 21 relevant studies with a total of 525,656 participants with 18,948 HF cases. Compared with the normal body weight index (body mass index < 25 kg/m2), overweight (body mass index 25 to 29.9 kg/m2) was associated with a 33% higher risk of developing HF (pooled risk ratios 1.33; 95% confidence interval 1.16 to 1.52; p <0.001), with substantial heterogeneity among studies (I2 = 83.6%). In addition, class I, II, and III obesity were stepwise-associated with an increase in the risk of developing HF as 73%, 85% and 189%, respectively (all p <.001) compared with normal weight. In conclusion, compared with healthy normal-weight patients, these results show that both overweight patients were independently associated with a significantly higher incidence of HF. These results highlight the need for a better understanding of the potential mechanisms of overweight and HF.
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23
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Hart PD. Using Structural Equation Modeling to Examine the Effects of Sex and Physical Activity on the Metabolic Syndrome and Health-related Quality of Life Relationship. EXERCISE MEDICINE 2018. [DOI: 10.26644/em.2018.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Burroughs Peña M, Swett K, Schneiderman N, Spevack DM, Ponce SG, Talavera GA, Kansal MM, Daviglus ML, Cai J, Hurwitz BE, Llabre MM, Rodriguez CJ. Cardiac structure and function with and without metabolic syndrome: the Echocardiographic Study of Latinos (Echo-SOL). BMJ Open Diabetes Res Care 2018; 6:e000484. [PMID: 30116540 PMCID: PMC6091897 DOI: 10.1136/bmjdrc-2017-000484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/11/2018] [Accepted: 04/19/2018] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE We assessed the hypothesis that metabolic syndrome is associated with adverse changes in cardiac structure and function in participants of the Echocardiographic Study of Latinos (Echo-SOL). METHODS Non-diabetic Echo-SOL participants were included in this cross-sectional analysis. Metabolic syndrome was defined according to the American Heart Association/National Heart, Lung, and Blood Institute 2009 Joint Scientific Statement. Survey multivariable linear regression analyses using sampling weights were used adjusting for multiple potential confounding variables. Additional analysis was stratified according to the presence/absence of obesity (body mass index (BMI) ≥25 kg/m2) and the presence/absence of metabolic syndrome. RESULTS Within Echo-SOL, 1260 individuals met inclusion criteria (59% female; mean age 55.2 years). Compared with individuals without metabolic syndrome, those with metabolic syndrome had lower medial and lateral E' velocities (-0.4 cm/s, (SE 0.1), p=0.0002; -0.5 cm/s (0.2), p=0.02, respectively), greater E/E' (0.5(0.2), p=0.01) and worse two-chamber left ventricular longitudinal strain (0.9%(0.3), p=0.009), after adjusting for potential confounding variables. Increased left ventricular mass index (9.8 g/m2 (1.9), p<0.0001 and 7.5 g/m2 (1.7), p<0.0001), left ventricular end-diastolic volume (11.1 mL (3.0), p=0.0003 and 13.3 mL (2.7), p<0.0001), left ventricular end-systolic volume (5.0 mL (1.4), p=0.0004 and 5.7 mL (1.3) p<0.0001) and left ventricular stroke volume (10.2 mL (1.8), p<0.0001 and 13.0 mL (2.0), p<0.0001) were observed in obese individuals with and without metabolic syndrome compared with individuals with normal weight without metabolic syndrome. In sensitivity analyses, individuals with normal weight (BMI <25 kg/m2) and metabolic syndrome had worse left ventricular global longitudinal strain (2.1%(0.7), p=0.002) and reduced left ventricular ejection fraction (-3.5%(1.4), p=0.007) compared with normal-weight individuals without metabolic syndrome. CONCLUSIONS In a sample of US Hispanics/Latinos metabolic syndrome was associated with worse left ventricular systolic and diastolic function. Adverse changes in left ventricular size and function were observed in obese individuals with and without metabolic syndrome but decreased left ventricular function was also present in normal-weight individuals with metabolic syndrome.
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Affiliation(s)
| | - Katrina Swett
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Neil Schneiderman
- Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Daniel M Spevack
- Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sonia G Ponce
- Department of Family and Preventive Medicine, University of California, San Diego, California, USA
| | - Gregory A Talavera
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Mayank M Kansal
- Division of Cardiology, University of Illinois, Chicago, Illinois, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois, Chapel Hill, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barry E Hurwitz
- Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Maria M Llabre
- Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Carlos J Rodriguez
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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25
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Vest AR, Kennel PJ, Maldonado D, Young JB, Mountis MM, Naka Y, Colombo PC, Mancini DM, Starling RC, Schulze PC. Recovery of Serum Cholesterol Predicts Survival After Left Ventricular Assist Device Implantation. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.002881. [PMID: 27623768 DOI: 10.1161/circheartfailure.115.002881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 08/10/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Advanced systolic heart failure is associated with myocardial and systemic metabolic abnormalities, including low levels of total cholesterol and low-density lipoprotein. Low cholesterol and low-density lipoprotein have been associated with greater mortality in heart failure. Implantation of a left ventricular assist device (LVAD) reverses some of the metabolic derangements of advanced heart failure. METHODS AND RESULTS A cohort was retrospectively assembled from 2 high-volume implantation centers, totaling 295 continuous-flow LVAD recipients with ≥2 cholesterol values available. The cohort was predominantly bridge-to-transplantation (67%), with median age of 59 years and 49% ischemic heart failure cause. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels all significantly increased after LVAD implantation (median values from implantation to 3 months post implantation 125-150 mg/dL, 67-85 mg/dL, 32-42 mg/dL, and 97-126 mg/dL, respectively). On Cox proportional hazards modeling, patients achieving recovery of total cholesterol levels, defined as a median or greater change from pre implantation to 3 months post-LVAD implantation, had significantly better unadjusted survival (hazard ratio, 0.445; 95% confidence interval, 0.212-0.932) and adjusted survival (hazard ratio, 0.241; 95% confidence interval, 0.092-0.628) than those without cholesterol recovery after LVAD implantation. The continuous variable of total cholesterol at 3 months post implantation and the cholesterol increase from pre implantation to 3 months were also both significantly associated with survival during LVAD support. CONCLUSIONS Initiation of continuous-flow LVAD support was associated with significant recovery of all 4 lipid variables. Patients with a greater increase in total cholesterol by 3 months post implantation had superior survival during LVAD support.
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Affiliation(s)
- Amanda R Vest
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.).
| | - Peter J Kennel
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Dawn Maldonado
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - James B Young
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Maria M Mountis
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Yoshifumi Naka
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Paolo C Colombo
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Donna M Mancini
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Randall C Starling
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - P Christian Schulze
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
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Rodríguez-Calvo R, Girona J, Alegret JM, Bosquet A, Ibarretxe D, Masana L. Role of the fatty acid-binding protein 4 in heart failure and cardiovascular disease. J Endocrinol 2017; 233:R173-R184. [PMID: 28420707 DOI: 10.1530/joe-17-0031] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/18/2017] [Indexed: 01/05/2023]
Abstract
Obesity and ectopic fat accumulation in non-adipose tissues are major contributors to heart failure (HF) and cardiovascular disease (CVD). Adipocytes act as endocrine organs by releasing a large number of bioactive molecules into the bloodstream, which participate in a communication network between white adipose tissue and other organs, including the heart. Among these molecules, fatty acid-binding protein 4 (FABP4) has recently been shown to increase cardiometabolic risk. Both clinical and experimental evidence have identified FABP4 as a relevant player in atherosclerosis and coronary artery disease, and it has been directly related to cardiac alterations such as left ventricular hypertrophy (LVH) and both systolic and diastolic cardiac dysfunction. The available interventional studies preclude the establishment of a direct causal role of this molecule in CVD and HF and propose FABP4 as a biomarker rather than as an aetiological factor. However, several experimental reports have suggested that FABP4 may act as a direct contributor to cardiac metabolism and physiopathology, and the pharmacological targeting of FABP4 may restore some of the metabolic alterations that are conducive to CVD and HF. Here, we review the current knowledge regarding FABP4 in the context of HF and CVD as well as the molecular basis by which this protein participates in the regulation of cardiac function.
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Affiliation(s)
- Ricardo Rodríguez-Calvo
- Vascular Medicine and Metabolism UnitResearch Unit on Lipids and Atherosclerosis, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain
| | - Josefa Girona
- Vascular Medicine and Metabolism UnitResearch Unit on Lipids and Atherosclerosis, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain
| | - Josep M Alegret
- Department of CardiologyCardiovascular Research Group, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Reus, Spain
| | - Alba Bosquet
- Vascular Medicine and Metabolism UnitResearch Unit on Lipids and Atherosclerosis, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain
| | - Daiana Ibarretxe
- Vascular Medicine and Metabolism UnitResearch Unit on Lipids and Atherosclerosis, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain
| | - Lluís Masana
- Vascular Medicine and Metabolism UnitResearch Unit on Lipids and Atherosclerosis, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain
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27
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Affiliation(s)
- Amanda R Vest
- From the Division of Cardiology, Tufts Medical Center, Boston, MA.
| | - Ayan R Patel
- From the Division of Cardiology, Tufts Medical Center, Boston, MA
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28
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Sardu C, Santamaria M, Funaro S, Sacra C, Barbieri M, Paolisso P, Marfella R, Paolisso G, Rizzo MR. Cardiac electrophysiological alterations and clinical response in cardiac resynchronization therapy with a defibrillator treated patients affected by metabolic syndrome. Medicine (Baltimore) 2017; 96:e6558. [PMID: 28383431 PMCID: PMC5411215 DOI: 10.1097/md.0000000000006558] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Metabolic syndrome (MS) is a multifactorial disease that can affect clinical outcomes in patients treated by Cardiac Resynchronization Therapy with a defibrillator (CRT-d).Ninety-one patients received a CRT-d. According to clinical diagnosis, the study population was divided into 46 MS (cases) versus 45 no MS (controls) patients. These patients were followed by clinical, instrumental assessment, and device telemetric interrogations at follow-up. The design of the study was to evaluate the functionality of the CRT-d leads, the arrhythmic events, the CRT-d response, and the clinical outcomes at follow-up.At follow-up, there was a statistical significant difference, comparing MS versus no MS patients regarding the sensing, pacing, and impedance thresholds of the right atrium, right ventricle, and left ventricle leads. There was a statistically significant difference in the percentage of CRT-d responders comparing MS (n = 16, 51%) versus no MS (n = 40, 77%) patients (P = 0.017). MS may be predictive for hospitalization for heart failure worsening (hazard ratio 0.327, 95% confidence interval 0.096-0.943, P = 0.044) in CRT-d patients.MS is a complex multifactorial disease that may affect the functionality of CRT-d leads, the CRT-d response, and clinical outcomes in failing heart patients. These parameters may be detectable by follow-up monitoring.
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Affiliation(s)
- Celestino Sardu
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University Study of Naples, Naples
- Cardiovascular and Arrhythmias Department, Giovanni Paolo II Research and Care, Foundation, Campobasso, Italy
| | - Matteo Santamaria
- Cardiovascular and Arrhythmias Department, Giovanni Paolo II Research and Care, Foundation, Campobasso, Italy
| | - Stefania Funaro
- Cardiovascular and Arrhythmias Department, Giovanni Paolo II Research and Care, Foundation, Campobasso, Italy
| | - Cosimo Sacra
- Cardiovascular and Arrhythmias Department, Giovanni Paolo II Research and Care, Foundation, Campobasso, Italy
| | - Michelangela Barbieri
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University Study of Naples, Naples
| | - Pasquale Paolisso
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University Study of Naples, Naples
| | - Raffaele Marfella
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University Study of Naples, Naples
| | - Giuseppe Paolisso
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University Study of Naples, Naples
| | - Maria Rosaria Rizzo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University Study of Naples, Naples
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Bozkurt B, Aguilar D, Deswal A, Dunbar SB, Francis GS, Horwich T, Jessup M, Kosiborod M, Pritchett AM, Ramasubbu K, Rosendorff C, Yancy C. Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e535-e578. [DOI: 10.1161/cir.0000000000000450] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Klip IJT, Voors AA, Swinkels DW, Bakker SJL, Kootstra-Ros JE, Lam CS, van der Harst P, van Veldhuisen DJ, van der Meer P. Serum ferritin and risk for new-onset heart failure and cardiovascular events in the community. Eur J Heart Fail 2016; 19:348-356. [PMID: 27758018 DOI: 10.1002/ejhf.622] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/30/2016] [Accepted: 07/04/2016] [Indexed: 12/20/2022] Open
Abstract
AIMS Heart failure (HF) is a common manifestation of patients with primary and secondary causes of iron overload, whereas in patients with established HF iron deficiency impairs outcome. Whether iron stores, either depleted or in overload, amplify the risk for new-onset HF among healthy individuals is unknown. The present study aimed to assess whether markers of iron status or the iron-regulatory hormone hepcidin are associated with new-onset HF or cardiovascular (CV) events in the general population. METHODS AND RESULTS In 6386 subjects from the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) trial, a prospective, community-based, cohort study, markers of iron status and the iron-regulatory hormone hepcidin were measured. Mean age was 53.1 ± 12.0 years, and 50.7% of the cohort was female. During a median follow-up of 8.3 (interquartile range 7.8-8.9) years, 199 subjects (3.1%) were newly diagnosed with HF, 456 (7.1%) experienced a CV event, and 356 (5.6%) died from all causes. A higher annual HF incidence per ferritin quartile was observed in women (P < 0.001), but not in men (P for interaction 0.032). Multivariable analyses demonstrated ferritin levels to remain independently predictive for new-onset HF in women only (P = 0.024). This association persisted within strata defined by markers of the metabolic syndrome, markers of inflammation, or other markers of iron homeostasis, including hepcidin. No association between ferritin or hepcidin and incident CV events or all-cause mortality was observed in either sex. CONCLUSIONS Increased serum ferritin levels independently amplify the risk for new-onset HF in women in the community.
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Affiliation(s)
- IJsbrand T Klip
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jenny E Kootstra-Ros
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolyn S Lam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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Silva JF, Correa IC, Diniz TF, Lima PM, Santos RL, Cortes SF, Coimbra CC, Lemos VS. Obesity, Inflammation, and Exercise Training: Relative Contribution of iNOS and eNOS in the Modulation of Vascular Function in the Mouse Aorta. Front Physiol 2016; 7:386. [PMID: 27656148 PMCID: PMC5013134 DOI: 10.3389/fphys.2016.00386] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/22/2016] [Indexed: 12/27/2022] Open
Abstract
Background: The understanding of obsesity-related vascular dysfunction remains controversial mainly because of the diseases associated with vascular injury. Exercise training is known to prevent vascular dysfunction. Using an obesity model without comorbidities, we aimed at investigating the underlying mechanism of vascular dysfunction and how exercise interferes with this process. Methods: High-sugar diet was used to induce obesity in mice. Exercise training was performed 5 days/week. Body weight, energy intake, and adipose tissues were assessed; blood metabolic and hormonal parameters were determined; and serum TNFα was measured. Blood pressure and heart rate were assessed by plethysmography. Changes in aortic isometric tension were recorded on myograph. Western blot was used to analyze protein expression. Nitric oxide (NO) was evaluated using fluorescence microscopy. Antisense oligodeoxynucleotides were used for inducible nitric oxide synthase isoform (iNOS) knockdown. Results: Body weight, fat mass, total cholesterol, low-density lipoprotein cholesterol fraction, insulin, and leptin were higher in the sedentary obese group (SD) than in the sedentary control animals (SS). Exercise training prevented these changes. No difference in glucose tolerance, insulin sensitivity, blood pressure, and heart rate was found. Decreased vascular relaxation and reduced endothelial nitric oxide synthase (eNOS) functioning in the SD group were prevented by exercise. Contractile response to phenylephrine was decreased in the aortas of the wild SD mice, compared with that of the SS group; however, no alteration was noted in the SD iNOS−/− animals. The decreased contractility was endothelium-dependent, and was reverted by iNOS inhibition or iNOS silencing. The aortas from the SD group showed increased basal NO production, serum TNFα, TNF receptor-1, and phospho-IκB. Exercise training attenuated iNOS-dependent reduction in contractile response in high-sugar diet–fed animals, decreased iNOS expression, and increased eNOS expression. Conclusion: Obesity caused endothelium dysfunction, TNFα, and iNOS pathway up-regulation, decreasing vascular contractility in the obese animals. Exercise training was an effective therapy to control iNOS-dependent NO production and to preserve endothelial function in obese individuals.
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Affiliation(s)
- Josiane F Silva
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Izabella C Correa
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Thiago F Diniz
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Paulo M Lima
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Roger L Santos
- Department of Physiological Science, Universidade Federal do Espírito Santo Espírito Santo, Brazil
| | - Steyner F Cortes
- Department of Pharmacology, Institute of Biological Sciences, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Cândido C Coimbra
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Virginia S Lemos
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
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Aune D, Sen A, Norat T, Janszky I, Romundstad P, Tonstad S, Vatten LJ. Body Mass Index, Abdominal Fatness, and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Circulation 2016; 133:639-49. [PMID: 26746176 DOI: 10.1161/circulationaha.115.016801] [Citation(s) in RCA: 238] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 12/29/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Obesity has been associated with increased risk of heart failure, but whether overweight also increases risk is unclear. It is also unclear whether abdominal adiposity is more strongly associated with heart failure risk than general adiposity. We conducted a systematic review and meta-analysis of prospective studies to clarify the strength and shape of the dose-response relationship between general and abdominal adiposity and the risk of heart failure. METHODS AND RESULTS PubMed and Embase databases were searched up to October 10, 2014. Summary relative risks were calculated using random-effects models. A total of 28 studies (27 publications) were included. Twenty-three prospective studies with >15 905 incident cases among 647 388 participants were included in the analysis of body mass index and heart failure incidence, and 4 studies were included for heart failure mortality. The summary relative risk for a 5-unit increment in body mass index was 1.41 (95% confidence interval, 1.34-1.47; I(2)=83%) for heart failure incidence and 1.26 (95% confidence interval, 0.85-1.87; I(2)=95%) heart failure mortality. Although the test for nonlinearity was significant (P<0.0001), this appeared to be attributable to a threshold at a body mass index of ≈23 to 24 kg/m(2); however, there was evidence of increased risk even in the overweight body mass index range. The summary relative risk for a 10-cm increase in waist circumference was 1.29 (95% confidence interval, 1.21-1.37; I(2)=89%) and per 0.1-unit increase in waist-to-hip ratio was 1.29 (95% confidence interval, 1.13-1.47; I(2)=82%). CONCLUSION Overweight and obesity and abdominal adiposity are associated with increased risk of heart failure.
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Affiliation(s)
- Dagfinn Aune
- From Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (D.A., A.S., I.J., P.R., L.J.V.); Department of Epidemiology and Biostatistics, Imperial College, London, UK (D.A., T.N.); and Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway (S.T.).
| | - Abhijit Sen
- From Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (D.A., A.S., I.J., P.R., L.J.V.); Department of Epidemiology and Biostatistics, Imperial College, London, UK (D.A., T.N.); and Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway (S.T.)
| | - Teresa Norat
- From Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (D.A., A.S., I.J., P.R., L.J.V.); Department of Epidemiology and Biostatistics, Imperial College, London, UK (D.A., T.N.); and Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway (S.T.)
| | - Imre Janszky
- From Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (D.A., A.S., I.J., P.R., L.J.V.); Department of Epidemiology and Biostatistics, Imperial College, London, UK (D.A., T.N.); and Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway (S.T.)
| | - Pål Romundstad
- From Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (D.A., A.S., I.J., P.R., L.J.V.); Department of Epidemiology and Biostatistics, Imperial College, London, UK (D.A., T.N.); and Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway (S.T.)
| | - Serena Tonstad
- From Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (D.A., A.S., I.J., P.R., L.J.V.); Department of Epidemiology and Biostatistics, Imperial College, London, UK (D.A., T.N.); and Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway (S.T.)
| | - Lars J Vatten
- From Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (D.A., A.S., I.J., P.R., L.J.V.); Department of Epidemiology and Biostatistics, Imperial College, London, UK (D.A., T.N.); and Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway (S.T.)
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Perrone-Filardi P, Paolillo S, Costanzo P, Savarese G, Trimarco B, Bonow RO. The role of metabolic syndrome in heart failure. Eur Heart J 2015; 36:2630-4. [PMID: 26242711 DOI: 10.1093/eurheartj/ehv350] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 06/24/2015] [Indexed: 12/14/2022] Open
Abstract
Metabolic syndrome (MS) is a highly prevalent condition in patients affected by heart failure (HF); however, it is still unclear whether, in the setting of cardiac dysfunction, it represents an adverse risk factor for the occurrence of cardiac events. The epidemiologic implications of MS in HF have been studied intensely, as many of its components contribute to the incidence and severity of HF. In particular, insulin resistance, diabetes mellitus, and lipid abnormalities represent the main components that negatively influence disease progression and evolution. Yet, other components of the MS, i.e. overweight/obesity and high blood pressure, are favourably associated with outcome in HF patients. The aim of this review was to report epidemiology and prognostic role of MS in HF and to investigate current clinical implications and future research needs.
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Affiliation(s)
- Pasquale Perrone-Filardi
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Via Pansini 5, Naples 80131, Italy
| | - Stefania Paolillo
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
| | | | - Gianluigi Savarese
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Via Pansini 5, Naples 80131, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Via Pansini 5, Naples 80131, Italy
| | - Robert O Bonow
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
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Guimaraes JFC, Muzio BP, Rosa CM, Nascimento AF, Sugizaki MM, Fernandes AAH, Cicogna AC, Padovani CR, Okoshi MP, Okoshi K. Rutin administration attenuates myocardial dysfunction in diabetic rats. Cardiovasc Diabetol 2015; 14:90. [PMID: 26185015 PMCID: PMC4504040 DOI: 10.1186/s12933-015-0255-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/03/2015] [Indexed: 01/08/2023] Open
Abstract
Background Oxidative stress plays a major role in diabetic cardiomyopathy pathogenesis. Anti-oxidant therapy has been investigated in preventing or treating several diabetic complications. However, anti-oxidant action on diabetic-induced cardiac remodeling is not completely clear. This study evaluated the effects of rutin, a flavonoid, on cardiac and myocardial function in diabetic rats. Methods Wistar rats were assigned into control (C, n = 14); control-rutin (C-R, n = 14); diabetes mellitus (DM, n = 16); and DM-rutin (DM-R, n = 16) groups. Seven days after inducing diabetes (streptozotocin, 60 mg/kg, i.p.), rutin was injected intraperitoneally once a week (50 mg/kg) for 7 weeks. Echocardiogram was performed and myocardial function assessed in left ventricular (LV) papillary muscles. Serum insulin concentration was measured by ELISA. Statistics: One-way ANOVA and Tukey’s post hoc test. Results Glycemia was higher in DM than DM-R and C and in DM-R than C-R. Insulin concentration was lower in diabetic groups than controls (C 2.45 ± 0.67; C-R 2.09 ± 0.52; DM 0.59 ± 0.18; DM-R 0.82 ± 0.21 ng/mL). Echocardiogram showed no differences between C-R and C. DM had increased LV systolic diameter compared to C, and increased left atrium diameter/body weight (BW) ratio and LV mass/BW ratio compared to C and DM-R. Septal wall thickness, LV diastolic diameter/BW ratio, and relative wall thickness were lower in DM-R than DM. Fractional shortening and posterior wall shortening velocity were lower in DM than C and DM-R. In papillary muscle preparation, DM and DM-R presented higher time to peak tension and time from peak tension to 50% relaxation than controls; time to peak tension was lower in DM-R than DM. Under 0.625 and 1.25 mM extracellular calcium concentrations, DM had higher developed tension than C. Conclusion Rutin attenuates cardiac remodeling and left ventricular and myocardial dysfunction caused by streptozotocin-induced diabetes mellitus.
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Affiliation(s)
- Julliano F C Guimaraes
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil.
| | - Bruno P Muzio
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil.
| | - Camila M Rosa
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil.
| | - Andre F Nascimento
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil.
| | - Mario M Sugizaki
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil.
| | - Ana A H Fernandes
- Department of Chemistry and Biochemistry, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu, Brazil.
| | - Antonio C Cicogna
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil.
| | - Carlos R Padovani
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil.
| | - Marina P Okoshi
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil.
| | - Katashi Okoshi
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil. .,Departamento de Clinica Medica, Faculdade de Medicina de Botucatu, UNESP Rubiao Junior, S/N 18618-970, Botucatu, SP, Brazil.
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Yang H, Negishi K, Otahal P, Marwick TH. Clinical prediction of incident heart failure risk: a systematic review and meta-analysis. Open Heart 2015; 2:e000222. [PMID: 25893103 PMCID: PMC4395833 DOI: 10.1136/openhrt-2014-000222] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/15/2015] [Accepted: 03/17/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Early treatment may alter progression to overt heart failure (HF) in asymptomatic individuals with stage B HF (SBHF). However, the identification of patients with SBHF is difficult. This systematic review sought to examine the strength of association of clinical factors with incident HF, with the intention of facilitating selection for HF screening. METHODS Electronic databases were systematically searched for studies reporting risk factors for incident HF. Effect sizes, typically HRs, of each risk variable were extracted. Pooled crude and adjusted HRs with 95% CIs were computed for each risk variable using a random-effects model weighted by inverse variance. RESULTS Twenty-seven clinical factors were identified to be associated with risk of incident HF in 15 observational studies in unselected community populations which followed 456 850 participants over 4-29 years. The strongest independent associations for incident HF were coronary artery disease (HR=2.94; 95% CI 1.36 to 6.33), diabetes mellitus (HR=2.00; 95% CI 1.68 to 2.38), age (HR (per 10 years)=1.80; 95% CI 1.13 to 2.87) followed by hypertension (HR=1.61; 95% CI 1.33 to 1.96), smoking (HR=1.60; 95% CI 1.45 to 1.77), male gender (HR=1.52; 95% CI 1.24 to 1.87) and body mass index (HR (per 5 kg/m(2))=1.15; 95% CI 1.06 to 1.25). Atrial fibrillation (HR=1.88; 95% CI 1.60 to 2.21), left ventricular hypertrophy (HR=2.46; 95% CI 1.71 to 3.53) and valvular heart disease (HR=1.74; 95% CI 1.07 to 2.84) were also strongly associated with incident HF but were not examined in sufficient papers to provide pooled hazard estimates. CONCLUSIONS Prediction of incident HF can be calculated from seven common clinical variables. The risk associated with these may guide strategies for the identification of high-risk people who may benefit from further evaluation and intervention.
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Affiliation(s)
- Hong Yang
- Menzies Institute for Medical Research , Hobart, Tasmania , Australia
| | - Kazuaki Negishi
- Menzies Institute for Medical Research , Hobart, Tasmania , Australia
| | - Petr Otahal
- Menzies Institute for Medical Research , Hobart, Tasmania , Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research , Hobart, Tasmania , Australia
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Gopal DM, Santhanakrishnan R, Wang YC, Ayalon N, Donohue C, Rahban Y, Perez AJ, Downing J, Liang CS, Gokce N, Colucci WS, Ho JE. Impaired right ventricular hemodynamics indicate preclinical pulmonary hypertension in patients with metabolic syndrome. J Am Heart Assoc 2015; 4:e001597. [PMID: 25758604 PMCID: PMC4392440 DOI: 10.1161/jaha.114.001597] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Metabolic disease can lead to intrinsic pulmonary hypertension in experimental models. The contributions of metabolic syndrome (MetS) and obesity to pulmonary hypertension and right ventricular dysfunction in humans remain unclear. We investigated the association of MetS and obesity with right ventricular structure and function in patients without cardiovascular disease. Methods and Results A total of 156 patients with MetS (mean age 44 years, 71% women, mean body mass index 40 kg/m2), 45 similarly obese persons without MetS, and 45 nonobese controls underwent echocardiography, including pulsed wave Doppler measurement of pulmonary artery acceleration time (PAAT) and ejection time. Pulmonary artery systolic pressure was estimated from PAAT using validated equations. MetS was associated with lower tricuspid valve e′ (right ventricular diastolic function parameter), shorter PAAT, shorter ejection time, and larger pulmonary artery diameter compared with controls (P<0.05 for all). Estimated pulmonary artery systolic pressure based on PAAT was 42±12 mm Hg in participants with MetS compared with 32±9 and 32±10 mm Hg in obese and nonobese controls (P for ANOVA <0.0001). After adjustment for age, sex, hypertension, diabetes, body mass index, and triglycerides, MetS remained associated with a 20‐ms–shorter PAAT (β=−20.4, SE=6.5, P=0.002 versus obese). This association persisted after accounting for left ventricular structure and function and after exclusion of participants with obstructive sleep apnea. Conclusions MetS is associated with abnormal right ventricular and pulmonary artery hemodynamics, as shown by shorter PAAT and subclinical right ventricular diastolic dysfunction. Estimated pulmonary artery systolic pressures are higher in MetS and preclinical metabolic heart disease and raise the possibility that pulmonary hypertension contributes to the pathophysiology of metabolic heart disease.
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Affiliation(s)
- Deepa M Gopal
- Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.M.G.)
| | - Rajalakshmi Santhanakrishnan
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA (R.S., N.A., C.D., A.J.P., J.D., C.L., N.G., W.S.C., J.E.H.)
| | - Yi-Chih Wang
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y.C.W.)
| | - Nir Ayalon
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA (R.S., N.A., C.D., A.J.P., J.D., C.L., N.G., W.S.C., J.E.H.)
| | - Courtney Donohue
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA (R.S., N.A., C.D., A.J.P., J.D., C.L., N.G., W.S.C., J.E.H.)
| | - Youssef Rahban
- Department of Medicine, Boston University School of Medicine, Boston, MA (Y.R.)
| | - Alejandro J Perez
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA (R.S., N.A., C.D., A.J.P., J.D., C.L., N.G., W.S.C., J.E.H.)
| | - Jill Downing
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA (R.S., N.A., C.D., A.J.P., J.D., C.L., N.G., W.S.C., J.E.H.)
| | - Chang-seng Liang
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA (R.S., N.A., C.D., A.J.P., J.D., C.L., N.G., W.S.C., J.E.H.)
| | - Noyan Gokce
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA (R.S., N.A., C.D., A.J.P., J.D., C.L., N.G., W.S.C., J.E.H.)
| | - Wilson S Colucci
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA (R.S., N.A., C.D., A.J.P., J.D., C.L., N.G., W.S.C., J.E.H.)
| | - Jennifer E Ho
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA (R.S., N.A., C.D., A.J.P., J.D., C.L., N.G., W.S.C., J.E.H.)
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Vieira EC, Peixoto MDRG, Silveira EAD. Prevalence and factors associated with Metabolic Syndrome in elderly users of the Unified Health System. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 17:805-17. [DOI: 10.1590/1809-4503201400040001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 02/25/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: To evaluate the prevalence and factors associated with metabolic syndrome in the elderly. METHODS: Cross-sectional study, with 133 individuals randomly selected in the Unified Health System in Goiania, Goiás. The following variables were researched: anthropometric (BMI, waist circumference, fat percentage by Dual X-ray absorptiometry), sociodemographic (gender, age, color, income, marital status and years of schooling), lifestyle (physical activity, smoking and risk alcohol consumption) and food intake (risk and protective foods). The metabolic syndrome was assessed according to harmonized criteria proposed by the World Health Organization (WHO). The combinations were tested by Poisson regression for confounding factors. RESULTS: The prevalence of metabolic syndrome was 58.65% (95%CI 49.8 - 67.1), with 60.5% (95%CI 49.01 - 71.18) for females and 55.7% (95%CI 41.33 - 69.53) for males. Hypertension was the most prevalent component of the syndrome in both men, with 80.8% (95%CI 64.5 - 90.4), and women, with 85.2% (95%CI 75.5 - 92.1). After the multivariate analysis, only the excess of weight measured by body mass index (prevalence ratio = 1.66; p < 0.01) remained associated with the metabolic syndrome. CONCLUSIONS: The prevalence of metabolic syndrome in this sample was high, indicating the need for systematic actions by health workers in the control of risk factors through prevention strategies and comprehensive care to the elderly.
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López-Suárez A, Bascuñana-Quirell A, Beltrán-Robles M, Elvira-González J, Fernández-Palacín F, Barroso-Casamitjana E, Solino-Ocaña I. Metabolic syndrome does not improve the prediction of 5-year cardiovascular disease and total mortality over standard risk markers. Prospective population based study. Medicine (Baltimore) 2014; 93:e212. [PMID: 25501079 PMCID: PMC4602819 DOI: 10.1097/md.0000000000000212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Metabolic syndrome (MS) is widely believed to be an important risk factor for cardiovascular disease (CVD). We assessed whether a model based on MS improved prediction of CVD and total mortality over the Framingham's general CVD system (FRS) and whether MS was better than its individual components. Prospective cohort study of 855 participants randomly selected from the general population. Cox proportional hazards models were used to estimate the hazard ratios selecting a composite endpoint of CVD and total mortality. The performance of the FRS was compared with that of 4 MS-based models that differed in their use of individual components of MS as well as in the use of optimized cut-points of MS. The assessment included metrics of discrimination, calibration, and risk reclassification. Of all the models, only the model containing the 5 optimized components of MS improved model fit (deviance 10.7, P = 0.005), discrimination (difference of areas under the receiving operating curves 0.018), and risk reclassification in participants without events (net reclassification index 5.97, P = 0.01). The addition of optimized waist circumference to the FRS model improved the performance more than any other MS-based model. Every model containing the dichotomous definition of MS failed to improve model fit, discrimination, and risk reclassification. MS did not contribute predictive information over the FRS for the 5-year risk of CVD and total mortality. Some individual components of MS, in particular waist circumference, might play a role as part of the FRS provided their cut-off points are optimized.
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Affiliation(s)
- Alejandro López-Suárez
- From the Internal Medicine Department, Virgen del Camino Hospital, Carretera de Chipiona, Sanlúcar de Barrameda, Cádiz, Spain (ALS, ABQ, MBR, JEG, EBC, ISO); and Statistic and Operative Research, Faculty of Sciences, University of Cdiz, Avda. República Saharaui s/n, Puerto Real, Cádiz, Spain (FFP)
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Perrone-Filardi P, Savarese G, Scarano M, Cavazzina R, Trimarco B, Minneci S, Maggioni AP, Tavazzi L, Tognoni G, Marchioli R. Prognostic impact of metabolic syndrome in patients with chronic heart failure: data from GISSI-HF trial. Int J Cardiol 2014; 178:85-90. [PMID: 25464226 DOI: 10.1016/j.ijcard.2014.10.094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/04/2014] [Accepted: 10/21/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The adverse prognostic impact of metabolic syndrome (METS) in unselected populations and in patients with coronary heart disease has been previously shown. The aim of the current analysis was to evaluate the impact of METS on prognosis in chronic heart failure (HF). METHODS International Diabetes Federation criteria were used for the diagnosis of METS. Adjusted Cox regression models with all-cause and HF death as outcomes were fitted in 6648 patients enrolled in GISSI-HF trial with no missing values for the variables of interest. RESULTS Risk of all-cause and HF death was significantly reduced in patients with METS compared to patients without METS (HR: 0.83, 95% CI: 0.72 to 0.95, p=0.005; HR: 0.76, 95% CI: 0.59 to 0.98, p=0.031; respectively). As compared with patients with no METS and no type 2 diabetes mellitus (DM), the risk of all-cause and HF death was significantly lower in patients with METS and no DM (HR: 0.76, 95% CI: 0.62 to 0.95, p=0.015; HR: 0.65, 95% CI: 0.42 to 0.99, p=0.046; respectively), whereas it was significantly increased in patients with DM and no METS (HR: 1.34, 95% CI: 1.21 to 1.48, p<0.001; HR: 1.44, 95% CI: 1.21 to 1.72, p<0.001; respectively). Patients with METS and DM showed no difference for risk of total and HF death compared with patients with no METS and no DM (HR: 1.03, 95% CI: 0.87 to 1.21, p=0.762; HR: 0.99; 95% CI: 0.73 to 1.35; p=0.963; respectively). CONCLUSIONS METS is associated with reduced all-cause and HF mortality in patients with HF. HF patients with DM without METS are at the highest risk of mortality, whereas METS attenuates mortality risk in HF patients with DM.
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Affiliation(s)
| | - Gianluigi Savarese
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Marco Scarano
- Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy
| | | | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Sergio Minneci
- Azienda Universitaria Ospedaliera Careggi, Florence, Italy
| | - Aldo Pietro Maggioni
- Centro Studi Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, E.S. Health Science Foundation, Cotignola, RA, Italy
| | - Gianni Tognoni
- Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy
| | - Roberto Marchioli
- Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy; Hematology/Oncology TDU, Quintiles Milan, Italy
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Lupattelli G, Reboldi G, Paciullo F, Vaudo G, Pirro M, Pasqualini L, Nobili A, Mannucci P, Mannarino E. Heart failure and chronic kidney disease in a registry of internal medicine wards. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Minagawa K, Iwasaki M, Ogawa H, Yoshihara A, Miyazaki H. Relationship between metabolic syndrome and periodontitis in 80-year-old Japanese subjects. J Periodontal Res 2014; 50:173-9. [DOI: 10.1111/jre.12190] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 01/22/2023]
Affiliation(s)
- K. Minagawa
- Division of Preventive Dentistry; Department of Oral Health Science; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
| | - M. Iwasaki
- Division of Preventive Dentistry; Department of Oral Health Science; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
| | - H. Ogawa
- Division of Preventive Dentistry; Department of Oral Health Science; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
| | - A. Yoshihara
- Division of Oral Science for Health Promotion; Department of Oral Health and Welfare; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
| | - H. Miyazaki
- Division of Preventive Dentistry; Department of Oral Health Science; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
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Esteghamati A, Hafezi-Nejad N, Sheikhbahaei S, Heidari B, Zandieh A, Ebadi M, Nakhjavani M. Risk of coronary heart disease associated with metabolic syndrome and its individual components in Iranian subjects: A matched cohort study. J Clin Lipidol 2014; 8:279-86. [DOI: 10.1016/j.jacl.2014.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 02/01/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
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Dashnamirov RL. THE EFFECTIVENESS OF CARVEDILOL AND EPROSARTAN IN PATIENTS WITH METABOLIC SYNDROME AND CHRONIC HEART FAILURE. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2014. [DOI: 10.15829/1728-8800-2014-2-46-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Аim. of the study was to assess the effectiveness of carvedilol and eprosartan in addition to the traditional treatment (Nitrosorbid 30mg/day + Digoxin 0.25mg/day + TromboASS 100mg/day + Atorvastatin 20mg/day + Furosemid 40mg/day + Verospiron 50mg/day + Atenolol 12.5–25 mg/day) in patients with metabolic syndrome and chronic heart failure.Materials and methods. 91 patients with MS and CHF included sharing mentioned criteria. Carvedilol in doses of 6,25 ÷ 25 mg/day and eprosartan in doses of 300 ÷ 600 mg/day were administered in addition to the traditional treatment.Results. After 12 months of treatment systolic BP decreased by 23.6% and diastolic by 17.2%. Heart rate decreased by 23.1%, and exercise tolerance increased by 22.3%. Dynamics of the presented indicators are statistically significant.Conclusion. Administration of an alpha-beta blocker carvedilol and angiotensin II receptor blocker eprosartan in the above dosages promote the longest remission of heart failure, improvement in functional class and regression of pathological remodeling.
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Fitchett D, Connelly KA. Impaired cardiac function in metabolic syndrome. Can J Cardiol 2014; 30:270-1. [PMID: 24565251 DOI: 10.1016/j.cjca.2014.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 01/17/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- David Fitchett
- Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada.
| | - Kim A Connelly
- Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Ontario, Canada
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Vest AR, Young JB. Should we target obesity in advanced heart failure? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:284. [PMID: 24482160 DOI: 10.1007/s11936-013-0284-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OPINION STATEMENT Obesity is a risk factor for the development of heart failure (HF), but has been associated with improved survival in patients with established HF. Weight loss should clearly be recommended and supported for obese individuals without cardiac pathology to prevent cardiomyopathy development. Clinical recommendations at the other end of the obesity heart failure spectrum are also relatively clear. Morbidly obese individuals (BMI ≥ 40 kg/m(2)) aged <50 years with severely depressed systolic function and NYHA class III-IV symptoms should be considered for malabsorptive bariatric surgery at an experienced center. The goal is either improved systolic function and symptoms, or sufficient weight loss for heart transplant eligibility. Recommendations for patients falling between these extremes are more challenging. Overweight and mildly obese HF patients (25-35 kg/m(2)) may be somewhat protected from cardiac cachexia and weight loss is not expected to enhance survival, but may offer symptomatic benefits.
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Affiliation(s)
- Amanda R Vest
- Heart and Vascular Institute, Section of Heart Failure, 9500 Euclid Avenue, Mail Code J3-4, Cleveland, OH, 44195, USA,
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Lai YH, Liu CC, Kuo JY, Hung TC, Wu YJ, Yeh HI, Bulwer BE, Hung CL. Independent effects of body fat and inflammatory markers on ventricular geometry, midwall function, and atrial remodeling. Clin Cardiol 2014; 37:172-7. [PMID: 24399410 DOI: 10.1002/clc.22242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 12/03/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The effect of body fat distribution on left ventricular (LV) mass and geometry has been recently recognized. However, data regarding circulating inflammatory markers in relation to regional visceral fat deposits, which are metabolically active tissues that can impact cardiac structural remodeling, remain sparse. HYPOTHESIS We hypothesized that obesity has adverse effects on cardiac function and structure. METHODS We consecutively studied 1071 asymptomatic subjects (age 49.5 ± 10.5 years, 39.4% female) free from significant valvular disorders, chronic lung disease, or renal disease. Echocardiography-defined cardiac structures and LV geometries including LV mass, mass-to-volume ratio, and fractional shortening were all determined. Body fat composition (Tanita-305 Body-Fat Analyzer; Tanita Corp., Tokyo, Japan) was obtained and calculated. Multivariate regression models from various models were used to represent the independent association between body fat and echo-derived ventricular mass and geometries. RESULTS In multivariable analysis, increasing body fat was significantly related to increase in left atrial (LA) and LV diameter, posterior wall thickness, relative wall thickness (RWT), LV mass, mass-to-volume ratio, and decreased midwall fractional shortening with or without stress correction (all P < 0.001). When LV mass and severity of mitral regurgitation was further added, the independent association between increased body fat composition and larger LA diameter remained significant (β coefficient = 0.37, P < 0.001). Elevated high-sensitivity C-reactive protein (Hs-CRP) level was associated with larger LA diameter, increased RWT, and worsened midwall mechanics in the female gender (all interaction P < 0.05). CONCLUSIONS Accumulated body fat seemed to be related to worse ventricular midwall contractility and atrial remodeling, particularly in the female gender, with high systemic inflammation. These gender and Hs-CRP-specific modification effects may potentiate the pathological mechanisms involved in heart failure with preserved ejection fraction.
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Affiliation(s)
- Yau-Huei Lai
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College and Mackay Medicine Nursing and Management College, Taipei, Taiwan
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Wensley I, Salaveria K, Bulmer AC, Donner DG, du Toit EF. Myocardial structure, function and ischaemic tolerance in a rodent model of obesity with insulin resistance. Exp Physiol 2013; 98:1552-64. [PMID: 23851919 DOI: 10.1113/expphysiol.2013.074948] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Obesity and its comorbidities (dyslipidaemia, insulin resistance and hypertension) that together constitute the metabolic syndrome are all risk factors for ischaemic heart disease. Although obesity has been reported to be an independent risk factor for congestive heart failure, whether obesity-induced heart failure develops in the absence of increased afterload (induced by hypertension) is not clear. We have previously shown that obesity with insulin resistance decreases myocardial tolerance to ischaemia-reperfusion, but the mechanism for this decreased tolerance remains unclear. We hypothesize that obesity with insulin resistance induces adverse cardiac remodelling and pump dysfunction, as well as adverse changes in myocardial prosurvival reperfusion injury salvage kinase (RISK) pathway signalling to reduce myocardial tolerance to ischaemia-reperfusion. Wistar rats were fed an obesogenic (obese group) or a standard rat chow diet (control group) for 32 weeks. Echocardiography was performed over the 32 weeks before isolated Langendorff-perfused hearts were subjected to 40 min coronary artery ligation followed by reperfusion, and functional recovery (rate-pressure product), infarct size and RISK pathway function were assessed (Western blot analysis). Obesity with insulin resistance increased myocardial lipid accumulation but had no effect on in vivo or ex vivo left ventricular structure/function. Hearts from obese rats had lower reperfusion rate-pressure products (13115 ± 562 beats min(-1) mmHg for obese rats versus 17781 ± 1109 beats min(-1) mmHg for control rats, P < 0.05) and larger infarcts (36.3 ± 5.6% of area at risk in obese rats versus 14.1 ± 2.8% of area at risk in control rats, P < 0.01) compared with control hearts. These changes were associated with reductions in RISK pathway function, with 30-50 and 40-60% reductions in Akt and glycogen synthase kinase 3 beta (GSK-3β) expression and phosphorylation, respectively, in obese rat hearts compared with control hearts. Total endothelial nitric oxide synthase expression was reduced by 25% in obese rats. We conclude that obesity with insulin resistance had no effect on basal cardiac structure or function but decreased myocardial tolerance to ischaemia-reperfusion. This reduction in ischaemic tolerance was likely to be due to compromised RISK pathway function in obese, insulin-resistant animals.
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Affiliation(s)
- I Wensley
- E. F. du Toit: School of Medical Science, Griffith University, Southport, QLD 4222, Australia.
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48
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Ebong IA, Goff DC, Rodriguez CJ, Chen H, Sibley CT, Bertoni AG. Association of lipids with incident heart failure among adults with and without diabetes mellitus: Multiethnic Study of Atherosclerosis. Circ Heart Fail 2013; 6:371-8. [PMID: 23529112 PMCID: PMC3991930 DOI: 10.1161/circheartfailure.112.000093] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 03/15/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dyslipidemia is a known risk factor for coronary disease, but its role in heart failure (HF) development is less well-defined. METHODS AND RESULTS We included 5688 participants, aged 45 to 84 years, without clinical cardiovascular disease, and not receiving lipid-lowering medications at baseline, from the Multiethnic Study of Atherosclerosis. Cox-proportional hazards models were used to evaluate associations of triglyceride, total cholesterol/high-density lipoprotein-cholesterol (HDL-C) ratio, HDL-C, and non HDL-C with incident HF. We investigated for effect-modification by diabetes mellitus status and sex. During a median follow-up of 8.5 years, there were 152 incident HF cases. There were no interactions by sex. We observed significant interactions between triglyceride and diabetes mellitus (P(interaction)<0.05). We stratified our analyses by diabetes mellitus status. In participants with diabetes, the hazard ratios were 2.03 (0.97-4.27) and 1.68 (1.18-2.38) for high triglyceride and log of triglyceride, respectively, after adjusting for confounders, comorbidities, and diabetes mellitus severity/treatment. The association of high triglyceride with incident HF was attenuated by interim myocardial infarction. The hazard ratios were greatest in participants with diabetes who also had high triglyceride, low HDL-C, or high total cholesterol/HDL-C ratio (3.59 [2.03-6.33], 3.62 [2.06-6.36], and 3.54 [1.87-6.70], respectively). Lipid measures were not associated with incident HF in individuals without diabetes. CONCLUSIONS The risk of incident HF is greater in individuals with diabetes mellitus who also have high triglyceride, low HDL-C, or high total cholesterol/HDL-C ratio. The association of high triglyceride with incident HF is partly mediated by myocardial infarction.
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Affiliation(s)
- Imo A Ebong
- Department of Medicine, University of Southern California, Los Angeles, CA 90089, USA.
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Wang JH, Lee CJ, Hsieh JC, Chen YC, Hsu BG. Inverse association of long-acting natriuretic peptide with metabolic syndrome in congestive heart failure patients. Diabetol Metab Syndr 2013; 5:19. [PMID: 23566312 PMCID: PMC3635959 DOI: 10.1186/1758-5996-5-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 04/01/2013] [Indexed: 12/05/2022] Open
Abstract
AIMS Long-acting natriuretic peptide (LANP) is one of the peptide hormones in atrial natriuretic peptide (ANP) pro-hormone. Low levels of natriuretic peptide may lead to reduced lipolysis and excessive weight gain in obese patients. The aim of this study was to investigate the relationship between fasting serum LANP level and the metabolic syndrome (MetS) among congestive heart failure (CHF) patients. METHODS Fasting blood samples were obtained from 186 patients with normal renal function in cardiac clinic outpatients. CHF defined by the American College of Cardiology Foundation and the American Heart Association 2005 Guidelines. MetS and its components were defined using diagnostic criteria from the International Diabetes Federation. RESULTS Ninety-eight patients (52.7%) had CHF. There was a tendency of increased fasting LANP levels as the NYHA CHF functional classes increased (p = 0.002). Forty-six of the CHF patients (46.9%) had MetS. Fasting LANP level negatively correlated with MetS among CHF patients (p < 0.001). Univariate linear regression analysis showed that BUN (p = 0.026) positively correlated with fasting serum LANP levels, while body weight (p = 0.009), BMI (p = 0.004), homeostasis model assessment of insulin resistance (HOMA-IR; p = 0.024) and HOMA-β (p = 0.001) negatively correlated with fasting serum LANP levels among the CHF patients. Multivariate forward stepwise linear regression analysis of the significant variables showed that the HOMA-β (R2 change = 0.292, p < 0.001) and HOMA-IR (R2 change = 0.081, p = 0.019) were independent predictors of fasting serum LANP levels in CHF patients. CONCLUSIONS LANP level is significantly reduced in CHF patients affected by MetS. HOMA-β and HOMA-IR were independent predictors of serum LANP levels in CHF patients.
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Affiliation(s)
- Ji-Hung Wang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chung-Jen Lee
- Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
| | - Jen-Che Hsieh
- Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Yu-Chih Chen
- Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Bang-Gee Hsu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Nephrology, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Chung-Yang Raod, Hualien, Taiwan
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Yoon HJ, Ahn Y, Kim KH, Park JC, Choi DJ, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, Shin MS, Seong IW, Kang SM, Kim YJ, Kim HS, Chae SC, Oh BH, Lee MM, Ryu KH. The prognostic implication of metabolic syndrome in patients with heart failure. Korean Circ J 2013; 43:87-92. [PMID: 23508725 PMCID: PMC3596669 DOI: 10.4070/kcj.2013.43.2.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/27/2012] [Accepted: 10/08/2012] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives Metabolic syndrome (MetS) increases the risk of heart failure (HF). The purpose of this study was to identify the prevalence of MetS in patients with HF and determine the syndrome's association with HF in clinical and laboratory parameters. Subjects and Methods A total of 3200 HF patients (67.6±14.5 years) enrolled in a nationwide prospective Korea HF Registry between Jan. 2005 and Oct. 2009. Patients were divided into two groups according to the presence or absence of MetS at admission: group I (presence, n=1141) and group II (absence, n=2059). Results The prevalence of MetS was 35.7% across all subjects and was higher in females (56.0%). The levels of white blood cells, platelets, creatinine, glucose, and cholesterol were significantly higher in group I than in group II. Left ventricular dimension and volume was smaller and ejection fraction was higher in group I than in group II. An ischemic cause of HF was more frequent in group I. The rates of valvular and idiopathic cause were lower in group I than in group II. The rate of mortality was lower in group I than in group II (4.9% vs. 8.3%, p<0.001). Conclusion Despite the increased cardiovascular risks in MetS, MetS was found to be associated with decreased mortality in HF.
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Affiliation(s)
- Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
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