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Björk A, Mandalenakis Z, Giang KW, Rosengren A, Eriksson P, Dellborg M. Incidence of diabetes mellitus and effect on mortality in adults with congenital heart disease. Int J Cardiol 2024; 401:131833. [PMID: 38320668 DOI: 10.1016/j.ijcard.2024.131833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/03/2024] [Accepted: 02/01/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Worldwide, 1-2% of children are born with congenital heart disease (CHD) with 97% reaching adulthood. OBJECTIVES This study aims to demonstrate the risk of diabetes in patients with CHD, and the influence of incident diabetes on mortality in CHD patients and controls. METHODS By combining data from patient registries, the incidence of adult-onset diabetes registered at age 35 or older, and subsequent mortality risk were analysed in two successive birth cohorts (born in 1930-1959 and 1960-1983), by type of CHD lesion and sex, compared with population-based controls matched for sex and year of birth and followed until a maximum of 87 years of age. RESULTS Out of 24,699 patients with CHD and 270,961 controls, 8.4% and 5.6%, respectively, were registered with a diagnosis of diabetes at the age of 35 or older, hazard ratio (HR) 1.47 (95% CI 1.40-1.54). The risk of diabetes was higher in the second birth cohort (HR of 1.74, 95% CI 1.54-1.95) and increased with complexity of CHD. After onset of DM, the total mortality among patients with CHD was 475 compared to 411/ 10,000 person-years among controls (HR 1.16, 95% CI 1.07-1.25). CONCLUSIONS In this nationwide cohort of patients with CHD and controls, the incidence of diabetes was almost 50% higher in patients with CHD, with higher risk in the most recent birth cohort and in those with conotruncal defects, with the combination of CHD and diabetes associated with a significantly increased mortality compared to diabetic controls.
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Affiliation(s)
- Anna Björk
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Adult Congenital Heart Unit, Dept of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Kok Wai Giang
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Adult Congenital Heart Unit, Dept of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Clode M, Tran D, Majumdar A, Ayer J, Ferrie S, Cordina R. Nutritional considerations for people living with a Fontan circulation: a narrative review. Cardiol Young 2024; 34:238-249. [PMID: 38258459 DOI: 10.1017/s1047951123004389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
The population of people living with a Fontan circulation are highly heterogenous, including both children and adults, who have complex health issues and comorbidities associated with their unique physiology throughout life. Research focused on nutritional considerations and interventions in the Fontan population is extremely limited beyond childhood. This review article discusses the current literature examining nutritional considerations in the setting of Fontan physiology and provides an overview of the available evidence to support nutritional management strategies and future research directions. Protein-losing enteropathy, growth deficits, bone mineral loss, and malabsorption are well-recognised nutritional concerns within this population, but increased adiposity, altered glucose metabolism, and skeletal muscle deficiency are also more recently identified issues. Emergencing evidence suggets that abnormal body composition is associated with poor circulatory function and health outcomes. Many nutrition-related issues, including the impact of congenital heart disease on nutritional status, factors contributing to altered body composition and comorbidities, as well as the role of the microbiome and metabolomics, remain poodly understood.
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Affiliation(s)
- Melanie Clode
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Derek Tran
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Institute, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Avik Majumdar
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - Julian Ayer
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- The Heart Centre for Children, The Sydney Children's Hospital Network, Westmead, NSW, Australia
| | - Suzie Ferrie
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Rachael Cordina
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Heart Research Institute, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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3
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Anagnostopoulou A. Τhe Burden of Obesity on Adult Survivors of Congenital Heart Disease, Past, and Future Directions. Curr Probl Cardiol 2023; 48:101610. [PMID: 36682391 DOI: 10.1016/j.cpcardiol.2023.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
The ongoing obesity epidemic has started to ebb. However, as most children with congenital heart disease survive until adulthood, the burgeoning trend has started to spill over in the adult congenital heart disease population as well. This review aims to decipher the prevalence, outcomes, and future directions of obesity in adult survivors of congenital heart disease.
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Prognostic implications of weight gain and weight loss in adults with congenital heart disease. Int J Cardiol 2023; 371:147-152. [PMID: 36130618 DOI: 10.1016/j.ijcard.2022.09.032] [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: 04/11/2022] [Revised: 08/23/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are conflicting data about the association between obesity and clinical outcomes in adults with congenital heart disease (CHD), and the effects of weight gain or weight loss remain unclear. The purpose of this study was to determine whether a temporal change in body mass index (BMI) was associated with clinical outcomes independent of baseline BMI in adults with CHD. METHODS Retrospective cohort study of adults with CHD that had clinical assessments at baseline and 5 years afterwards. Weight gain and weight loss were defined as ≥5% change from baseline BMI. Atherosclerotic cardiovascular disease (ASCVD) risk profile (blood pressure [BP], low density lipoprotein cholesterol [LDL-C] and hemoglobin A1C [HBA1c]) and cardiovascular events (heart failure hospitalization, transplant, death) were ascertained. RESULTS Of the 3407, 1804 (53%) had stable weight, 1291 (38%) had weight gain, and 312 (9%) had weight loss at follow-up assessment. The median change in BMI (∆ BMI) was +3% (1-5). The baseline BMI and ∆ BMI were associated with worsening ASCVD risk profile (higher BP, LDL-C and HBA1C), and an increase in cardiovascular events in patients with obesity at baseline. CONCLUSIONS Collectively, the results provide evidence to support lifestyle interventions aimed at weight maintenance in patients with normal weight, and to promote weight loss in patients that are overweight or obese. Further studies are required to determine the optimal type of lifestyle interventions that will be most effective in this population.
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The prevalence of underweight and obesity in CHD. Response to body mass index and age are associated with ventricular end-diastolic pressure in adults with a Fontan circulation. Cardiol Young 2022; 32:1873-1874. [PMID: 36278477 DOI: 10.1017/s1047951122003304] [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] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The aim of the study is to determine the impact of obesity in children with CHD which is severe enough to require invasive catheterisation. METHODOLOGY This is a retrospective study in a cardiac catheterisation laboratory of a large paediatric hospital. The material consisted of 378 children from 2 to 19 years old who underwent heart catheterisation in the years 2011-2019. Their anthropometric data were collected, and the body mass index was calculated. The BMI centile was then calculated according to the Centers for Diseases Control (CDC). They were classified as overweight (85-95th centile), obese (> 95th centile), normal weight (5th-85 centile), and underweight (< 5th centile). RESULTS 18.7% of children were underweight, 54.76% were normal weight, 11.64% were overweight, and 14.81% were obese. Overall, 26.45% of the children were overweight. Boys were more likely to have increased body weight than girls, but the difference was not statistically significant. The percentage of increased weight was similar in children with acyanotic CHD as well as heart disease from other causes. On the contrary, children with cyanotic heart disease were more likely to be younger and have a higher percentage of underweight children. CONCLUSIONS The rates of obesity and overweight in children with CHD depend on the sex, age, and cardiopathy type. In addition, they agree with the findings that have been published in international series studies for children with CHD.
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Baldini L, Librandi K, D’Eusebio C, Lezo A. Nutritional Management of Patients with Fontan Circulation: A Potential for Improved Outcomes from Birth to Adulthood. Nutrients 2022; 14:nu14194055. [PMID: 36235705 PMCID: PMC9572747 DOI: 10.3390/nu14194055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022] Open
Abstract
Fontan circulation (FC) is a surgically achieved palliation state offered to patients affected by a wide variety of congenital heart defects (CHDs) that are grouped under the name of univentricular heart. The procedure includes three different surgical stages. Malnutrition is a matter of concern in any phase of life for these children, often leading to longer hospital stays, higher mortality rates, and a higher risk of adverse neurodevelopmental and growth outcomes. Notwithstanding the relevance of proper nutrition for this subset of patients, specific guidelines on the matter are lacking. In this review, we aim to analyze the role of an adequate form of nutritional support in patients with FC throughout the different stages of their lives, in order to provide a practical approach to appropriate nutritional management. Firstly, the burden of faltering growth in patients with univentricular heart is analyzed, focusing on the pathogenesis of malnutrition, its detection and evaluation. Secondly, we summarize the nutritional issues of each life phase of a Fontan patient from birth to adulthood. Finally, we highlight the challenges of nutritional management in patients with failing Fontan.
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Affiliation(s)
- Letizia Baldini
- Postgraduate School of Pediatrics, University of Turin, 10126 Turin, Italy
- Pediatria Specialistica, Ospedale Infantile Regina Margherita, Piazza Polonia 94, 10126 Torino, Italy
- Correspondence:
| | - Katia Librandi
- Postgraduate School of Pediatrics, University of Turin, 10126 Turin, Italy
| | - Chiara D’Eusebio
- Dietetic and Clinical Nutrition Unit, Pediatric Hospital Regina Margherita, University of Turin, 10126 Turin, Italy
| | - Antonella Lezo
- Dietetic and Clinical Nutrition Unit, Pediatric Hospital Regina Margherita, University of Turin, 10126 Turin, Italy
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Johansson K, Johansson B, Sandberg C. Reduced bone strength in adults with moderate or complex congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Overweight and Obesity in Patients with Congenital Heart Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189931. [PMID: 34574853 PMCID: PMC8466650 DOI: 10.3390/ijerph18189931] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022]
Abstract
Background: Overweight and obesity have become a major public health concern in recent decades, particularly in patients with chronic health conditions like congenital heart disease (CHD). This systematic review elaborates on the prevalence and the longitudinal development of overweight and obesity in children and adults with CHD. Methods: A systematic literature search was conducted in PubMed, Cochrane, and Scopus from January 2010 to December 2020 on overweight and obesity prevalence in children and adults with CHD. Results: Of 30 included studies, 15 studies evaluated 5680 pediatric patients with CHD, 9 studies evaluated 6657 adults with CHD (ACHD) and 6 studies examined 9273 both pediatric patients and ACHD. Fifteen studies received the quality rating “good”, nine studies “fair”, and six studies “poor”. In children with CHD, overweight prevalence was between 9.5–31.5%, and obesity prevalence was between 9.5–26%; in ACHD, overweight prevalence was between 22–53%, and obesity was between 7–26%. The prevalence of overweight and obesity was thereby similar to the general population. Overweight and obesity have been shown to increase with age. Conclusion: The prevalence of overweight and obesity in children and adults with CHD is similar to the general population, demonstrating that the growing obesity pandemic is also affecting the CHD population.
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10
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Despite reductions in muscle mass and muscle strength in adults with CHD, the muscle strength per muscle mass relationship does not differ from controls. Cardiol Young 2021; 31:792-798. [PMID: 33455600 DOI: 10.1017/s1047951120004709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with CHD exhibit reduced isometric muscle strength and muscle mass; however, little is known how these parameters relate. Therefore, the aim was to investigate the relation between isometric limb muscle strength and muscle mass for patients in comparison to age- and sex-matched control subjects. METHODS Seventy-four patients (35.6 ± 14.3 years, women n = 22) and 74 matched controls were included. Isometric muscle strength in elbow flexion, knee extension, and hand grip was assessed using dynamometers. Lean mass, reflecting skeletal muscle mass, in the arms and legs was assessed with dual-energy x-ray absorptiometry. RESULTS Compared to controls, patients had lower muscle strength in elbow flexion, knee extension, and hand grip, and lower muscle mass in the arms (6.6 ± 1.8 kg versus 5.8 ± 1.7 kg, p < 0.001) and legs (18.4 ± 3.5 kg versus 15.9 ± 3.2 kg, p < 0.001). There was no difference in achieved muscle force per unit muscle mass in patients compared to controls (elbow flexion 0.03 ± 0.004 versus 0.03 ± 0.005 N/g, p = 0.5; grip strength 0.008 ± 0.001 versus 0.008 ± 0.001 N/g, p = 0.7; knee extension 0.027 ± 0.06 versus 0.028 ± 0.06 N/g, p = 0.5). For both groups, muscle mass in the arms correlated strongly with muscle strength in elbow flexion (patients r = 0.86, controls, r = 0.89), hand grip (patients, r = 0.84, controls, r = 0.81), and muscle mass in the leg to knee extension (patients r = 0.64, controls r = 0.68). CONCLUSION The relationship between isometric muscle strength and limb muscle mass in adults with CHD indicates that the skeletal muscles have the same efficiency as in healthy controls.
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Fernandes SM, Lui GK, Long J, Lin A, Rogers IS, Sillman C, Romfh A, Dade TC, Dong E, Haeffele C, Scribner C, Major M, McElhinney DB. Predicting 10-year mortality in adults with congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2020.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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12
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Hansson L, Lind T, Öhlund I, Wiklund U, Rydberg A. Increased abdominal fat mass and high fat consumption in young school children with congenital heart disease: results from a case‐control study. J Hum Nutr Diet 2020; 33:566-573. [DOI: 10.1111/jhn.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- L. Hansson
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - T. Lind
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - I. Öhlund
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - U. Wiklund
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
| | - A. Rydberg
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
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13
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Sarcopenia is common in adults with complex congenital heart disease. Int J Cardiol 2019; 296:57-62. [DOI: 10.1016/j.ijcard.2019.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/07/2019] [Accepted: 06/06/2019] [Indexed: 12/21/2022]
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14
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Fedchenko M, Mandalenakis Z, Dellborg H, Hultsberg-Olsson G, Björk A, Eriksson P, Dellborg M. Cardiovascular risk factors in adults with coarctation of the aorta. CONGENIT HEART DIS 2019; 14:549-558. [PMID: 31099471 DOI: 10.1111/chd.12785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/18/2019] [Accepted: 04/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aging patient with adult congenital heart disease (ACHD) faces the risk of developing atherosclerotic disease. Patients with coarctation of the aorta (CoA) are especially vulnerable because of an inherent high risk of developing hypertension. However, data on the prevalence of other cardiovascular risk factors are scarce. Therefore, this study aimed to describe the prevalence of traditional cardiovascular risk factors (diabetes, hypertension, hyperlipidemia, smoking, obesity, and sedentary lifestyle) in adult patients with CoA. METHODS Patients with CoA who were registered at the ACHD clinic in Gothenburg were asked to participate in a comprehensive cardiovascular risk assessment. This assessment included a glucose tolerance test, cholesterol profile, ambulatory blood pressure measurements, and a lifestyle questionnaire. RESULTS A total of 72 patients participated. The median age was 43.5 years and 58.3% were men. Sixty-six (91.7%) patients had ≥one cardiovascular risk factor and 40.3% had ≥three risk factors. Three (4.2%) patients were newly diagnosed with diabetes or impaired glucose tolerance. More than half of the patients had hyperlipidemia (n = 42, 58.3%) and 35 patients (48.6%) were overweight or obese. Only three (4.2%) patients smoked regularly. Of the 60 patients who underwent 24-hour ambulatory blood pressure measurement, 33 (55.0%) were hypertensive. Of the 30 patients with known hypertension only 9 (30.0%) had well-controlled blood pressure on ambulatory blood pressure measurement. CONCLUSIONS Cardiovascular risk factors among patients with CoA are prevalent. This may indicate a need for more aggressive screening strategies of traditional risk factors to minimize the risk of these patients also developing atherosclerotic disease.
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Affiliation(s)
- Maria Fedchenko
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Helena Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Görel Hultsberg-Olsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Anna Björk
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Peter Eriksson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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15
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Malavazos AE, Capitanio G, Chessa M, Matelloni IA, Milani V, Stella E, Al Kassem LF, Sironi F, Boveri S, Giamberti A, Masocco M, Ranucci M, Menicanti L, Morricone L. Body mass index stratification in hospitalized Italian adults with congenital heart disease in relation to complexity, diagnosis, sex and age. Nutr Metab Cardiovasc Dis 2019; 29:367-377. [PMID: 30795994 DOI: 10.1016/j.numecd.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/18/2019] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS Adults with congenital heart disease (ACHD) are at risk of overweight and obesity, two major health problems, though underweight can be a negative prognostic factor too. Awareness of the body mass index (BMI) in ACHD is very limited. The present study describes the use and prevalence of BMI in Italian symptomatic hospitalized ACHD patients in relation to complexity by Bethesda system classification, diagnosis, sex and age. METHODS AND RESULTS We classified 1388 ACHD patients, aged 18-69 years, on the basis of their BMI, and compared them to the Italian reference population. In our total ACHD population we found a significantly higher prevalence of underweight compared to the Italian reference population (6.34% vs 3.20%). ACHD women were more underweight than men. Underweight decreased with age. Overweight was significantly less frequent in the total ACHD population (26.73% compared to 31.70%) in the Italian reference population. Men were more likely to be overweight than women. In statistical terms obesity was similar in the Italian reference population (10.50%) and our ACHD population (9.58%). Both overweight and obesity increased with age. Results were comparable using a diagnostic anatomical-functional classification and the Bethesda system classification. CONCLUSIONS In our cohort of ACHD the prevalence of underweight was double that of the Italian reference population. The prevalence of overweight was lower, while obesity was similar. Since BMI does not account for differences in body fat distribution, a future aim will be to quantify the visceral component of the adipose tissue in ACHD patients and examine their body composition in order to reflect their risk of acquired cardiovascular disease better, and either to maintain or achieve an adequate visceral component.
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Affiliation(s)
- A E Malavazos
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy.
| | - G Capitanio
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
| | - M Chessa
- Pediatric and Adult Congenital Heart Centre, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - I A Matelloni
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
| | - V Milani
- Scientific Directorate, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - E Stella
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
| | - L F Al Kassem
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
| | - F Sironi
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
| | - S Boveri
- Scientific Directorate, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - A Giamberti
- Pediatric and Adult Congenital Heart Centre, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - M Masocco
- Italian National Health Institute, Rome, Italy
| | - M Ranucci
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - L Menicanti
- Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - L Morricone
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
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16
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Age-related cardiovascular risk in adult patients with congenital heart disease. Int J Cardiol 2019; 277:90-96. [DOI: 10.1016/j.ijcard.2018.09.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/31/2018] [Accepted: 09/10/2018] [Indexed: 01/09/2023]
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17
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Zaqout M, Vandekerckhove K, Michels N, Demulier L, Bove T, François K, De Backer J, De Henauw S, De Wolf D. Body mass index in adults with congenital heart disease. CONGENIT HEART DIS 2019; 14:479-486. [PMID: 30681771 DOI: 10.1111/chd.12751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the status of body mass index (BMI) in adult people with congenital heart disease (ACHD). METHODS Five hundred thirty-nine adults with CHD (53.8% men) were seen in the outpatient clinic from 2013 to 2015 and compared to a reference population (n = 1737). The severity of CHD was categorized as mild, moderate, and severe according to standard guidelines. Patients were categorized based on BMI as underweight (<18.5), overweight (25-30), or obese (>30). Echocardiography and magnetic resonance imaging were used to measure ventricular function while exercise capacity was estimated via cardiopulmonary exercise test. RESULTS Adults with CHD had slightly lower BMI than the reference group (24.1 ± 4.3 vs 24.6 ± 4.3; P = .012). Men in the mild and severe group (23.9 ± 3.6; 23.3 ± 4.4 vs 25.1 ± 3.7; P = .007; P = .023) and women in the severe group (21.6 ± 3.3 vs 24.2 ± 4.7; P < .001) had lower BMI compared to the reference group. In the subgroups, men with ventricular septal defect, coarctation of aorta/ventricular septal defect and Fontan circulation and women with Fontan circulation had lower BMI than the reference group. Underweight was more prevalent in women with severe lesions compared to the reference group (22.2% vs 3.8%; P < .001). BMI was associated with age and exercise capacity in patients with mild and moderate lesions, while higher BMI was related to better ventricular function in women with Fontan circulation. CONCLUSION Underweight was more prevalent in ACHD patients with severe lesions. Special attention should be paid to the possible existence of underweight-related comorbidities.
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Affiliation(s)
- Mahmoud Zaqout
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.,Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Nathalie Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Laurent Demulier
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Julie De Backer
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Stefaan De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
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18
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Cardiac Rehabilitation for Adults With Congenital Heart Disease: Physical and Psychosocial Considerations. Can J Cardiol 2018; 34:S270-S277. [DOI: 10.1016/j.cjca.2018.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022] Open
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19
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Verma SK. Glycogen synthase kinase 3β helps heart to pump better in obese patients. Int J Cardiol 2018; 259:166-167. [PMID: 29579595 DOI: 10.1016/j.ijcard.2018.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Suresh Kumar Verma
- Division of Cardiovascular Diseases, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, United States; Comprehensive Cardiovascular Center, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, United States.
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20
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Harris KC, Voss C, Rankin K, Aminzadah B, Gardner R, Mackie AS. Modifiable cardiovascular risk factors in adolescents and adults with congenital heart disease. CONGENIT HEART DIS 2018; 13:563-570. [DOI: 10.1111/chd.12612] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Kevin C. Harris
- Division of Cardiology, Children's Heart Centre, BC Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | - Christine Voss
- Division of Cardiology, Children's Heart Centre, BC Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | - Kathryn Rankin
- Division of Cardiology, Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
| | - Basmina Aminzadah
- Division of Cardiology, Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
| | - Ross Gardner
- Division of Cardiology, Children's Heart Centre, BC Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | - Andrew S. Mackie
- Division of Cardiology, Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
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21
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Bodell A, Björkhem G, Thilén U, Naumburg E. National quality register of congenital heart diseases – Can we trust the data? JOURNAL OF CONGENITAL CARDIOLOGY 2017. [DOI: 10.1186/s40949-017-0013-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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22
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McKillop A, McCrindle BW, Dimitropoulos G, Kovacs AH. Physical activity perceptions and behaviors among young adults with congenital heart disease: A mixed-methods study. CONGENIT HEART DIS 2017; 13:232-240. [DOI: 10.1111/chd.12553] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/05/2017] [Accepted: 10/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Adam McKillop
- Labatt Family Heart Centre; The Hospital for Sick Children; Toronto Ontario Canada
| | - Brian W. McCrindle
- Labatt Family Heart Centre; The Hospital for Sick Children; Toronto Ontario Canada
- Department of Paediatrics; University of Toronto; Toronto Ontario Canada
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23
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Dutta HK, Khangkeo CW, Baruah K, Borbora D. Growth and Psychological Development in Postoperative Patients With Anterior Encephaloceles. Pediatr Neurol 2017; 71:29-34. [PMID: 28499675 DOI: 10.1016/j.pediatrneurol.2017.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/28/2016] [Accepted: 01/29/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Anterior encephaloceles are rare malformations that are frequently associated with other brain anomalies. This study evaluates the growth and psychological development of children following encephalocele repair. MATERIALS & METHODS Growth and psychological assessment was done in 24 children with only encephalocele (group I); nine children with encephalocele and hydrocephalus (group II); seven children with encephalocele, hydrocephalus, and secondary malformations (group III); and 40 apparently healthy control subjects. Psychological assessment was done by evaluating intelligence and temperament. RESULTS Single-stage repair was performed in 38 children, and two underwent multistage repair. Major postoperative complications were noted in three individuals. The follow-up period ranged from 12 to 168 months, and during this time the growth velocity declined significantly among group II and group III patients when compared with control subjects. After adjusting the body mass index for age, our data revealed that group III participants had a significantly (P = 0.02) lower body mass index than the control group. Group III also had poor indices for intelligence quotient (P ≤ 0.01) and temperament (P ≤ 0.01). Female patients had lower temperament indices when compared with unaffected females with regard to approach withdrawal (P ≤ 0.01), mood (P = 0.026), and intensity (P = 0.03). Overall, increased disease severity adversely affected the psychological indices. CONCLUSION Individuals with anterior encephalocele without associated intracranial defects had excellent postoperative outcomes in terms of growth and psychological developments. Hydrocephalus and agenesis of corpus callosum had the least impact on psychological development. However, the presence of secondary brain defects led to developmental delays. Gender differences in temperament may suggest a need for distinct treatment regimens to assess psychosocial well-being for males and females.
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Affiliation(s)
- Hemonta Kumar Dutta
- Department of Pediatric Surgery, Assam Medical College & Hospital, Dibrugarh, Assam, India.
| | - Chow Wachana Khangkeo
- Department of Pediatric Surgery, Assam Medical College & Hospital, Dibrugarh, Assam, India
| | - Kaberi Baruah
- Department of Psychiatry, Assam Medical College & Hospital, Dibrugarh, Assam, India
| | - Debasish Borbora
- Department of Biotechnology, Gauhati University, Guwahati, Assam, India
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24
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Brida M, Dimopoulos K, Kempny A, Liodakis E, Alonso-Gonzalez R, Swan L, Uebing A, Baumgartner H, Gatzoulis MA, Diller GP. Body mass index in adult congenital heart disease. Heart 2017; 103:1250-1257. [DOI: 10.1136/heartjnl-2016-310571] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 02/03/2017] [Accepted: 02/04/2017] [Indexed: 11/03/2022] Open
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25
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Lerman JB, Parness IA, Shenoy RU. Body Weights in Adults With Congenital Heart Disease and the Obesity Frequency. Am J Cardiol 2017; 119:638-642. [PMID: 27931725 DOI: 10.1016/j.amjcard.2016.10.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 12/15/2022]
Abstract
Obesity may associate with greater cardiovascular risk in adults with congenital heart disease (ACHD) than in the general population. As ACHD often have exercise limitations, they may be uniquely predisposed to obesity. Nevertheless, obesity prevalence in ACHD, compared with the general population, has not been quantified in a large US cohort. Hence, we sought to determine the prevalence of obesity (30 ≤ body mass index <40) and morbid obesity (body mass index ≥40), in a large cohort of ACHD, compared with matched controls. Retrospective analysis was thus performed on all ACHD seen in an academic system in 2013. CHD severity was classified as simple, complex, or unclassified, using recently published criteria. A control group without CHD was randomly generated matching for age, gender, and race/ethnicity; 1,451 ACHD met inclusion criteria; 59.5% of ACHD were overweight to morbidly obese. Compared with controls, ACHD had similar prevalence of overweight (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.89 to 1.22, p = 0.63) and obesity (OR 0.96, 95% CI 0.81 to 1.15, p = 0.69) but lower prevalence of morbid obesity (OR 0.24, 95% CI 0.16 to 0.34, p <0.001). These relationships were not attenuated by adjustment for CHD severity. In conclusion, ACHD are at equal risk as their matched peers to be overweight and obese. This is the largest study of obesity in US ACHD and the highest reported obesity prevalence in ACHD to date. As obesity is associated with significant cardiovascular risk, our findings indicate a need for improved lifestyle counseling in patients with CHD of all ages.
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26
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Rinnström D, Dellborg M, Thilén U, Sörensson P, Nielsen NE, Christersson C, Johansson B. Hypertension in adults with repaired coarctation of the aorta. Am Heart J 2016; 181:10-15. [PMID: 27823680 DOI: 10.1016/j.ahj.2016.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/22/2016] [Indexed: 11/15/2022]
Abstract
AIMS In adults with coarctation of the aorta (CoA), hypertension (HTN) is a common long-term complication. We investigated the prevalence of HTN and analyzed factors associated with HTN. METHODS AND RESULTS In the national register for congenital heart disease, 653 adults with repaired CoA were identified (mean age 36.9±14.4years); 344 (52.7%) of them had HTN, defined as either an existing diagnosis or blood pressure (BP) ≥140/90mmHg at the clinical visit. In a multivariable model, age (years) (odds ratio [OR] 1.07, CI 1.05-1.10), sex (male) (OR 3.35, CI 1.98-5.68), and body mass index (kilograms per square meter) (OR 1.09, CI 1.03-1.16) were independently associated with having HTN, and so was systolic arm-leg BP gradient where an association with HTN was found at the ranges of (10, 20] and >20mmHg, in comparison to the interval ≤10mmHg (OR 3.58, CI 1.70-7.55, and OR 11.38, CI 4.03-32.11). This model remained valid when all patients who had increased BP (≥140/90mmHg) without having been diagnosed with HTN were excluded from the analyses. CONCLUSIONS Hypertension is common in patients with previously repaired CoA and is associated with increasing age, male sex, and elevated body mass index. There is also an association with arm-leg BP gradient, starting at relatively low levels that are usually not considered for intervention.
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Affiliation(s)
- Daniel Rinnström
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Thilén
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Peder Sörensson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Niels-Erik Nielsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Bengt Johansson
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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27
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Sandberg C, Pomeroy J, Thilén U, Gradmark A, Wadell K, Johansson B. Habitual Physical Activity in Adults With Congenital Heart Disease Compared With Age- and Sex-Matched Controls. Can J Cardiol 2016; 32:547-53. [DOI: 10.1016/j.cjca.2015.08.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/20/2015] [Accepted: 08/20/2015] [Indexed: 01/25/2023] Open
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28
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Martinez SC, Byku M, Novak EL, Cedars AM, Eghtesady P, Ludbrook PA, Billadello JJ. Increased Body Mass Index Is Associated with Congestive Heart Failure and Mortality in Adult Fontan Patients. CONGENIT HEART DIS 2015; 11:71-9. [PMID: 26365670 DOI: 10.1111/chd.12296] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Obesity affects adults with congenital heart disease (CHD). The effect of an increased body mass index (BMI) with respect to morbidity and mortality has not been evaluated in adults with complex CHD. Our objective was to evaluate the effects of increased BMI on heart failure and mortality in univentricular patients who had undergone Fontan palliation. METHODS A query of Fontan patients' first appointments at the Washington University Center for Adults with CHD between 2007 and 2014 yielded 79 patients. BMI status as normal (<25 kg/m(2) ), overweight (≥25, <30 kg/m(2) ), and obese (≥30 kg/m(2) ) was established at the patient's first appointment. We analyzed demographics, diuretic requirements, New York Heart Association (NYHA) class, and laboratory values using Student's two-sample t-test and Fisher's exact test. Mortality was assessed via survival curves, and hazard ratios were compiled with proportional hazard modeling. RESULTS The recent average BMI was significantly greater in patients with NYHA classes II-IV (29.3 ± 9 kg/m(2) ) compared with asymptomatic patients (24.8 ± 5.1 kg/m(2) , P = .006). Additionally, the average BMI of patients with a high diuretic requirement (≥40 mg/day IV furosemide equivalent) was obese, at 32.15 ± 9.1 kg/m(2) , compared with 25.91 ± 7.3 kg/m(2) for those on no or lower doses of diuretics (P = .009). Eighteen of the 79 patients met an endpoint of death, hospice placement, or cardiac transplant by the study conclusion. Kaplan-Meier analysis from time of first appointment until recent follow-up revealed a significant association between time to combined endpoint and BMI class. Cox proportional hazard modeling with age adjustment yielded a hazard ratio of 3.2 (95% CI 1.096-9.379) for obesity upon first presentation to an adult CHD clinic. CONCLUSIONS In patients with univentricular hearts and Fontan palliation, obesity is associated with symptomatic heart failure and mortality.
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Affiliation(s)
- Sara C Martinez
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, Mo, USA
| | - Mirnela Byku
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, Mo, USA
| | - Eric L Novak
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, Mo, USA
| | - Ari M Cedars
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, Mo, USA
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo, USA
| | - Philip A Ludbrook
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, Mo, USA
| | - Joseph J Billadello
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, Mo, USA
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