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Hill MC, Kim N, Galanter W, Gerber BS, Hubbard CC, Darbar D, McCauley MD. Association between obesity and statin use on mortality and hospital encounters in atrial fibrillation. IJC HEART & VASCULATURE 2024; 53:101450. [PMID: 39036424 PMCID: PMC11260021 DOI: 10.1016/j.ijcha.2024.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024]
Abstract
Background Obesity increases risk of atrial fibrillation (AF) at least in part due to pro-inflammatory effects, but has been paradoxically associated with improved mortality. Although statins have pleiotropic anti-inflammatory properties, their interaction with obesity and clinical outcomes in AF is unknown. We explored the relationship between BMI, statin use, and all-cause mortality and AF/congestive heart failure (CHF)-related encounters, hypothesizing that statin exposure may be differentially associated with improved outcomes in overweight/obesity. Methods This was a single center retrospective cohort study of adults with AF diagnosed between 2011-2018. Patients were grouped by body mass index (BMI) and statin use at time of AF diagnosis. Outcomes included all-cause mortality and ED or inpatient encounters for AF or CHF. Results and Conclusions A total of 2503 subjects were included (median age 66 years, 43.4 % female, median BMI 29.8 kg/m2, 54.6 % on baseline statin therapy). Increasing BMI was associated with decreased mortality hazard but not associated with AF/CHF encounter risk. Adjusting for statin-BMI interaction, demographics, and cardiovascular comorbidities, overweight non-statin users experienced improved mortality (adjusted hazard ratio [aHR] 0.55, 95 % CI 0.35-0.84) compared to statin users (aHR 0.98, 95 % CI 0.69-1.40; interaction P-value = 0.013). Mortality hazard was consistently lower in obese non-statin users than in statin users, however interaction was insignificant. No significant BMI-statin interactions were observed in AF/CHF encounter risk. In summary, statin use was not differentially associated with improved mortality or hospitalization risk in overweight/obese groups. These findings do not support statins for secondary prevention of adverse outcomes based on overweight/obesity status alone.
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Affiliation(s)
- Michael C. Hill
- Division of Cardiology, College of Medicine, University of Illinois at Chicago, United States
| | - Noah Kim
- Division of Cardiology, College of Medicine, University of Illinois at Chicago, United States
| | - William Galanter
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, United States
| | - Ben S. Gerber
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts, United States
| | - Colin C. Hubbard
- Division of Hospital Medicine, University of California San Francisco, United States
| | - Dawood Darbar
- Division of Cardiology, College of Medicine, University of Illinois at Chicago, United States
- Jesse Brown VA Medical Center, United States
| | - Mark D. McCauley
- Division of Cardiology, College of Medicine, University of Illinois at Chicago, United States
- Jesse Brown VA Medical Center, United States
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Matsumoto S, Kataoka N, Imamura T. Detailed mechanism of SGLT2 inhibitor therapy on preventing arrhythmia recurrence after atrial fibrillation ablation. J Cardiovasc Electrophysiol 2024. [PMID: 39075803 DOI: 10.1111/jce.16387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024]
Affiliation(s)
- Sayaka Matsumoto
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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Saglietto A, Falasconi G, Penela D, Francia P, Sau A, Ng FS, Dusi V, Castagno D, Gaita F, Berruezo A, De Ferrari GM, Anselmino M. Glucagon-like peptide-1 receptor agonist semaglutide reduces atrial fibrillation incidence: A systematic review and meta-analysis. Eur J Clin Invest 2024:e14292. [PMID: 39058274 DOI: 10.1111/eci.14292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are new anti-hyperglycaemic drugs with proven cardiovascular (CV) benefit in diabetic and non-diabetic patients at high CV risk. Despite a neutral class effect on arrhythmia risk, data on semaglutide suggest a possible drug-specific benefit in reducing atrial fibrillation (AF) occurrence. OBJECTIVE To perform a meta-analysis of randomized clinical trials (RCTs) to assess the risk of incident AF in patients treated with semaglutide compared to placebo. METHODS AND RESULTS Ten RCTs were included in the analysis. Study population encompassed 12,651 patients (7285 in semaglutide and 5366 in placebo arms), with median follow-up of 68 months. A random effect meta-analytic model was adopted to pool relative risk (RR) of incident AF. Semaglutide reduces the risk of AF by 42% (RR .58, 95% CI .40-.85), with low heterogeneity across the studies (I2 0%). At subgroup analysis, no differences emerged between oral and subcutaneous administration (oral: RR .53, 95% CI .23-1.24, I2 0%; subcutaneous: RR .59, 95% CI .39-.91, I2 0%; p-value .83). In addition, meta-regression analyses did not show any potential influence of baseline study covariates, in particular the proportion of diabetic patients (p-value .14) and body mass index (BMI) (p-value .60). CONCLUSIONS Semaglutide significantly reduces the occurrence of incident AF by 42% as compared to placebo in individuals at high CV risk, mainly affected by type 2 diabetes mellitus. This effect appears to be consistent independently of the route of administration of the drug (oral or subcutaneous), the presence of underlying diabetes and BMI.
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Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
| | - Giulio Falasconi
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
- Arrhythmology Department, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Diego Penela
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
- Arrhythmology Department, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Pietro Francia
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University
| | - Arunashis Sau
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Fu Siong Ng
- National Heart and Lung Institute, Hammersmith Campus, Imperial College London, London, UK
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Cardiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Veronica Dusi
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Department of Medical Sciences, University of Turin, Turin, Italy
- Cardiology Unit, J Medical, Turin, Italy
| | | | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
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Zhang X, Zhang Y, Sun G, Li Z, Tan W, Fan Y, Gao W, Zhang G. Effectiveness of sodium-glucose co-transporter 2 inhibitors on atrial fibrillation recurrence after catheter ablation: A systemic review and meta-analysis. Int J Cardiol 2024; 413:132359. [PMID: 39004352 DOI: 10.1016/j.ijcard.2024.132359] [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: 06/04/2024] [Revised: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Studies have revealed the beneficial effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i) for the treatment of heart failure (HF) regardless of the presence of diabetes. Besides, SGLT2i can decrease the incidence of atrial fibrillation (AF) in a broad population. However, the effects of SGLT2i on AF recurrence following catheter ablation (CA) remain uncertain. Therefore, this meta-analysis was undertaken to elucidate the effects of SGLT2i on AF recurrence after CA in AF patients. METHODS A comprehensive search of PubMed, Embase, and Cochrane library was conducted for relevant studies, encompassing data from inception until March 20, 2024. The data were pooled using a fixed-effects model if the I2 value was <50%; otherwise, a random-effects model was adopted. RESULTS One randomized controlled trial (RCT) and five observational studies involving 5623 patients with AF who underwent CA were included. SGLT2i treatment was associated with a significantly lower rate of AF recurrence (odds ratio [OR] = 0.45, 95% confidence interval [CI]: 0.31-0.66). Subgroup analysis demonstrated that patients treated with SGLT2i exhibited a lower incidence of AF recurrence compared to those treated with dipeptidyl peptidase-4 inhibitors (DPP4i). The favorable effects of SGLT2i on AF recurrence were more pronounced in male patients and patients with persistent AF. CONCLUSIONS This meta-analysis provided evidence supporting the effectiveness of SGLT2i in reducing the risk of AF recurrence after CA in AF patients. SGLT2i may serve as an additional therapy option in this population.
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Affiliation(s)
- Xuefang Zhang
- Department of Cardiology, Jiangmen central hospital, Jiangmen, Guangdong, China
| | - Yuting Zhang
- Department of Endocrinology, Jiangmen central hospital, Jiangmen, Guangdong, China
| | - Gang Sun
- Department of Cardiology, Jiangmen central hospital, Jiangmen, Guangdong, China
| | - Zhiquan Li
- Department of Emergency, Jiangmen central hospital, Jiangmen, Guangdong, China
| | - Wenfeng Tan
- Department of Cardiology, Jiangmen central hospital, Jiangmen, Guangdong, China
| | - Yongqiang Fan
- Department of Cardiology, Dongguan Tungwah, Songshan Lake Hospital, Dongguan, Guangdong,China.
| | - Weidong Gao
- Department of Cardiology, Jiangmen central hospital, Jiangmen, Guangdong, China.
| | - Gaoxing Zhang
- Department of Cardiology, Jiangmen central hospital, Jiangmen, Guangdong, China.
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Zhou W, Wang Z, Hu H, Shi Y, Wang Q, Xue M. Borderline personality disorder and risk of atrial fibrillation: insights from a bidirectional Mendelian randomization study. Front Psychiatry 2024; 15:1392605. [PMID: 39050916 PMCID: PMC11266161 DOI: 10.3389/fpsyt.2024.1392605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Background Atrial fibrillation (AF) is one of the most common form of arrhythmia. Previous studies have shown a link between AF and mental illness. However, the causal relationship between mental illness and AF remains unclear. The purpose of this study was to investigate the bidirectional causal relationship between borderline personality disorder (BPD) and AF. Method We used the bidirectional Two-sample Mendelian randomization (TSMR) method to evaluate the causal relationship between BPD and AF. Instrumental variables associated with BPD were derived from a genome-wide association study involving 214,816 Europeans (2,637 cases and 212,179 controls). We then obtained atrial fibrillation data from the GWAS meta-analysis (60,620 cases and 970,216 controls). The TSMR analyses were performed in five methods, namely fixed-effect inverse-variance weighted (IVW) method、random-effect IVW method, MR Egger regression method, Weighted median method and Simple mode method. Several sensitivity analyses are used to test the robustness of positive results. Results The fixed-effect inverse-variance weighted model [Odds ratio (OR), 1.033, 95% confidence interval (CI), 1.011-1.056, P = 0.0031], random-effect inverse-variance weighted model (OR, 1.033; 95%CI, 1.005-1.062; P = 0.0191) and Weighted median (OR, 1.034; 95%CI, 1.002-1.068; P = 0.0394) all showed that genetically predicted BPD was associated with an increased risk of AF. Sensitivity analysis using other MR Methods, including the MR-Egger intercept, MR-Presso method, and leave-one-out analyses, showed that the results were robust. In reverse MR analysis, there was no causal relationship of AF on BPD. Conclusion Our study provides a causal relationship between BPD and AF. This means that patients with BPD should be monitored for the occurrence of AF. Early screening and proper management of BPD may show anti-arrhythmic benefits.
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Affiliation(s)
- Wenzhe Zhou
- Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Zhimiao Wang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Hesheng Hu
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yugen Shi
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Qiubo Wang
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Mei Xue
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Chen YY, Chen CS, Huang JF, Su WH, Li CY, Chen WS, Lin ES, Chuang WL, Yu ML, Wang SC. The obesity-related mutation gene on nonalcoholic fatty liver disease. Hum Genet 2024:10.1007/s00439-024-02686-x. [PMID: 38985322 DOI: 10.1007/s00439-024-02686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 06/30/2024] [Indexed: 07/11/2024]
Abstract
The prevalence of overweight and obesity is increasing, leading to metabolic-associated fatty liver disease (MAFLD) characterized by excessive accumulation of liver fat and a risk of developing hepatocellular carcinoma (HCC). The driver gene mutations may play the roles of passengers that occur in single 'hotspots' and can promote tumorigenesis from benign to malignant lesions. We investigated the impact of high body weight and BMI on HCC survival using The Cancer Genome Atlas Liver Hepatocellular Carcinoma (TCGA-LIHC) dataset. To explore the effects of obesity-related gene mutations on HCC, we collected driver mutation genes in 34 TCGA patients with BMI ≥ 27 and 23 TCGA patients with BMI < 27. The digital PCR performing the PBMC samples for the variant rate by clinical cohort of 96 NAFLD patients. Our analysis showed that obesity leads to significantly worse survival outcomes in HCC. Using cbioportal, we identified 414 driver mutation genes in patients with obesity and 127 driver mutation genes in non-obese patients. Functional analysis showed that obese-related genes significantly enriched the regulated lipid and insulin pathways in HCC. The insulin secretion pathway in patients with obesity HCC-specific survival identified ABCC8 and PRKCB as significant genes (p < 0.001). It revealed significant differences in gene mutation and gene expression profiles compared to non-obese patients. The digital PCR test ABCC8 variants were detected in PBMC samples and caused a 14.5% variant rate, significantly higher than that of non-obese NAFLD patients. The study findings showed that the gene ABCC8 was a patient with the obesity-related gene in NAFLD, which provides the probability that ABCC8 mutation contributes to the pre-cancer lesion biomarker for HCC.
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Affiliation(s)
- Yen-Yu Chen
- School of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Chi-Sheng Chen
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Jee-Fu Huang
- Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
- Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Wen-Hsiu Su
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Chia-Yang Li
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Wei-Shiun Chen
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - En-Sheng Lin
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
- Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
- Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, 80756, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, 80756, Taiwan
| | - Shu-Chi Wang
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan.
- Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan.
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan.
- Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, 80756, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan.
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Urbanek L, Schmidt B, Bordignon S, Schaack D, Ebrahimi R, Tohoku S, Hirokami J, Efe TH, Plank K, Schulte-Hahn B, Nowak B, Chun JKR, Chen S. Cryoablation of atrial fibrillation in "very severe" obese patients (BMI ≥ 40): Indications, feasibility, procedural safety and efficacy, and clinical outcome (the ICE-Obese Extreme). J Cardiovasc Electrophysiol 2024; 35:1412-1421. [PMID: 38750671 DOI: 10.1111/jce.16302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Management of atrial fibrillation (AF) in very severe obese patients is challenging. Cryoballoon ablation (CBA) represents an effective rhythm control strategy. However, data in this patient group were limited. METHODS Highly symptomatic AF patients with body mass index (BMI) ≥ 40 kg/m2 who had failed antiarrhythmic drug therapy and electrocardioversion and failure to achieve targeted body-weight-reduction underwent CBA. RESULTS Data of 72 very severe obese AF patients (Group A) and 129 AF patients with normal BMI (Group B, BMI < 25 kg/m2) were consecutively collected. Group A had significantly younger age (60.6 ± 10.4 vs. 69.2 ± 11.2 years), higher BMI (44.3 ± 4.3 vs. 22.5 ± 1.6 kg/m2). Procedural pulmonary vein isolation (PVI) was successful in all patients (2 touch-up ablation in Group A). Compared to Group B, Group A had similar procedural (61.3 ± 22.6 vs. 57.5 ± 19 min), similar fluoroscopy time (10.1 ± 5.5 vs. 9.2 ± 4.8 min) but significantly higher radiation dose (2852 ± 2095 vs. 884 ± 732 µGym2). We observed similar rates of real-time-isolation (78.6% vs. 78.5%), single-shot-isolation (86.5% vs. 88.8%), but significantly longer time-to-sustained-isolation (53.5 ± 33 vs. 43.2 ± 25 s). There was significantly higher rate of puncture-site-complication (6.9% vs. 1.6%) in Group A. One-year clinical success in paroxysmal AF was (Group A: 69.4% vs. Group B: 80.2%; p < .001), in persistent AF was (Group A: 58.1% vs. Group B: 62.8%; p = .889). In Re-Do procedures Group A had a numerically lower PVI durability (75.0% vs. 83.6%, p = .089). CONCLUSION For very severe obese AF patients, CBA appears feasible, leads to relatively good clinical outcome.
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Affiliation(s)
- Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Ramin Ebrahimi
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Tolga Han Efe
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Karin Plank
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Britta Schulte-Hahn
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Bernd Nowak
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
- Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
- Section of Rhythmology/Electrophysiology, Department of Internal Medicine B (Kardiologie, Angiologie, Pneumologie/Infektiologie und internistische Intensivmedizin), University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, Germany
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Yang QH, Zhang YH, Lok Wong AY, Xu HR, Bi X, Ching YL, Du SH, Wang YC, Wang XQ. Associations between Physical Activity and the Incidence of Cerebrovascular Disease or All-Cause Mortality among 146,742 Older Adults: A 13-Year Prospective Cohort Study. J Am Med Dir Assoc 2024; 25:105010. [PMID: 38702045 DOI: 10.1016/j.jamda.2024.03.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES Although studies have indicated that physical activity (PA) is related to cardiovascular disease, the specific association between PA and incident cerebrovascular disease (CBVD) remains uncertain. The current study aimed to investigate the associations between PA levels and the CBVD incidence or all-cause mortality. DESIGN Prospective cohort study. SETTINGS AND PARTICIPANTS Older participants (aged >60 years) from the UK Biobank. METHODS The baseline PA was classified as total, light, moderate, and vigorous PA based on the metabolic equivalent-minutes per week (MET-min/wk) and considered as exposures, whereas CBVD incidence and all-cause mortality were considered as the outcomes. Cox proportional hazards were used to calculate the hazard ratios (HRs) and 95% CIs for the influence of the association between PA and CBVD incidence and all-cause mortality. RESULTS A total of 146,742 participants aged 60 years and older were included. During a median follow-up period of 13.5 years (interquartile range of 12.8-14.2), 9338 older individuals developed CBVD and 3033 death were recorded (including 767 CBVD-related deaths). High volumes of PA were consistently associated with lower risks of CBVD and all-cause mortality. The lowest risk of CBVD incidence was observed at 2001-2500 MET-min/wk of total PA (HR 0.61, 95% CI 0.53-0.70), and the lowest risk of all-cause mortality was observed at 2501-5000 MET-min/wk (HR 0.52, 95% CI 0.43-0.63) in older adults. Total PA at 2001-2500 MET-min/wk significantly reduced the CBVD incidence in older women (HR 0.57, 95% CI 0.46-0.71), which was more pronounced than that in older men (HR for 2001-2500 MET-min/wk: 0.64, 95% CI 0.50-0.77). CONCLUSIONS AND IMPLICATIONS Total PA at 2001-2500 MET-min/wk significantly reduced the risk of incident CBVD and all-cause mortality in adults aged >60 years, although the extents of risk reduction vary in men and women.
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Affiliation(s)
- Qi-Hao Yang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China; Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yong-Hui Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China; School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Hao-Ran Xu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xia Bi
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuen Lim Ching
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shu-Hao Du
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu-Chen Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xue-Qiang Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China; Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
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9
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Zhao M, Wu Q, Duanmu W, Shen J, Yuan W, Sun Y, Zhang X, Zhang J, He S. Clinical Analysis of Myocardial Injury in Highlanders with Pulmonary Hypertension. High Alt Med Biol 2024. [PMID: 38900692 DOI: 10.1089/ham.2023.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
Background: Pulmonary hypertension (PH) is a prevalent adverse cardiovascular event at high-altitude environments. Prolonged exposure to high altitudes may result in myocardial injury, which is associated with poor clinical outcomes. This study aims to investigate the clinical characteristics of myocardial injury in patients with PH at high altitude. Methods: Consecutive patients admitted to a general tertiary hospital at the altitude of 3,650 m were selected into this retrospective study. Clinical and biochemical data were collected, as well as based on cardiac troponin I (cTnI) and echocardiography, patients were divided into myocardial injury group and non-myocardial injury group. Results: A total of 231 patients were enrolled, among whom 29 (12.6%) had myocardial injury. We found that body mass index, left ventricular end-diastolic dimension, and serum level of creatine kinase-MB (CK-MB) in myocardial injury group were significantly higher than non-myocardial injury group. Spearman correlation analysis revealed that cTnI has a significant positive correlation with CK-MB and lactic dehydrogenase instead of aspartate aminotransferase. A receiver operating characteristic curve was drawn to demonstrate that CK-MB could significantly predict the occurrence of myocardial injury with an area under the curve of 0.749, and a level of 3.035 (sensitivity = 59.3%, specificity = 90.5%) was optimal cutoff value. Conclusion: The incidence of myocardial injury in highlanders with PH is significant. CK-MB, as a convenient and efficient marker, has been found to be closely associated with cTnI and plays a predictive role in the occurrence of myocardial injury with PH in individuals exposed to high altitude.
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Affiliation(s)
- Maolin Zhao
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, The General Hospital of Western Theater Command, Chengdu, China
| | - Qianjin Wu
- Department of Health Service, Tibetan Military General Hospital, Lhasa, China
| | - Wangsheng Duanmu
- Department of Neurology, Tibetan Military General Hospital, Lhasa, China
| | - Junxian Shen
- Department of Neurology, Tibetan Military General Hospital, Lhasa, China
| | - Weixin Yuan
- Department of Neurology, Tibetan Military General Hospital, Lhasa, China
| | - Yingbin Sun
- Department of Cardiology, Tibetan Military General Hospital, Lhasa, China
| | - Xu Zhang
- Department of Cardiology, Tibetan Military General Hospital, Lhasa, China
| | - Jinbao Zhang
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, The General Hospital of Western Theater Command, Chengdu, China
| | - Siyi He
- Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Jiaotong University, The General Hospital of Western Theater Command, Chengdu, China
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10
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Di Vincenzo A, Granzotto M, Trevellin E, Purificati C, Vecchiato M, Foletto M, Pesavento M, Vettor R, Rossato M. Bariatric surgery modulates plasma levels of antibodies against angiotensin II type 1 and endothelin 1 type A receptor in severe obesity. J Endocrinol Invest 2024:10.1007/s40618-024-02412-4. [PMID: 38900373 DOI: 10.1007/s40618-024-02412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE The contribution of endothelial-targeted autoantibodies against the angiotensin II type 1 receptor (anti-AT1R) and the anti-endothelin 1 type A receptor (anti-ETAR1) has been proposed in the development of cardiovascular diseases. However, no data have been reported yet in obesity. In this observational study we evaluated the relationship between anthropometric and metabolic parameters and anti-AT1R and anti-ETAR1 concentrations in a cohort of patients with severe obesity and associated comorbidities undergoing bariatric surgery. METHODS Clinical evaluation and metabolic assessment were performed in 36 subjects referring to our Center for the Study and Integrated Treatment of Obesity at the University Hospital of Padova. Circulating inflammatory adipocytokines and the endothelial dysfunction marker asymmetric dimethylarginine (ADMA) were evaluated; plasma levels of anti-AT1R and anti-ETAR1 were also determined. 10 normal-weight subjects were considered as a control group. 29 patients out of 36 were re-evaluated after surgery. RESULTS With respect to normal-weight controls patients showed significantly higher plasma levels of anti-AT1R (28 ± 20.4 vs 13.5 ± 2.8 U/mL, p < 0.005) and ADMA (0.8 ± 0.1 vs 0.54 ± 0.08 uM/L, p < 0.0001) but not anti-ETAR1 (14.2 ± 1.3 vs 13.3 ± 2 U/mL, p = 0.1). Anti-AT1R concentration showed an increasing trend with the worsening of glycemic status, while the presence of arterial hypertension among the patients did not affect autoantibodies levels. One year after surgery, a significant improvement in body weight and metabolic and inflammatory parameters was observed, along with a significant reduction of anti-AT1R (28.1 ± 20.4 U/mL vs 22.6 ± 16 U/mL, p < 0.05) and anti-ETAR1 (14.2 ± 1.3 U/L vs 13 ± 1.6 U/L, p < 0.01). CONCLUSIONS Subjects with obesity present higher plasma levels of anti-AT1R which are more related to glycemic profile than blood pressure levels, and are reduced by bariatric surgery. Considering the detrimental effects of these autoantibodies on vascular health, they should be assessed as potential biomarkers in obesity and metabolic diseases.
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Affiliation(s)
- A Di Vincenzo
- Internal Medicine 3, Department of Medicine, University-Hospital of Padova, Padua, Italy.
- Endocrine-Metabolic Laboratory, Department of Medicine, University-Hospital of Padova, Padua, Italy.
| | - M Granzotto
- Endocrine-Metabolic Laboratory, Department of Medicine, University-Hospital of Padova, Padua, Italy
| | - E Trevellin
- Endocrine-Metabolic Laboratory, Department of Medicine, University-Hospital of Padova, Padua, Italy
| | - C Purificati
- Internal Medicine 3, Department of Medicine, University-Hospital of Padova, Padua, Italy
| | - M Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University-Hospital of Padova, Padua, Italy
| | - M Foletto
- Week Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University-Hospital of Padova, Padua, Italy
| | - M Pesavento
- Internal Medicine 3, Department of Medicine, University-Hospital of Padova, Padua, Italy
| | - R Vettor
- Internal Medicine 3, Department of Medicine, University-Hospital of Padova, Padua, Italy
- Endocrine-Metabolic Laboratory, Department of Medicine, University-Hospital of Padova, Padua, Italy
| | - M Rossato
- Internal Medicine 3, Department of Medicine, University-Hospital of Padova, Padua, Italy
- Endocrine-Metabolic Laboratory, Department of Medicine, University-Hospital of Padova, Padua, Italy
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11
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Nteli M, Nteli D, Moysidis DV, Foka A, Zymaris P, Grantza T, Kazarli O, Vagianos A, Papazoglou AS, Kartas A, Samaras A, Bekiaridou A, Spyridonidis E, Ziakas A, Tzikas A, Giannakoulas G. Prognostic Impact of Body Mass Index in Atrial Fibrillation. J Clin Med 2024; 13:3294. [PMID: 38893005 PMCID: PMC11172694 DOI: 10.3390/jcm13113294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Contradictory results have been reported regarding the influence of obesity on the prognosis of atrial fibrillation (AF). The present study aimed to explore the potential association of body mass index (BMI) with the clinical outcomes of hospitalized patients with AF. Methods: In this retrospective, post hoc analysis of the MISOAC-AF randomized trial, 1113 AF patients were included and stratified as the following: underweight (BMI < 18 kg/m2), normal weight (BMI 18-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), and obese (BMI ≥ 30 kg/m2). The primary outcome was all-cause mortality; the secondary composite outcome was any hospitalization related to AF, heart failure (HF), or stroke. Cox regression analysis, survival analysis, and spline curve models were utilized. Results: Of the patients (median age: 76 years (IQR: 13), male: 54.6%), the majority were overweight (41.4%), followed by obese (33%), normal weight (24%), and underweight (1.6%). During a median 31-month follow-up, 436 (39.2%) patients died and 657 (59%) were hospitalized due to AF, HF, or stroke. Underweight, overweight, and obesity groups were significantly associated with an increased risk of all-cause mortality (p-values 0.02, 0.001, and <0.001, respectively), while overweight and obesity were significantly associated with the composite endpoint (p-values 0.01, <0.001, respectively) compared to normal weight. The spline curve analyses yielded that BMIs > 26.3 and > 25 were incrementally associated with all-cause mortality and the composite endpoint, respectively. A J-shaped relationship between BMI and AF prognosis was deduced. Conclusions: In conclusion, in recently hospitalized AF patients, BMI values outside the normal range were independently associated with poorer prognosis; therefore, it is essential that AF patients maintain a normal weight.
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Affiliation(s)
- Maria Nteli
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Despoina Nteli
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Dimitrios V. Moysidis
- 424 General Military Hospital of Thessaloniki, 56429 Thessaloniki, Greece; (D.V.M.); (E.S.)
| | - Anastasia Foka
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Panagiotis Zymaris
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Triantafyllia Grantza
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Olga Kazarli
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Alexis Vagianos
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | | | - Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Athanasios Samaras
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Alexandra Bekiaridou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA
| | | | - Antonios Ziakas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
| | - Apostolos Tzikas
- Interbalkan European Medical Center, 55535 Thessaloniki, Greece;
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.N.); (D.N.); (A.F.); (P.Z.); (T.G.); (O.K.); (A.V.); (A.K.); (A.S.); (A.B.); (A.Z.)
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12
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Ma C, Wu S, Liu S, Han Y. Chinese guidelines for the diagnosis and management of atrial fibrillation. Pacing Clin Electrophysiol 2024; 47:714-770. [PMID: 38687179 DOI: 10.1111/pace.14920] [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: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 05/02/2024]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting patients' quality of life and increasing the risk of death, stroke, heart failure, and dementia. Over the past two decades, there have been significant breakthroughs in AF risk prediction and screening, stroke prevention, rhythm control, catheter ablation, and integrated management. During this period, the scale, quality, and experience of AF management in China have greatly improved, providing a solid foundation for the development of the guidelines for the diagnosis and management of AF. To further promote standardized AF management, and apply new technologies and concepts to clinical practice timely and fully, the Chinese Society of Cardiology of Chinese Medical Association and the Heart Rhythm Committee of Chinese Society of Biomedical Engineering jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. The guidelines comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2‑VASc‑60 stroke risk score based on the characteristics of the Asian AF population. The guidelines also reevaluated the clinical application of AF screening, emphasized the significance of early rhythm control, and highlighted the central role of catheter ablation in rhythm control.
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Affiliation(s)
- Changsheng Ma
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Shulin Wu
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Shaowen Liu
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Yaling Han
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
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13
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Machado Carvalhais R, Siochi C, Harutyunyan G, Segura Torres D, Shahmoradi V, Sobieraj P, Canuto Miller A, Jesmajian S. Differences in the Impact of Obesity and Bariatric Surgery on Patients Hospitalized for Atrial Flutter and Atrial Fibrillation: A Nationwide Analysis, 2016-2020. Cureus 2024; 16:e62284. [PMID: 39006678 PMCID: PMC11245680 DOI: 10.7759/cureus.62284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND The "obesity paradox" claims that although obesity is a risk factor for atrial fibrillation, obese patients have lower inpatient mortality when admitted due to atrial fibrillation. This study aims to analyze if the obesity paradox still holds true after weight loss from bariatric surgery. Methods: This study analyzed discharge data from the National Inpatient Sample, 2016-2020. Patients admitted due to atrial fibrillation or atrial flutter, with or without obesity, and with or without a past medical history of bariatric surgery were identified using ICD-10-CM and ICD-10-PCS codes. The primary outcome was mortality. Secondary outcomes included length of stay, resource utilization, necessity for endotracheal intubation, and necessity for cardioversion. STATA v.13 was used for univariate and multivariate analysis (StataCorp LLC, Texas, USA). RESULTS Among 2,292,194 patients who had a primary diagnosis of atrial fibrillation or atrial flutter, 494,830 were obese and 25,940 had bariatric surgery. Mortality was not significantly different in post-bariatric surgery patients when compared to the general population (OR 0.76; 95% [CI 0.482-1.2; p=0.24]). Mortality was significantly lower in obese patients when compared to the general population (OR 0.646; 95% [CI 0.583-0.717; p<0.001]). Therefore, post-bariatric surgery patients had a higher mortality than obese patients when compared to the general population. Obese patients spent more days in the hospital (regression 0.219; 95% [CI 0.19-0.248, p<0.001]), had higher resource utilization (regression 3491.995; 95% [CI 2870.085-4113.905, p<0.001]), more cardioversions (OR 1.434; 95% [CI 1.404-1.465; p<0.001]), and no difference in endotracheal intubation rate (OR 1.02; 95% [CI 0.92-1.127; p=0.724]) when compared to the general population. Post-bariatric patients had no difference in length of stay (regression -0.053; 95% [CI -0.137-0.031; p=0.218]) and resource utilization (regression 577.297; 95% [CI -1069.801-2224.396; p=0.492]), fewer endotracheal intubations (OR 0.583; 95% [CI 0.343-0.99; p=0.046]), and more cardioversions (OR 1.223; 95% [CI 1.134-1.32; p<0.001]) when compared to the general population. CONCLUSION Compared to the general population, post-bariatric patients had higher inpatient mortality than obese patients when admitted due to atrial fibrillation or atrial flutter. This research reinforces the presence of the obesity paradox following bariatric surgery with respect to mortality.
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Affiliation(s)
- Ricardo Machado Carvalhais
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Christian Siochi
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Gohar Harutyunyan
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Danny Segura Torres
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Vahe Shahmoradi
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Peter Sobieraj
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Aressa Canuto Miller
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Stephen Jesmajian
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
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14
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Noh HJ, Cha SJ, Kim CH, Choi SW, Lee CH, Hwang JK. Efficacy of dapagliflozin in improving arrhythmia-related outcomes after ablation for atrial fibrillation: a retrospective single-center study. Clin Res Cardiol 2024; 113:924-932. [PMID: 38358416 DOI: 10.1007/s00392-024-02389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is a widespread type of sustained arrhythmia that poses significant health risks. Catheter ablation is the preferred treatment; however, arrhythmia recurrence remains challenging. Sodium-glucose co-transporter 2 inhibitors, particularly dapagliflozin (DAPA), have exhibited cardiovascular benefits. However, to date, the influence of these inhibitors on AF post-ablation remains unclear. METHODS We analyzed the records of 272 patients who underwent catheter ablation for AF from January 2018 to December 2022. Patients were divided into the control (n = 199) and DAPA (n = 73) groups based on DAPA prescription post-ablation. The primary outcome was total atrial arrhythmia recurrence after a 3-month blanking period. RESULTS The mean age was 72.19 ± 5.45 years; 86.8% of the patients were men. At 18 months post-ablation, 36.2% and 9.5% of the patients in the control and DAPA groups, respectively, reported atrial arrhythmia. Multivariate analysis revealed that DAPA use was associated with a significantly reduced risk of arrhythmia recurrence (adjusted hazard ratio [aHR]: 0.15, 95% confidence interval [CI]: 0.07-0.32, p < 0.001). After propensity score-matching (PSM) in 65 pairs, arrhythmia recurrence was lower in the DAPA group compared with the control (8.3% versus 30.8%, aHR: 0.17, 95% CI: 0.06-0.51, p = 0.002). Freedom from total arrhythmia recurrence was significantly higher in the DAPA group compared with the control group in both the overall and PSM population (log-rank test p < 0.01). CONCLUSION DAPA administration post-ablation was associated with significantly reduced atrial arrhythmia recurrence rates, indicating its potential as an adjunct therapy for enhancing the success of AF ablation.
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Affiliation(s)
- Hyeong Jun Noh
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, (05368) #53 Jinhawngdo-Ro 61 Gil, Gangdong-Gu, Seoul, Republic of Korea
| | - Sung Joo Cha
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, (05368) #53 Jinhawngdo-Ro 61 Gil, Gangdong-Gu, Seoul, Republic of Korea
| | - Chee Hae Kim
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, (05368) #53 Jinhawngdo-Ro 61 Gil, Gangdong-Gu, Seoul, Republic of Korea
| | - Suk-Won Choi
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, (05368) #53 Jinhawngdo-Ro 61 Gil, Gangdong-Gu, Seoul, Republic of Korea
| | - Chang Hoon Lee
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, (05368) #53 Jinhawngdo-Ro 61 Gil, Gangdong-Gu, Seoul, Republic of Korea
| | - Jin Kyung Hwang
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, (05368) #53 Jinhawngdo-Ro 61 Gil, Gangdong-Gu, Seoul, Republic of Korea.
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15
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Obi MF, Sharma M, Namireddy V, Patel V, Reinberg Palmar A, Kanu NT. Enhancing Treatment Outcomes in Atrial Fibrillation: A Contemporary Literature Review of the Impact of Optimizing Patient Well-Being in Treatment Management. Cureus 2024; 16:e62321. [PMID: 39006593 PMCID: PMC11246104 DOI: 10.7759/cureus.62321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
Atrial fibrillation (AF) is the most common heart rhythm disorder, defined by an irregular and rapid heartbeat. It is the most prevalent cardiac arrhythmia in the United States, characterized by irregular heartbeats due to asynchrony between atrial and ventricular contractions. AF can be categorized as paroxysmal or persistent and, as such, poses significant health risks, including heart failure and stroke. Factors like age, sex, lifestyle, and existing health conditions elevate AF risk. There have been a lot of debates around AF risk management and its impact on prognosis. This literature review aims to explore the influence of addressing modifiable risk factors in AF patients on its morbidity and mortality, exploring various treatment options and their effectiveness. Current guidelines suggest rate control and anticoagulation for persistent AF with medications like beta blockers and non-vitamin K oral anticoagulants. Catheter ablation for rhythm control is contentious. Studies on supplemental treatments, lifestyle changes, and managing comorbidities show mixed results, necessitating further research for comprehensive treatment effectiveness in AF patients, which this literature review will discuss.
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Affiliation(s)
- Mukosolu F Obi
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | - Manjari Sharma
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | | | - Vyoma Patel
- Medicine, St. George's University School of Medicine, True Blue, GRD
| | | | - Ngozi T Kanu
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
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16
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Bode D, Pronto JRD, Schiattarella GG, Voigt N. Metabolic remodelling in atrial fibrillation: manifestations, mechanisms and clinical implications. Nat Rev Cardiol 2024:10.1038/s41569-024-01038-6. [PMID: 38816507 DOI: 10.1038/s41569-024-01038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/01/2024]
Abstract
Atrial fibrillation (AF) is a continually growing health-care burden that often presents together with metabolic disorders, including diabetes mellitus and obesity. Current treatments often fall short of preventing AF and its adverse outcomes. Accumulating evidence suggests that metabolic disturbances can promote the development of AF through structural and electrophysiological remodelling, but the underlying mechanisms that predispose an individual to AF are aetiology-dependent, thus emphasizing the need for tailored therapeutic strategies to treat AF that target an individual's metabolic profile. AF itself can induce changes in glucose, lipid and ketone metabolism, mitochondrial function and myofibrillar energetics (as part of a process referred to as 'metabolic remodelling'), which can all contribute to atrial dysfunction. In this Review, we discuss our current understanding of AF in the setting of metabolic disorders, as well as changes in atrial metabolism that are relevant to the development of AF. We also describe the potential of available and emerging treatment strategies to target metabolic remodelling in the setting of AF and highlight key questions and challenges that need to be addressed to improve outcomes in these patients.
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Affiliation(s)
- David Bode
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Julius Ryan D Pronto
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Gabriele G Schiattarella
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Deutsches Herzzentrum der Charité (DHZC), Charité - Universitätsmedizin Berlin, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
| | - Niels Voigt
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.
- Cluster of Excellence 'Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells' (MBExC), University of Göttingen, Göttingen, Germany.
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17
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Gao Z, Wei H, Xiao J, Huang W. Mediators between body mass index and atrial fibrillation: a Mendelian randomization study. Front Nutr 2024; 11:1369594. [PMID: 38840698 PMCID: PMC11150702 DOI: 10.3389/fnut.2024.1369594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
Background Although obesity is a recognized risk factor of atrial fibrillation (AF), the mechanisms are not fully understood. Objective We aimed to identify the potential mediators between body mass index (BMI) and AF. Methods We conducted a two-sample Mendelian randomization (MR) analysis using publicly available summary-level data from genome-wide association studies. Univariable MR analyses were applied to identify potential mediators, and then the multivariable MR analyses were conducted to explore the mediated roles of circulating biomarkers, metabolic markers and comorbidities in the association between BMI and AF. Results This MR study found a significant causal association between BMI and AF (OR = 1.41, 95% CI = 1.33-1.50; p < 0.001), which was attenuated to 1.21 (95% CI = 1.03-1.43) after being adjusted for leptin, in which 48.78% excess risk was mediated. After further adjustment for leptin and some cormorbidies, the association was attenuated to null (adjusted for leptin and sleep apnoea: OR=1.05, 95% CI = 0.85-1.30; adjusted for leptin and coronary heart disease: OR = 1.08, 95% CI = 0.90-1.30; adjusted for leptin and systolic blood pressure: OR = 1.11, 95% CI = 0.88-1.41), resulting in 87.80%, 80.49% and 73.17% excess risk being mediated, respectively. Conclusion These results identified an important mediated role of leptin, particularly for individuals with sleep apnoea, coronary heart disease or hypertension, providing some clues for the underlying mechanisms behind the impact of obesity on AF risk.
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Affiliation(s)
- Ziting Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Hongye Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jun Xiao
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Wuqing Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
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18
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Carrard J, Hofer M, Prechtl L, Fleischlin E, Huber M, Gallart-Ayala H, Teav T, Infanger D, Höchsmann C, Koehler K, Hinrichs T, Hanssen H, Ivanisevic J, Schmidt-Trucksäss A. Effect of an eight-week high-intensity interval training programme on circulating sphingolipid levels in middle-aged adults at elevated cardiometabolic risk (SphingoFIT)-Protocol for a randomised controlled exercise trial. PLoS One 2024; 19:e0302477. [PMID: 38717997 PMCID: PMC11078397 DOI: 10.1371/journal.pone.0302477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Evidence indicates that sphingolipid accumulation drives complex molecular alterations promoting cardiometabolic diseases. Clinically, it was shown that sphingolipids predict cardiometabolic risk independently of and beyond traditional biomarkers such as low-density lipoprotein cholesterol. To date, little is known about therapeutic modalities to lower sphingolipid levels. Exercise, a powerful means to prevent and treat cardiometabolic diseases, is a promising modality to mitigate sphingolipid levels in a cost-effective, safe, and patient-empowering manner. METHODS This randomised controlled trial will explore whether and to what extent an 8-week fitness-enhancing training programme can lower serum sphingolipid levels of middle-aged adults at elevated cardiometabolic risk (n = 98, 50% females). The exercise intervention will consist of supervised high-intensity interval training (three sessions weekly), while the control group will receive physical activity counselling based on current guidelines. Blood will be sampled early in the morning in a fasted state before and after the 8-week programme. Participants will be provided with individualised, pre-packaged meals for the two days preceding blood sampling to minimise potential confounding. An 'omic-scale sphingolipid profiling, using high-coverage reversed-phase liquid chromatography coupled to tandem mass spectrometry, will be applied to capture the circulating sphingolipidome. Maximal cardiopulmonary exercise tests will be performed before and after the 8-week programme to assess patient fitness changes. Cholesterol, triglycerides, glycated haemoglobin, the homeostatic model assessment for insulin resistance, static retinal vessel analysis, flow-mediated dilatation, and strain analysis of the heart cavities will also be assessed pre- and post-intervention. This study shall inform whether and to what extent exercise can be used as an evidence-based treatment to lower circulating sphingolipid levels. TRIAL REGISTRATION The trial was registered on www.clinicaltrials.gov (NCT06024291) on August 28, 2023.
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Affiliation(s)
- Justin Carrard
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- SportAdo Centre, Children and Adolescent Surgery, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuel Hofer
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Luisa Prechtl
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Eva Fleischlin
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Manuel Huber
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Hector Gallart-Ayala
- Metabolomics Platform, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Tony Teav
- Metabolomics Platform, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Denis Infanger
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Christoph Höchsmann
- Department of Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Karsten Koehler
- Department of Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Timo Hinrichs
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Henner Hanssen
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Julijana Ivanisevic
- Metabolomics Platform, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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19
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Li T, Rong L, Gao Y, Cheng W. The causal relationship between obesity, obstructive sleep apnea and atrial fibrillation: a study based on mediated Mendelian randomization. Front Cardiovasc Med 2024; 11:1406192. [PMID: 38707891 PMCID: PMC11066229 DOI: 10.3389/fcvm.2024.1406192] [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: 03/24/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
Background Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with obesity and obstructive sleep apnea syndrome (OSA). Obesity and OSA may increase the risk of AF by affecting cardiovascular health. Methods The study used the Mendelian randomization (MR) approach, combined with two-sample and multivariable analyses, to assess the relationships between obesity, OSA, and AF. The study utilized GWAS data and applied various statistical methods for the analysis. Results The study found that obesity increased the risk of OSA, which in turn significantly increased the risk of AF. Through mediating MR analysis, it was found that OSA played a certain role in the causal relationship between obesity and AF, with about 6.4% of the risk of AF being mediated by OSA. Conclusion This study highlights the relationships among obesity, OSA, and AF, providing useful guidance for future clinical researches.
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Affiliation(s)
| | | | | | - Wei Cheng
- Department of Cardiology, Anhui No.2 Provincial People's Hospital, Hefei, Anhui, China
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20
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Cheng YJ, Deng H, Liao YJ, Fang XH, Liao HT, Liu FZ, He Q, Wang JJ, Wu SL, Lin WD, Xue YM. Role of ideal cardiovascular health metrics in reducing risk of incident arrhythmias. Eur J Prev Cardiol 2024; 31:658-666. [PMID: 37966902 DOI: 10.1093/eurjpc/zwad357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
AIMS Cardiovascular health (CVH) has been proven to reduce cardiovascular disease burden and mortality, but data are lacking regarding cardiac arrhythmias. The aim of this study was to assess the association between CVH metrics and atrial fibrillation/flutter (AF), ventricular arrhythmias, and bradyarrhythmias. METHODS AND RESULTS This study analysed data from the Atherosclerosis Risk in Communities (ARIC) cohort, with participants recruited from four different communities across the United States. Cardiovascular health metrics were scored at baseline (1987-89) following the American Heart Association's recommendations and categorized as poor, intermediate, or ideal. Arrhythmia episodes were diagnosed by International Classification of Diseases (ICD)-9 code. Adjusted associations were estimated using Cox models and event rates and population attributable fractions were calculated by CVH metrics category. The study population consisted of 13 078 participants, with 2548 AF, 1363 ventricular arrhythmias, and 706 bradyarrhythmias occurred. The adjusted hazard ratios (HRs) for ideal (vs. poor) CVH metrics were 0.59 [95% confidence interval (CI): 0.50-0.69] for AF, 0.38 (95% CI: 0.28-0.51) for ventricular arrhythmias, and 0.70 (95% CI: 0.51-0.97) for bradyarrhythmia. The risk of incident arrhythmias decreased steadily as the CVH metrics improved from 0 to 14 scores. The adjusted population attributable fractions were calculated to be 29.9% for AF, 54.4% for ventricular arrhythmias, and 21.9% for bradyarrhythmia, respectively. The association between CVH metrics and incident arrhythmias was also seen in people who remained free of coronary heart disease over the follow-up. CONCLUSION Achieving ideal CVH metrics recommendations by AHA in midlife was associated with a lower risk of incident arrhythmias later in life.
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Affiliation(s)
- Yun-Jiu Cheng
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
- The Second School of Clinical Medicine, Southern Medical University, No. 1023-1063 ShaTaiNan Rd, Guangzhou 510515, China
| | - Hai Deng
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Yi-Jian Liao
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
| | - Xian-Hong Fang
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Hong-Tao Liao
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Fang-Zhou Liu
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Qian He
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Jin-Jie Wang
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Shu-Lin Wu
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Wei-Dong Lin
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Yu-Mei Xue
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
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21
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Aguilar M. My Big Fat Coronary Bypass Surgery: Sex, Obesity, and Postoperative Atrial Fibrillation. Can J Cardiol 2024:S0828-282X(24)00292-7. [PMID: 38579962 DOI: 10.1016/j.cjca.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- Martin Aguilar
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
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Chen D, Feng J, He H, Xiao W, Liu X. Classification, Diagnosis, and Treatment of Obesity-Related Heart Diseases. Metab Syndr Relat Disord 2024; 22:161-169. [PMID: 38294776 DOI: 10.1089/met.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Evidence-based medicine shows that obesity is associated with a wide range of cardiovascular (CV) diseases. Obesity can lead to changes in cardiac structure and function, which can lead to obese cardiomyopathy, subclinical cardiac dysfunction, and even heart failure. It also increases the risk of atrial fibrillation and sudden cardiac death. Many invasive and noninvasive diagnostic methods can detect obesity-related heart disease at an early stage, so that appropriate measures can be selected to prevent adverse CV events. However, studies have shown a protective effect of obesity on clinical outcomes of CV disease, a phenomenon that has been termed the obesity paradox. The "obesity paradox" essentially refers to the fact that the classification of obesity defined by body mass index (BMI) does not consider the impact of obesity heterogeneity on CV disease prognosis, but simply puts subjects with different clinical and biochemical characteristics into the same category. In any case, indicators such as waist-to-hip ratio, ectopic body fat qualitative and quantitative, and CV fitness have been shown to be able to distinguish different CV risks in patients with the same BMI, which is convenient for early intervention in an appropriate way. A multidisciplinary approach, including lifestyle modification, evidence-based generic and novel pharmacotherapy, and surgical intervention, can improve CV outcomes in overweight/obese patients.
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Affiliation(s)
- Dan Chen
- Department of Electrocardiogram, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Artificial Intelligence Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong, China
| | - Juan Feng
- Department of Echocardiography, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - HongYan He
- Department of Electrocardiogram, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, Shandong, China
| | - WeiPing Xiao
- Department of Acupuncture, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, Shandong, China
| | - XiaoJing Liu
- Department of Endocrinology and Metabolism, The Second Hospital of Shandong University, Jinan, Shandong, China
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23
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MA CS, WU SL, LIU SW, HAN YL. Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. J Geriatr Cardiol 2024; 21:251-314. [PMID: 38665287 PMCID: PMC11040055 DOI: 10.26599/1671-5411.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting patients' quality of life and increasing the risk of death, stroke, heart failure, and dementia. Over the past two decades, there have been significant breakthroughs in AF risk prediction and screening, stroke prevention, rhythm control, catheter ablation, and integrated management. During this period, the scale, quality, and experience of AF management in China have greatly improved, providing a solid foundation for the development of guidelines for the diagnosis and management of AF. To further promote standardized AF management, and apply new technologies and concepts to clinical practice in a timely and comprehensive manner, the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2-VASc-60 stroke risk score based on the characteristics of AF in the Asian population. The guidelines have also reevaluated the clinical application of AF screening, emphasized the significance of early rhythm control, and highlighted the central role of catheter ablation in rhythm control.
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24
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Tu J, Ye Z, Cao Y, Xu M, Wang S. Establishment and evaluation of a nomogram for in-hospital new-onset atrial fibrillation after percutaneous coronary intervention for acute myocardial infarction. Front Cardiovasc Med 2024; 11:1370290. [PMID: 38562185 PMCID: PMC10982328 DOI: 10.3389/fcvm.2024.1370290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Background New-onset atrial fibrillation (NOAF) is prognostic in acute myocardial infarction (AMI). The timely identification of high-risk patients is essential for clinicians to improve patient prognosis. Methods A total of 333 AMI patients were collected who underwent percutaneous coronary intervention (PCI) at Zhejiang Provincial People's Hospital between October 2019 and October 2020. Least absolute shrinkage and selection operator regression (Lasso) and multivariate logistic regression analysis were applied to pick out independent risk factors. Secondly, the variables identified were utilized to establish a predicted model and then internally validated by 10-fold cross-validation. The discrimination, calibration, and clinical usefulness of the prediction model were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow test decision curve analyses, and clinical impact curve. Result Overall, 47 patients (14.1%) developed NOAF. Four variables, including left atrial dimension, body mass index (BMI), CHA2DS2-VASc score, and prognostic nutritional index, were selected to construct a nomogram. Its area under the curve is 0.829, and internal validation by 10-fold cross-folding indicated a mean area under the curve is 0.818. The model demonstrated good calibration according to the Hosmer-Lemeshow test (P = 0.199) and the calibration curve. It showed satisfactory clinical practicability in the decision curve analyses and clinical impact curve. Conclusion This study established a simple and efficient nomogram prediction model to assess the risk of NOAF in patients with AMI who underwent PCI. This model could assist clinicians in promptly identifying high-risk patients and making better clinical decisions based on risk stratification.
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Affiliation(s)
- Junjie Tu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Ziheng Ye
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yuren Cao
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Mingming Xu
- Department of Cardiovascular Medicine, Zhejiang Greentown Cardiovascular Hospital, Hangzhou, China
| | - Shen Wang
- Department of Cardiovascular Medicine, Zhejiang Greentown Cardiovascular Hospital, Hangzhou, China
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Zhou H, Ji Y, Sun L, Wang Z, Jin S, Wang S, Yang C, Yin D, Li J. Exploring the causal relationships and mediating factors between depression, anxiety, panic, and atrial fibrillation: A multivariable Mendelian randomization study. J Affect Disord 2024; 349:635-645. [PMID: 38211754 DOI: 10.1016/j.jad.2024.01.061] [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: 06/16/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Atrial fibrillation is a significant cardiovascular disease, and the increased risk of its occurrence may be influenced by mental disorders. Currently, the causal relationship between them remains controversial. Our aim is to ascertain the relationship between atrial fibrillation and mental disorders including depression, anxiety, and panic, as well as the risk factors mediating this relationship, through the judgment of genetic susceptibility. METHODS We utilized the summarized statistics from nine large-scale genome-wide association studies (in European populations), including depression (PGC, N = 807,553), anxiety (FinnGen, N = 429,209), panic (PGC, N = 230,878), diabetes (UK Biobank, N = 655,666), smoking (IEU, 607,291), hypertension (UK biobank, N = 463,010), obstructive sleep apnea (IEU, N = 476,853), obesity (UK biobank, N = 463,010), and AF (IEU, N = 1,030,836). By applying bidirectional two-sample Mendelian randomization and multivariable Mendelian randomization to depression, anxiety, panic, and AF, we analyzed their causal relationships and the independent influence of specific risk factors. Furthermore, a two-step MR approach was used to assess the mediating effects of diabetes, smoking, hypertension, obstructive sleep apnea, and obesity. RESULTS Results from the Two-Sample Mendelian Randomization Inverse Variance Weighted Random Effects Model show: the occurrence of genetically predicted depression is related to an increased risk of atrial fibrillation (AF) (OR: 1.073; [95 % CI: 1.005-1.146] P < 0.05), and panic is more significantly associated than depression (OR: 1.017; [95 % CI: 1.008-1.027] P < 0.001), while anxiety has no causal relationship with the occurrence of AF (OR: 1.023; [95 % CI: 0.960-1.092], P > 0.05), and AF is not significantly related to the occurrence of depression, anxiety, or panic (P > 0.05). After correcting for the other two risk factors using multivariable Mendelian randomization, depression remains significantly related to the occurrence of AF (β: 0.075; 95 % CI: [0.006, 0.144], P < 0.05), while panic and anxiety are not related to the occurrence of AF. Among them, the risk factors for AF occurrence, hypertension and obesity, are mediators between depression and AF, with mediation proportions of 74.9 % and 14.3 %, respectively. The mediating effects of diabetes, smoking, and obstructive sleep apnea were found to be not statistically significant. The above results are robust after sensitivity analysis. CONCLUSION Our results identified that the genetic susceptibility to depression is an independent risk factor for the occurrence of AF, and that hypertension and obesity can mediate this process. Panic also poses some risk to the onset of AF. This demonstrates that controlling hypertension and obesity for emotional management is of great importance in preventing the occurrence of AF.
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Affiliation(s)
- Han Zhou
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yingjie Ji
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Sun
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zihang Wang
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuya Jin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Suhuai Wang
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chen Yang
- Department of Ophthalmology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dechun Yin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Jingjie Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
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26
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Palatini P, Saladini F, Mos L, Vriz O, Ermolao A, Battista F, Berton G, Canevari M, Rattazzi M. Healthy overweight and obesity in the young: Prevalence and risk of major adverse cardiovascular events. Nutr Metab Cardiovasc Dis 2024; 34:783-791. [PMID: 38228410 DOI: 10.1016/j.numecd.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
AIMS To investigate the prevalence of metabolically healthy overweight/obesity and to study its longitudinal association with major adverse cardiovascular and renal events (MARCE). METHODS AND RESULTS The study was conducted in 1210 young-to-middle-age subjects grouped according to their BMI and metabolic status. The risk of MARCE was evaluated during 17.4 years of follow-up. Forty-eight-percent of the participants had normal weight, 41.9% had overweight, and 9.3% had obesity. Metabolically healthy status was found in 31.1% of subjects with normal weight and in 20.0% of those with overweight/obesity. During the follow-up, there were 108 MARCE. In multivariate Cox analysis adjusted for confounders and risk factors, no association was found between MARCE and overweight/obesity (p = 0.49). In contrast, metabolic status considered as a two-class variable (0 versus at least one metabolic abnormality) was a significant predictor of MARCE (HR, 2.11; 95%CI, 1.21-3.70, p = 0.009). Exclusion of atrial fibrillation from MARCE (N = 87) provided similar results (HR, 2.11; 95%CI, 1.07-4.16, p = 0.030). Inclusion of average 24 h BP in the regression model attenuated the strength of the associations. Compared to the group with healthy metabolic status, the metabolically unhealthy overweight/obesity participants had an increased risk of MARCE with an adjusted HR of 2.33 (95%CI, 1.05-5.19, p = 0.038). Among the metabolically healthy individuals, the CV risk did not differ according to BMI group (p = 0.53). CONCLUSION The present data show that the risk of MARCE is not increased in young metabolically healthy overweight/obesity suggesting that the clinical approach to people with high BMI should focus on parameters of metabolic health rather than on BMI.
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Affiliation(s)
- Paolo Palatini
- Department of Medicine - University of Padova, Padova, Italy.
| | | | - Lucio Mos
- San Antonio Hospital, San Daniele del Friuli, Italy
| | - Olga Vriz
- San Antonio Hospital, San Daniele del Friuli, Italy
| | - Andrea Ermolao
- Department of Medicine - University of Padova, Padova, Italy
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Quan Y, Lu F, Zhang Y. Use of brown adipose tissue transplantation and engineering as a thermogenic therapy in obesity and metabolic disease. Obes Rev 2024; 25:e13677. [PMID: 38114233 DOI: 10.1111/obr.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 12/21/2023]
Abstract
The induction of thermogenesis in brown adipose tissue is emerging as an attractive therapy for obesity and metabolic syndrome. However, the long-term efficacy and safety of clinical pharmaceutical agents have yet to be fully characterized. The transplantation of brown adipose tissue represents an alternative approach that might have a therapeutic effect by inducing a long-term increase in energy expenditure. However, limited tissue resources hinder the development of transplantation. Stem cell-based therapy and brown adipose tissue engineering, in addition to transplantation, represent alternative approaches that might resolve this problem. In this article, we discuss recent advances in understanding the mechanisms and applications of brown adipose tissue transplantation in the treatment of obesity and related metabolic disorders. Specifically, the induction of brown adipocytes and the fabrication of engineered brown adipose tissue as novel transplantation resources have long-term effects on ameliorating metabolic defects in rodent models. Additionally, we explore future prospects regarding the development of three-dimensional engineered brown adipose tissue and the associated challenges.
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Affiliation(s)
- Yuping Quan
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Plastic Surgery and Regenerative Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuteng Zhang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Zhang L, Chen S, Cao X, Yu J, Yang Z, Abdelrahman Z, Yang G, Wang L, Zhang X, Zhu Y, Wu S, Liu Z. Trajectories of Body Mass Index and Waist Circumference in Relation to the Risk of Cardiac Arrhythmia: A Prospective Cohort Study. Nutrients 2024; 16:704. [PMID: 38474832 DOI: 10.3390/nu16050704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The aim of the current study was to explore the trajectories, variabilities, and cumulative exposures of body mass index (BMI) and waist circumference (WC) with cardiac arrhythmia (CA) risks. METHODS In total, 35,739 adults from the Kailuan study were included. BMI and WC were measured repeatedly during the 2006-2010 waves. CA was identified via electrocardiogram diagnosis. BMI and WC trajectories were fitted using a group-based trajectory model. The associations were estimated using Cox proportional hazards models. RESULTS We identified four stable trajectories for BMI and WC, respectively. Neither the BMI trajectories nor the baseline BMI values were associated with the risk of CA. Compared to the low-stable WC group, participants in the high-stable WC group had a higher risk of CA (hazard ratio (HR) = 1.40, 95% confidence interval (CI): 1.06, 1.86). Interestingly, the cumulative exposures of BMI and WC instead of their variabilities were associated with the risk of CA. In the stratified analyses, the positive associations of the high-stable WC group with the risk of CA were found in females only (HR = 1.98, 95% CI: 1.02, 3.83). CONCLUSIONS A high-stable WC trajectory is associated with a higher risk of CA among Chinese female adults, underscoring the potential of WC rather than BMI to identify adults who are at risk.
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Affiliation(s)
- Liming Zhang
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Hebei United University, Tangshan 063000, China
| | - Xingqi Cao
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jiening Yu
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Zhenqing Yang
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Zeinab Abdelrahman
- Centre for Public Health, Queen's University of Belfast, Belfast BT12 6BA, UK
| | - Gan Yang
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Liang Wang
- Department of Public Health, Robbins College of Human Health and Sciences, Baylor University, Waco, TX 76711, USA
| | - Xuehong Zhang
- Department of Nutrition, Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Yimin Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou 310058, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Hebei United University, Tangshan 063000, China
| | - Zuyun Liu
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, China
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Ibdah RK, Zaitoun KJ, Altawalbeh RB, Tayyem SH, Nazzal UA, Rawashdeh SI, Khader YS, Al-Mistarehi AHW, Khassawneh BY. Prevalence of Obstructive Sleep Apnea Among Atrial Fibrillation Patients: A Cross-Sectional Study from Jordan. J Multidiscip Healthc 2024; 17:701-710. [PMID: 38375526 PMCID: PMC10875174 DOI: 10.2147/jmdh.s452589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
Background Obstructive Sleep Apnea (OSA) is a common respiratory disorder that causes intermittent upper airway collapse during sleep and can lead to various acute cardiovascular complications. Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of cardiovascular hospitalization and all-cause mortality. Our study aimed to investigate the prevalence of individuals with AF and those considered at high risk for OSA. Methods A cross-sectional study was conducted with a population comprising patients who had visited KAUH cardiology clinics between 2017-2019; subjects were categorized into AF patients and general cardiology patients. Patients were surveyed for OSA using the Berlin Questionnaire to assess the degree of OSA symptoms and to classify patients into high- or low-risk groups based on their responses. Results Of the 656 patients, 545 met our inclusion criteria, of whom 192 were diagnosed with AF. Comparable demographic characteristics were observed between the AF and non-AF groups, barring higher rates of obesity (p=0.001) and smoking (p=0.042) in the AF group. The prevalence of high-risk OSA was significantly higher in AF patients (68.2%) compared to non-AF patients (29.4%), with an adjusted odds ratio of 2.473 times (95% CI: 1.434 -4.266, p=0.001) greater for AF. The age, gender, and BMI categories did not differ significantly between the two groups. Binary logistic regression revealed significant associations between OSA and risk factors such as asthma (OR=4.408, 95% CI: 2.634-7.376, p=0.001). Conclusion These results serve to display a statistically significant increase in high-risk OSA in existing AF patients, irrespective of the presence of conventional OSA risk factors; this could imply a more immediate and direct relationship between both diseases and calls to include routine screening for OSA in patients diagnosed, newly or otherwise, with AF.
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Affiliation(s)
- Rasheed K Ibdah
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Khaled J Zaitoun
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Rana B Altawalbeh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Saad H Tayyem
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ulla A Nazzal
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Sukaina I Rawashdeh
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | | | - Basheer Y Khassawneh
- Department of Internal Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Vyas A, Desai R, Vasavada A, Ghadge N, Jain A, Pandya D, Lavie CJ. Intersection of sepsis, atrial fibrillation, and severe obesity: a population-based analysis in the United States. Int J Obes (Lond) 2024; 48:224-230. [PMID: 37898714 DOI: 10.1038/s41366-023-01403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is an indicator of poor prognosis in patients with sepsis and can increase the risk of stroke and mortality. Data on the impact of severe obesity on the outcomes of sepsis complicated by AF remains poorly understood. METHODS National Inpatient Sample (2018) and ICD-10 CM codes were used to identify the principal sepsis admissions with AF. We assessed comorbidities and outcomes of sepsis in people without obesity (BMI < 30) vs. non-severe obesity (BMI 30-35) and severe obesity (BMI > 35) cohorts. We also did a subgroup analysis to further stratify obesity based on metabolic health and analyzed the findings. The primary outcomes were the prevalence and adjusted odds of AF, AF-associated stroke, and all-cause mortality in sepsis by obesity status. Multivariable regression analyses were adjusted for patient- and hospital-level characteristics and comorbidities. RESULTS Our main analysis showed that of the 1,345,595 sepsis admissions, the severe obesity cohort was the youngest (median age 59 vs. non-severe 64 and people without obesity 68 years). Patients with obesity, who were often female, were more likely to have hypertension, diabetes, congestive heart failure, chronic pulmonary disease, and chronic kidney disease. The crude prevalence of AF was highest in non-severe obesity (19.9%). The adjusted odds of AF in non-severe obesity (OR 1.21; 95% CI:1.16-1.27) and severe obesity patients with sepsis (OR 1.49; 95% CI:1.43-1.55) were significantly higher than in people without obesity (p < 0.001). Paradoxically, the rates of AF-associated stroke (1%, 1.5%, and 1.7%) and in-hospital mortality (3.3%, 4.9%, and 7.1%) were lowest in the severe obesity cohort vs. the non-severe and people without obesity cohorts, respectively. On multivariable regression analyses, the all-cause mortality revealed lower odds in sepsis-AF patients with severe obesity (OR 0.78; 95% CI:0.67-0.91) or non-severe obesity (OR 0.63; 95% CI:0.54-0.74) vs. people without obesity. There was no significant difference in stroke risk. CONCLUSIONS A higher prevalence of cardiovascular comorbidities can be linked to a higher risk of AF in people with obesity and sepsis. Paradoxically, lower rates of stroke and all-cause mortality secondary to AF in people with obesity and sepsis warrant further investigation.
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Affiliation(s)
- Ankit Vyas
- Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX, USA
| | | | - Advait Vasavada
- Department of Medicine, M. P. Shah Medical College, Jamnagar, Gujarat, India
| | | | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA, USA
| | - Dishita Pandya
- Division of Cardiology, East Carolina University, ECU Health Medical Center, Greenville, NC, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA.
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Fu X, Iglesias-Álvarez D, García-Campos A, Martínez-Monzonís MA, Almenglo C, Martinez-Cereijo JM, Reija L, Fernandez ÁL, Gonzalez-Juanatey JR, Rodriguez-Manero M, Eiras S. Enhanced Levels of Adiposity, Stretch and Fibrosis Markers in Patients with Coexistent Heart Failure and Atrial Fibrillation. J Cardiovasc Transl Res 2024; 17:13-23. [PMID: 37878196 DOI: 10.1007/s12265-023-10454-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
The coexistence of heart failure (HF) and atrial fibrillation (AF) worsens the prognosis of patients. We aimed to study the inflammation, metabolism, adiposity, and fibrosis markers on epicardial and subcutaneous fat and blood, and their relationship with HF and AF. Samples from 185 patients undergoing cardiac surgery were collected. Levels of multi-markers on fat biopsies and plasma were analyzed. Patients were grouped by HF or AF presence. Plasma adiposity markers were increased in AF patients, while increased stretch markers correlated with HF. Patients with both AF and HF had higher ANP and GDF-15 levels. After excluding AF patients, plasma FABP4 was identified as the main HF predictor. Fat biopsies from AF patients showed an enhanced inflammatory profile. Higher levels of adiposity markers are associated with AF or HF, and higher stretch and fibrosis markers with combined AF and HF, suggesting a role of adiposity-fibrosis pathway in HF and AF coexistence.
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Affiliation(s)
- Xiaoran Fu
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Diego Iglesias-Álvarez
- Cardiovascular Area, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana García-Campos
- Cardiovascular Area, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- CIBERCV, Madrid, Spain
| | | | - Cristina Almenglo
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Laura Reija
- Heart Surgery Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángel Luis Fernandez
- CIBERCV, Madrid, Spain
- Heart Surgery Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Ramón Gonzalez-Juanatey
- Cardiovascular Area, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- CIBERCV, Madrid, Spain
- Medicine Department, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Moises Rodriguez-Manero
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Cardiovascular Area, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- CIBERCV, Madrid, Spain
| | - Sonia Eiras
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain.
- CIBERCV, Madrid, Spain.
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Niu H, Li J, Teng C, Lu X, Jin C, Cai P, Shi A, Shen X, Chen Q, Chen M, Yuan Y, Li P. The incidence and impact of atrial fibrillation on hospitalized Coronavirus disease-2019 patients. Clin Cardiol 2024; 47:e24240. [PMID: 38402574 PMCID: PMC10894524 DOI: 10.1002/clc.24240] [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: 12/02/2023] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Since 2019, Coronavirus disease-2019 (COVID-19) has raised unprecedented global health crisis. The incidence and impact of atrial fibrillation (AF) on patients with COVID-19 remain unclearly defined. METHODS We conducted a retrospective cohort study using ICD-10 codes to identify patients with a primary diagnosis of COVID-19 with or without AF in National Inpatient Sample Database 2020. We compared the outcome of COVID-19 patients with a concurrent diagnosis of AF with those without. HYPOTHESIS AF will adversely affect the prognosis of hospitalized COVID-19 patients. RESULTS A total of 211 619 patients with a primary diagnosis of COVID-19 were identified. Among these patients, 31 923 (15.08%) had a secondary diagnosis of AF. Before propensity score matching, COVID-AF cohort was older (75.8 vs. 62.2-year-old, p < .001) and had more men (57.5% vs. 52.0%, p < .001). It is associated with more comorbidities, mainly including diabetes mellitus (43.7% vs. 39.9%, p < .001), hyperlipidemia (54.6% vs. 39.8%, p < .001), chronic kidney disease (34.5% vs. 17.0%, p < .001), coronary artery disease (35.3% vs. 14.4%, p < .001), anemia (27.8% vs. 18.6%, p < .001), and cancer (4.8% vs. 3.4%, p < .001). After performing propensity score match, a total of 31 862 patients were matched within each group. COVID-AF cohort had higher inpatient mortality (22.2% vs. 15.3%, p < .001) and more complications, mainly including cardiac arrest (3.9% vs. 2.3%, p < .001), cardiogenic shock (0.9% vs. 0.3%, p < .001), hemorrhagic stroke (0.4% vs. 0.3%, p = .025), and ischemic stroke (1.3% vs. 0.7%, p < .001). COVID-AF cohort was more costly, with a longer length of stay, and a higher total charge. CONCLUSION AF is common in patients hospitalized for COVID-19, and is associated with poorer in-hospital mortality, immediate complications and increased healthcare resource utilization.
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Affiliation(s)
- Haiming Niu
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Jianwei Li
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Catherine Teng
- Division of Cardiology, Department of MedicineUniversity of Texas Health Science CenterSan AntonioTexasUSA
| | - Xiaojia Lu
- Department of Cardiology, Mount Sinai Beth IsraelIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Chengyue Jin
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMassachusettsUSA
| | - Ao Shi
- Faculty of MedicineSt. George University of LondonLondonUK
| | - Xiaoqing Shen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Qiqi Chen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Miaolian Chen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Yong Yuan
- Department of CardiovasculogyZhongshan People's HospitalZhongshanP.R. China
| | - Pengyang Li
- Division of Cardiology, Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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Elfar S, Mahmoud SA, Hamdi S, Emad AA, Abd-ElGawad M, Taha NA. The safety and efficacy of nonvitamin K antagonist oral anticoagulants in morbidly obese patients with atrial fibrillation: a meta-analysis. BMC Cardiovasc Disord 2024; 24:74. [PMID: 38279126 PMCID: PMC10811832 DOI: 10.1186/s12872-024-03731-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND AND AIM Atrial fibrillation (AF) is the most frequently observed cardiac arrhythmia in clinical settings. Obesity can influence the efficacy of the treatment administered, which requires a larger dose and more time to accomplish therapeutic targets due to altered pathophysiology. Our study aimed to assess the overall efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) versus warfarin in AF patients with morbid obesity (BMI > 40 kg/m2 and/or weight > 120 kg) to prevent complications. METHODS We conducted a literature search on PubMed, Web of Science, the Cochrane Library, and Scopus till October 2022 for articles addressing the efficacy and safety of NOACs versus warfarin for the treatment of AF in morbidly obese patients. We performed the meta-analysis with RevMan software version 5.4 and Open Meta Analyst. The main outcomes assessed were stroke, major bleeding, and minor bleeding after anticoagulation, as did the history of comorbidities and risk factors in morbidly obese patients. Quality assessment was performed using Cochrane's ROB-2 tool and the Newcastle-Ottawa scale. RESULTS Regarding major bleeding events, pooled data showed that patients taking NOACs had a significantly lower risk than patients taking warfarin (OR = 0.54, 95% CI: [0.41-0.70]; p < 0.00001). However, for minor bleeding, there was a nonsignificant effect of NOACs on reducing the risk of bleeding (OR = 0.72, 95% CI = 0.47-1.09; p = 0.12), which became highly significant in favor of NOACs after sensitivity analysis (OR = 0.55, 95% CI = 0.49-0.61]; p < 0.00001). There was a significant difference in the incidence of stroke between the NOAC group and the warfarin group (OR = 0.69, 95% CI = 0.60-0.80]; p < 0.00001). According to the results of the single-arm study analysis, the overall effect of all the outcomes was associated with a high risk of disease development in patients receiving NOACs. CONCLUSION Our meta-analysis showed a favorable effect of NOACs vs warfarin in morbidly obese patients. Some outcomes were not significantly different, which calls for future research to better assess their safety and efficacy in this particular weight group. TRIAL REGISTRATION The study was registered with PROSPERO under registration number CRD42022362493 on October 2022.
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Affiliation(s)
| | | | - Samar Hamdi
- Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
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Medina-Inojosa BJ, Lopez-Jimenez F. Are body mass index changes related to incident atrial fibrillation?-Results of the Danish Diet, Cancer, and Health Cohort. Eur J Prev Cardiol 2024; 31:214-215. [PMID: 37883698 DOI: 10.1093/eurjpc/zwad333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Betsy J Medina-Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Francisco Lopez-Jimenez
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Aga Y, Acardag Y, Chin JF, Kroon D, Snelder SM, De Groot-De Laat L, Biter U, Zijlstra F, Brugts J, van Dalen B. Improved identification of left atrial enlargement in patients with obesity. Int J Cardiovasc Imaging 2024; 40:65-72. [PMID: 37882958 PMCID: PMC10774171 DOI: 10.1007/s10554-023-02981-0] [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: 03/30/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
Accurate standardization of left atrium volume (LAV) in patients with obesity is challenging. The aim of this study was to investigate and to examine the relation between LAV indexed to height2 and left atrial function in patients with moderate to severe obesity. Echocardiograms of patients with moderate to severe obesity (body mass index (BMI) ≥ 35 kg/m2) without known cardiac disease were analyzed. LAV was indexed to body surface area (BSA) and height2, and patients were divided into those with or without left atrial enlargement (LAE) based on normalization using either BSA (LAEbsa) or height2 (LAEh2). Using speckle tracking echocardiography, LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contractile strain (LASct) were assessed as a measure of LA function. LA dysfunction was defined as LASct < 14%. A total of 142 patients were included in the analysis of whom 54.2% had LAEh2 and 18.3% LAEBSA. The LAEh2 group had significantly lower LASct (12.2% ± 3.2% vs. 13.6% ± 4.5%, p = 0.019) as compared to the patients without LAEh2. Significantly more patients with LA dysfunction would be correctly identified by LAEh2 than by LAEBSA (41.5% vs. 15.0%, p < 0.001). In patients with moderate to severe obesity, the use of LAEh2 identified significantly more patients with decreased LA function. LAVh2 should be preferred over LAVBSA in patients with moderate to severe obesity.
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Affiliation(s)
- Yaar Aga
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, The Netherlands
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Yalin Acardag
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, The Netherlands
| | - Jie Fen Chin
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, The Netherlands
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Daan Kroon
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, The Netherlands
| | - Sanne Marjolein Snelder
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | | | - Ulas Biter
- Department of Bariatric Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Jasper Brugts
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Bas van Dalen
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, The Netherlands.
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands.
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den Uijl I, Sunamura M, Brouwers RMW, Stam HJ, Boersma E, van den Berg-Emons RJG, Ter Hoeve N. Cardiac rehabilitation for patients with obesity: lessons learned from the OPTICARE XL trial. Neth Heart J 2024; 32:14-22. [PMID: 37982980 PMCID: PMC10781911 DOI: 10.1007/s12471-023-01832-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/21/2023] Open
Abstract
Obesity is a known and commonly encountered risk factor for the development of cardiac diseases. Patients with cardiac diseases who also have obesity do not benefit optimally from standard cardiac rehabilitation (CR) programs. Exercises performed during CR are not the best fit for patients with obesity and counselling sessions often do not address their specific needs. OPTICARE XL is the first large multicentre randomised controlled trial to investigate the added value of a dedicated one-year CR program specifically designed for patients with obesity and integrated in daily practice. The short-term effects on body weight and physical activity were promising and patients with obesity experienced the program as highly desirable. However, the OPTICARE XL CR program did not show long-term added value compared with standard CR on health-related quality of life, psychosocial well-being, body weight, physical activity and physical fitness, nor on costs. The current article offers an overview of the background of this trial and discusses the most important results of the OPTICARE XL trial and the reasons behind the unanticipated long-term outcomes. Furthermore, it offers recommendations for future research and how to redesign the OPTICARE XL CR program to expand the short-term results.
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Affiliation(s)
- Iris den Uijl
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | | | - Rutger M W Brouwers
- Department of Cardiology, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Nienke Ter Hoeve
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands.
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Rafaqat S, Sharif S, Majeed M, Naz S, Saqib M, Manzoor F. Association of adiponectin gene expression with atrial fibrillation in a Pakistani populace. Sci Rep 2023; 13:22589. [PMID: 38114533 PMCID: PMC10730827 DOI: 10.1038/s41598-023-46388-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/31/2023] [Indexed: 12/21/2023] Open
Abstract
Adiponectin, an adipocytokine produced and secreted by adipose tissue, has anti-diabetic, anti-atherogenic, and anti-inflammatory properties. This case-control study was aimed to assess the expression and serum levels of adiponectin in subject suffereing from atrial fibrillation (AF). The study's subjects (n = 690) were enrolled from the Punjab Institute of Cardiology, Lahore and were grouped into control, AF without Metabolic syndrome (MetS), and AF with MetS groups. Along with the collection of demographic data, an analysis of adiponectin and biochemical parameters were performed. A highly significant difference in serum levels of adiponectin was observed among the control, AF without MetS, and AF with MetS groups (61.61 ± 45.30 ng/ml, 37.20 ± 19.46 ng/ml, 63.78 ± 61.69 ng/ml). The expression analysis of adiponectin was decreased (n-fold = ̴ 0.30) in AF without MetS group as compared to control group (n-fold = ~ 1.16) but increased in AF with MetS group (n-fold = ̴ 6.26). The correlation analysis revealed a highly significant positive relationship between the expression of the adiponectin gene with waist-to-hip ratio (WHR) in AF without MetS group. Whereas, serum adiponectin was negatively related to serum triglycerides (TG) in AF with MetS group. In multiple regression analysis using adiponectin expression as the dependent variable, WHR was a determinant in AF without MetS. Whereas, when serum adiponectin was used as the dependent variable, serum TG was the determinant in group AF with MetS. The present study implicates that decreased expression and serum levels of adiponectin were associated with the development of AF in which WHR and serum TG also contributed towards the onset of atrial fibrillation.
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Affiliation(s)
- Saira Rafaqat
- Department of Zoology, Lahore College for Women University, Lahore, Pakistan
| | - Saima Sharif
- Department of Zoology, Lahore College for Women University, Lahore, Pakistan.
| | - Mona Majeed
- Emergency Department, Punjab Institute of Cardiology, Lahore, Pakistan
| | - Shagufta Naz
- Department of Zoology, Lahore College for Women University, Lahore, Pakistan
| | - Muhammad Saqib
- Department of Medicine, Sir Ganga Ram Hospital, Lahore, Pakistan
| | - Farkhanda Manzoor
- Department of Zoology, Lahore College for Women University, Lahore, Pakistan
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Rossello X, Ramallal R, Romaguera D, Alonso-Gómez ÁM, Alonso A, Tojal-Sierra L, Fernández-Palomeque C, Martínez-González MÁ, Garrido-Uriarte M, López L, Díaz A, Zaldua-Irastorza O, Shah AJ, Salas-Salvadó J, Fitó M, Toledo E. Effect of an intensive lifestyle intervention on the structural and functional substrate for atrial fibrillation in people with metabolic syndrome. Eur J Prev Cardiol 2023:zwad380. [PMID: 38102071 DOI: 10.1093/eurjpc/zwad380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/30/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
AIMS To evaluate the effect of an intensive lifestyle intervention (ILI) on the structural and functional cardiac substrate of atrial fibrillation (AF) in overweight or obese people with metabolic syndrome (MetS). METHODS Participants of the PREDIMED-PLUS trial (n = 6874) were randomised 1:1 to an ILI program based on an energy-reduced Mediterranean diet, increased physical activity, and cognitive-behavioural weight management, or to a control intervention of low-intensity dietary advice. Left atrial (LA) strain, function, and volumes were evaluated by a core echocardiography lab in 534 participants at baseline, 3-year and 5-year follow-up. Mixed models were used to evaluate the effect of the ILI on LA structure and function. RESULTS In the subsample, baseline mean age was 65 years (SD 5 years), and 40% of the participants were women. Mean weight change after 5-years was -3.9 kg (SD 5.3 kg) in the ILI group and -0.3 kg (SD 5.1 kg) in the control group. Over the 5-year period, both groups experienced worsening of LA structure and function, with increases in LA volumes and stiffness index and decreases in LA longitudinal strain, LA function index and LA emptying fraction over time. Changes in the ILI and control group were not significantly different for any of the primary outcomes (LA emptying fraction: -0.95% (95%CI -0.93, -0.98) in control group, -0.97% (95%CI -0.94, -1.00) in ILI group, pbetween groups = 0.80; LA longitudinal strain: 0.82% (95%CI 0.79, 0.85) in control group, 0.85% (95%CI 0.82, 0.89) in ILI group, pbetween groups = 0.24) or any of the secondary outcomes. CONCLUSIONS In overweight or obese people with MetS, an ILI had no impact on the underlying structural and functional left atrial substrate measurements associated with AF risk.
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Affiliation(s)
- Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Raúl Ramallal
- Department of Cardiology, University Hospital of Navarra, Servicio Navarro de Salud Osasunbidea, IDISNA, Pamplona, Spain
| | - Dora Romaguera
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Ángel M Alonso-Gómez
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lucas Tojal-Sierra
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Carlos Fernández-Palomeque
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Miguel Ángel Martínez-González
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - María Garrido-Uriarte
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Luis López
- Cardiology Service, Hospital de Manacor, Manacor, Spain
| | - Agnes Díaz
- Cardiology Service, Clinica Universidad de Navarra, Pamplona, Spain
| | - Olatz Zaldua-Irastorza
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jordi Salas-Salvadó
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Rovira i Virigili University, Reus, Spain
| | - Montserrat Fitó
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Estefania Toledo
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain
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Wang N, Yu Y, Sun Y, Zhang H, Wang Y, Chen C, Tan X, Wang B, Lu Y. Acquired risk factors and incident atrial fibrillation according to age and genetic predisposition. Eur Heart J 2023; 44:4982-4993. [PMID: 37723974 PMCID: PMC10719493 DOI: 10.1093/eurheartj/ehad615] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/06/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND AND AIMS Atrial fibrillation (AF) is the most common sustained arrhythmia in adults. Investigations of risk factor profiles for AF according to age and genetic risk groups are essential to promote individualized strategies for the prevention and control of AF. METHODS A total of 409 661 participants (mean age, 56 years; 46% men) free of AF at baseline and with complete information about risk factors were included from the UK Biobank cohort. The hazard ratios and population-attributable risk (PAR) percentages of incident AF associated with 23 risk factors were examined, including 3 social factors, 7 health behaviours, 6 cardiometabolic factors, 6 clinical comorbidities, and the genetic risk score (GRS), across 3 age groups (40-49, 50-59, and 60-69 years) and 3 genetic risk groups (low, moderate, and high GRS). RESULTS After a follow-up of 5 027 587 person-years, 23 847 participants developed AF. Most cardiometabolic factors and clinical comorbidities showed a significant interaction with age, whereby the associations were generally strengthened in younger groups (Pinteraction < .002). However, only low LDL cholesterol, renal dysfunction, and cardiovascular disease showed a significant interaction with genetic risk, and the associations with these factors were stronger in lower genetic risk groups (Pinteraction < .002). Cardiometabolic factors consistently accounted for the largest number of incident AF cases across all age groups (PAR: 36.2%-38.9%) and genetic risk groups (34.0%-41.9%), with hypertension and overweight/obesity being the two leading modifiable factors. Health behaviours (PAR: 11.5% vs. 8.7%) and genetic risk factors (19.1% vs. 14.3%) contributed to more AF cases in the 40-49 years group than in the 60-69 years group, while the contribution of clinical comorbidities remained relatively stable across different age groups. The AF risk attributable to overall cardiometabolic factors (PAR: 41.9% in the low genetic risk group and 34.0% in the high genetic risk group) and clinical comorbidities (24.7% and 15.9%) decreased with increasing genetic risk. The impact of social factors on AF was relatively low across the groups by age and genetic risk. CONCLUSIONS This study provided comprehensive information about age- and genetic predisposition-related risk factor profiles for AF in a cohort of UK adults. Prioritizing risk factors according to age and genetic risk stratifications may help to achieve precise and efficient prevention of AF.
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Affiliation(s)
- Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Yuefeng Yu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Ying Sun
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Haojie Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Xiao Tan
- School of Public Health, Zhejiang University, Hangzhou, China
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bin Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
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Saglietto A, Falasconi G, Soto-Iglesias D, Francia P, Penela D, Alderete J, Viveros D, Bellido AF, Franco-Ocaña P, Zaraket F, Turturiello D, Marti-Almor J, Berruezo A. Assessing left atrial intramyocardial fat infiltration from computerized tomography angiography in patients with atrial fibrillation. Europace 2023; 25:euad351. [PMID: 38011712 PMCID: PMC10751854 DOI: 10.1093/europace/euad351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/27/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023] Open
Abstract
AIMS Epicardial adipose tissue might promote atrial fibrillation (AF) in several ways, including infiltrating the underlying atrial myocardium. However, the role of this potential mechanism has been poorly investigated. The aim of this study is to evaluate the presence of left atrial (LA) infiltrated adipose tissue (inFAT) by analysing multi-detector computer tomography (MDCT)-derived three-dimensional (3D) fat infiltration maps and to compare the extent of LA inFAT between patients without AF history, with paroxysmal, and with persistent AF. METHODS AND RESULTS Sixty consecutive patients with AF diagnosis (30 persistent and 30 paroxysmal) were enrolled and compared with 20 age-matched control; MDCT-derived images were post-processed to obtain 3D LA inFAT maps for all patients. Volume (mL) and mean signal intensities [(Hounsfield Units (HU)] of inFAT (HU -194; -5), dense inFAT (HU -194; -50), and fat-myocardial admixture (HU -50; -5) were automatically computed by the software. inFAT volume was significantly different across the three groups (P = 0.009), with post-hoc pairwise comparisons showing a significant increase in inFAT volume in persistent AF compared to controls (P = 0.006). Dense inFAT retained a significant difference also after correcting for body mass index (P = 0.028). In addition, more negative inFAT radiodensity values were found in AF patients. Regional distribution analysis showed a significantly higher regional distribution of LA inFAT at left and right superior pulmonary vein antra in AF patients. CONCLUSION Persistent forms of AF are associated with greater degree of LA intramyocardial adipose infiltration, independently of body mass index. Compared to controls, AF patients present higher LA inFAT volume at left and right superior pulmonary vein antra.
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Affiliation(s)
- Andrea Saglietto
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Citta della Salute e della Scienza’ Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giulio Falasconi
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- IRCCS Humanitas Research Hospital, Electrophysiology Department, Rozzano, Milan, Italy
- Campus Clínic, University of Barcelona, C/Villarroel 170, Barcelona, 08024, Spain
| | - David Soto-Iglesias
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Pietro Francia
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- Department of Clinical and Molecular Medicine, Cardiology Unit, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Diego Penela
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- IRCCS Humanitas Research Hospital, Electrophysiology Department, Rozzano, Milan, Italy
| | - José Alderete
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- OpenHeart Foundation, Barcelona, Spain
| | - Daniel Viveros
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Aldo Francisco Bellido
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- OpenHeart Foundation, Barcelona, Spain
| | - Paula Franco-Ocaña
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Fatima Zaraket
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Darío Turturiello
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- OpenHeart Foundation, Barcelona, Spain
| | - Julio Marti-Almor
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
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Sapir O, Lopez-Jimenez F, Tsaban G. Habits and heartbeats: learning from historical longitudinal data on primary prevention of atrial fibrillation. Eur J Prev Cardiol 2023; 30:1789-1790. [PMID: 37697416 DOI: 10.1093/eurjpc/zwad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Orly Sapir
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA
| | - Gal Tsaban
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA
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Yin S, Xu H, Xia J, Lu Y, Xu D, Sun J, Wang Y, Liao W, Sun G. Effect of Alpha-Linolenic Acid Supplementation on Cardiovascular Disease Risk Profile in Individuals with Obesity or Overweight: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2023; 14:1644-1655. [PMID: 37778442 PMCID: PMC10721518 DOI: 10.1016/j.advnut.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/22/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
Overweight and obesity are highly prevalent worldwide and are associated with cardiovascular disease (CVD) risk factors, including systematic inflammation, dyslipidemia, and hypertension. Alpha-linolenic acid (ALA) is a plant-based essential polyunsaturated fatty acid associated with reduced CVD risks. This systematic review and meta-analysis aimed to investigate the effects of supplementation with ALA compared with the placebo on CVD risk factors in people with obesity or overweight (International Prospective Register of Systematic Reviews Registration No. CRD42023429563). This review included studies with adults using oral supplementation or food or combined interventions containing vegetable sources of ALA. All studies were randomly assigned trials with parallel or crossover designs. The Cochrane Collaboration tool was used for assessing the risk of bias (Version 1). PubMed, Web of Science, Embase, and Cochrane library databases were searched from inception to April 2023. Nineteen eligible randomized controlled trials, including 1183 participants, were included in the meta-analysis. Compared with placebo, dietary ALA supplementation significantly reduced C-reactive protein concentration (standardized mean difference [SMD] = -0.38 mg/L; 95% confidence interval [CI]: -0.72, -0.04), tumor necrosis factor-α concentration (SMD = -0.45 pg/mL; 95% CI: -0.73, -0.17), triglyceride in serum (SMD = -4.41 mg/dL; 95% CI: -5.99, -2.82), and systolic blood pressure (SMD = -0.37 mm Hg; 95% CI: -0.66, -0.08); but led to a significant increase in low-density lipoprotein cholesterol concentrations (SMD = 1.32 mg/dL; 95% CI: 0.05, 2.59). ALA supplementation had no significant effect on interleukin-6, diastolic blood pressure, total cholesterol, or high-density lipoprotein cholesterol (all P ≥ 0.05). Subgroup analysis revealed that ALA supplementation at a dose of ≥3 g/d from flaxseed and flaxseed oil had a more prominent effect on improving CVD risk profiles, particularly where the intervention duration was ≥12 wk and where the baseline CVD profile was poor.
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Affiliation(s)
- Shiyu Yin
- Department of Nutrition and Food Hygiene, Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Hai Xu
- Department of Nutrition and Food Hygiene, Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China; Department of Food Processing and Safety, College of Biology and Food Engineering, Chongqing Three Gorges University, Chongqing, China
| | - Jiayue Xia
- Department of Nutrition and Food Hygiene, Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Yifei Lu
- Department of Nutrition and Food Hygiene, Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Dengfeng Xu
- Department of Nutrition and Food Hygiene, Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Jihan Sun
- Department of Nutrition and Food Hygiene, Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Yuanyuan Wang
- Department of Nutrition and Food Hygiene, Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Wang Liao
- Department of Nutrition and Food Hygiene, Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China; China-DRIs Expert Committee on Macronutrients, Chinese Nutrition Society, Beijing, China
| | - Guiju Sun
- Department of Nutrition and Food Hygiene, Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China; China-DRIs Expert Committee on Macronutrients, Chinese Nutrition Society, Beijing, China.
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Liu P, Wang Y, Zhang X, Zhang Z, Zhao N, Ou W, Wang G, Yang X, Li M, Zhang Y, Yang X, Wu S. Obesity and Cardiac Conduction Block Disease in China. JAMA Netw Open 2023; 6:e2342831. [PMID: 37955899 PMCID: PMC10644217 DOI: 10.1001/jamanetworkopen.2023.42831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023] Open
Abstract
Importance Although a high body mass index (BMI) has been found to be associated with increased risk of cardiac conduction block (CCB) in older adults, no further studies have investigated the association between obesity and CCB in the general population. Objective To investigate the association between obesity and CCB, including its subtypes. Design, Setting, and Participants This cohort study used data from participants in the Kailuan Study in China (2006-2018) who had completed a physical examination in 2006 (baseline) and had not experienced CCB before baseline. Data analysis was conducted from March to September 2023. Exposures Obesity status was defined by BMI in 3 groups: normal weight (18.5 to <24), overweight (24 to <28), and obesity (≥28). Main Outcome and Measures The primary outcome was CCB, which was diagnosed from standard 12-lead electrocardiography. The primary end point included high-grade atrioventricular block (HAVB), complete right bundle branch block, complete left bundle branch block, left anterior fascicular block (LAFB), and left posterior fascicular block. First-degree atrioventricular block (FAVB), second-degree type 1 AVB, HAVB, complete and incomplete right and left bundle branch block, LAFB, and left posterior fascicular block were considered separately as secondary end points. Results Among 86 635 participants (mean [SD] age, 50.8 [11.9] years; 68 205 males [78.7%]), there were 33 259 individuals with normal weight (38.4%), 37 069 individuals with overweight (42.8%), and 16 307 individuals with obesity (18.8%). The mean (SD) follow-up was 10.6 (3.07) years. In the multivariable Cox proportional hazards regression analysis, obesity was associated with an increased risk of incident CCB (hazard ratio [HR], 1.21; 95% CI, 1.04-1.42) vs normal BMI. In secondary analysis, obesity was associated with an increased risk of FAVB (HR, 1.44; 95% CI, 1.21-1.73), HAVB (HR, 1.99; 95% CI, 1.03-3.82), and LAFB (HR, 1.29; 95% CI, 1.03-1.62) vs normal BMI. There was no association between obesity and other CCB subtypes. Obesity was associated with a greater increase in risk of CCB vs normal BMI in older (aged ≥65 years; HR, 1.44; 95% CI, 1.05-1.96) vs younger (aged <65 years; HR, 1.13; 95% CI, 0.96-1.34) participants (P for interaction < .001) and those with diabetes (HR, 2.16; 95% CI, 1.24-3.76) vs without diabetes (HR, 1.19; 95% CI, 1.02-1.39) (P for interaction = .02). Conclusions and Relevance This study found that obesity was associated with an increased risk of CCB, with greater increases in risk for FAVB, HAVB, and LAFB. Individuals who were older and those who had diabetes had larger increases in risk.
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Affiliation(s)
- Peipei Liu
- School of Public Health, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, Hebei, China
| | - Yanxiu Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Xiaofu Zhang
- Hebei Key Laboratory for Chronic Diseases, Tangshan Key Laboratory for Preclinical and Basic Research on Chronic Diseases, School of Basic Medical Sciences, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, Hebei, China
| | - Zihao Zhang
- School of Public Health, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, Hebei, China
| | - NaiHui Zhao
- School of Public Health, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, Hebei, China
| | - Wenli Ou
- School of Public Health, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, Hebei, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Xuemei Yang
- School of Clinical Medicine, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, Hebei, China
| | - Man Li
- School of Clinical Medicine, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, Hebei, China
| | - Yaya Zhang
- School of Public Health, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, Hebei, China
| | - Xiuhong Yang
- School of Public Health, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, Hebei, China
- Hebei Key Laboratory for Chronic Diseases, Tangshan Key Laboratory for Preclinical and Basic Research on Chronic Diseases, School of Basic Medical Sciences, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, Hebei, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
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Goldman SA, Requena-Ibanez JA, Devesa A, Santos-Gallego CG, Badimon JJ, Fuster V. Uncovering the Role of Epicardial Adipose Tissue in Heart Failure With Preserved Ejection Fraction. JACC. ADVANCES 2023; 2:100657. [PMID: 38938732 PMCID: PMC11198699 DOI: 10.1016/j.jacadv.2023.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 06/29/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure. Obesity is a modifiable risk factor of HFpEF; however, body mass index provides limited information on visceral adiposity and patients with similar anthropometrics can present variable cardiovascular risk. Epicardial adipose tissue (EAT) is the closest fat deposit to the heart and has been proposed as a biomarker of visceral adiposity. EAT may be particularly important for cardiac function, because of its location (under the pericardium) and because it acts as a metabolically active endocrine organ (which can produce both beneficial and detrimental cytokines). In this paper, the authors review the role of EAT in normal and pathologic conditions and discuss the noninvasive imaging modalities that allow its identification. This review highlights EAT implications in HFpEF and discuss new therapies that act on EAT and might also exert beneficial effects on the cardiovascular system.
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Affiliation(s)
- Sarah A. Goldman
- Department of Internal Medicine, Zucker School of Medicine at Hofstra Northwell, Lenox Hill Hospital New York, New York, New York, USA
| | - Juan Antonio Requena-Ibanez
- Atherothrombosis Research Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai School of Medicine, New York, New York, USA
| | - Ana Devesa
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Carlos G. Santos-Gallego
- Atherothrombosis Research Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai School of Medicine, New York, New York, USA
| | - Juan José Badimon
- Atherothrombosis Research Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai School of Medicine, New York, New York, USA
| | - Valentin Fuster
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
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Knechtel M. Risk factor modification as a treatment pillar in managing atrial fibrillation. JAAPA 2023; 36:1-5. [PMID: 37751265 DOI: 10.1097/01.jaa.0000977728.68782.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
ABSTRACT Atrial fibrillation (AF) is common, with many modifiable and nonmodifiable risk factors contributing to its increasing prevalence. Pharmacologic management and invasive procedures are the mainstays of treatment, but cardiovascular risk modification is overlooked as a key adjuvant treatment strategy. This article describes the clinical effects of implementing a risk factor modification strategy to reduce dysrhythmia load.
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Affiliation(s)
- Maureen Knechtel
- Maureen Knechtel is an associate professor and academic coordinator in the PA program at Milligan University in Johnson City, Tenn. The author has disclosed no potential conflicts of interest, financial or otherwise
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Di Salvo G, Cattapan I, Fumanelli J, Pozza A, Moscatelli S, Sabatino J, Avesani M, Reffo E, Sirico D, Castaldi B, Cerutti A, Biffanti R, Pergola V. Childhood Obesity and Congenital Heart Disease: A Lifelong Struggle. J Clin Med 2023; 12:6249. [PMID: 37834891 PMCID: PMC10573337 DOI: 10.3390/jcm12196249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Congenital heart disease (CHD) affects approximately one in every one hundred infants worldwide, making it one of the most prevalent birth abnormalities globally. Despite advances in medical technology and treatment choices, CHD remains a significant health issue and necessitates specialized care throughout an individual's life. Childhood obesity has emerged as a novel global epidemic, becoming a major public health issue, particularly in individuals with lifelong conditions such as CHD. Obesity has profound effects on cardiac hemodynamics and morphology, emphasizing the importance of addressing obesity as a significant risk factor for cardiovascular health. Obesity-induced alterations in cardiac function can have significant implications for cardiovascular health and may contribute to the increased risk of heart-related complications in obese individuals. Moreover, while diastolic dysfunction may be less apparent in obese children compared to adults, certain parameters do indicate changes in early left ventricular relaxation, suggesting that obesity can cause cardiac dysfunction even in pediatric populations. As most children with CHD now survive into adulthood, there is also concern about environmental and behavioral health risk factors in this particular patient group. Addressing obesity in individuals with CHD is essential to optimize their cardiovascular health and overall quality of life. This review aims to succinctly present the data on the impact of obesity on CHD and to enhance awareness of this perilous association among patients, families, and healthcare providers.
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Affiliation(s)
- Giovanni Di Salvo
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
| | - Irene Cattapan
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Jennifer Fumanelli
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Alice Pozza
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Sara Moscatelli
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
- Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Jolanda Sabatino
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
| | - Martina Avesani
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
| | - Elena Reffo
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Domenico Sirico
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Biagio Castaldi
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Alessia Cerutti
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Roberta Biffanti
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Valeria Pergola
- Cardiology Unit, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy;
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Gonzalez Casanova I, Alonso-Gómez ÁM, Romaguera D, Toledo E, Li L, Fortuny E, López L, Ramallal R, Salas-Salvadó J, Tojal-Sierra L, Castañer O, Alonso A. Lifestyles, Left Atrial Structure and Function, and Cognitive Decline in Adults with Metabolic Syndrome. J Clin Med 2023; 12:6066. [PMID: 37763005 PMCID: PMC10532379 DOI: 10.3390/jcm12186066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Evidence supports associations of lifestyle (including diet and physical activity) and weight with cognitive functioning, but the pathways responsible for these associations have not been fully elucidated. Because healthier lifestyles have been associated with better left atrial structure and function, which in turn is associated with better cognitive functioning, we tested the hypothesis that left atrial structure and function is a potential mediator of the association between lifestyle and cognition. We included 476 participants classed as overweight or obese with metabolic syndrome from three centers in Spain. These participants underwent lifestyle assessments and transthoracic echocardiography at baseline and repeated measurements of the Trail Making A test, a measure of executive function, taken at baseline and at the two-year follow-up. We conducted mediation analyses to test if measures of left atrial structure and function mediated associations between adherence to the Mediterranean diet scores, physical activity, and weight at baseline, as well as a two-year change in Trail Making A scores. The analysis did not find an association between these factors and Trail Making A scores, and no indirect effects appeared to be mediated by echocardiographic measurements. The modest sample size in this analysis is a limitation, and larger studies should be conducted to determine potential cardiovascular factors mediating the association between lifestyle and cognition.
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Affiliation(s)
- Ines Gonzalez Casanova
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, IN 47404, USA
| | - Ángel M. Alonso-Gómez
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 01009 Vitoria-Gasteiz, Spain
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain (E.T.); (J.S.-S.)
| | - Dora Romaguera
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain (E.T.); (J.S.-S.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Estefanía Toledo
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain (E.T.); (J.S.-S.)
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Linzi Li
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA (A.A.)
| | - Elena Fortuny
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
- Cardiology Service, Manacor Hospital, 07500 Palma de Mallorca, Spain
| | - Luis López
- Cardiology Service, Son Espases University Hospital, 07120 Palma de Mallorca, Spain;
| | - Raúl Ramallal
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Department of Cardiology, University Hospital of Navarra, Servicio Navarro de Salud Osasunbidea, 31008 Pamplona, Spain
| | - Jordi Salas-Salvadó
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain (E.T.); (J.S.-S.)
- Group ANUT-DSM, Human Nutrition Unit, Department of Biochemistry and Biotechnology, Universitat Rovira i Virgili, 43201 Reus, Spain
- Human Nutrition Unit, Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
| | - Lucas Tojal-Sierra
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 01009 Vitoria-Gasteiz, Spain
| | - Olga Castañer
- Cardiovascular Risk and Nutrition Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- CIBER Consortium, M.P. Epidemiology and Public Health (CIBEROESP), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA (A.A.)
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den Uijl I, van den Berg-Emons RJG, Sunamura M, Lenzen MJ, Stam HJ, Boersma E, Tenbült-van Limpt NCCW, Kemps HMC, Geleijnse ML, ter Hoeve N. Effects of a Dedicated Cardiac Rehabilitation Program for Patients With Obesity on Body Weight, Physical Activity, Sedentary Behavior, and Physical Fitness: The OPTICARE XL Randomized Controlled Trial. Phys Ther 2023; 103:pzad055. [PMID: 37265452 PMCID: PMC10476876 DOI: 10.1093/ptj/pzad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/23/2022] [Accepted: 02/19/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Previously published results of the OPTICARE XL open label randomized controlled trial showed no added value of OPTICARE XL CR, a dedicated cardiac rehabilitation (CR) program for patients with obesity, with respect to health-related quality of life (primary outcome). This clinical trial studied the effects of OPTICARE XL CR on several secondary outcomes, which included body weight, physical activity, sedentary behavior, and physical fitness. METHODS Patients with coronary artery disease or atrial fibrillation and body mass index ≥ 30 were randomized to OPTICARE XL CR (n = 102) or standard CR (n = 99). OPTICARE XL CR was a 1-year group intervention, specifically designed for patients with obesity that included aerobic and strength exercise, behavioral coaching, and an aftercare program. Standard CR consisted of a 6- to 12-week group aerobic exercise program, supplemented with cardiovascular lifestyle education. Study end points included body weight, physical activity, sedentary behavior (accelerometer), and physical fitness (6-Minute Walk Test and handgrip strength), which were evaluated 6 months after the end of CR (primary endpoint) and 3 months after the start of CR. RESULTS Six months after completion of either program, improvements in body weight, physical activity, sedentary behavior, and physical fitness were similar between the groups. Three months after CR start, patients randomized to OPTICARE XL CR showed greater weight loss (mean change = -3.6 vs -1.8 kg) and a larger improvement in physical activity (+880 vs +481 steps per day) than patients randomized to standard CR. CONCLUSION Patients allocated to OPTICARE XL CR lost significantly more body weight and showed promising results with respect to physical activity 3 months after the start of CR; however, these short-term results were not expanded or sustained in the longer term. IMPACT Patients with obesity do not benefit from standard CR programs. The new OPTICARE XL CR program showed its effects in the short term on weight loss and physical activity, and, therefore, redesign of the aftercare phase is recommended.
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Affiliation(s)
- Iris den Uijl
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | | | - Mattie J Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Nienke ter Hoeve
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Capri Cardiac Rehabilitation, Rotterdam, the Netherlands
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Rossello X, Ramallal R, Romaguera D, Alonso-Gómez ÁM, Alonso A, Tojal-Sierra L, Fernández-Palomeque C, Martínez-González MÁ, Garrido-Uriarte M, López L, Díaz A, Zaldua-Irastorza O, Shah AJ, Salas-Salvadó J, Fitó M, Toledo E. Effect of an intensive lifestyle intervention on the structural and functional substrate for atrial fibrillation in people with metabolic syndrome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.02.23293550. [PMID: 37577657 PMCID: PMC10418292 DOI: 10.1101/2023.08.02.23293550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Aims To evaluate the effect of an intensive lifestyle intervention (ILI) on the structural and functional cardiac substrate of atrial fibrillation (AF) in overweight or obese people with metabolic syndrome (MetS). Methods Participants of the PREDIMED-PLUS trial (n=6874) were randomised 1:1 to an ILI program based on an energy-reduced Mediterranean diet, increased physical activity, and cognitive-behavioural weight management, or to a control intervention of low-intensity dietary advice. Left atrial (LA) strain, function, and volumes were evaluated by a core echocardiography lab in 534 participants at baseline, 3-year and 5-year follow-up. Mixed models were used to evaluate the effect of the ILI on LA structure and function. Results In the subsample, baseline mean age was 65 years (SD 5 years), and 40% of the participants were women. Over the 5-year period, both groups experienced worsening of LA structure and function, with increases in LA volumes and stiffness index and decreases in LA longitudinal strain, LA function index and LA emptying fraction over time. Changes in the ILI and control group were not significantly different for any of the primary outcomes (LA emptying fraction: -0.95% (95%CI -0.93, -0.98) in control group, -0.97% (95%CI -0.94, -1.00) in ILI group, p between groups =0.80; LA longitudinal strain: 0.82% (95%CI 0.79, 0.85) in control group, 0.85% (95%CI 0.82, 0.89) in ILI group, p between groups =0.24) or any of the secondary outcomes. Conclusions In overweight or obese people with MetS, an ILI had no impact on the underlying structural and functional left atrial substrate measurements associated with AF risk.
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50
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Boakye E, Grandhi GR, Dardari Z, Adhikari R, Soroosh G, Jha K, Dzaye O, Tasdighi E, Erhabor J, Kumar SJ, Whelton S, Blumenthal RS, Albert M, Rozanski A, Berman DS, Budoff MJ, Miedema MD, Nasir K, Rumberger JA, Shaw LJ, Blaha M. Cardiovascular risk stratification among individuals with obesity: The Coronary Artery Calcium Consortium. Obesity (Silver Spring) 2023; 31:2240-2248. [PMID: 37534563 PMCID: PMC10524261 DOI: 10.1002/oby.23832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE The effectiveness of coronary artery calcification (CAC) for risk stratification in obesity, in which imaging is often limited because of a reduced signal to noise ratio, has not been well studied. METHODS Data from 9334 participants (mean age: 53.3 ± 9.7 years; 67.9% men) with BMI ≥ 30 kg/m2 from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior cardiovascular diseases (CVD), were used. The predictive value of CAC for all-cause and cause-specific mortality was evaluated using multivariable-adjusted Cox proportional hazards and competing-risks regression. RESULTS Mean BMI was 34.5 (SD 4.4) kg/m2 (22.7% Class II and 10.8% Class III obesity), and 5461 (58.5%) had CAC. Compared with CAC = 0, those with CAC = 1-99, 100-299, and ≥300 Agatston units had higher rates (per 1000 person-years) of all-cause (1.97 vs. 3.5 vs. 5.2 vs. 11.3), CVD (0.4 vs. 1.1 vs. 1.5 vs. 4.2), and coronary heart disease (CHD) mortality (0.2 vs. 0.6 vs. 0.6 vs. 2.5), respectively, after mean follow-up of 10.8 ± 3.0 years. After adjusting for traditional cardiovascular risk factors, CAC ≥ 300 was associated with significantly higher risk of all-cause (hazard ratio [HR]: 2.05; 95% CI: 1.49-2.82), CVD (subdistribution HR: 3.48; 95% CI: 1.81-6.70), and CHD mortality (subdistribution HR: 5.44; 95% CI: 2.02-14.66), compared with CAC = 0. When restricting the sample to individuals with BMI ≥ 35 kg/m2 , CAC ≥ 300 remained significantly associated with the highest risk. CONCLUSIONS Among individuals with obesity, including moderate-severe obesity, CAC strongly predicts all-cause, CVD, and CHD mortality and may serve as an effective cardiovascular risk stratification tool to prioritize the allocation of therapies for weight management.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gowtham R Grandhi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rishav Adhikari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garshasb Soroosh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kunal Jha
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erfan Tasdighi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John Erhabor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sant J Kumar
- Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Seamus Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Albert
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai, St. Luke's Hospital, New York, New York, USA
| | - Daniel S Berman
- Departments of Imaging and Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - John A Rumberger
- Department of Cardiac Imaging, Princeton Longevity Center, Princeton, New Jersey, USA
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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