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Shi YJ, Dong GJ, Guo M. Targeting epicardial adipose tissue: A potential therapeutic strategy for heart failure with preserved ejection fraction with type 2 diabetes mellitus. World J Diabetes 2023; 14:724-740. [PMID: 37383601 PMCID: PMC10294070 DOI: 10.4239/wjd.v14.i6.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/10/2023] [Accepted: 04/24/2023] [Indexed: 06/14/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with various comorbidities, multiple cardiac and extracardiac pathophysiologic abnormalities, and diverse phenotypic presentations. Since HFpEF is a heterogeneous disease with different phenotypes, individualized treatment is required. HFpEF with type 2 diabetes mellitus (T2DM) represents a specific phenotype of HFpEF, with about 45%-50% of HFpEF patients suffering from T2DM. Systemic inflammation associated with dysregulated glucose metabolism is a critical pathological mechanism of HFpEF with T2DM, which is intimately related to the expansion and dysfunction (inflammation and hypermetabolic activity) of epicardial adipose tissue (EAT). EAT is well established as a very active endocrine organ that can regulate the pathophysiological processes of HFpEF with T2DM through the paracrine and endocrine mechanisms. Therefore, suppressing abnormal EAT expansion may be a promising therapeutic strategy for HFpEF with T2DM. Although there is no treatment specifically for EAT, lifestyle management, bariatric surgery, and some pharmaceutical interventions (anti-cytokine drugs, statins, proprotein convertase subtilisin/kexin type 9 inhibitors, metformin, glucagon-like peptide-1 receptor agonists, and especially sodium-glucose cotransporter-2 inhibitors) have been shown to attenuate the inflammatory response or expansion of EAT. Importantly, these treatments may be beneficial in improving the clinical symptoms or prognosis of patients with HFpEF. Accordingly, well-designed randomized controlled trials are needed to validate the efficacy of current therapies. In addition, more novel and effective therapies targeting EAT are needed in the future.
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Affiliation(s)
- Yu-Jiao Shi
- Department of Cardiovascular Medicine, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing 100091, China
| | - Guo-Ju Dong
- Department of Cardiovascular Medicine, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing 100091, China
| | - Ming Guo
- Department of Cardiovascular Medicine, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing 100091, China
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Onofrei VA, Zamfir CL, Anisie E, Ceasovschih A, Constantin M, Mitu F, Adam CA, Grigorescu ED, Petroaie AD, Timofte D. Determinants of Arterial Stiffness in Patients with Morbid Obesity. The Role of Echocardiography and Carotid Ultrasound Imaging. Medicina (B Aires) 2023; 59:medicina59030428. [PMID: 36984428 PMCID: PMC10053097 DOI: 10.3390/medicina59030428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Background and objective: Morbid obesity is accompanied by an increased cardiovascular (CV) risk, which justifies a multidisciplinary, integrative approach. Arterial stiffness has a well-defined additional role in refining individual CV risk. Given that echocardiography and carotid ultrasound are usual methods for CV risk characterization, we aimed to identify the imaging parameters with a predictive value for early-onset arterial stiffness. Material and methods: We conducted a study in which 50 patients (divided into two equal groups with morbid obesity and without obesity), age and gender matched, untreated for cardiovascular risk factors, were addressed to bariatric surgery or non-inflammatory benign pathology surgery. Before the surgical procedures, we evaluated demographics, anthropometric data and biochemical parameters including adipokines (chemerin, adiponectin). Arterial stiffness was evaluated using the Medexpert ArteriographTM TL2 device. Transthoracic echocardiography and carotid ultrasound were also performed. We also analyzed adipocyte size and vascular wall thickness in intraoperative biopsies. Results: Left ventricle (LV) mass index (p = 0.2851), LV ejection fraction (LVEF) (p = 0.0073), epicardial adipose tissue thickness (p = 0.0001) as echocardiographic parameters and carotid intima–media thickness (p = 0.0033), relative wall thickness (p = 0.0295), wall to lumen thickness ratio (p = 0.0930) and carotid cross-sectional area (p = 0.0042) as ultrasound parameters were significant measures in our groups and were assessed in relation to adipocyte size, blood vessel wall thickness and adipokines serum levels. Statistical analysis revealed directly proportional relationships between LV mass index (p = 0.008), carotid systolic thickness of the media (p = 0.009), diastolic thickness of the media (p = 0.007), cross-sectional area (p = 0.001) and blood vessel wall thickness. Carotid relative wall thickness positively correlates with adipocyte size (p = 0.023). In patients with morbid obesity, chemerin and adiponectin/chemerin ratio positively correlates with carotid intima–media thickness (p = 0.050), systolic thickness of the media (p = 0.015) and diastolic thickness of the media (p = 0.001). The multiple linear regression models revealed the role of epicardial adipose tissue thickness and carotid cross-sectional area in predicting adipocyte size which in turn is an independent factor for arterial stiffness parameters such as pulse wave velocity, subendocardial viability ratio and aortic augmentation index. Conclusions: Our results suggest that epicardial adipose tissue thickness, carotid intima–media thickness, relative wall thickness and carotid cross-sectional area might be useful imaging parameters for early prediction of arterial stiffness in patients with morbid obesity.
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Affiliation(s)
- Viviana Aursulesei Onofrei
- Department of Medical Specialties I and II, Morpho-Functional Sciences I and Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
- Correspondence: (V.A.O.); (C.A.A.)
| | - Carmen Lacramioara Zamfir
- Department of Medical Specialties I and II, Morpho-Functional Sciences I and Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Ecaterina Anisie
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Alexandr Ceasovschih
- Department of Medical Specialties I and II, Morpho-Functional Sciences I and Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Mihai Constantin
- Department of Medical Specialties I and II, Morpho-Functional Sciences I and Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I and II, Morpho-Functional Sciences I and Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Academy of Medical Sciences, Ion C. Brătianu Boulevard No 1, 030167 Bucharest, Romania
- Academy of Romanian Scientists, Professor Dr. Doc. Dimitrie Mangeron Boulevard No. 433, 700050 Iasi, Romania
| | - Cristina Andreea Adam
- Department of Medical Specialties I and II, Morpho-Functional Sciences I and Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Correspondence: (V.A.O.); (C.A.A.)
| | - Elena-Daniela Grigorescu
- Department of Medical Specialties I and II, Morpho-Functional Sciences I and Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Antoneta Dacia Petroaie
- Department of Medical Specialties I and II, Morpho-Functional Sciences I and Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Daniel Timofte
- Department of Medical Specialties I and II, Morpho-Functional Sciences I and Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
- Academy of Medical Sciences, Ion C. Brătianu Boulevard No 1, 030167 Bucharest, Romania
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Song XT, Zhang PY, Fan L, Rui YF. Epicardial adipose tissue and right ventricular function in type 2 diabetes mellitus using two-dimensional speckle tracking echocardiography. Diab Vasc Dis Res 2022; 19:14791641221118622. [PMID: 35999047 PMCID: PMC9421037 DOI: 10.1177/14791641221118622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Epicardial adipose tissue is an emerging cardiovascular risk factor. The aim of this study was to evaluate right ventricular function and investigate its association with EAT in T2DM patients. METHODS 154 T2DM patients were divided into two groups according to EAT thickness: T2DM with EAT <5 mm and T2DM with EAT ≥5 mm. Seventy non-T2DM patients were enrolled as control group. RV function was evaluated using both conventional echocardiography as well as two-dimensional speckle tracking echocardiography. EAT thickness was measured as the echo-free space between the free wall of the right ventricle and the visceral layer of pericardium at end-systole. RESULTS Compared to control group, EAT thickness was significantly higher and RV systolic function and early diastolic function are all impaired in all T2DM patients. In T2DM with EAT ≥5 mm group, RV systolic function and early diastolic function suffered more severe impairment when compared with T2DM with EAT <5 mm group. Multivariate linear regression analysis revealed that EAT was associated with RV systolic and early diastolic dysfunction independent of traditional cardiovascular risk factors. CONCLUSIONS Our research suggest that in T2DM patients RV systolic function and early diastolic function are all impaired which are associated with the thickened EAT.
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Affiliation(s)
- Xiang-ting Song
- Department of Echocardiography, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- Xiang-ting Song, Department of Echocardiography, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, No. 29, Xinglong Lane, Tianning District, Changzhou 213003, China.
| | - Ping-yang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Li Fan
- Department of Echocardiography, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Yi-fei Rui
- Department of Echocardiography, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
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Yilmaz M, Candemir B. Approach to recurrence of atrial fibrillation after catheter ablation. Minerva Cardiol Angiol 2021; 69:81-93. [PMID: 33691388 DOI: 10.23736/s2724-5683.20.05173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial fibrillation (AF) is the most commonly observed sustained rhythm disorder during adult ages. Since it has been shown that the ectopic beat initiating AF is usually caused by pulmonary veins, AF ablation has become the mainstay of therapy worldwide. Cryoballoon and radiofrequency ablation are the most commonly used methods in today's technologies. However, despite technological advances, the success of a single procedure in AF ablation is still limited and multiple procedures may be required for the majority of patients. In cases in which a redo ablation is required, pulmonary vein isolation is still the main target, but non-pulmonary vein targets should also be considered in AF episodes that continue despite multiple ablations. Many issues are still unclear as to which energy to choose in the first procedure, and what ablation strategy will be utilized when a redo ablation is required. The studies on this subject are very limited but, it still seems feasible and a rational approach to utilize a customized treatment strategy in each specific patient subgroup.
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Affiliation(s)
- Mustafa Yilmaz
- Department of Cardiology, Faculty of Medicine, Baskent University, Adana, Turkey -
| | - Basar Candemir
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Aksu Çerman A, Er Kara A, Aktaş Karabay E, Kaya HE, Kıvanç Altunay İ. Evaluation of epicardial fat thickness and the ankle-brachial index in patients with rosacea: A case-control study. J Cosmet Dermatol 2021; 20:3041-3045. [PMID: 33576108 DOI: 10.1111/jocd.13997] [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: 10/13/2020] [Revised: 01/08/2021] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent data suggest that rosacea is related to cardiovascular diseases (CVD) due to its inflammatory nature and immune dysregulation. AIM The aim of this study was to evaluate the values of epicardial fat thickness (EFT) and the ankle-brachial index (ABI) in patients with rosacea, as indicators of subclinical atherosclerosis and CVD risk. METHODS This prospective case-control study was carried out on 62 participants, including 31 rosacea patients and 31 controls. The values of EFT and ABI were measured in all subjects. RESULTS The mean thickness of EFT was statistically higher in rosacea patients (0.54 ± 0.12 mm) than in the controls (0.39 ± 0.05 mm) (P < 0.01). ABI was not significantly different between the subjects with rosacea and the comparison group (1.02 ± 0.1 vs 0.98 ± 0.07; P = 0.131). A total of 29% of the rosacea patients had mitral valve insufficiency (MVI), while 3.2% of the control group had MVI (P = 0.006). A mild degree of tricuspid valve insufficiency (TVI) was present in 45.2% of the rosacea patients, while 19.4% of the controls had TVI (P = 0.03). CONCLUSION Rosacea may be associated with subclinical cardiac dysfunction. EFT measurements in rosacea patients can provide early detection of possible subclinical cardiovascular diseases, which can be life-extending in rosacea. However, further studies with larger sample sizes are required to confirm the present findings.
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Affiliation(s)
- Aslı Aksu Çerman
- Department of Dermatology, Health Science University Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Arzu Er Kara
- Department of Cardiology, Health Science University Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Aktaş Karabay
- Department of Dermatology, Okmeydanı Training and Research Hospital (Prof Dr Cemil Taşçıoğlu City Hospital), Istanbul, Turkey
| | - Hazel Ezgi Kaya
- Department of Dermatology, Health Science University Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - İlknur Kıvanç Altunay
- Department of Dermatology, Health Science University Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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6
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El Khoudary SR, Venugopal V, Manson JE, Brooks MM, Santoro N, Black DM, Harman M, Naftolin F, Hodis HN, Brinton EA, Miller VM, Taylor HS, Budoff MJ. Heart fat and carotid artery atherosclerosis progression in recently menopausal women: impact of menopausal hormone therapy: The KEEPS trial. ACTA ACUST UNITED AC 2021; 27:255-262. [PMID: 32015261 DOI: 10.1097/gme.0000000000001472] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Heart fat deposition has been linked to atherosclerosis, and both accelerate after menopause. Hormone therapy (HT) may differentially slow heart fat deposition and progression of atherosclerosis, depending on the specific HT agent or its route of administration. Our objective was to evaluate the effects of different HT agents, oral and transdermal, on associations between heart fat accumulation and atherosclerosis progression, measured by carotid intima-media thickness (CIMT), in recently menopausal women from the Kronos Early Estrogen Prevention Study (KEEPS) trial. METHODS KEEPS was a randomized, placebo-controlled trial of the effects of 0.45 mg/d oral conjugated equine estrogens (o-CEE) or 50 mcg/d transdermal 17β-estradiol (t-E2), compared with placebo, on 48 months progression of CIMT. Epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT) volumes were quantified by computed tomography. RESULTS In all, 467 women (mean age [SD] 52.7 [2.5]; 78.2% White; 30% on o-CEE, 30.8% t-E2, 39.2% placebo) with heart fat volumes and CIMT at baseline and 48 months were included. EAT and PAT changes were not associated with CIMT progression; however, the assigned treatment significantly modified the association between PAT (but not EAT) change and CIMT progression. In the o-CEE group, adjusted CIMT progression was 12.66 μm (95% confidence interval [CI] 1.80, 23.52) lower than in t-E2 group (P = 0.02), and 10.09 μm (95% CI 0.79, 19.39) lower than in placebo group (P = 0.03), as per 1-SD increase in PAT. CONCLUSION Compared with t-E2, o-CEE appears to slow down the adverse effect of increasing PAT on progression of atherosclerosis. Whether this beneficial association is specific to CEE or to the oral route of CEE administration is unclear and should be assessed further.
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Affiliation(s)
| | | | - JoAnn E Manson
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | | | | | - Dennis M Black
- University of California San Francisco, San Francisco, CA
| | | | - Frederick Naftolin
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Howard N Hodis
- Atherosclerosis Research Unit, University of Southern California, Los Angeles, CA
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Corica D, Oreto L, Pepe G, Calabrò MP, Longobardo L, Morabito L, Pajno GB, Alibrandi A, Aversa T, Wasniewska M. Precocious Preclinical Cardiovascular Sonographic Markers in Metabolically Healthy and Unhealthy Childhood Obesity. Front Endocrinol (Lausanne) 2020; 11:56. [PMID: 32194501 PMCID: PMC7062712 DOI: 10.3389/fendo.2020.00056] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Childhood obesity is related to a wide spectrum of cardiovascular and metabolic comorbidities. Objectives: (1) To identify precocious, preclinical, cardiovascular sonographic modifications, in a cohort of overweight (OW) and obese (OB) children and adolescents compared to lean controls; (2) to investigate the association between clinical and metabolic variables and cardiovascular sonographic parameters; (3) to evaluate their relation with two different phenotypes of obesity: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). Materials and Methods: Fifty-nine OW and OB children and adolescents (9.8 ± 2.9 years) and 20 matched lean controls underwent anthropometric, biochemical, echocardiography assessment, and sonographic evaluation of carotid artery and ascending aorta (AA). OW and OB subjects were divided in MHO and MUO, according to the Camhi et al. definition. Results: OW and OB children showed significantly higher left ventricular (LV) dimensions and mass, carotid artery intima-media thickness (CIMT), carotid stiffness [β-index, pulse wave velocity (PWV)], significantly lower mitral peak early (E) and late (A) velocity ratio (E/A ratio), and significantly impaired global longitudinal strain (GLS) compared to controls. BMI SD and HOMA-IR were positively significantly related to LV dimensions, LA volume and epicardial adipose tissue (EAT), and negative to E/A ratio. Waist circumference (WC) was positively correlated to LV dimensions, LA volume, CIMT, PWV, AA diameter, and EAT. Furthermore, WC was a strong predictor of LV dimensions, LA volume and strain, AA stiffness and diameter; BMI SD was significantly associated with EAT, LVM index, and E/A ratio; HOMA-IR and triglycerides were significant predictors of GLS. MUO patients showed higher BMI SD (p = 0.02), WC (p = 0.001), WHtR (p = 0.001), HOMA-IR (p = 0.004), triglycerides (p = 0.01), SBP (p = 0.001), as well as LV dimensions, EAT (p = 0.03), CIMT (p = 0.01), AA diameter (p = 0.02), β-index (p = 0.03) and PWV (p = 0.002), AA stiffness (p = 0.006), and significantly impaired GLS (p = 0.042) compared to MHO. Conclusions: Severity of overweight, abdominal obesity, insulin resistance, and MUO phenotype negatively affect cardiovascular remodeling and subclinical myocardial dysfunction in OW and OB children. MUO phenotype is likely to increase the risk of developing cardiometabolic complications since the pediatric age. Distinction between MHO and MUO phenotypes might be useful in planning a personalized follow-up approach in obese children.
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Affiliation(s)
- Domenico Corica
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
- *Correspondence: Domenico Corica
| | - Lilia Oreto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Maria Pia Calabrò
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Luca Longobardo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Letteria Morabito
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Giovanni Battista Pajno
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | | | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
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Sánchez E, Betriu À, López-Cano C, Hernández M, Fernández E, Purroy F, Bermúdez-López M, Farràs-Sallés C, Barril S, Pamplona R, Rius F, Hernández C, Simó R, Lecube A. Characteristics of atheromatosis in the prediabetes stage: a cross-sectional investigation of the ILERVAS project. Cardiovasc Diabetol 2019; 18:154. [PMID: 31729979 PMCID: PMC6857207 DOI: 10.1186/s12933-019-0962-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/02/2019] [Indexed: 12/23/2022] Open
Abstract
Background Prediabetes has recently been associated with subclinical atheromatous disease in the middle-aged population. Our aim was to characterize atheromatous plaque burden by the number of affected territories and the total plaque area in the prediabetes stage. Methods Atheromatous plaque burden (quantity of plaques and total plaque area) was assessed in 12 territories from the carotid and femoral regions using ultrasonography in 6688 non-diabetic middle-aged subjects without cardiovascular disease. Prediabetes was defined by glycosylated hemoglobin (HbA1c) between 5.7 and 6.4% according to the American Diabetes Association guidelines. Results Prediabetes was diagnosed in 33.9% (n = 2269) of the ILERVAS participants. Subjects with prediabetes presented a higher prevalence of subclinical atheromatous disease than participants with HbA1c < 5.7% (70.4 vs. 67.5%, p = 0.017). In the population with prediabetes this was observed at the level of the carotid territory (p < 0.001), but not in the femoral arteries. Participants in the prediabetes stage also presented a significantly higher number of affected territories (2 [1;3] vs. 1 [0;3], p = 0.002), with a positive correlation between HbA1c levels and the number of affected territories (r = 0.068, p < 0.001). However, atheromatosis was only significantly (p = 0.016) magnified by prediabetes in those subjects with 3 or more cardiovascular risk factors. The multivariable logistic regression model showed that the well-established cardiovascular risk factors together with HbA1c were independently associated with the presence of atheromatous disease in participants with prediabetes. When males and females were analyzed separately, we found that only men with prediabetes presented both carotid and femoral atherosclerosis, as well as an increase of total plaque area in comparison with non-prediabetic subjects. Conclusions The prediabetes stage is accompanied by an increased subclinical atheromatous disease only in the presence of other cardiovascular risk factors. Prediabetes modulates the atherogenic effect of cardiovascular risk factors in terms of distribution and total plaque area in a sex-dependent manner. Trial registration NCT03228459 (clinicaltrials.gov)
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Affiliation(s)
- Enric Sánchez
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Àngels Betriu
- Vascular and Renal Translational Research Group, IRBLleida, RedinRen-ISCIII, Lleida, Spain
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Elvira Fernández
- Vascular and Renal Translational Research Group, IRBLleida, RedinRen-ISCIII, Lleida, Spain
| | - Francisco Purroy
- Stroke Unit, University Hospital Arnau de Vilanova, Clinical Neurosciences Group. IRBLleida, University of Lleida, Lleida, Spain
| | | | - Cristina Farràs-Sallés
- Applied Epidemiology Research Group, IRBLleida, Lleida, Spain.,Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Silvia Barril
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Reinald Pamplona
- Experimental Medicine Department, IRBLleida, University of Lleida, Lleida, Spain
| | - Ferran Rius
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Cristina Hernández
- Endocrinology and Nutrition Department, University Hospital Vall d'Hebron. Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Autonomous University of Barcelona, Pg. Vall d'Hebron 119-129, 08024, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Rafael Simó
- Endocrinology and Nutrition Department, University Hospital Vall d'Hebron. Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Autonomous University of Barcelona, Pg. Vall d'Hebron 119-129, 08024, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Albert Lecube
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research Group, IRBLleida, University of Lleida, Lleida, Spain. .,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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Lind L. A detailed lipoprotein profile in relation to intima-media thickness and echogenicity of three major arteries. Clin Physiol Funct Imaging 2019; 39:415-421. [PMID: 31529768 DOI: 10.1111/cpf.12594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/09/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate differences in risk-factor profile, with special emphasis on detailed characterization of the lipoprotein profile, for intima-media thickness (IMT) and echogenicity of the intima-media complex (IM-GSM) in three major arteries: the carotid, femoral and brachial arteries. METHODS IMT and IM-GSM were measured by ultrasound in the carotid, femoral and brachial arteries in 778 subjects, all aged 75 years (50% women), in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, in which a detailed lipoprotein profile was also determined by nuclear magnetic resonance spectroscopy. RESULTS First, IMT was considerably lower, and IM-GSM higher, in the brachial artery compared to the other two arteries. Second, IMT and IM-GSM in the arteries were related to each other. Third, significant different traditional risk-factor profiles were seen for both IMT and IM-GSM, with generally weaker relationships for IMT in the femoral and brachial arteries compared with the carotid artery. Fourth, the strength of associations between an atherogenic lipoprotein profile and IMT in the carotid artery was attenuated in the femoral artery and virtually absent in the brachial artery. Fifth, slightly different lipoprotein profiles were seen for IM-GSM in the three arteries. CONCLUSION Differences between the carotid, femoral and brachial artery IMT and IM-GSM were seen regarding the traditional risk factors, as well as the lipoprotein profile.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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10
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Yılmaz HEB, Yılmaz M, Şen N, Ünsal ZE, Eyüboğlu FÖ, Akçay Ş. Investigation of the Relationship between Asthma and Visceral Obesity by Epicardial Fat Thickness Measurement. Turk Thorac J 2019; 20:1-5. [PMID: 30664419 DOI: 10.5152/turkthoracj.2018.18028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/17/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Obesity is a risk factor defined in recent years for asthma. It is associated not only with asthma but also with many cardiovascular diseases. Visceral obesity is a more significant risk factor than general obesity in cardiovascular diseases. Although the association of visceral obesity with cardiovascular diseases is well known, the relationship in patients with asthma is not fully understood. The aim of the present study was to investigate whether there is a relationship between asthma and visceral fat by using epicardial fat thickness (EFT) measurement. MATERIALS AND METHODS A total of 401 subjects (229 patients with persistent asthma and 172 controls) were enrolled in the study. In our study, EFT was measured, recorded by echocardiography, and was evaluated whether there was a statistical significant difference between the two groups. RESULTS The mean EFT was 5.84±0.79 mm in the patient group and 5.71±0.93 mm in the control group. There was no statistically significant difference between the groups (p=0.145). Similarly, when we compared control and asthma severity subgroups, we did not find statistically significant differences (control group mean 5.71±0.93 mm, mild group mean 5.86±0.81 mm, moderate group mean 5.8±0.84 mm, and severe group mean 5.83±0.67 mm, p=0.505). CONCLUSION In the present study, we observed that the EFT did not increase in patients with asthma compared with the normal population. Based on our results, we suggest that visceral obesity may not be a significant risk factor for asthma.
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Affiliation(s)
| | - Mustafa Yılmaz
- Department of Cardiology, Başkent University School of Medicine, Adana, Turkey
| | - Nazan Şen
- Department of Pulmonary Medicine, Başkent University School of Medicine, Adana, Turkey
| | - Zuhal Ekici Ünsal
- Department of Pulmonary Medicine, Başkent University School of Medicine, Adana, Turkey
| | - Füsun Öner Eyüboğlu
- Department of Pulmonary Medicine, Başkent University School of Medicine, Ankara, Turkey
| | - Şule Akçay
- Department of Pulmonary Medicine, Başkent University School of Medicine, Ankara, Turkey
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11
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Kul S, Dursun İ, Sayın MR, Şahin S, Turan T, Akyüz AR, Korkmaz L, Karadeniz A, Yılmaz AS, Durmuş İ. Presystolic wave is associated with carotid intima media thickness. Echocardiography 2018; 36:237-242. [DOI: 10.1111/echo.14217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Selim Kul
- Department of CardiologyTrabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application CenterSaglik Bilimleri Universitesi (University of Health Sciences) Trabzon Turkey
| | - İhsan Dursun
- Department of CardiologyTrabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application CenterSaglik Bilimleri Universitesi (University of Health Sciences) Trabzon Turkey
| | - Muhammet Raşit Sayın
- Department of CardiologyTrabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application CenterSaglik Bilimleri Universitesi (University of Health Sciences) Trabzon Turkey
| | - Sinan Şahin
- Department of CardiologyTrabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application CenterSaglik Bilimleri Universitesi (University of Health Sciences) Trabzon Turkey
| | - Turhan Turan
- Department of CardiologyTrabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application CenterSaglik Bilimleri Universitesi (University of Health Sciences) Trabzon Turkey
| | - Ali Rıza Akyüz
- Department of CardiologyTrabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application CenterSaglik Bilimleri Universitesi (University of Health Sciences) Trabzon Turkey
| | - Levent Korkmaz
- Department of CardiologyTrabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application CenterSaglik Bilimleri Universitesi (University of Health Sciences) Trabzon Turkey
| | - Ayşegül Karadeniz
- Department of RadiologyTrabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application CenterSaglik Bilimleri Universitesi (University of Health Sciences) Trabzon Turkey
| | - Ahmet Seyda Yılmaz
- Department of CardiologyTrabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application CenterSaglik Bilimleri Universitesi (University of Health Sciences) Trabzon Turkey
| | - İsmet Durmuş
- Department of CardiologyTrabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application CenterSaglik Bilimleri Universitesi (University of Health Sciences) Trabzon Turkey
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12
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Altin C, Erol V, Aydin E, Yilmaz M, Tekindal MA, Sade LE, Gulay H, Muderrisoglu H. Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: A prospective study. Nutr Metab Cardiovasc Dis 2018; 28:501-509. [PMID: 29571589 DOI: 10.1016/j.numecd.2018.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/09/2018] [Accepted: 02/02/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease (CVD) is one of the leading causes of mortality in obese patients. We aimed to investigate the influence of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on carotid intima media thickness (CIMT) and epicardial fat thickness (EFT) which are the independent predictors of subclinical atherosclerosis. METHODS AND RESULTS Patients were recruited for standard indications. A total of 105 patients (79 women and 26 men) with the mean age of 43.61 ± 12.42 were prospectively enrolled. On B-mode duplex ultrasound; the mean CIMT at the far wall of both left and right common carotid arteries were measured. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Delta (Δ) values were obtained by subtracting sixth month values from the baseline values. Body mass index (BMI) was significantly reduced from 46.95 ± 7.54 to 33.54 ± 6.41 kg/m2 (p < 0.001) in sixth months after LSG. Both EFT and CIMT were significantly decreased after surgery (8.68 ± 1.95 mm vs. 7.41 ± 1.87 mm; p < 0.001 and 0.74 ± 0.13 mm vs. 0.67 ± 0.11 mm; p < 0.001 respectively). A significant correlation between ΔEFT and ΔBMI (r = 0.431, p < 0.001) was shown. ΔCIMT is significantly correlated with ΔEFT, ΔBMI and Δ systolic blood pressure (r = 0.310, r = 0.285 and r = 0.231 respectively, p < 0.05 for all). In multivariate stepwise linear regression analysis; among variables only ΔBMI was the independent predictor of ΔEFT (β = 153, p = 0.001). CONCLUSION Early atherosclerotic structural changes may be reversed or improved by sustained weight loss after LSG in asymptomatic obese patients.
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Affiliation(s)
- C Altin
- Department of Cardiology, Baskent University Faculty of Medicine Hospitals, İzmir, Turkey.
| | - V Erol
- Department of General Surgery, Baskent University Faculty of Medicine Hospitals, İzmir, Turkey
| | - E Aydin
- Department of Radiology, Baskent University Faculty of Medicine Hospitals, İzmir, Turkey
| | - M Yilmaz
- Department of Cardiology, Baskent University Faculty of Medicine Hospitals, Adana, Turkey
| | - M A Tekindal
- Department of Biostatistics, Selcuk University, Konya, Turkey
| | - L E Sade
- Department of Cardiology, Baskent University Faculty of Medicine Hospitals, Ankara, Turkey
| | - H Gulay
- Department of General Surgery, Baskent University Faculty of Medicine Hospitals, İzmir, Turkey
| | - H Muderrisoglu
- Department of Cardiology, Baskent University Faculty of Medicine Hospitals, Ankara, Turkey
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13
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Belli AA, Altun I, Altun I. Thickness of carotid intima and epicardial fat in rosacea: a cross-sectional study. An Bras Dermatol 2018; 92:820-825. [PMID: 29364439 PMCID: PMC5786397 DOI: 10.1590/abd1806-4841.20176832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/22/2017] [Indexed: 01/14/2023] Open
Abstract
Background Rosacea is a chronic facial skin disease associated with excessive
inflammatory response to various triggers. Although some studies have
supported the increased risk of cardiovascular diseases in rosacea, it has
not been completely accepted. Objective We aimed to investigate epicardial fat thickness and carotid intima-media
thickness as cardiovascular risk predictors in rosacea patients. Methods We conducted a cross-sectional study including 40 rosacea patients and 40
controls. Demographic data, epicardial fat thickness, carotid intima-media
thickness, lipid parameters, biochemical parameters, presence of insulin
resistance, and presence of metabolic syndrome of the participants were
recorded. Results Forty rosacea patients (31 female and 9 male) and 40 controls (30 female and
10 male) were enrolled in the study. Rosacea patients had significantly
higher epicardial fat thickness and carotid intima-media thickness volumes
than controls (P<0.001). In the multivariate logistic regression
analysis, epicardial fat thickness was independently related to presence of
rosacea (P<0.001, OR=13.31). In the multiple linear regression analysis,
the epicardial fat thickness was independently associated with rosacea
(β= 0.47, P<0.001), carotid intima-media thickness (β=
0.36, P<0.001), and systolic blood pressure (β=0.19, P=0.015) and
the carotid intima-media thickness was independently associated with
epicardial fat thickness (β= 0.6, P<0.001). The epicardial fat
thickness levels were correlated with carotid intima-media thickness
(r=0.63, P<0.001), LDL (r=0.23, P=0.037), systolic blood pressure
(r=0.45, P<0.001), and diastolic blood pressure levels (r=0.37, P=0.001).
The carotid intima-media thickness levels were correlated with epicardial
fat thickness (r=0.63, P<0.001), systolic blood pressure (r=0.04,
P<0.001), and diastolic blood pressure levels (r=0.27, P=0.016). Study limitations The small number of participants. Conclusions Examination and follow-up of rosacea patients for cardiovascular diseases may
be recommended practices.
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Affiliation(s)
- Asli Akin Belli
- Department of Dermatology, Mugla Sitki Kocman University Training and Research Hospital - Muğla, Turkey
| | - Ilknur Altun
- Department of Radiology, Mugla Sitki Kocman University Training and Research Hospital - Muğla, Turkey
| | - Ibrahim Altun
- Department of Cardiology, Mugla Sitki Kocman University Medical School - Muğla, Turkey
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14
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Altin C, Yilmaz M, Ozsoy HM, Gezmis E, Balci S, Tekindal MA, Sade LE, Muderrisoglu H. Assessment of epicardial fat and carotid intima media thickness in gestational hypertension. J Obstet Gynaecol Res 2018; 44:1072-1079. [DOI: 10.1111/jog.13631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 02/08/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Cihan Altin
- Department of Cardiology; Baskent University Faculty of Medicine; Ankara Turkey
| | - Mustafa Yilmaz
- Department of Cardiology; Baskent University Faculty of Medicine; Ankara Turkey
| | - Hasmet M. Ozsoy
- Department of Gyneacology and Obstetrics; Baskent University Faculty of Medicine; Ankara Turkey
| | - Esin Gezmis
- Department of Radiology; Baskent University Faculty of Medicine; Ankara Turkey
| | - Serdar Balci
- Department of Gyneacology and Obstetrics; Baskent University Faculty of Medicine; Ankara Turkey
| | | | - Leyla E. Sade
- Department of Cardiology; Baskent University Faculty of Medicine; Ankara Turkey
| | - Haldun Muderrisoglu
- Department of Cardiology; Baskent University Faculty of Medicine; Ankara Turkey
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15
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Echolucency of the carotid artery is associated with short-term plaque progression and positive remodeling in the culprit coronary artery in AMI survivors. J Cardiol 2017; 70:438-445. [DOI: 10.1016/j.jjcc.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/05/2017] [Accepted: 01/13/2017] [Indexed: 11/20/2022]
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