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Gupta A, Garg R, Chawla SPS, Kaur S, Goyal S. Assessment of Cardiovascular Parameters on Submaximal Treadmill Exercise in Obese versus Nonobese Adults. Int J Appl Basic Med Res 2023; 13:212-217. [PMID: 38229726 PMCID: PMC10789467 DOI: 10.4103/ijabmr.ijabmr_290_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/17/2023] [Accepted: 10/18/2023] [Indexed: 01/18/2024] Open
Abstract
Background Obesity and overweight, irrespective of metabolic status, confer an increased risk of adverse consequences including cardiovascular diseases (CVDs). The mechanisms underlying altered cardiovascular responses in obese individuals during and after submaximal treadmill exercise are the subjects of great interest to public health. After graded exercise, delayed heart rate recovery (HRR), exaggerated blood pressure (BP) response, and prolongation of QT interval are the powerful predictors of cardiovascular morbidity and mortality that may facilitate timely identification of individuals at risk of CVD and help to evaluate the effectiveness of treatment interventions. Aim To compare the cardiovascular parameters on submaximal treadmill exercise in obese and nonobese adults. Materials and Methods This study was conducted on 80 subjects, 40 obese (cases) and 40 normal-weight individuals (controls), belonging to the age group of 18-60 years. Each participant was subjected to submaximal treadmill exercise according to the Bruce protocol. Heart rate (HR), systolic BP and diastolic BP (SBP and DBP), mean arterial pressure (MAP), QT and corrected QT (QTc) intervals, and rate pressure product (RPP) were measured preexercise, immediately after exercise, and during passive recovery at 1 min and 5 min after exercise. The Chi-square test and Mann-Whitney U-test, whichever is appropriate, were employed for the comparison of variables between the two study groups. P < 0.05 was considered statistically significant. Results Mean HR immediately after exercise, at 1 min and 5 min postexercise was significantly higher in obese when compared to nonobese participants (P = 0.006, P = 0.001, P = 0.001) despite similar resting HR in both the groups (P = 0.874). Mean SBP, DBP, MAP, and RPP were significantly higher in obese in comparison to nonobese subjects in all stages, i.e. before exercise, immediately after exercise, at 1 min and 5 min after exercise. QT and QTc intervals were also found to be significantly greater in obese than nonobese subjects in all stages (P = 0.001 each). Conclusion Obese subjects had higher resting BP (SBP, DBP, and MAP), QT/QTc interval, RPP, and increased response to submaximal treadmill exercise activity. Delayed HRR after exercise was also noted in obese subjects which indicates that obese populations are at risk of developing CVDs due to alteration in autonomic functions with sympathetic hyperactivity.
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Affiliation(s)
- Aditya Gupta
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Ravinder Garg
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sumit Pal Singh Chawla
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sarabjot Kaur
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Shiwali Goyal
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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McGee JE, Early KS, Huff AC, Clunan MC, Hursey NR, Osborne B, Bucher C, Tanner C, Brewer SB, Brophy PM, Clark A, Pories WJ, Matarese LE, Houmard JA, Collier D, May LE, McClung JM, Earnest CP, Swift DL. Effects of weight loss and weight loss maintenance on cardiac autonomic function in obesity: a randomized controlled trial. Appl Physiol Nutr Metab 2023; 48:678-691. [PMID: 37229779 PMCID: PMC11042485 DOI: 10.1139/apnm-2023-0025] [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] [Indexed: 05/27/2023]
Abstract
NOVELTY Caloric restriction and exercise exert significant improvements in cardiac autonomic function as measured by HRV in overweight and obesity. Aerobic exercise training, within recommended guidelines coupled with weight loss maintenance, retains cardiac autonomic function benefits from weight loss in previously obese individuals.
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Affiliation(s)
- Joshua E. McGee
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Kate S. Early
- Department of Health, Columbus State University, Columbus, GA, 31907, USA
| | - Anna C. Huff
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Marie C. Clunan
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Nicole R. Hursey
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | | | | | - Charles Tanner
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Savanna B. Brewer
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Patricia M. Brophy
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
| | - Angela Clark
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
| | - Walter J. Pories
- Department of Surgery, East Carolina University, Greenville, NC 27858, USA
| | - Laura E. Matarese
- Department of Internal Medicine, East Carolina University, Greenville, NC 27858, USA
| | - Joseph A. Houmard
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - David Collier
- Department of Pediatrics, East Carolina University, Greenville, NC 27858, USA
| | - Linda E. May
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
| | - Joseph M. McClung
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
- Department of Physiology, East Carolina University, Greenville, NC 27858, USA
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC 27858, USA
| | - Conrad P. Earnest
- Texas A&M University, Department of Health and Kinesiology, College Station, TX 79016, USA
| | - Damon L. Swift
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
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Rafiq N, Nabi T, Kotwal S, Charak G, Shekhar S. Effect of isometric exercise on heart rate variability in prehypertensive young adults. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_31_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chen H, Wang X, Xiong C, Zou H. The negative effects of obesity on heart, especially the electrophysiology of the heart. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2021; 48:1055-1062. [PMID: 32696673 DOI: 10.1080/21691401.2020.1770269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Obesity is associated with ventricular arrhythmia and sudden cardiac death. Numerous studies have shown that obesity may have effects on the heart by affecting the ventricular re-polarisation (VR). As an effective detection method for VR the measurement of the QT interval has been extensively studied in obese patients (OP). This review aims to investigate the relationship between obesity and obesity-related diseases; including diabetes, hypertension and cardiovascular diseases (CVD). This review compares the advantages and disadvantages of different QT interval measurement methods, as well as explores the possible mechanisms of obesity leading to heart disease. Finally, it also reviews the feasibility of various weight loss methods to reverse the risk of obesity leading to heart disease is discussed.
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Affiliation(s)
- Haishan Chen
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Xin Wang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Chongxiang Xiong
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Hequn Zou
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
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Itagi ABH, Jayalakshmi MK, Yunus GY. Effect of obesity on cardiovascular responses to submaximal treadmill exercise in adult males. J Family Med Prim Care 2020; 9:4673-4679. [PMID: 33209782 PMCID: PMC7652132 DOI: 10.4103/jfmpc.jfmpc_543_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/26/2020] [Accepted: 05/20/2020] [Indexed: 11/06/2022] Open
Abstract
Context: Obesity is a major risk factor for chronic diseases. Abnormal changes in cardiovascular responses to exercise indicate the alteration in autonomic activity in obese. Aims: To assess and compare the cardiovascular parameters before and after exercise among obese and nonobese adult males. Subjects and Methods: Thirty each obese and normal-weight males between the age group 18-45 years were selected as cases and controls, respectively. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), corrected QT intervals were measured before and after submaximal treadmill exercise (QT and QTc) were done according to Bruce protocol. HR, SBP, DBP, MAP, QT, and QTc were also measured during passive recovery at 1 min and 5 min after exercise. Statistical Analysis Used: One-way analysis of variance and t-test were used to assess changes before and after exercise. Results: Resting HR was significantly higher in obese when compared to nonobese (P < 0.05). SBP, DBP, MAP, QT, and QTc were significantly higher in obese when compared to nonobese (P < 0.001). Immediately after exercise HR, SBP, DBP, MAP, QT, and QTc were significantly higher in obese when compared to nonobese (P < 0.001) 1 min after exercise. Conclusions: Obese individuals had elevated resting cardiovascular parameters and showed increased responses to steady exercise which could be due to alteration in autonomic functions with sympathetic hyperactivity. Delayed rate of decrease in HR and BP after exercise was also observed in obese, which indicates that they are at risk of developing cardiovascular diseases.
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Affiliation(s)
- Afreen Begum H Itagi
- Department of Physiology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - M K Jayalakshmi
- Department of Physiology, Gadag Institute of Medical Sciences, Gadag, Karnataka, India
| | - G Y Yunus
- Department of of Public Health Dentistry, Aditya Dental College, Beed, Maharashtra, India
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Murine model of left ventricular diastolic dysfunction and electro-mechanical uncoupling following high-fat diet. Int J Obes (Lond) 2019; 44:1428-1439. [PMID: 31792335 DOI: 10.1038/s41366-019-0500-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/24/2019] [Accepted: 11/06/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES It is well established that obesity is an independent risk factor for cardiac death. In particular various cardiac alterations have been described in obese patients such as long QT on ECG, impaired diastolic filling of the left ventricle (LV), and all-type arrhythmias. In the present study, the above alterations were all reproduced in a mouse model of fat diet-induced obesity. ANIMALS/METHODS In C57BL6 mice fed on a high fat (n = 20, HF-group) or standard diet (n = 20, C-group) for 13 weeks, balanced by sex and age, we examined heart morphology and function by high-frequency ultrasounds and electric activity by surface ECG. Besides, the autonomic sympathovagal balance (heart-rate variability) and the arrhythmogenic susceptibility to adrenergic challenge (i.p. isoproterenol) were compared in the two groups, as well as glucose tolerance (i.p. glucose test) and liver steatosis (ultrasounds). RESULTS Body weight in HF-group exceeded C-group at the end of the experiment (+28% p < 0.01). An abnormal ventricular repolarization (long QTc on ECG) together with impaired LV filling rate and increased LV mass was found in HF-group as compared to C. Moreover, HF-group showed higher heart rate, unbalanced autonomic control with adrenergic prevalence and a greater susceptibility to develop rhythm disturbances under adrenergic challenge (i.p. isoprenaline). Impaired glucose tolerance and higher liver fat accumulation were also found in HF mice compared to C. CONCLUSIONS The described murine model of 13 weeks on HF diet, well reproduced the cardiovascular and metabolic disorders reported in clinical obesity, suggesting its potential utility as translational mean suitable for testing new pharmaco-therapeutic approaches to the treatment of obesity and its comorbidity.
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Ma Q, Li Z, Guo X, Guo L, Yu S, Yang H, Zou L, Zheng L, Pan G, Zhang Y, Sun Y. Prevalence and risk factors of prolonged corrected QT interval in general Chinese population. BMC Cardiovasc Disord 2019; 19:276. [PMID: 31783793 PMCID: PMC6884801 DOI: 10.1186/s12872-019-1244-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 11/06/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Corrected QT (QTc) interval has been correlated with total and CVD mortality. Although much is known about the relation between prolonged QTc interval and clinical outcome, there is no information on the prevalence and specific risk factors of QTc prolongation in general Chinese population. We evaluated the prevalence of prolonged QTc interval and its risk factors in general Chinese population, aiming to fill in the gaps in the literature and provide evidence for potential CVD risk prediction and disease burden estimate in community. METHODS A population-based survey was conducted on 11,209 participants over the age of 35 in rural areas of Liaoning Province from 2012 to 2013. Twelve-lead ECGs and automatic analysis were performed on all participants. Logistic regression adjustments were made by using the Bazett's formula to correlate specific risk factors with prolonged QTc intervals (> 440 ms) for potential confounders. RESULTS The overall prevalence of prolonged QTc interval was 31.6%. The prevalence increased significantly with age (24.1% among those aged 35-44 years; 28.3%, 45-54 years; 35.2%, 55-64 years; 43.4%, ≥65 years, P < 0.001). Participants with a history of CVD had a higher prevalence of QTc prolongation (40.7% vs. 30.0%). In the fully adjusted logistic regress model, older age, abdominal obesity, hypertension, diabetes, hypokalemia and any medicine used in the past two weeks were associated independently with increased risk for prolonged QTc interval (All P < 0.05). We found no significant differences between general obesity, hypocalcemia and hypomagnesemia with prolongation of QTc interval. Female sex showed opposite results after applying clinical diagnostic criteria, and high physical activity could reduce the risk of prolonged QTc interval. CONCLUSIONS The prevalence of prolonged QTc interval was relatively high in general Chinese population and listed relevant factors, which would help identify patients at risk in pre-clinical prevention and provide evidence for estimating potential CVD burden and making management strategies in community.
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Affiliation(s)
- Qun Ma
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Zhao Li
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Xiaofan Guo
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Liang Guo
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Shasha Yu
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Hongmei Yang
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Lu Zou
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Guowei Pan
- Department of Prevention of Chronic Non-communicable Diseases, Center for Disease Prevention and Control of Liaoning Province, Shenyang, Liaoning People’s Republic of China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu People’s Republic of China
| | - Yingxian Sun
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
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Kumar T, Jha K, Sharan A, Sakshi P, Kumar S, Kumari A. Study of the effect of obesity on QT-interval among adults. J Family Med Prim Care 2019; 8:1626-1629. [PMID: 31198727 PMCID: PMC6559070 DOI: 10.4103/jfmpc.jfmpc_168_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Obesity affects the different organ systems of human body and has been recognized as a risk factor for the development of many diseases. Most of the cardiovascular diseases develop due to obesity which reflects alterations in either cardiac morphology or conduction defects. These abnormalities are reflected in ECG as prolongation of various intervals. Prolongation of QT-interval has been found to be associated with ventricular arrhythmia and sudden cardiac death. AIMS AND OBJECTIVES The aim of the study was to investigate the effect of obesity on QT-interval to assess the risk of development of cardiovascular diseases in early stage. MATERIALS AND METHODS A cross-sectional study was conducted on 80 cases and 80 controls, which included adults of 18-40 years age groups from both sexes. The cases were obese [body mass index (BMI) >30 kg/m2] and the controls were nonobese (BMI < 25 kg/m2). ECG of the cases and controls was recorded and their QT-intervals were calculated and analyzed with BMI by independent samples test. RESULTS We found significantly higher QT-intervals in obese group in comparison to that of nonobese group (P = 0.000). CONCLUSION Obesity was found to be associated with prolongation of QT-interval among young obese adults. This prolongation of QT-interval duration increases the possibility of left ventricular enlargement and ventricular fibrillation. Hence the present study helps in creating awareness among obese people so that they can change their lifestyle in order to prevent the onset of the deleterious effects of obesity on their health.
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Affiliation(s)
- Tarun Kumar
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Kamlesh Jha
- Department of Physiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ashok Sharan
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Pooja Sakshi
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shishir Kumar
- Department of Community Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Amita Kumari
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Crystalloid coloading vs. colloid coloading in elective Caesarean section: postspinal hypotension and vasopressor consumption, a prospective, observational clinical trial. J Anesth 2018; 33:40-49. [PMID: 30523408 DOI: 10.1007/s00540-018-2581-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/06/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Maternal hypotension is a common side effect of spinal anaesthesia for Caesarean section. The combination of colloid coloading and vasopressors was considered our standard for its prevention and treatment. As the safety of hydroxyethyl starch is under debate, we replaced colloid with crystalloid coloading. OBJECTIVE We hypothesize that the mean blood pressure drop is greater when coloading with crystalloids. DESIGN Prospective, observational clinical trial. SETTING Two-centre study conducted in Berlin, Germany. PATIENTS Parturients scheduled for a Caesarean section were screened for eligibility. INTERVENTION The study protocol and patient monitoring were based on the standard operating procedure for Caesarean section in both centres. The data from the crystalloid group were prospectively collected between November 2014 and July 2015. MAIN OUTCOME MEASURES The primary endpoint was the median drop in mean blood pressure after induction of spinal anaesthesia. Secondary endpoints were incidence of hypotension (drop > 20% of baseline systolic pressure /drop < 100 mmHg), vasopressor and additional fluid requirements (mL), incidence of bradycardia (heart rate < 60 beats per minute), blood loss, Apgar score, and umbilical artery pH. In case of hypotension, patients received phenylephrine or cafedrine/theodrenaline according to their heart rate. A p < 0.05 was considered significant. RESULTS 345 prospectively enrolled patients (n = 193 crystalloid group vs. n = 152 colloid group) were analysed. The median drop in mean blood pressure was greater in the crystalloid group [34 mmHg (25; 42 mmHg) vs. 21 mmHg (13; 29 mmHg), p < 0.001]. Incidences of hypotension [93.3% vs. 83.6%, p: 0.004] and bradycardia [19.7% vs. 9.9%, p: 0.012] were also significantly greater in the crystalloid group. Vasopressor requirements, blood loss and neonatal outcome were not different between the groups. CONCLUSIONS Crystalloid coloading was associated with a greater drop in mean blood pressure and a higher incidence of hypotension when compared with colloid coloading. Neonatal outcome was, however, unaffected by the type of fluid. TRIAL REGISTRATION DRKS00006783 ( http://www.drks.de ).
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Costa J, Moreira A, Moreira P, Delgado L, Silva D. Effects of weight changes in the autonomic nervous system: A systematic review and meta-analysis. Clin Nutr 2018; 38:110-126. [PMID: 29395374 DOI: 10.1016/j.clnu.2018.01.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obesity has been linked to autonomic dysfunction, which is thought to be one of the main contributors for hypertension, cardiac remodelling and death. Exercise and diet-based weight loss are the mainstay therapy for obesity, but there is a paucity of data regarding the effect of weight changes in autonomic nervous system (ANS) activity. OBJECTIVE To describe the impact of weight changes in autonomic nervous system. METHODS A systematic literature search of four biomedical databases was performed evaluating effects of weight changes, thorough diet and/or exercise-based interventions, in the following ANS outcomes: heart rate variability, namely low frequency (LF)/high frequency (HF) ratio (LF/HF ratio), normalized units of LF (LFnu) and HF (HFnu), muscle sympathetic nerve activity (MSNA), noradrenaline spillover rate (NA-SR), standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), baroreflex sensitivity and pupillometry. Quality appraisal was performed using the GRADE methodology and, where fitting, studies with comparable outcomes were pooled for meta-analysis. RESULTS Twenty-seven studies - 7 controlled clinical trials and 20 observational studies - were included. Weight gain was reported in 4 studies and weight loss in all the other studies. Interventions inducing weight changes included: hypocaloric or hypercaloric diets, exercise (strength, endurance or aerobic training) and hypocaloric diet coupled with exercise programs. Most studies which resulted in weight loss reported decreases in LF/HF ratio, LFnu, MSNA burst frequency and incidence, NA-SR, and an increase of baroreflex sensitivity, HF, HFnu and RMSSD, pointing to a parasympathetic nervous system activation. Meta-analysis regarding weight loss interventions showed a significant pooled effect size (95% CI) with a decreased of MSNA burst frequency -5.09 (-8.42, -1.75), MSNA incidence -6.66 (-12.40, -0.62), however this was not significant for SDNN 14.32 (-4.31, 32.96). Weight gain was associated with an increase in LF/HF, LFnu, MSNA burst frequency and incidence. The weight loss effects were potentiated by the association of hypocaloric diet with exercise. Nevertheless, weight changes effects in these outcomes were based in low or very low quality of evidence. CONCLUSIONS Diet and exercise based weight loss appears to increase parasympathetic and decrease sympathetic activity, the opposing effects being observed with weight gain. These findings are not uniformly reported in the literature, possibly due to differences in study design, methodology, characteristics of the participants and techniques used to estimate autonomic nervous activity.
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Affiliation(s)
- João Costa
- Faculty of Medicine, University of Porto, Porto, Portugal.
| | - André Moreira
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, Universidade do Porto, Porto, Portugal
| | - Luís Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
| | - Diana Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
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Okura T, Enomoto D, Miyoshi KI, Nagao T, Kukida M, Tanino A, Pei Z, Higaki J, Uemura H. The Importance of Walking for Control of Blood Pressure: Proof Using a Telemedicine System. Telemed J E Health 2016; 22:1019-1023. [PMID: 27167766 DOI: 10.1089/tmj.2016.0008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Regular physical activity (PA), including daily walking, reduces the risk of many chronic diseases, especially hypertension. Pedometer is a potential motivational aid for increasing PA. In the present study, we used a telemedicine system and analyzed the relationship between daily walking, calculated by pedometers, and blood pressure (BP). METHODS BP was measured at home twice a day (morning and evening) using an oscillometric automatic device. Body weight (BW) and percent body fat (%BF) were measured after BP measurement. Daily walking steps (DWS) were calculated by a pedometer. These daily parameters were transmitted through the Internet to a central server computer and sent to the Medical Health Center. RESULTS Sixty-nine (N = 69) hypertensive patients were included in this study. The mean follow-up period was 378 days. Electronic data from a pedometer (DWS) were associated with reduced BW, body mass index, and %BF. Hypertensive patients were divided into two groups based on the DWS. In the high DWS group, morning systolic BP and diastolic BP and evening systolic BP were reduced after induction of the telemedicine system. CONCLUSION A telemedicine system confirmed the usefulness of walking to control BP in hypertensive patients.
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Affiliation(s)
- Takafumi Okura
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Daijiro Enomoto
- 2 Department of Community Emergency Medicine, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Ken-Ichi Miyoshi
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Tomoaki Nagao
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Masayoshi Kukida
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Akiko Tanino
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Zouwei Pei
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Jitsuo Higaki
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
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Chang KT, Shu HS, Chu CY, Lee WH, Hsu PC, Su HM, Lin TH, Voon WC, Lai WT, Sheu SH. Association between C-reactive protein, corrected QT interval and presence of QT prolongation in hypertensive patients. Kaohsiung J Med Sci 2014; 30:310-5. [PMID: 24835352 DOI: 10.1016/j.kjms.2014.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/01/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022] Open
Abstract
C-reactive protein (CRP) and corrected QT (QTc) interval are predictors of cardiovascular disease. Whether CRP is associated with QTc interval and QT prolongation is unknown in hypertensive patients. We recruited hypertensive patients from a cardiovascular clinic in a tertiary medical center in Taiwan. All received standard 12-lead electrocardiogram examination. QT prolongation was defined as QTc interval ≥ 440 ms in men or ≥ 450 ms in women. High-sensitive CRP kits were used for the measurement of the CRP levels. A total of 466 consecutive patients were finally enrolled. Mean age was 60.6 ± 12.0 years. CRP level was correlated with QTc interval (p < 0.001) and presence of QT prolongation (p = 0.014). Multivariate regression analysis showed that CRP level (p = 0.001), age (p = 0.004), sex (p < 0.001), height (p = 0.001), low-density lipoprotein (p = 0.041), and QRS interval (p < 0.001) were associated with QTc interval. Furthermore, CRP level [odds ratio (OR) = 1.203, 95% confidence interval (CI) = 1.027-1.410, p = 0.022], age (OR = 1.040, 95% CI = 1.010-1.071, p = 0.009), waist (OR = 1.033, 95% CI = 1.000-1.066, p = 0.047), triglyceride (OR = 0.993, 95% CI = 0.987-0.999, p = 0.021) and QRS interval (OR = 1.046, 95% CI = 1.028-1.065, p < 0.001) independently predicted the presence of QT prolongation. Because CRP is an independent predictor of QTc interval and presence of QT prolongation, it could be considered in the risk assessment for hypertensive patients.
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Affiliation(s)
- Kai-Ting Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Hsu-Shien Shu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Po-Chao Hsu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chol Voon
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hsiung Sheu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Pal GK, Chandrasekaran A, Hariharan AP, Dutta TK, Pal P, Nanda N, Venugopal L. Body mass index contributes to sympathovagal imbalance in prehypertensives. BMC Cardiovasc Disord 2012; 12:54. [PMID: 22812583 PMCID: PMC3441642 DOI: 10.1186/1471-2261-12-54] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 07/04/2012] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The present study was conducted to assess the nature of sympathovagal imbalance (SVI) in prehypertensives by short-term analysis of heart rate variability (HRV) to understand the alteration in autonomic modulation and the contribution of BMI to SVI in the genesis of prehypertension. METHODS Body mass index (BMI), basal heart rate (BHR), blood pressure (BP), rate pressure product (RPP) and HRV indices such as total power (TP), low-frequency power (LF), normalized LF (LFnu), high-frequency power (HF), normalized HF (HFnu), LF-HF ratio, mean heart rate (mean RR), square root of the mean squared differences of successive normal to normal intervals (RMSSD), standard deviation of normal to normal RR interval (SDNN), the number of interval differences of successive NN intervals greater than 50 ms (NN50) and the proportion derived by dividing NN50 by the total number of NN intervals (pNN50) were assessed in three groups of subjects: normotensives having normal BMI (Group 1), prehypertensives having normal BMI (Group 2) and prehypertensives having higher BMI (Group 3). SVI was assessed from LF-HF ratio and correlated with BMI, BHR, BP and RPP in all the groups by Pearson correlation. The contribution of BMI to SVI was assessed by multiple regression analysis. RESULTS LF and LFnu were significantly increased and HF and HFnu were significantly decreased in prehypertensive subjects in comparison to normotensive subjects and the magnitude of these changes was more prominent in subjects with higher BMI compared to that of normal BMI. LF-HF ratio, the sensitive indicator of sympathovagal balance had significant correlation with BMI (P=0.000) and diastolic blood pressure (DBP) (P=0.002) in prehypertensives. BMI was found to be an independent contributing factor to SVI (P=0.001) in prehypertensives. CONCLUSIONS It was concluded that autonomic imbalance in prehypertensives manifested in the form of increased sympathetic activity and vagal inhibition. In prehypertensives with higher BMI, vagal withdrawal was predominant than sympathetic overactivity. Magnitude of SVI (alteration in LF-HF ratio) was linked to changes in BMI and DBP. BMI had an independent influence on LF-HF ratio. It was advised that life-style modifications such as yoga and exercise would enable achieve the sympathovagal balance and blood pressure homeostasis in prehypertensives.
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Affiliation(s)
- Gopal Krushna Pal
- Department of Physiology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, 605 006, India
- Professor and Head, Department of Physiology, JIPMER, Puducherry, 605 006, India
| | | | | | | | - Pravati Pal
- Department of Physiology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, 605 006, India
| | - Nivedita Nanda
- Department of Biochemistry, Pondicherry Institute of Medical Sciences, Puducherry, 605 014, India
| | - Lalitha Venugopal
- Department of Physiology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, 605 006, India
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Figueroa A, Gil R, Wong A, Hooshmand S, Park SY, Vicil F, Sanchez-Gonzalez MA. Whole-body vibration training reduces arterial stiffness, blood pressure and sympathovagal balance in young overweight/obese women. Hypertens Res 2012; 35:667-72. [DOI: 10.1038/hr.2012.15] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Smithburger PL, Seybert AL, Armahizer MJ, Kane-Gill SL. QT prolongation in the intensive care unit: commonly used medications and the impact of drug–drug interactions. Expert Opin Drug Saf 2010; 9:699-712. [DOI: 10.1517/14740331003739188] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Fiorentini A, Perciaccante A, Valente R, Paris A, Serra P, Tubani L. The correlation among QTc interval, hyperglycaemia and the impaired autonomic activity. Auton Neurosci 2009; 154:94-8. [PMID: 19963442 DOI: 10.1016/j.autneu.2009.11.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 07/16/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The QT interval reflects the duration of the intracellular action potential. Little is known on the interval QT duration in non diabetic insulin-resistant subjects. OBJECTIVE The aims of the current study were to evaluate the QTc interval in three groups of non diabetic insulin-resistant subjects and the possible correlation between QTc and the autonomic nervous system's activity. DESIGN 90 subjects were divided in subjects with impaired fasting glycaemia (IFG) and, by the results of OGTT, according to the criteria of ADA, in subjects with normal glucose regulation (NGR) and impaired glucose tolerance (IGT). Insulin resistance was evaluated by the homeostasis model assessment-index (HOMA-I). Heart rate variability and Qtc were calculated. RESULTS QTc interval is correlated with SDNN, LF n.u. and LF/HF. CONCLUSION We have observed that the QTc interval is prolonged in insulin-resistant subjects with associated impaired glucose metabolism, while no difference was reported between insulin-resistant and non insulin-resistant subjects with normal glucose regulation. We hypothesize that hyperglycaemia could play a major role than hyperinsulinemia on the QTc prolongation.
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Friedman O, Logan AG. Can nocturnal hypertension predict cardiovascular risk? Integr Blood Press Control 2009; 2:25-37. [PMID: 21949613 PMCID: PMC3172086 DOI: 10.2147/ibpc.s4364] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Indexed: 11/23/2022] Open
Abstract
Nocturnal hypertension and non-dipping of blood pressure during sleep are distinct entities that often occur together and are regarded as important harbingers of poor cardiovascular prognosis. This review addresses several aspects related to these blood pressure abnormalities including definitions, diagnostic limitations, pathogenesis and associated patient profiles, prognostic significance, and therapeutic strategies. Taken together, persistent nocturnal hypertension and non-dipping blood pressure pattern, perhaps secondary to abnormal renal sodium handling and/or altered nocturnal sympathovagal balance, are strongly associated with deaths, cardiovascular events, and progressive loss of renal function, independent of daytime and 24-hour blood pressure. Several pharmacological and non-pharmacological approaches may restore nocturnal blood pressure and circadian blood pressure rhythm to normal; however, whether this translates to a clinically meaningful reduction in unfavorable cardiovascular and renal consequences remains to be seen.
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Affiliation(s)
- Oded Friedman
- Samuel Lunenfeld Research Institute, Division of Nephrology, Mount Sinai Hospital
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Brenck F, Hartmann B, Katzer C, Obaid R, Brüggmann D, Benson M, Röhrig R, Junger A. Hypotension after spinal anesthesia for cesarean section: identification of risk factors using an anesthesia information management system. J Clin Monit Comput 2009; 23:85-92. [DOI: 10.1007/s10877-009-9168-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/17/2009] [Indexed: 11/24/2022]
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Li L, Soonthornpun S, Chongsuvivatwong V. Association between circadian rhythm of blood pressure and glucose tolerance status in normotensive, non-diabetic subjects. Diabetes Res Clin Pract 2008; 82:359-63. [PMID: 18995921 DOI: 10.1016/j.diabres.2008.09.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 08/23/2008] [Accepted: 09/23/2008] [Indexed: 10/21/2022]
Abstract
AIMS To examine whether circadian rhythm of blood pressure (BP) is associated with glucose tolerance status in normotensive, non-diabetic subjects. METHODS A cross-sectional study recruited normotensive and non-diabetic subjects, aged 35-79 years. A 75 g oral glucose tolerance test (OGTT) and 24-h ambulatory blood pressure monitoring (24-h ABPM) were performed. RESULTS Among 31 impaired glucose tolerance (IGT) and 36 normal glucose tolerance (NGT) study subjects, the mean (+/-S.D.) diurnal-nocturnal differences of average systolic BP (SBP) were 7.1+/-6.9 and 9.9+/-6.2 mmHg, respectively (p=0.086). In a linear mixed-effects regression model, however, taking each measurement of BP as the outcome, nighttime reduction of SBP in the IGT group was 7.19 mmHg, which was significantly smaller compared to a reduction of 9.80 mmHg in the NGT group (p-value for IGT: nighttime interaction=0.0014). The prevalence of non-dipping BP pattern was 77.4% in the IGT group which was significantly higher than 52.8% of the NGT group (p=0.036). Logistic regression revealed a significant effect of IGT for predicting non-dipping pattern with an adjusted odds ratio of 3.71 (95% CI: 1.09, 12.66, p=0.029). CONCLUSIONS Among normotensive, non-diabetic subjects, the decreased nocturnal BP reduction was associated with impaired glucose tolerance status.
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Affiliation(s)
- Lina Li
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Machado MB, Velasco IT, Scalabrini-Neto A. Gastric Bypass and Cardiac Autonomic Activity: Influence of Gender and Age. Obes Surg 2008; 19:332-8. [DOI: 10.1007/s11695-008-9665-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 08/04/2008] [Indexed: 01/30/2023]
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21
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YILDIZ MUSTAFA, PAZARLI PINAR, SEMIZ OLCAY, KAHYAOGLU OSMAN, SAKAR İSMAIL, ALTINKAYNAK SEVIN. Assessment of P-Wave Dispersion on 12-Lead Electrocardiography in Students Who Exercise Regularly. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:580-3. [DOI: 10.1111/j.1540-8159.2008.01044.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Severe obesity and P-wave dispersion: the effect of surgically induced weight loss. Obes Surg 2007; 18:90-6. [PMID: 18080825 DOI: 10.1007/s11695-007-9340-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2007] [Accepted: 11/02/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent data have shown that obesity is an important potential risk factor for atrial fibrillation (AF). The mechanism of development of AF in obesity patients is still unclear and may be related to atrial refractoriness heterogeneity. The aim of our study was to determine the influence of bariatric surgery with a consequent substantial weight loss on P-wave dispersion in morbidly obese population. METHODS We enrolled in this study 40 severe obese patients, and 40 age-matched non-obese healthy subjects were also recruited as controls. All subjects underwent conventional 12-lead electrocardiography for the analysis of P-wave dispersion. All subjects underwent bariatric surgery and were resubmitted to electrocardiography, biochemical, and anthropometric examination within 12 months after intervention. RESULTS Severe obese patients had greater values in P-wave duration and dispersion than the normal weight controls. Bariatric surgery reduced significantly P-wave dispersion. There was a significant correlation between decrease of atrial refractoriness heterogeneity and bariatric-surgery-induced weight loss. CONCLUSIONS In severe obese patients, surgically induced weight loss reduction is associated with significant decreased in P-wave dispersion. The reduction of the atrial refractoriness heterogeneity may be of clinical significance by reducing the risk of atrial fibrillation in morbidly obese subjects.
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Maser RE, Lenhard MJ, Rizzo AA, Vasile AA. Continuous positive airway pressure therapy improves cardiovascular autonomic function for persons with sleep-disordered breathing. Chest 2007; 133:86-91. [PMID: 17951618 DOI: 10.1378/chest.07-1580] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is an independent risk factor for cardiovascular morbidity. Dysfunction of the cardiovascular autonomic nervous system may be a potential mechanism whereby SDB is linked to cardiovascular disease. Repetitive sympathetic activation during apneic episodes may impair cardiovascular reflex function, and increased sympathetic activity can stimulate renin release. Given that patients with SDB may have reduced cardiovascular autonomic function, the purpose of this study was to determine whether treatment with continuous positive airway pressure (CPAP) for 6 weeks would improve autonomic function. METHODS Twenty-nine participants with a diagnosis of SDB, who completed 6 weeks of CPAP therapy, were evaluated for cardiovascular autonomic nerve fiber function at baseline and post therapy. Autonomic function tests included the following: R-R interval variation during deep breathing measured by vector analysis (ie, mean circular resultant [MCR]) and expiration/inspiration (E/I) ratio; and the Valsalva maneuver. Participants were also evaluated prior to CPAP therapy for plasma renin activity levels. RESULTS Participants in this study showed improved cardiovascular autonomic function after 6 weeks of treatment (baseline vs follow-up) as assessed by the mean (+/- SD) MCR (33.2 +/- 22.5 vs 36.9 +/- 24.2, respectively; p < 0.05) and E/I ratio (1.20 +/- 0.12 vs 1.24 +/- 0.14, respectively; p < 0.01). Improved vagal tone was also noted for subjects with elevated renin levels. CONCLUSIONS Treatment of SDB with CPAP for 6 weeks improved vagal tone and may be beneficial in reducing the risk of developing clinical manifestations of cardiovascular autonomic dysfunction (eg, increased risk of mortality).
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Affiliation(s)
- Raelene E Maser
- Department of Medical Technology, University of Delaware, Newark, DE 19716, USA.
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Waterhouse J, Atkinson G, Reilly T, Jones H, Edwards B. Chronophysiology of the cardiovascular system. BIOL RHYTHM RES 2007. [DOI: 10.1080/09291010600906109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Maser RE, Lenhard MJ, Irgau I, Wynn GM. Impact of surgically induced weight loss on cardiovascular autonomic function: one-year follow-up. Obesity (Silver Spring) 2007; 15:364-9. [PMID: 17299109 DOI: 10.1038/oby.2007.554] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the impact of surgically induced weight loss on cardiovascular autonomic function in subjects with severe obesity and examine whether the effect was comparable for persons with and without diabetes. RESEARCH METHODS AND PROCEDURES Twenty-six severely obese individuals (BMI = 48 +/- 7 kg/m(2)) underwent bariatric surgery (laparoscopic Roux-en-Y gastric bypass, n = 21; laparoscopic adjustable gastric banding, n = 5). Cardiovascular autonomic function (heart rate variation during deep breathing and the Valsalva maneuver) was assessed before and 6 and 12 months after surgery. RESULTS Twelve months after bariatric surgery, there was a 28% decrease in BMI. There was an increase in all parasympathetic indices of autonomic function (all assessment modalities, p < 0.05) with weight loss. The amount of improvement from baseline for all measures of autonomic function did not differ for those with or without diabetes. DISCUSSION Surgically induced weight loss 12 months after surgery has a favorable effect on cardiovascular autonomic function in severely obese individuals with and without diabetes.
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Affiliation(s)
- Raelene E Maser
- Department of Medical Technology, University of Delaware, Newark, DE 19716, USA.
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Duru M, Seyfeli E, Kuvandik G, Kaya H, Yalcin F. Effect of weight loss on P wave dispersion in obese subjects. Obesity (Silver Spring) 2006; 14:1378-82. [PMID: 16988080 DOI: 10.1038/oby.2006.156] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to investigate effect of loss weight on P wave dispersion in obese subjects. RESEARCH METHODS AND PROCEDURES After a 12-week weight loss program (diet and medical therapy), a total of 30 (24 women and six men) obese subjects who had lost at least 10% of their original weight were included in the present study. All subjects underwent a routine standard 12-lead surface electrocardiogram. Electrocardiograms were transferred to a personal computer by a scanner and then magnified 400 times by Adobe Photoshop software (Adobe Systems, Mountain View, CA). P wave dispersion, which is also defined as the difference between the maximum P wave duration and the minimum P wave duration, was also calculated. RESULTS After a 12-week weight loss program, BMI (p < 0.001), maximum P wave duration (p < 0.001), and P wave dispersion (p < 0.001) significantly decreased. The mean percentage of weight loss was 13% (10% to 20.3%). The decrease in the level of P wave dispersion (21 +/- 10 and 7 +/- 12 ms, p < 0.002) was more prominent in Group II (>or=12% loss of their original weight) than Group I (<12% loss of their original weight) after the weight loss program. A statistically significant correlation between decrease in the level of P wave dispersion and percentage of weight loss was found (r = 0.624, p < 0.001). DISCUSSION Substantial weight loss in obese subjects is associated with a decrease of P wave duration and dispersion. Therefore, these observations suggest that substantial weight loss is associated with improvement in atrial repolarization abnormalities in obese subjects.
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Affiliation(s)
- Mehmet Duru
- Department of Emergency Medicine, School of Medicine, Mustafa Kemal University, 31100 Antakya, Hatay, Turkey.
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Benoit SR, Mendelsohn AB, Nourjah P, Staffa JA, Graham DJ. Risk factors for prolonged QTc among US adults: Third National Health and Nutrition Examination Survey. ACTA ACUST UNITED AC 2006; 12:363-8. [PMID: 16079644 DOI: 10.1097/01.hjr.0000173110.21851.a9] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND QT interval prolongation can lead to torsades de pointes, a potentially fatal arrhythmia. Although research exists on the relationship between QT prolongation and clinical outcome, few studies have described risk factors for prolonged QT interval in the general population. METHODS The Third National Health and Nutrition Examination Survey (NHANES III) collected electrocardiogram interval data on 8561 subjects over 40 years of age and projected results to the US population. QT was corrected for heart rate using Fridericia's formula. Logistic regression analyses were performed to identify factors independently associated with prolonged QTc interval, defined as being in the upper 5% of the population QTc interval distribution. Analyses were conducted separately for women and men as a result of differences in the QT distribution between the sexes and also because of potential effect modification. Analytical variables included age, race/ethnicity, electrolyte measurements, body mass index, the recent use of QT-prolonging drugs and past medical histories of stroke, thyroid disease, hypertension, diabetes and myocardial infarction. RESULTS Age, female sex, hypocalcemia (men), hypokalemia (women), and a history of thyroid disease and myocardial infarction (men) were associated with a prolonged QTc interval. In addition, taking QT-prolonging medications in the past month was associated with more than a twofold increase in the odds of prolonged QTc interval in both men and women. CONCLUSIONS Healthcare practitioners should be aware that a prolonged QTc interval is a potential indicator of cardiovascular risk, and should exercise caution in prescribing potentially QT-prolonging medications to certain patients.
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De Bruin ML, van Staa TP, Belitser SV, Leufkens HGM, Hoes AW. Predicting cardiac arrhythmias and sudden death in diabetic users of proarrhythmic drugs. Diabetes Care 2005; 28:440-2. [PMID: 15677812 DOI: 10.2337/diacare.28.2.440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Marie L De Bruin
- Utrecht Institute for Pharmaceutical Sciences, Department of Pharmacoepidemiology and Pharmacotherapy, P.O. Box 80082, 3508 TB Utrecht, Netherlands.
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Bazar KA, Yun AJ, Lee PY. Hypertrophic osteoarthropathy may be a marker of underlying sympathetic bias. Med Hypotheses 2004; 63:357-61. [PMID: 15236803 DOI: 10.1016/j.mehy.2004.02.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Accepted: 02/22/2004] [Indexed: 10/26/2022]
Abstract
Hypertrophic osteoarthropathy (HOA) is a condition that accompanies many seemingly unrelated diseases. It is commonly associated with various clinical conditions such as pregnancy, aging, pulmonary diseases, cancers, and other systemic illnesses. The condition has been attributed to various causes such as platelet abnormalities, hormonal disturbances, and cytokine dysfunction, but the exact underlying mechanism has been elusive. We propose a unifying hypothesis that activation of the adrenergic system is the common thread that links all of the disparate clinical associations of hypertrophic osteoarthropathy. In diseased states, autonomic stimulation may occur as a result of chemoreceptor activation in response to acidosis, hypoxia, or hypercapnia. Examples include sleep apnea, congestive heart failure, renal failure, and tumor-induced hypoxia. In this setting, clinical signs of HOA may be a marker of underlying autonomic dysfunction. Autonomic stimulation may also occur as a normal part of pregnancy or as an abnormal component of aging. The exact pathway linking adrenergic excess to HOA remains to be clarified, but a plausible scenario based on current molecular evidence is offered.
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Yun AJ, Lee PY. Sudden death among infants and adults: companion disorders of maladaptive sympathetic bias. Med Hypotheses 2004; 62:857-60. [PMID: 15142636 DOI: 10.1016/j.mehy.2003.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2003] [Accepted: 11/23/2003] [Indexed: 11/29/2022]
Abstract
Sudden infant death syndrome is the leading cause of death in infancy, but its pathophysiological mechanism has been elusive. Sudden death in adults is a common phenomenon, but the etiology in many cases remains unknown at autopsy. We hypothesize that maladaptive sympathetic bias is the explanatory mechanism that links many cases of sudden demise among adults and infants as companion syndromes. Normally, sympathetic response occurs as an adaptation to physiologic demands of the body through various autonomic reflex arcs such as chemoreceptors. Sympathetic response can become chronic and maladaptive when the normal sympathetic response fails to correct the precipitating physiologic trigger, leading to chronic activation of autonomic reflex arcs. In conditions such as infant sleep apnea or adult heart failure, a pernicious cycle of sympathetic bias may result. Chronic sympathetic bias increases susceptibility to sudden fatal arrhythmias, QT-related and otherwise, in the setting of an exaggerated adrenergic challenge. Examples of such adrenergic stressors include trauma, hypoxia, hypercapnia, acidosis, sleep arousal, illness, medical procedures, and physical activity, all of which have associations with sudden death. Our hypothesis may not only help explain the survival benefits of drugs such as beta-blockers and devices such as synchronization therapy, but also portend new application of similar therapies for many conditions of sympathetic bias.
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Affiliation(s)
- Anthony J Yun
- Department of Radiology, Stanford University, 470 University Avenue, Palo Alto, CA 94301, USA.
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Joon Yun A, Bazar KA, Lee PY. Tumors may modulate host immunity partly through hypoxia-induced sympathetic bias. Med Hypotheses 2004; 63:352-6. [PMID: 15236802 DOI: 10.1016/j.mehy.2004.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hypoxia can occur in solid tumors when oxygen demand from rapid tumor growth outstrips the blood supply. Once thought to be merely a consequence of tumor physiology, more recent evidence suggests that hypoxia may also be a tumor adaptation to promote its own survival. For example, hypoxic conditions generate local transcriptional changes that enhance angiogenesis and glycolysis, processes that directly promote tumor growth. We hypothesize that maladaptive local chemoreceptor host response to hypoxia may contribute to a shift in immune balance that favors cancer survival. Specifically, we propose that hypoxia in the tumor microenvironment activates local adrenergic activity which in turn inhibits Th1 function while favoring Th2 function. Th1 function is vital to the host defense against cancer, and Th1 depletion is associated with increased cancer risk. In our view, the sympathetic bias induces Th2 bias independent of the direct immunomodulatory effects of tumor-derived cytokines. The hypoxia-induced local adrenergic response may be part of a broad tumor adaptation that enables its evasion of host immune surveillance. That the host response of Th2 bias is so reflexively linked to hypoxia may reflect the likelihood that trauma, rather than modern diseases such as cancer, were the most common causes of hypoxia during our teleologic past when natural selection shaped our biologic pathways. Validation of our hypothesis may shed more light on the biology of cancer and reveal novel diagnostic and therapeutic strategies.
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Affiliation(s)
- A Joon Yun
- Department of Radiology, Stanford University, 470 University Avenue, Palo Alto, CA 94301, USA.
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Kreier F, Yilmaz A, Kalsbeek A, Romijn JA, Sauerwein HP, Fliers E, Buijs RM. Hypothesis: shifting the equilibrium from activity to food leads to autonomic unbalance and the metabolic syndrome. Diabetes 2003; 52:2652-6. [PMID: 14578282 DOI: 10.2337/diabetes.52.11.2652] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
“The stability of the internal environment is the condition that life should be free and independent… So, far from the higher animal being indifferent to the external world, it is on the contrary in a precise and informed relation with it, in such a way that its equilibrium results from a continuous and delicate compensation, established as by the most sensitive of balances.”
Claude Bernard (1865)
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Affiliation(s)
- Felix Kreier
- Netherlands Institute for Brain Research, Amsterdam, the Netherlands.
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Kreier F, Kalsbeek A, Ruiter M, Yilmaz A, Romijn JA, Sauerwein HP, Fliers E, Buijs RM. Central nervous determination of food storage—a daily switch from conservation to expenditure: implications for the metabolic syndrome. Eur J Pharmacol 2003; 480:51-65. [PMID: 14623350 DOI: 10.1016/j.ejphar.2003.08.092] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Here, we present a neuroendocrine concept to review the circularly interacting energy homeostasis system between brain and body. Body-brain interaction is circular because the brain immediately integrates an input to an output, and because part of this response may be that the brain modulates the sensitivity of this perception. First, we describe how the brain senses the body through neurons and blood-borne factors. Direct neuronal connections report the state of various organs. In addition, humoral factors are perceived by the blood-brain barrier and circumventricular organs. We describe how circulating energy carriers are sensed and what signals reach the brain during food intake, exercise and an immune response. We describe that the brain regulates the homeostatic process at two fundamentally different levels during the active and inactive states. The unbalanced output of the brain in the metabolic syndrome is discussed in relation with such circadian rhythms and with regional activity of the autonomic nervous system. In line with the above, we suggest a new approach for the diagnosis and therapy of the metabolic syndrome.
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Affiliation(s)
- Felix Kreier
- Netherlands Institute for Brain Research, 1105 AZ, Amsterdam, The Netherlands.
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