Levels of and Changes in Childhood Body Mass Index in Relation to Risk of Atrial Fibrillation and Atrial Flutter in Adulthood

Controversies and challenges of anticoagulation therapy in obesity

INTRODUCTION

The relationship between anticoagulation efficacy and safety in obesity is complex and can vary between degrees of obesity and anticoagulant choice. Indeed, patients at extremes of body weight were under-represented in randomized trials. Additionally, the possibility of an 'obesity paradox' has been raised in atrial fibrillation, describing decreased thromboembolic risk in obese patients.

AREAS COVERED

We explore the current literature on anticoagulation in obesity, specifically with regard to efficacy in atrial fibrillation, efficacy in venous thromboembolism, and bleeding risk. Pharmacodynamic and pharmacokinetic considerations are also discussed.

EXPERT OPINION

As a class, direct oral anticoagulants are comparable to vitamin-K antagonists in preventing and treating thromboembolism in overweight and obese patients, whilst not increasing bleeding risk.

Association between early age body mass index and the risk of adulthood cardiovascular diseases: a systematic review and meta-analysis

BACKGROUND

Several studies have attempted to demonstrate the associations between body mass index (BMI) in early age and cardiovascular diseases (CVDs). However, their findings were inconsistent and inconclusive, indicating the need for further investigation.

METHODS

We conducted a systematic review and meta-analysis of studies focusing on BMI in early age (age from 2 to 22) in relation to CVDs in adulthood, including coronary artery disease (CHD), ischemic and hemorrhagic stroke, myocardial infarction and heart failure. Fixed-effects and Random-effects models were used to pool the data. Sex, age, adjustment of socioeconomic status and fatal events specific analysis were conducted to examine their effects on the results.

RESULTS

Thirty-eight studies were eligible for inclusion. BMI in early age was positively related to CVD (HR = 1.18, 95% CI: 1.07-1.30), CHD (HR = 1.13, 95% CI: 1.07-1.19), heart failure (HR = 1.16, 95% CI: 1.11-1.20) but not stroke (HR = 0.99, 95% CI: 0.93-1.05). The results remained consistent after stratified by sex, fatal or non-fatal events and adjustment for socioeconomic status. Further age-specific analysis showed that both childhood and early adulthood group showed positive associations on CHD and HF. While estimates in early adulthood for all CVDs were numerically higher than that for childhood. Category analyses showed a positive association between being overweight or obesity and adulthood CVDs, including stroke.

CONCLUSION

We found a positive association between early-age BMI and adulthood cardiovascular diseases except for stroke.

TRIAL REGISTRATION

Systemic review registration https://www.crd.york.ac.uk/Prospero/ , identifier CRD42023403602.

Early-life body mass index and the risk of six cardiovascular diseases: A Mendelian Randomization study

BACKGROUND

Observational studies consistently indicate an association between early-life body mass index (BMI) and several cardiovascular diseases (CVDs). However, the causal relationship remains uncertain. The primary objective of this study was to assess the causal relationship between early-life BMI and six types of CVDs using the Mendelian Randomization (MR) approach.

METHODS

The dataset for this study was derived from large-scale, summary-level Genome-Wide Association Studies. Specifically, the following datasets we used, early-life BMI (n = 61 111, age = 2-10), heart failure (HF) dataset (n = 977 323), atrial fibrillation (AF) dataset (n = 1 030 836), coronary artery disease (CAD) dataset (n = 184 305), peripheral artery disease (PAD) dataset (n = 243 060), deep venous thrombosis (DVT) dataset (n = 1 500 861) and myocardial infarction (MI) dataset (n = 638 000). Multiple MR methods were utilized to evaluate the causal relationship between exposure and outcomes, accompanied by sensitivity analysis.

RESULTS

Early-life BMI positively correlates with the risk of developing the six distinct CVDs included in this study. Specifically, elevated BMI during childhood is associated with a 31.9% risk for HF (Odds ratio [OR] = 1.319, 95% CI [1.160 to 1.499], p = 2.33 × 10-5), an 18.3% risk for AF (R = 1.183, 95% CI [1.088 to 1.287], p = 8.22 × 10-5), an 14.8% risk for CAD (OR = 1.148, 95% CI [1.028 to 1.283], p = 1.47 × 10-2), a 40.5% risk for PAD (OR = 1.405, 95% CI [1.233 to 1.600], p = 3.10 × 10-7) and 12.0% risk for MI (OR = 1.120, 95% CI [1.017 to 1.234], p = 2.18 × 10-2). Interestingly, the risk for deep venous thrombosis only increased by 0.5% (OR = 1.005, 95% CI [1.001 to 1.008], p = 2.13 × 10-3).

CONCLUSION

Genetically inferred early-life BMI is significantly associated with six distinct CVDs. This indicates that elevated early-life BMI is a significant risk factor for multiple cardiovascular disorders.

Childhood Adiposity and Risk of Major Clinical Heart Diseases in Adulthood: A Mendelian Randomization Study

BACKGROUND

The causal relationship between childhood adiposity and adult risk of heart diseases has not been clearly demonstrated. This study aims to ascertain whether genetically predicted childhood body mass index (BMI) and childhood obesity are causally associated with adult coronary heart disease, myocardial infarction, heart failure, atrial fibrillation, hypertrophic cardiomyopathy, and pulmonary heart disease.

METHODS AND RESULTS

To investigate the causative relationships and underlying mechanisms between childhood adiposity and adult heart diseases, 3 main methods of Mendelian randomization were used: 2-sample Mendelian randomization, multivariable Mendelian randomization with controlling for several cardiometabolic risk variables, and mediation analysis. Every 1-SD rise in genetically predicted childhood body mass index was associated with 24% (odds ratio [OR], 1.24 [95% CI, 1.12-1.37]), 28% (OR, 1.28 [95% CI, 1.14-1.42]), 28% (OR, 1.28 [95% CI, 1.14-1.42]), and 27% (OR, 1.27 [95% CI, 1.04-1.49]) higher risk of coronary heart disease, myocardial infarction, heart failure, and atrial fibrillation, respectively. Every 1-unit increase in log-odds in childhood obesity was associated with 11% (OR, 1.11 [95% CI, 1.06-1.16]), 14% (OR, 1.14 [95% CI, 1.04-1.23]), 10% (OR, 1.10 [95% CI, 1.03-1.18]), and 20% (OR, 1.20 [95% CI, 1.08-1.32]) higher risk of coronary heart disease, myocardial infarction, heart failure, and atrial fibrillation, respectively. The link between childhood adiposity and adult heart diseases was found to be mediated by high-density lipoprotein cholesterol, triglyceride, hypertension, and type 2 diabetes.

CONCLUSIONS

Our findings support the causal relationships between childhood adiposity and risk of adult coronary heart disease, myocardial infarction, heart failure, and atrial fibrillation. Blood lipids, hypertension, and type 2 diabetes are factors that mediate the aforementioned associations.

Effects of childhood obesity on heart failure and its associated risk factors in the European population: A Mendelian randomization study

BACKGROUND AND AIMS

Observational studies have shown that obesity considerably affects the cardiovascular system. Thus we conducted this Mendelian randomization (MR) analysis to evaluate the causal effect of childhood obesity on heart failure (HF) and its risk factors.

METHODS AND RESULTS

We obtained genetic instruments from genome-wide association studies (GWAS) that investigated childhood obesity, HF, type 2 diabetes mellitus (T2DM), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), chronic kidney disease (CKD), valvular heart disease, myocarditis, hypertrophic cardiomyopathy, and hyperthyroidism. Inverse variance weighting (IVW), weighted median analysis, MR-Egger, and MR-pleiotropy residual sum and outlier (MR-PRESSO) were employed for MR analyses. In addition, the leave-one-out sensitivity test, MR-PRESSO global test, and Cochran's Q test were used for sensitivity analyses. Genetic evaluations showed that childhood obesity increases the risk of HF (odds ratio [OR] = 1.11, 95%CI: 1.05-1.17, p = 1.26 × 10-4), T2DM (OR = 1.17, 95%CI: 1.12-1.23, p = 8.80 × 10-12), AF (OR = 1.08, 95%CI: 1.05-1.12, p = 2.66 × 10-7), MI (OR = 1.08, 95%CI: 1.04-1.13, p = 3.35 × 10-4), and CAD (OR = 1.08, 95%CI: 1.03-1.13, p = 1.48 × 10-3). We found no association between childhood obesity and CKD, valvular heart disease, myocarditis, hypertrophic cardiomyopathy, or hyperthyroidism. Sensitivity analysis and Bonferroni's correction showed consistent results.

CONCLUSIONS

Our study provides new evidence for the relationship between childhood obesity and HF and its risk factors. The results indicate that individuals with a history of childhood obesity require more clinical attention to prevent the development of HF.

Genetically predicted childhood obesity and adult atrial fibrillation: A mendelian randomization study

BACKGROUND AND AIMS

It is unclear whether the association of childhood obesity with adult atrial fibrillation observed in observational studies reflects causal effects. The aim of this study was to evaluate the association of childhood obesity with adult atrial fibrillation using genetic instruments.

METHODS AND RESULTS

We used a two-sample Mendelian randomization (MR) design to evaluate the association between childhood obesity and adult atrial fibrillation. Two sets of genetic variants (15 single nucleotide polymorphisms [SNPs] for childhood body mass index [BMI] and 12 SNPs for dichotomous childhood obesity) were selected as instruments. Summary data on SNP-childhood obesity and SNP-atrial fibrillation associations were obtained from recently published genome-wide association studies. Effect estimates were evaluated using inverse-variance weighted (IVW) methods. Other MR analyses, including MR-Egger, simple and weighted median, weighted MBE and MR-PRESSO methods were performed in sensitivity analyses. The IVW models showed that both a genetically predicted one-standard deviation increase in childhood BMI (kg/m²) and higher log-odds of childhood obesity were associated with a substantial increase in the risk of atrial fibrillation (OR = 1.22, 95% CI: 1.11-1.34, P < 0.001; OR = 1.09, 95% CI: 1.04-1.14, P < 0.001). MR-Egger regression showed no evidence of genetic pleiotropy for childhood BMI (intercept = 0.000, 95% CI: -0.024 to 0.023), but for childhood obesity (intercept = -0.036, 95% CI: -0.057 to -0.015). Similar results were observed using leave-one-out and other MR methods in sensitivity analyses.

CONCLUSIONS

This MR analysis found a consistent association between genetically predicted childhood obesity and an increased risk of adult atrial fibrillation. Further research is warranted to validate our findings.

The Risk of Atrial Fibrillation Increases with Earlier Onset of Obesity: A Mendelian Randomization Study

Background: Obesity is a well-established risk factor for atrial fibrillation (AF). Previous epidemiological research on obesity and AF often focused on adult populations and now broadened to earlier in life. Therefore, this study aimed to determine the relationships between obesity at different periods of life and the risk of AF. Methods: A two-sample Mendelian randomization (MR) study design using summarised data from 6 genome-wide association studies (GWASs) was employed in this study. Single nucleotide polymorphisms (SNPs) associated with adult obesity, childhood obesity, childhood body mass index (BMI), waist-to-hip ratio adjusted for BMI (WHRadjBMI), birth weight and AF were independently retrieved from large-scale GWASs. For SNP identification, the genome-wide significance threshold was set at p <5.00×10^-8. To obtain causal estimates, MR analysis was conducted using the inverse variance-weighted (IVW) method. The weighted median, MR-Egger methods and MR-robust adjusted profile score (MR-RAPS) were used to evaluate the robustness of MR analysis. Results: A total of 204 SNPs were identified as the genetic instrumental variables (5 SNPs for childhood obesity, 13 SNPs for childhood BMI, 137 SNPs for birth weight, 35 SNPs for adult WHRadjBMI, and 14 SNPs for adult obesity). The results of MR analysis demonstrated that the genetically predicted adult obesity, childhood BMI, and birth weight were associated with AF risk. Notably, a 1 unit standard deviation (1-SD) increase in adult obesity was related to a 13% increased risk of AF [p=6.51×10^-7, OR, 1.13 (95% CI, 1.08-1.19)], a 1-SD increase in childhood BMI was related to a 18% increased risk of AF [p=1.77×10^-4, OR, 1.18 (95% CI, 1.08-1.29)], and a 1-SD increase in birth weight was related to a 26% increased risk of AF [p=1.27×10^-7, OR, 1.26 (95% CI, 1.16-1.37)]. There was no evidence of pleiotropy or heterogeneity between the MR estimates obtained from multiple SNPs. Conclusion: Our study reveals the association of genetic susceptibility to obesity with a higher risk of AF. Moreover, an earlier age at obesity was associated with an increased risk of AF. Therefore, public awareness of the dangers of obesity and active early weight control may prevent the development of AF.

Causative Mechanisms of Childhood and Adolescent Obesity Leading to Adult Cardiometabolic Disease: A Literature Review

The past few decades have shown a worrisome increase in the prevalence of obesity and its related illnesses. This increasing burden has a noteworthy impact on overall worldwide mortality and morbidity, with significant economic implications as well. The same trend is apparent regarding pediatric obesity. This is a particularly concerning aspect when considering the well-established link between cardiovascular disease and obesity, and the fact that childhood obesity frequently leads to adult obesity. Moreover, most obese adults have a history of excess weight starting in childhood. In addition, given the cumulative character of both time and severity of exposure to obesity as a risk factor for associated diseases, the repercussions of obesity prevalence and related morbidity could be exponential in time. The purpose of this review is to outline key aspects regarding the current knowledge on childhood and adolescent obesity as a cardiometabolic risk factor, as well as the most common etiological pathways involved in the development of weight excess and associated cardiovascular and metabolic diseases.

Body Mass Index in 1.9 Million Adolescents and Stroke in Young Adulthood

[Figure: see text].

Adult obesity and its complications: a pediatric disease?

PURPOSE OF REVIEW

Approximately 2.6 million people die each year secondary to obesity related diseases. The risk of developing serious comorbidities depends on the age of onset as well as duration of obesity. In this review, we discuss trends in BMI trajectories from early childhood to adulthood with latest evidence on comorbidities in adulthood stemming from pediatric obesity and benefits of early intervention and treatment in childhood obesity.

RECENT FINDINGS

Childhood obesity poses high risk of metabolic and cardiovascular disorders like type 2 diabetes, hypertension, atherosclerosis, coronary artery disease, and some types of cancer in adulthood. Early life obesity also increases risks of developing menstrual irregularities, infertility, and pregnancy complications. Several grave concerns including malignancies, autoimmune disorders, higher asthma morbidity, and psychiatric implications are found to be associated with childhood obesity. Disease outcomes can be transgenerational, causing suboptimal health in children of mothers with obesity. Encouragingly, many risks associated with childhood obesity can be reduced, delayed, or even reversed by early resolution of obesity necessitating close BMI monitoring and treatment early.

SUMMARY

Early identification and aggressive management of childhood obesity is critical in prevention of debilitating comorbidities in adult life.

VIDEO ABSTRACT

http://links.lww.com/COE/A19.

Change in body mass index from childhood onwards and risk of adult cardiovascular disease

Childhood obesity adversely affects the structure and function of the cardiovascular system, but the relationship between excessive weight gain during childhood and adult cardiovascular disease (CVD) is not fully understood. This review summarizes evidence for associations of change in body mass index (BMI) from childhood onwards with CVD outcomes. We found that excessive gain in BMI from childhood onwards was consistently associated with the presence of CVD risk factors, with increased risks of coronary heart disease, and there were suggestions of associations with stroke, atrial fibrillation and heart failure, but a lack of evidence precludes firm conclusions. These results indicate that the risk of CVD can be traced back to child ages and highlights the importance of primordial prevention of CVD by preventing excessive weight gain in childhood.