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Mabeza RM, Cho NY, Vadlakonda A, Sakowitz S, Ebrahimian S, Moazzez A, Benharash P. Association of body mass index with morbidity following elective ventral hernia repair. Surg Open Sci 2023; 14:11-16. [PMID: 37409072 PMCID: PMC10319335 DOI: 10.1016/j.sopen.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023] Open
Abstract
Background Prior work has linked body mass index (BMI) with postoperative outcomes of ventral hernia repair (VHR), though recent data characterizing this association are limited. This study used a contemporary national cohort to investigate the association between BMI and VHR outcomes. Methods Adults ≥ 18 years undergoing isolated, elective, primary VHR were identified using the 2016-2020 American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI. Restricted cubic splines were utilized to ascertain the BMI threshold for significantly increased morbidity. Multivariable models were developed to evaluate the association of BMI with outcomes of interest. Results Of ~89,924 patients, 0.5 % were considered Underweight, 12.9 % Normal Weight, 29.5 % Overweight, 29.1 % Class I, 16.6 % Class II, 9.7 % Class III, and 1.7 % Superobese. After risk adjustment, class I (Adjusted Odds Ratio [AOR] 1.22, 95 % Confidence Interval [95%CI]: 1.06-1.41), class II (AOR 1.42, 95%CI: 1.21-1.66), class III obesity (AOR 1.76, 95%CI: 1.49-2.09) and superobesity (AOR 2.25, 95 % CI: 1.71-2.95) remained associated with increased odds of overall morbidity relative to normal BMI following open, but not laparoscopic, VHR. A BMI of 32 was identified as the threshold for the most significant increase in predicted rate of morbidity. Increasing BMI was linked to a stepwise rise in operative time and postoperative length of stay. Conclusion BMI ≥ 32 is associated with greater morbidity following open, but not laparoscopic VHR. The relevance of BMI may be more pronounced in open VHR and must be considered for stratifying risk, improving outcomes, and optimizing care. Key message Body mass index (BMI) continues to be a relevant factor in morbidity and resource use for elective open ventral hernia repair (VHR). A BMI of 32 serves as the threshold for significant increase in overall complications following open VHR, though this association is not observed in operations performed laparoscopically.
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Affiliation(s)
- Russyan Mark Mabeza
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Shayan Ebrahimian
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ashkan Moazzez
- Depatment of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Mühleck F, Laufs U. [Primary prevention of coronary heart disease : Evidence-based drug treatment]. Herz 2019; 45:39-49. [PMID: 31822926 DOI: 10.1007/s00059-019-04873-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Coronary artery disease (CAD) is the most frequent cause of morbidity and mortality worldwide. Lifestyle modifications and drug treatment of cardiovascular risk factors are able to effectively prevent CAD. The basis of prevention is the assessment of the individual cardiovascular risk, e.g. by using a validated risk score. Documented evidence for prevention of CAD is available for the control of hypertension using angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB) and calcium antagonists, for the treatment of hypercholesterolemia using statins, ezetimibe and proprotein convertase subtilisin-kexin type 9 (PCSK-9) inhibitors and for the treatment of type 2 diabetes mellitus with metformin, sodium-glucose transporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists. There is no positive benefit-risk ratio for people with a low risk in the use of acetylsalicylic acid in primary prevention, in contrast to the positive recommendations for secondary prevention. There is no evidence for the efficacy of primary prevention with beta blockers, dipeptidyl peptidase 4 (DPP-4) inhibitors, glitazones, sulfonylureas or insulin. Similarly, there is no evidence for drug treatment of obesity, any supplementation with vitamins or hormone preparations or omega‑3 fatty acids.
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Affiliation(s)
- Franziska Mühleck
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
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Ladwig KH, Baumert J, Marten-Mittag B, Lukaschek K, Johar H, Fang X, Ronel J, Meisinger C, Peters A. Room for depressed and exhausted mood as a risk predictor for all-cause and cardiovascular mortality beyond the contribution of the classical somatic risk factors in men. Atherosclerosis 2017; 257:224-231. [PMID: 28110940 DOI: 10.1016/j.atherosclerosis.2016.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 11/17/2016] [Accepted: 12/01/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Depressed mood and exhaustion (DEEX) have gained attention as a risk predictor for cardiovascular disease (CVD). Studies to estimate its ranking in prediction models are sparse. METHODS The study included 3428 men aged 45-74 years who participated in one of three population-based MONICA/KORA Augsburg surveys conducted between 1984 and 1995. Within a follow-up time of 10 years (31,791 person-years), 557 cases of all-cause mortality and 269 fatal CVD events were observed. Adjusted Cox proportional hazards models were used to assess mortality risks for DEEX and five classical cardiovascular risk factors. The predictive ability was evaluated by the area under the receiver-operating characteristic curve, the integrated discrimination improvement statistics and the net classification improvement. RESULTS The (crude) absolute mortality risk for DEEX was 23.1 cases per 1000 person-years for all-cause and 11.2 for CVD mortality. The adjusted hazard ratios of 1.52 for all-cause and 1.52 for CVD mortality (p < 0.01) were higher than those for hypercholesterolemia and obesity, but lower than for hypertension, smoking and diabetes. The improvements in risk prediction from DEEX were comparable to those of hypercholesterolemia and obesity, but substantially lower than those of hypertension, smoking and diabetes. The adjusted population-attributable risk (PAR) for DEEX accounted for about 15% for all-cause and CVD mortality, which gives DEEX a middle ranking amongst the classical risk factors. CONCLUSIONS DEEX is a strong predictor of mortality risk, ranking in a medium position amongst classical somatic risk factors.
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Affiliation(s)
- Karl-Heinz Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Jens Baumert
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karoline Lukaschek
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University of Marburg and Gießen, Germany
| | - Hamimatunnisa Johar
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Xioayan Fang
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany
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Rücker V, Keil U, Fitzgerald AP, Malzahn U, Prugger C, Ertl G, Heuschmann PU, Neuhauser H. Predicting 10-Year Risk of Fatal Cardiovascular Disease in Germany: An Update Based on the SCORE-Deutschland Risk Charts. PLoS One 2016; 11:e0162188. [PMID: 27612145 PMCID: PMC5017762 DOI: 10.1371/journal.pone.0162188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/18/2016] [Indexed: 11/19/2022] Open
Abstract
Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008–11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40–65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29% and the estimated proportion of high risk people (10-year risk > = 5%) by 50% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk.
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Affiliation(s)
- Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Ulrich Keil
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Anthony P Fitzgerald
- Department of Epidemiology and Public Health, Department of Statistics, University College Cork, Cork, Ireland
| | - Uwe Malzahn
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Christof Prugger
- Institute of Public Health, Charité ‒ Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Ertl
- Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center Würzburg, University Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center Würzburg, University Würzburg, Würzburg, Germany
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
- * E-mail:
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Pires JR, Dezem TU, Barroso EM, Toledo BECD, Monteiro SCM, Martins AT, Zuza EP. Cardiovascular risk in obese patients with chronic periodontitis: a clinical controlled study. REVISTA DE ODONTOLOGIA DA UNESP 2013. [DOI: 10.1590/s1807-25772013000300008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Studies have shown that obesity is considered a risk factor for the development of periodontal disease and cardiovascular events. OBJECTIVE: The objective was to evaluate the risk for cardiovascular diseases (CVDs) in obese patients with and without periodontal. MATERIAL AND METHOD: One hundred patients were divided into four groups: Group O - obese without chronic periodontitis (n=25); Group OP - obese with chronic periodontitis (n=25); Group NO - non-obese without chronic periodontitis (n=25); and Group NOP - non-obese with chronic periodontitis (n=25). Demographic and laboratorial data (total cholesterol, high-density lipoprotein - HDL and low-density lipoprotein - LDL, triglycerides, and glucose); anthropometric measurements (body mass index - BMI; waist circumference - WC; body fat - BF); blood pressure; and periodontal parameters (bleeding on probing - BOP, periodontal probing depth - PPD, and the clinical attachment level - CAL) were evaluated. Cardiovascular risk was obtained according to the PROCAM's score. The correlation between obesity, periodontal disease and risk for CVD was verified by Spearman's test (α = 0.05). RESULT: The group OP showed a statistically higher rate of PPD > 7 mm (11.2 ± 2.03) when compared with other groups, as well as higher levels of triglycerides, total cholesterol, and LDL (p<0.05). The risk for CVD was statistically higher in the group OP (28.1 ± 3.3) when compared with group O (16.5 ± 3.5), group NOP (12.8 ± 3.9), and group NO (7.7 ± 0.9). Obesity and periodontal disease are directly related to a moderate increase in CVD risk (r = 0.53, p <0.0001 and r = 0.62, p <0.0001, respectively). CONCLUSION: It was concluded that obesity and periodontal disease increases the risk to cardiovascular events.
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Erbel R, Budoff M. Improvement of cardiovascular risk prediction using coronary imaging: subclinical atherosclerosis: the memory of lifetime risk factor exposure. Eur Heart J 2012; 33:1201-13. [PMID: 22547221 DOI: 10.1093/eurheartj/ehs076] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Deaths from diseases of the heart are decreasing. Cardiovascular diseases (CVD) will be the main cause of morbidity and mortality in 2015 according to a WHO report. The main problem is related to the long-time delay between the start of the development of atherosclerosis in young adults and the manifestation many decades later. Despite a recent decline in a CVD mortality rate in men and women, the main problem is related to the acute manifestation as the acute coronary syndrome, which leads 30-50% of subjects to sudden and fatal outcomes. In addition, about 20% of first and recurrent acute myocardial infarctions are silent. The lifetime risk of coronary artery disease after 40 years is 49% for men and 32% for women. That means, we are confronted with a major health care problem. This is even more obvious, when the rate of coronary heart disease deaths out of the hospital are taken into account which amount to 70% in 2007. These data are confirmed for Europe despite a strong decline of hospital deaths. Another problem is related to the fact that the number of sudden cardiac death amounts to >300 000 in the general US population. It is about 10 times higher than in those patients who are defined as prone to sudden death due to low ejection fraction, ventricular arrhythmias, and acute myocardial infarction. For cardiologists, this general topic becomes even more obvious, because even well-known cardiologists experienced early (≤65 years) sudden cardiac deaths such as RW Campbell, JM Isner, PA Poole-Wilson, H Drexler, and recently the paediatric cardiologist from Hannover, A Wessels. These events underline again what has been emphasized 15 years ago by the MONICA study that two-thirds of patients die outside the hospital and that we have to concentrate on primary and secondary prevention, also in memory of these colleagues. This review will demonstrate the potential value of coronary artery calcification screening which can be used as a sign of subclinical coronary arteriosclerosis for improved risk prediction, the first step to prevention. Subclinical atherosclerosis represents the vessel memory of risk factor exposure.
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Affiliation(s)
- Raimund Erbel
- Department of Cardiology, West-German Heart Center Essen, University Duisburg Essen, Hufelandstrasse 55, Essen, Germany.
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Reinsch N, Neuhaus K, Esser S, Potthoff A, Hower M, Mostardt S, Neumann A, Brockmeyer NH, Gelbrich G, Erbel R, Neumann T. Are HIV patients undertreated? Cardiovascular risk factors in HIV: results of the HIV-HEART study. Eur J Prev Cardiol 2011; 19:267-74. [DOI: 10.1177/1741826711398431] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nico Reinsch
- Department of Cardiology, West-German Heart Center, University of Essen, Germany
| | - Kathrin Neuhaus
- Department of Cardiology, West-German Heart Center, University of Essen, Germany
| | - Stefan Esser
- Department of Dermatology and Venerology, University of Essen, Germany
| | - Anja Potthoff
- Department of Dermatology, Ruhr-University Bochum, Germany
| | - Martin Hower
- Department of Internal Medicine, Pneumology and Infectiology, Klinikum Dortmund, Germany
| | - Sarah Mostardt
- Chair for Medical Management, University Duisburg-Essen, Germany
| | - Anja Neumann
- Chair for Medical Management, University Duisburg-Essen, Germany
| | | | - Götz Gelbrich
- Center for Clinical Trials (ZKS), University of Leipzig, Germany
| | - Raimund Erbel
- Department of Cardiology, West-German Heart Center, University of Essen, Germany
| | - Till Neumann
- Department of Cardiology, West-German Heart Center, University of Essen, Germany
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Abstract
Preventive efforts should be guided by the patient's global cardiovascular (CV) risk. A risk stratification should be done in every person > age 35 with more than a single risk factor. Recommendations for improved lifestyle are applicable to all persons with CV risk factors: smoking cessation, daily exercise, normal body mass index, Mediterranean diet, blood pressure < 140 mmHg systolic, and LDL cholesterol < 130 mg/dl are beneficial. If the 10-year risk is > or = 20% for CV events or > or = 5% for CV death, additional drug interventions are usually necessary: acetylsalicylic acid 100 mg daily, statins to lower LDL cholesterol to < 100 mg/dl or, in diabetics with coronary artery disease, to < 70 mg/dl, blood pressure should be < 130 mmHg systolic, e.g., in patients with diabetes or renal disease. After bare-metal stent implantation clopidogrel should be given for > or = 4 weeks and after drug-eluting stents for > or = 6 months. In patients after myocardial infarction with an ejection fraction of < 40%, ACE inhibitors and beta-blocker should be started. Influenza vaccination improves prognosis in high-risk patients.
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Integrated electronic decision support increases cardiovascular disease risk assessment four fold in routine primary care practice. ACTA ACUST UNITED AC 2008; 15:173-8. [DOI: 10.1097/hjr.0b013e3282f13af4] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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