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Lim AMW, Lim EU, Chen PL, Fann CSJ. Unsupervised clustering identified clinically relevant metabolic syndrome endotypes in UK and Taiwan Biobanks. iScience 2024; 27:109815. [PMID: 39040048 PMCID: PMC11260869 DOI: 10.1016/j.isci.2024.109815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/02/2024] [Accepted: 04/23/2024] [Indexed: 07/24/2024] Open
Abstract
Metabolic syndrome (MetS) is a collection of cardiovascular risk factors; however, the high prevalence and heterogeneity impede effective clinical management. We conducted unsupervised clustering on individuals from UK Biobank to reveal endotypes. Five MetS subgroups were identified: Cluster 1 (C1): non-descriptive, Cluster 2 (C2): hypertensive, Cluster 3 (C3): obese, Cluster 4 (C4): lipodystrophy-like, and Cluster 5 (C5): hyperglycemic. For all of the endotypes, we identified the corresponding cardiometabolic traits and their associations with clinical outcomes. Genome-wide association studies (GWASs) were conducted to identify associated genotypic traits. We then determined endotype-specific genotypic traits and constructed polygenic risk score (PRS) models specific to each endotype. GWAS of each MetS clusters revealed different genotypic traits. C1 GWAS revealed novel findings of TRIM63, MYBPC3, MYLPF, and RAPSN. Intriguingly, C1, C3, and C4 were associated with genes highly expressed in brain tissues. MetS clusters with comparable phenotypic and genotypic traits were identified in Taiwan Biobank.
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Affiliation(s)
- Aylwin Ming Wee Lim
- Taiwan International Graduate Program in Molecular Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei 112304, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
- ASUS Intelligent Cloud Services (AICS), Taipei 112, Taiwan
| | - Evan Unit Lim
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Pei-Lung Chen
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Cathy Shen Jang Fann
- Taiwan International Graduate Program in Molecular Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei 112304, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
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2
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Luo X, Liu W, Sun N, Bo P, Chen Y, Han Q, Li N, Lu X, Mou J, Sun G, Zhang Y. The prevalence of monotherapy and combination therapy in hypertension in China from 2019 to 2021: A nationwide population-based cross-sectional study. J Clin Hypertens (Greenwich) 2024. [PMID: 39012241 DOI: 10.1111/jch.14870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/13/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
There are no nationwide surveys on antihypertensive drugs in China. In order to assess the current status of antihypertensive drug therapy in patients with hypertension and analyzed factors that may affect combination therapy, using convenience sampling, we recruited 305,624 patients with hypertension from the Chinese Cardiovascular Association Database-Hypertension Center between January 2019 and December 2021. Chi-squared test was performed to analyze the administered antihypertensive drug types and their combinations in different hospital settings. Logistic regression was used to assess the factors influencing combination therapy. We found around 33.1% of the participants had stage 2 and above hypertension, of which 67.9% were treated with combination therapy. In community or general hospitals, the most common monotherapy was calcium channel blockers (CCB), angiotensin-converting enzyme inhibitor/angiotensin II receptor inhibitor (ACEI/ARB) and diuretic were the main single-pill combinations (SPCs), and ACEI/ARB and CCB were the main free combination. From 2019 to 2021, the rates of combination therapy increased (58.8%-64.1%) with SPCs from 25.9% to 31.0% and free combination from 31.9% to 32.6%. Patients aged < 60 years, with stage 2 and above hypertension, with an education level of high school and above, visiting general hospitals, living in the eastern region of China, with hypertension risk factors and comorbidities, and without anxiety or depression were more likely to receive combination therapy (all P < .05). The combination therapy use rate increased yearly and the rate of SPCs rose obviously. Individual, hospital, and regional differences in patients with hypertension influenced combination therapy.
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Affiliation(s)
- Xiaoyang Luo
- Cardiovascular Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Cardiovascular Department, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei Liu
- Cardiovascular Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Ningling Sun
- Cardiovascular Department, Peking University People's Hospital, Beijing, China
| | - Peili Bo
- Cardiovascular Department, Qilu Hospital of Shandong University, Jinan, China
| | - Yuanyuan Chen
- Cardiovascular Department, Peking University People's Hospital, Beijing, China
| | - Qinghua Han
- Cardiovascular Department, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Nanfang Li
- Cardiovascular Department, Xinjiang Uigur Municipal People's Hospital, Urumqi, China
| | - Xinzheng Lu
- Cardiovascular Department, Jiangsu Province Hospital, Nanjing, China
| | - Jianjun Mou
- Cardiovascular Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Gang Sun
- Cardiovascular Department, The Second Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Yuqing Zhang
- Cardiovascular Department, Fu Wai Hospital, Center for Cardiovascular Diseases, Beijing, China
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Johnson LS, Mente A, Joseph P, Conen D, Benz AP, McIntyre WF, Drake I, Engström G, Connolly SJ, Yusuf S, Healey JS. Sodium Intake and Incident Atrial Fibrillation in Individuals With Vascular Disease. JAMA Netw Open 2024; 7:e2421589. [PMID: 38990569 PMCID: PMC11240191 DOI: 10.1001/jamanetworkopen.2024.21589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/13/2024] [Indexed: 07/12/2024] Open
Abstract
Importance Numerous prospective cohort studies have reported a J-shaped association of urinary sodium excretion with cardiovascular events and mortality. Objective To study the association between sodium intake and incident atrial fibrillation (AF). Design, Setting, and Participants This cohort study included participants in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND) multicenter, randomized clinical trials comparing the effect of ramipril 10 mg daily with telmisartan 80 mg daily, or their combination (ONTARGET) or 80 mg telmisartan daily with placebo (TRANSCEND) for the outcome of death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. ONTARGET and TRANSCEND included 31 546 participants with vascular disease or high-risk diabetes, and this study excluded participants without a urine sample for sodium measurement, missing data for key covariates, a history of AF, or AF detected in the first year after enrollment. Analyses were performed in July 2023 to May 2024. Exposure Estimated sodium intake from a morning fasting urine sample (Kawasaki formula). Main Outcomes and Measures The main outcome was incident AF. The association between estimated sodium intake and incident AF was modeled using multivariable adjusted Cox regression and cubic splines. Results A total of 27 391 participants (mean [SD] age, 66.3 [7.2] years; 19 310 [70.5%] male) were included. Mean (SD) estimated sodium intake was 4.8 (1.6) g/d. During a mean (SD) follow-up of 4.6 (1.0) years, 1562 participants (5.7%) had incident AF. After multivariable adjustment, a J-shaped association between sodium intake and AF risk was observed (P for nonlinearity = .03). Sodium intake of 8 g/d or greater (3% of participants) was associated with incident AF (hazard ratio, 1.32; 95% CI, 1.01-1.74) compared with sodium intake of 4 to 5.99 g/d. Cubic splines showed that sodium intake greater than 6 g/d (19% of participants) was associated with a 10% increased AF risk per additional 1-g/d sodium intake (hazard ratio, 1.10; 95% CI, 1.03-1.18), but with no further lowering of AF risk at lower levels of sodium intake. Conclusions and Relevance In this cohort study of sodium intake and AF risk, there was a J-shaped association between sodium intakes and AF risk in patients with cardiovascular disease or diabetes. Lowering sodium intake for AF prevention is best targeted at individuals who consume high sodium diets.
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Affiliation(s)
- Linda S Johnson
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Mente
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Philip Joseph
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alexander P Benz
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - William F McIntyre
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Isabel Drake
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Zhang W, Chen Y, Hu LX, Xia JH, Ye XF, Cheng YB, Wang Y, Guo QH, Li Y, Lowres N, Freedman B, Wang JG. New-onset hypertension as a contributing factor to the incidence of atrial fibrillation in the elderly. Hypertens Res 2024; 47:1490-1499. [PMID: 38438728 DOI: 10.1038/s41440-024-01617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/20/2024] [Accepted: 01/27/2024] [Indexed: 03/06/2024]
Abstract
Hypertension and atrial fibrillation are closely related. However, hypertension is already prevalent in young adults, but atrial fibrillation usually occurs in the elderly. In the present analysis, we investigated incident atrial fibrillation in relation to new-onset hypertension in an elderly Chinese population. Our study participants were elderly (≥65 years) hypertensive residents, recruited from community health centers in the urban Shanghai (n = 4161). Previous and new-onset hypertension were defined as the use of antihypertensive medication or elevated systolic/diastolic blood pressure (≥140/90 mmHg), respectively, at entry and during follow-up on ≥ 2 consecutive clinic visits. Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG. During a median of 2.1 years follow-up, the incidence rate of atrial fibrillation was 7.60 per 1000 person-years in all study participants; it was significantly higher in patients with new-onset hypertension (n = 368) than those with previous hypertension (n = 3793, 15.76 vs. 6.77 per 1000 person-years, P = 0.02). After adjustment for confounding factors, the hazard ratio for the incidence of atrial fibrillation was 2.21 (95% confidence interval 1.15-4.23, P = 0.02) in patients with new-onset hypertension versus those with previous hypertension. The association was even stronger in those aged ≥ 75 years (hazard ratio 2.70, 95% confidence interval 1.11-6.56, P = 0.03). In patients with previous hypertension, curvilinear association (P for non-linear trend = 0.04) was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension. Our study showed a significant association between new-onset hypertension and the incidence of atrial fibrillation in elderly Chinese. In an elderly Chinese population with previous and new-onset hypertension, we found that the new-onset hypertension during follow-up, compared with previous hypertension, was associated with a significantly higher risk of incident atrial fibrillation. In patients with previous hypertension, curvilinear association was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension.
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Affiliation(s)
- Wei Zhang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei-Xiao Hu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia-Hui Xia
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Fei Ye
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nicole Lowres
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ben Freedman
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Natale P, Palmer SC, Navaneethan SD, Craig JC, Strippoli GF. Angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers for preventing the progression of diabetic kidney disease. Cochrane Database Syst Rev 2024; 4:CD006257. [PMID: 38682786 PMCID: PMC11057222 DOI: 10.1002/14651858.cd006257.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Guidelines suggest that adults with diabetes and kidney disease receive treatment with angiotensin-converting-enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB). This is an update of a Cochrane review published in 2006. OBJECTIVES We compared the efficacy and safety of ACEi and ARB therapy (either as monotherapy or in combination) on cardiovascular and kidney outcomes in adults with diabetes and kidney disease. SEARCH METHODS We searched the Cochrane Kidney and Transplants Register of Studies to 17 March 2024 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA We included studies evaluating ACEi or ARB alone or in combination, compared to each other, placebo or no treatment in people with diabetes and kidney disease. DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias and extracted data. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS One hundred and nine studies (28,341 randomised participants) were eligible for inclusion. Overall, the risk of bias was high. Compared to placebo or no treatment, ACEi may make little or no difference to all-cause death (24 studies, 7413 participants: RR 0.91, 95% CI 0.73 to 1.15; I2 = 23%; low certainty) and with similar withdrawals from treatment (7 studies, 5306 participants: RR 1.03, 95% CI 0.90 to 1.19; I2 = 0%; low certainty). ACEi may prevent kidney failure (8 studies, 6643 participants: RR 0.61, 95% CI 0.39 to 0.94; I2 = 0%; low certainty). Compared to placebo or no treatment, ARB may make little or no difference to all-cause death (11 studies, 4260 participants: RR 0.99, 95% CI 0.85 to 1.16; I2 = 0%; low certainty). ARB have uncertain effects on withdrawal from treatment (3 studies, 721 participants: RR 0.85, 95% CI 0.58 to 1.26; I2 = 2%; low certainty) and cardiovascular death (6 studies, 878 participants: RR 3.36, 95% CI 0.93 to 12.07; low certainty). ARB may prevent kidney failure (3 studies, 3227 participants: RR 0.82, 95% CI 0.72 to 0.94; I2 = 0%; low certainty), doubling of serum creatinine (SCr) (4 studies, 3280 participants: RR 0.84, 95% CI 0.72 to 0.97; I2 = 32%; low certainty), and the progression from microalbuminuria to macroalbuminuria (5 studies, 815 participants: RR 0.44, 95% CI 0.23 to 0.85; I2 = 74%; low certainty). Compared to ACEi, ARB had uncertain effects on all-cause death (15 studies, 1739 participants: RR 1.13, 95% CI 0.68 to 1.88; I2 = 0%; low certainty), withdrawal from treatment (6 studies, 612 participants: RR 0.91, 95% CI 0.65 to 1.28; I2 = 0%; low certainty), cardiovascular death (13 studies, 1606 participants: RR 1.15, 95% CI 0.45 to 2.98; I2 = 0%; low certainty), kidney failure (3 studies, 837 participants: RR 0.56, 95% CI 0.29 to 1.07; I2 = 0%; low certainty), and doubling of SCr (2 studies, 767 participants: RR 0.88, 95% CI 0.52 to 1.48; I2 = 0%; low certainty). Compared to ACEi plus ARB, ACEi alone has uncertain effects on all-cause death (6 studies, 1166 participants: RR 1.08, 95% CI 0.49 to 2.40; I2 = 20%; low certainty), withdrawal from treatment (2 studies, 172 participants: RR 0.78, 95% CI 0.33 to 1.86; I2 = 0%; low certainty), cardiovascular death (4 studies, 994 participants: RR 3.02, 95% CI 0.61 to 14.85; low certainty), kidney failure (3 studies, 880 participants: RR 1.36, 95% CI 0.79 to 2.32; I2 = 0%; low certainty), and doubling of SCr (2 studies, 813 participants: RR 1.14, 95% CI 0.70 to 1.85; I2 = 0%; low certainty). Compared to ACEi plus ARB, ARB alone has uncertain effects on all-cause death (7 studies, 2607 participants: RR 1.02, 95% CI 0.76 to 1.37; I2 = 0%; low certainty), withdrawn from treatment (3 studies, 1615 participants: RR 0.81, 95% CI 0.53 to 1.24; I2 = 0%; low certainty), cardiovascular death (4 studies, 992 participants: RR 3.03, 95% CI 0.62 to 14.93; low certainty), kidney failure (4 studies, 2321 participants: RR 1.15, 95% CI 0.67 to 1.95; I2 = 29%; low certainty), and doubling of SCr (3 studies, 2252 participants: RR 1.18, 95% CI 0.85 to 1.64; I2 = 0%; low certainty). Comparative effects of different ACEi or ARB and low-dose versus high-dose ARB were rarely evaluated. No study compared different doses of ACEi. Adverse events of ACEi and ARB were rarely reported. AUTHORS' CONCLUSIONS ACEi or ARB may make little or no difference to all-cause and cardiovascular death compared to placebo or no treatment in people with diabetes and kidney disease but may prevent kidney failure. ARB may prevent the doubling of SCr and the progression from microalbuminuria to macroalbuminuria compared with a placebo or no treatment. Despite the international guidelines suggesting not combining ACEi and ARB treatment, the effects of ACEi or ARB monotherapy compared to dual therapy have not been adequately assessed. The limited data availability and the low quality of the included studies prevented the assessment of the benefits and harms of ACEi or ARB in people with diabetes and kidney disease. Low and very low certainty evidence indicates that it is possible that further studies might provide different results.
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Affiliation(s)
- Patrizia Natale
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Jonathan C Craig
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giovanni Fm Strippoli
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
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Cooper TE, Teng C, Tunnicliffe DJ, Cashmore BA, Strippoli GF. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for adults with early (stage 1 to 3) non-diabetic chronic kidney disease. Cochrane Database Syst Rev 2023; 7:CD007751. [PMID: 37466151 PMCID: PMC10355090 DOI: 10.1002/14651858.cd007751.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a long-term condition that occurs as a result of damage to the kidneys. Early recognition of CKD is becoming increasingly common due to widespread laboratory estimated glomerular filtration rate (eGFR) reporting, raised clinical awareness, and international adoption of the Kidney Disease Improving Global Outcomes (KDIGO) classifications. Early recognition and management of CKD affords the opportunity to prepare for progressive kidney impairment and impending kidney replacement therapy and for intervention to reduce the risk of progression and cardiovascular disease. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are two classes of antihypertensive drugs that act on the renin-angiotensin-aldosterone system. Beneficial effects of ACEi and ARB on kidney outcomes and survival in people with a wide range of severity of kidney impairment have been reported; however, their effectiveness in the subgroup of people with early CKD (stage 1 to 3) is less certain. This is an update of a review that was last published in 2011. OBJECTIVES To evaluate the benefits and harms of ACEi and ARB or both in the management of people with early (stage 1 to 3) CKD who do not have diabetes mellitus (DM). SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 6 July 2023 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and Embase, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) reporting the effect of ACEi or ARB in people with early (stage 1 to 3) CKD who did not have DM were selected for inclusion. Only studies of at least four weeks duration were selected. Authors independently assessed the retrieved titles and abstracts and, where necessary, the full text to determine which satisfied the inclusion criteria. DATA COLLECTION AND ANALYSIS Data extraction was carried out by two authors independently, using a standard data extraction form. The methodological quality of included studies was assessed using the Cochrane risk of bias tool. Data entry was carried out by one author and cross-checked by another. When more than one study reported similar outcomes, data were pooled using the random-effects model. Heterogeneity was analysed using a Chi² test and the I² test. Results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach MAIN RESULTS: Six studies randomising 9379 participants with CKD stages 1 to 3 (without DM) met our inclusion criteria. Participants were adults with hypertension; 79% were male from China, Europe, Japan, and the USA. Treatment periods ranged from 12 weeks to three years. Overall, studies were judged to be at unclear or high risk of bias across all domains, and the quality of the evidence was poor, with GRADE rated as low or very low certainty. In low certainty evidence, ACEi (benazepril 10 mg or trandolapril 2 mg) compared to placebo may make little or no difference to death (any cause) (2 studies, 8873 participants): RR 2.00, 95% CI 0.26 to 15.37; I² = 76%), total cardiovascular events (2 studies, 8873 participants): RR 0.97, 95% CI 0.90 to 1.05; I² = 0%), cardiovascular-related death (2 studies, 8873 participants): RR 1.73, 95% CI 0.26 to 11.66; I² = 54%), stroke (2 studies, 8873 participants): RR 0.76, 95% CI 0.56 to 1.03; I² = 0%), myocardial infarction (2 studies, 8873 participants): RR 1.00, 95% CI 0.84 to 1.20; I² = 0%), and adverse events (2 studies, 8873 participants): RR 1.33, 95% CI 1.26 to 1.41; I² = 0%). It is uncertain whether ACEi (benazepril 10 mg or trandolapril 2 mg) compared to placebo reduces congestive heart failure (1 study, 8290 participants): RR 0.75, 95% CI 0.59 to 0.95) or transient ischaemic attack (1 study, 583 participants): RR 0.94, 95% CI 0.06 to 15.01; I² = 0%) because the certainty of the evidence is very low. It is uncertain whether ARB (losartan 50 mg) compared to placebo (1 study, 226 participants) reduces: death (any-cause) (no events), adverse events (RR 19.34, 95% CI 1.14 to 328.30), eGFR rate of decline (MD 5.00 mL/min/1.73 m2, 95% CI 3.03 to 6.97), presence of proteinuria (MD -0.65 g/24 hours, 95% CI -0.78 to -0.52), systolic blood pressure (MD -0.80 mm Hg, 95% CI -3.89 to 2.29), or diastolic blood pressure (MD -1.10 mm Hg, 95% CI -3.29 to 1.09) because the certainty of the evidence is very low. It is uncertain whether ACEi (enalapril 20 mg, perindopril 2 mg or trandolapril 1 mg) compared to ARB (olmesartan 20 mg, losartan 25 mg or candesartan 4 mg) (1 study, 26 participants) reduces: proteinuria (MD -0.40, 95% CI -0.60 to -0.20), systolic blood pressure (MD -3.00 mm Hg, 95% CI -6.08 to 0.08) or diastolic blood pressure (MD -1.00 mm Hg, 95% CI -3.31 to 1.31) because the certainty of the evidence is very low. AUTHORS' CONCLUSIONS There is currently insufficient evidence to determine the effectiveness of ACEi or ARB in patients with stage 1 to 3 CKD who do not have DM. The available evidence is overall of very low certainty and high risk of bias. We have identified an area of large uncertainty for a group of patients who account for most of those diagnosed as having CKD.
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Affiliation(s)
- Tess E Cooper
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Claris Teng
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Brydee A Cashmore
- Centre for Kidney Research, The University of Sydney and The Children's Hospital at Westmead, Sydney, Australia
| | - Giovanni Fm Strippoli
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
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7
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Hang F, Chen J, Wang Z, Yan J, Wu Y. Association Between the Frailty and New-Onset Atrial Fibrillation/Flutter Among Elderly Hypertensive Patients. Front Cardiovasc Med 2022; 9:881946. [PMID: 35600465 PMCID: PMC9120584 DOI: 10.3389/fcvm.2022.881946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Frailty was found to be common in patients with atrial fibrillation/flutter (AF), but there was still a lack of evidence regarding the relationship between frailty and new-onset AF. Methods We performed a post hoc analysis of data from the Systolic Blood Pressure Intervention Trial (SPRINT). In addition, we evaluated the relationship between baseline frailty status and new-onset AF in older adult patients with hypertension. Results In total, 7,316 participants were included in our analysis, and a total of 115 new-onset AF occurred during an average of 3.54 years of follow-up. Using SPRINT frailty index criteria, 1,535 fit, 4,041 less fit, and 1,740 frailty were enrolled. Compared with other groups, the incidence of new-onset AF in the frailty group was significantly higher. We constructed three Cox models to assess the relationship between the frailty status (fit group as reference) and new-onset AF. Participants with frailty had a significantly higher risk of new-onset AF compared with the fit group in all the models we used. We combined the fit group and the less fit group into a no frailty group to assess the impact of frailty on new-onset AF in various subgroups. After full adjustment (Model 3), frailty remained associated with the increased risk of new-onset AF compared with the no frailty group [hazard ratio [HR] = 2.09, 95% CI:(1.41, 3.09), p < 0.001]. Additionally, we examined the frailty index as continuous variable to assess the relationship between the frailty index and new-onset AF. The smooth curve showed that log HR appeared to increase linearly. And there was a significant interaction between baseline systolic blood pressure (SBP) categories and frailty on the risk of new-onset AF (p for interaction = 0.030). Conclusion This study found baseline frailty status was a strong independent risk factor for new-onset AF among older adult patients with hypertension. Screening for frailty should be considered in older adult patients with hypertension to prevent new-onset AF.
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Ríos-Jaimes F, Otero-González OA, Villarreal-Ríos E, García-Gutiérrez MC. [Fibrilación auricular de primera vez en evento vascular cerebral isquémico en el servicio de urgencias]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:453-457. [PMID: 33601404 PMCID: PMC8641461 DOI: 10.24875/acm.20000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/09/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the incidence of undiagnosed atrial fibrillation in patients with an ischemic cerebral vascular event. Methods A descriptive cross-sectional design was carried out in patients older than 18 years with a diagnosis of ischemic cerebral vascular event, attended in the emergency department. The sample size was made up of the total clinical records of patients with a diagnosis of ischemic cerebral vascular event (n = 199). All patients who underwent electrocardiogram were included. Age and sex were studied; history of diabetes mellitus and history of hypertension. The cerebral vascular event was diagnosed with a computerized axial tomography endorsed by a radiologist; atrial fibrillation was considered when an irregular R-R wave, absence of P wave, and irregular atrial activity were identified on the electrocardiogram. The reading and interpretation was performed by the emergency physician. Statistical analysis included percentages, confidence intervals for percentages and calculation of probability of occurrence of binomial event. Results The average age of the patients with a cerebral vascular event is 72.37 years (95% CI: 70.91-73.82), the male sex predominates with 57.7% (95% CI: 50.8-64.7). The diagnosis of arterial hypertension is present in 74.8% (95% CI: 68.8-80.9) of the patients. The incidence of first-time atrial fibrillation is 72.36% (95% CI: 66.0-78.6). Conclusion In the studied population, the incidence of previously undiagnosed atrial fibrillation in patients with ischemic cerebrovascular event is high.
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Affiliation(s)
- Franklin Ríos-Jaimes
- Servicio de Urgencias, Hospital General Regional N. 1, Instituto Mexicano del Seguro Social, Querétaro de Arteaga, Qro
| | - Olivia A. Otero-González
- Servicio de Urgencias, Hospital General de Zona N. 3, Instituto Mexicano del Seguro Social, Ciudad Mante, Tamps
| | - Enrique Villarreal-Ríos
- Unidad de Investigación Epidemiológica y en Servicios de Salud Querétaro, Instituto Mexicano del Seguro Social, Querétaro de Arteaga, Qro
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9
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Coccina F, Pierdomenico AM, De Rosa M, Lorenzo B, Foglietta M, Petrilli I, Vitulli P, Pizzicannella J, Trubiani O, Cipollone F, Renda G, Pierdomenico SD. Risk of Atrial Fibrillation in Masked and White Coat Uncontrolled Hypertension. Am J Hypertens 2021; 34:504-510. [PMID: 33186441 DOI: 10.1093/ajh/hpaa185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/17/2020] [Accepted: 11/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Risk of atrial fibrillation (AF) in masked and white coat uncontrolled hypertension (MUCH and WUCH, respectively) has not yet been investigated. We assessed the risk of new-onset AF in MUCH and WUCH detected by ambulatory blood pressure (BP) monitoring. METHODS The occurrence of AF was evaluated in 2,135 treated hypertensive patients aged >40 years, with baseline sinus rhythm, by electrocardiogram. Controlled hypertension (CH) was defined as clinic BP <140/90 mm Hg and daytime BP, regardless of nighttime BP, <135/85 mm Hg, MUCH as clinic BP <140/90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg, WUCH as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP <135/85 mm Hg, and sustained uncontrolled hypertension (SUCH) as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg. RESULTS MUCH was identified in 203 patients (9.5% of all the population, 29% of those with normal clinic BP) and WUCH in 503 patients (23.5% of all the population, 35% of those with high clinic BP). During the follow-up (mean 9.7 years), 116 cases of AF occurred. After adjustment for covariates, patients with MUCH (hazard ratio 2.02, 95% confidence interval, 1.06-3.85) and SUCH (hazard ratio 1.83, 95% confidence interval, 1.04-3.21) had higher risk of new-onset AF than those with CH, whereas those with WUCH (hazard ratio 1.12, 95% confidence interval, 0.59-2.13) did not. CONCLUSIONS When compared with patients with CH, those with MUCH and SUCH are at higher risk (approximately doubled) of new-onset AF, whereas those with WUCH are not.
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Affiliation(s)
- Francesca Coccina
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Anna M Pierdomenico
- Department of Medicine and Aging Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Matteo De Rosa
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Belli Lorenzo
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Melissa Foglietta
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Ivan Petrilli
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Piergiusto Vitulli
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Jacopo Pizzicannella
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Oriana Trubiani
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Giulia Renda
- Department of Neurosciences, Imaging and Clinical Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Sante D Pierdomenico
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
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10
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Coccina F, Pierdomenico AM, De Rosa M, Cuccurullo C, Pierdomenico SD. Association of clinic and ambulatory blood pressure with new-onset atrial fibrillation: A meta-analysis of observational studies. J Clin Hypertens (Greenwich) 2021; 23:1104-1111. [PMID: 33951286 PMCID: PMC8678663 DOI: 10.1111/jch.14256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to perform a meta‐analysis of studies evaluating the association of clinic and daytime, nighttime, and 24‐h blood pressure with the occurrence of new‐onset atrial fibrillation. We conducted a literature search through PubMed, Web of science, and Cochrane Library for articles evaluating the occurrence of new‐onset atrial fibrillation in relation to the above‐mentioned blood pressure parameters and reporting adjusted hazard ratio and 95% confidence interval. We identified five studies. The pooled population consisted of 7224 patients who experienced 444 cases of atrial fibrillation. The overall adjusted hazard ratio (95% confidence interval) was 1.05 (0.98‐1.13), 1.19 (1.11‐1.27), 1.18 (1.11‐1.26), and 1.23 (1.14‐1.32), per 10‐mmHg increment in clinic, daytime, nighttime, and 24‐h systolic blood pressure, respectively. The degree of heterogeneity of the hazard ratio estimates across the studies (Q and I‐squared statistics) were minimal. The results of this meta‐analysis strongly suggest that ambulatory systolic blood pressure prospectively predicts incident atrial fibrillation better than does clinic systolic blood pressure and that daytime, nighttime, and 24‐h systolic blood pressure are similarly associated with future atrial fibrillation.
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Affiliation(s)
- Francesca Coccina
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Anna M Pierdomenico
- Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Matteo De Rosa
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Chiara Cuccurullo
- Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Sante D Pierdomenico
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy
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11
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Mascolo A, Urbanek K, De Angelis A, Sessa M, Scavone C, Berrino L, Rosano GMC, Capuano A, Rossi F. Angiotensin II and angiotensin 1-7: which is their role in atrial fibrillation? Heart Fail Rev 2021; 25:367-380. [PMID: 31375968 DOI: 10.1007/s10741-019-09837-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atrial fibrillation (AF) is a significant cause of morbidity and mortality as well as a public health burden considering the high costs of AF-related hospitalizations. Pre-clinical and clinical evidence showed a potential role of the renin angiotensin system (RAS) in the etiopathogenesis of AF. Among RAS mediators, angiotensin II (AII) and angiotensin 1-7 (A1-7) have been mostly investigated in AF. Specifically, the stimulation of the pathway mediated by AII or the inhibition of the pathway mediated by A1-7 may participate in inducing and sustaining AF. In this review, we summarize the evidence showing that both RAS pathways may balance the onset of AF through different biological mechanisms involving inflammation, epicardial adipose tissue (EAT) accumulation, and electrical cardiac remodeling. EAT is a predictor for AF as it may induce its onset through direct (infiltration of epicardial adipocytes into the underlying atrial myocardium) and indirect (release of inflammatory adipokines, the stimulation of oxidative stress, macrophage phenotype switching, and AF triggers) mechanisms. Classic RAS blockers such as angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) may prevent AF by affecting the accumulation of the EAT, representing a useful therapeutic strategy for preventing AF especially in patients with heart failure and known left ventricular dysfunction. Further studies are necessary to prove this benefit in patients with other cardiovascular diseases. Finally, the possibility of using the A1-7 or ACE2 analogues, to enlarge current therapeutic options for AF, may represent an important field of research.
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Affiliation(s)
- Annamaria Mascolo
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy.
| | - Konrad Urbanek
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Antonella De Angelis
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Maurizio Sessa
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Cristina Scavone
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Liberato Berrino
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Giuseppe Massimo Claudio Rosano
- IRCCS San Raffaele Pisana, Rome, Italy.,Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK
| | - Annalisa Capuano
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
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12
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13
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Coccina F, Pierdomenico AM, Ianni U, De Rosa M, De Luca A, Pirro D, Pizzicannella J, Trubiani O, Cipollone F, Renda G, Pierdomenico SD. Ambulatory blood pressure and risk of new-onset atrial fibrillation in treated hypertensive patients. J Clin Hypertens (Greenwich) 2021; 23:147-152. [PMID: 33242233 PMCID: PMC8029687 DOI: 10.1111/jch.14112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the influence of clinic and ambulatory blood pressure (BP) on the occurrence of new-onset atrial fibrillation (AF) in treated hypertensive patients. We studied 2135 sequential treated hypertensive patients aged >40 years. During the follow-up (mean 9.7 years, range 0.4-20 years), 116 events (new-onset AF) occurred. In univariate analysis, clinic, daytime, nighttime, and 24-h systolic BP were all significantly associated with increased risk of new-onset AF, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.22 (1.11-1.35), 1.36 (1.21-1.53), 1.42 (1.29-1.57), and 1.42 (1.26-1.60), respectively. After adjustment for various covariates in multivariate analysis, clinic systolic BP was no longer associated with increased risk of new-onset AF, whereas daytime, nighttime, and 24-h systolic BP remained significantly associated with outcome, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.09 (0.97-1.23), 1.23 (1.10-1.39), 1.16 (1.03-1.31), and 1.22 (1.06-1.40), respectively. Daytime, nighttime, and 24-h systolic BP are superior to clinic systolic BP in predicting new-onset AF in treated hypertensive patients. Future studies are needed to evaluate whether a better control of ambulatory BP might be helpful in reducing the occurrence of new-onset AF.
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Affiliation(s)
- Francesca Coccina
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Anna M. Pierdomenico
- Department of Medicine and Aging SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Umberto Ianni
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Matteo De Rosa
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Andrea De Luca
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Davide Pirro
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Jacopo Pizzicannella
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Oriana Trubiani
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Francesco Cipollone
- Department of Medicine and Aging SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Giulia Renda
- Department of Neurosciences, Imaging and Clinical SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Sante D. Pierdomenico
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
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14
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Abstract
The population suffering from coronary heart disease (CHD) complicated by atrial fibrillation (AF) is rising rapidly. A strong correlation between the two diseases has been reported, and the many common risk factors they share may play prominent roles in their development. In addition, CHD can directly promote the progression of AF by affecting reentry formation, focal ectopic activity, and neural remodeling. At the same time, AF also affects CHD through three aspects: 1) atherosclerosis, 2) the mismatch of blood supply and oxygen consumption, and 3) thrombosis. In conclusion, CHD and AF can aggravate each other and seem to form a vicious cycle. For patients with CHD complicated by AF, principal studies and guidelines have focused on antithrombotic treatment and rhythm control, which are paramount for these patients. Of note, our review sheds light on the strategies to break the cycle of the two diseases, which may be fundamental to treat these patients and optimize the benefit.
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Affiliation(s)
- Feng Liang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Wang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Office, central and ambulatory blood pressure for predicting incident atrial fibrillation in older adults. J Hypertens 2020; 39:46-52. [PMID: 33031165 DOI: 10.1097/hjh.0000000000002613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Recently, more sophisticated blood pressure (BP) measurements, such as central and ambulatory BP (ABP), have proven to be stronger predictors of future cardiovascular disease than conventional office BP. Their predictive value for atrial fibrillation development is not established. We investigated the prognostic impact for incident atrial fibrillation of office, central and ambulatory BP measurements in a predominantly older population-based cohort. METHODS Of 1004 participants in the Cardiovascular Abnormalities and Brain Lesions (CABL) study, 769 in sinus rhythm with no history of atrial fibrillation or stroke (mean age 70.5 years) underwent ABP and arterial wave reflection analysis for central BP determination. Fine and Gray's proportional subdistribution hazards models were used to assess the association of BP parameters with incident atrial fibrillation. RESULTS During 9.5 years, atrial fibrillation occurred in 83 participants. No office BP variable showed a significant association with incident atrial fibrillation. Central SBP and central pulse pressure were marginally associated with incident atrial fibrillation in multivariate analysis. Among ABP variables, 24-h SBP [adjusted hazard ratio per 10 mmHg, 1.24; 95% confidence interval (CI) 1.07--1.44; P = 0.004], daytime SBP (adjusted hazard ratio per 10 mmHg, 1.21; 95% CI 1.04--1.40; P = 0.011) and night-time SBP (adjusted hazard ratio per 10 mmHg, 1.22; 95% CI 1.07--1.39; P = 0.002) were significantly associated with incident atrial fibillation. CONCLUSION In a predominantly older, stroke-free community-based cohort, ABP was a better independent predictor of incident atrial fibrillation than central BP, whereas office BP was inadequate for this purpose.
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16
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Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S. Intensive systolic blood pressure control and prevention of new onset atrial fibrillation in the SPRINT study: is the association really controversial? Blood Press 2020; 29:199-201. [PMID: 32584173 DOI: 10.1080/08037051.2020.1782595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sverre E Kjeldsen
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Suzanne Oparil
- Vascular Biology and Hypertension Programme, Department of Medicine, University of Alabama at Birmingham, AL, USA
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17
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Pouwels S, Buise MP, Twardowski P, Stepaniak PS, Proczko M. Obesity Surgery and Anesthesiology Risks: a Review of Key Concepts and Related Physiology. Obes Surg 2020; 29:2670-2677. [PMID: 31127496 DOI: 10.1007/s11695-019-03952-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The obesity epidemic is swelling to epic proportions. Obese patients often suffer from a combination of hypertension, dyslipidemia, and type 2 diabetes mellitus (T2DM), also known as the "metabolic syndrome." The metabolic syndrome is an independent predictor of cardiac dysfunction and cardiovascular disease and a risk factor for perioperative morbidity and mortality. In this paper, we discuss the perioperative risk factors and the need for advanced care of obese patients needing general anesthesia for (bariatric) surgical procedures based on physiological principles.
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Affiliation(s)
- Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
| | - Marc P Buise
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Pawel Twardowski
- Department of Anesthesia and Intensive Care, University Medical Center, Gdansk University, Gdansk, Poland
| | - Pieter S Stepaniak
- Department of Operating Rooms, Catharina Hospital, Eindhoven, The Netherlands
| | - Monika Proczko
- Department of Surgery, University Medical Center, Gdansk University, Gdansk, Poland
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18
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Motozato K, Suematsu Y, Norimatsu K, Kusumoto T, Miura SI. Reactive Hyperemia Index Associated With Atherosclerotic Cardiovascular Disease Under Treatment for Lifestyle Diseases. J Clin Med Res 2020; 12:293-299. [PMID: 32489504 PMCID: PMC7239580 DOI: 10.14740/jocmr4100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 02/17/2020] [Indexed: 12/03/2022] Open
Abstract
Background Endothelial dysfunction is an early phase of atherosclerosis and causes atherosclerotic cardiovascular disease (ASCVD), but the cutoff reactive hyperemia index (RHI) for identifying ASCVD patients under treatment for lifestyle diseases is unknown. Methods Patients who visited Cardiology Section, Izumi General Medical Center, Kagoshima, Japan and were measured RHI using Endo-PAT 2000 during May 2014 and March 2016 were enrolled. We divided them into ASCVD and non-ASCVD groups and investigated the association with RHI between the groups. Results ASCVD group included 195 patients and non-ASCVD group included 288 patients. Age, body mass index and the rate of male, hypertension, diabetes, dyslipidemia and chronic kidney disease in the ASCVD group were significantly higher than those in non-ASCVD group. RHI in the ASCVD group (1.65 (1.40 - 1.92)) was significantly lower than that in the non-ASCVD group (1.73 (1.45 - 2.24)) (P < 0.05). In multi-regression analysis, RHI (odds ratio: 0.67, 95% confidence interval: 0.45 - 0.99, P = 0.04) was independently associated with ASCVD after adjusted by age, sex, body mass index, smoking, hypertension, diabetes, dyslipidemia and chronic kidney disease. The cutoff RHI value between the groups was 1.80. Conclusion RHI was significantly associated with ASCVD under treatment for lifestyle diseases and the cutoff value was 1.80.
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Affiliation(s)
- Kota Motozato
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Cardiology, Izumi General Medical Center, Kagoshima, Japan.,Present address: Department of Cardiology, Kumamoto University, Kumamoto, Japan.,These authors contributed equally to this manuscript
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,These authors contributed equally to this manuscript
| | - Kenji Norimatsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Cardiology, Izumi General Medical Center, Kagoshima, Japan
| | - Takaaki Kusumoto
- Department of Cardiology, Izumi General Medical Center, Kagoshima, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
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19
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Sanches E, Timmermans M, Topal B, Celik A, Sundbom M, Ribeiro R, Parmar C, Ugale S, Proczko M, Stepaniak PS, Pujol Rafols J, Mahawar K, Buise MP, Neimark A, Severin R, Pouwels S. Cardiac remodeling in obesity and after bariatric and metabolic surgery; is there a role for gastro-intestinal hormones? Expert Rev Cardiovasc Ther 2019; 17:771-790. [PMID: 31746657 DOI: 10.1080/14779072.2019.1690991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Obesity is associated with various diseases such as type 2 diabetes, hypertension, obstructive sleep apnea syndrome (OSAS), metabolic syndrome, and cardiovascular diseases. It affects several organ systems, including the pulmonary and cardiac systems. Furthermore, it induces pulmonary and cardiac changes that can result in right and/or left heart failure.Areas covered: In this review, authors provide an overview of obesity and cardiovascular remodeling, the individual actions of the gut hormones (like GLP-1 and PYY), the effects after bariatric/metabolic surgery and its influence on cardiac remodeling. In this review, we focussed and searched for literature in Pubmed and The Cochrane library (from the earliest date until April 2019), regarding cardiac function changes before and after bariatric surgery and literature regarding changes in gastrointestinal hormones.Expert opinion: Regarding the surgical treatment of obesity and metabolic diseases there is recognition of the importance of both weight loss (bariatric surgery) and improvement in metabolic milieu (metabolic surgery). A growing body of evidence further suggests that bariatric surgical procedures [like the Sleeve Gastrectomy (SG), Roux-en Y Gastric Bypass (RYGB), or One Anastomosis Gastric Bypass (OAGB)] have can improve outcomes of patients suffering from a number of cardiovascular diseases, including heart failure.
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Affiliation(s)
- Elijah Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Marieke Timmermans
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Besir Topal
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Alper Celik
- Department of Bariatric and Metabolic Surgery, Metabolic Surgery Clinic, Sisli, Turkey
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rui Ribeiro
- Centro Multidisciplinar da Doença Metabólica, Clínica de Santo António, Lisbon, Portugal
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, UK
| | - Surendra Ugale
- Bariatric & Metabolic Surgery Clinic, Kirloskar Hospital, Hyderabad, India
| | - Monika Proczko
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Gdansk University, Gdansk, Poland
| | - Pieter S Stepaniak
- Department of Operating Rooms, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | - Marc P Buise
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Aleksandr Neimark
- Department of Surgery, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Rich Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.,Doctor of Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
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20
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Invited review: hypertension and atrial fibrillation: epidemiology, pathophysiology, and implications for management. J Hum Hypertens 2019; 33:824-836. [DOI: 10.1038/s41371-019-0279-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023]
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21
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Liatakis I, Manta E, Tsioufis C. Hypertension and Atrial Fibrillation: Epidemiological Data, Pathogenesis, and Therapeutic Implications. Am J Hypertens 2019; 32:725-726. [PMID: 31091309 DOI: 10.1093/ajh/hpz077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ioannis Liatakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Eleni Manta
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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22
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Tlegenova ZS, Zholdin BK, Kudaiberdieva GZ, Abdrakhmanov AS. [Factors associated with atrial fibrillation in patients with hypertension and preserved left ventricle systolic function]. ACTA ACUST UNITED AC 2019; 59:37-46. [PMID: 31221074 DOI: 10.18087/cardio.2617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 11/18/2022]
Abstract
The objective of our study was to define factors associated with atrial fibrillation (AF) in patients with hypertension (HTN) and preserved left ventricle systolic function. MATERIAL AND METHODS Overall, 273 consecutive patients with HTN residing in urban area were included in the study. Patients were divided into 2 groups: the first - 60 patients with paroxysmal and persistent AF (33% men, age 62, 28 (10,02), the second - 213 patients without AF (33% men, age 59,37 (8,27). RESULTS Stepwise logistic regression analysis demonstrated AF presence was associated with alcohol intake ≥ 7 drinks per week (OR 4,12; 95%CI: 1,04-16,35), low physical activity (OR 3,18; 95% CI: 1,32-7,68), higher hip circumference (OR 1,19; 95% CI: 1,08-1,31) and history of HTN (OR 1,10; 95% CI: 1,04-1,17). BMI was not associated with presence of AF (OR 0,75; 95% CI: 0,61-0,91). CONCLUSION Thus in our urban population with hypertension, AF is associated with alcohol intake ≥ 7 drinks per week, low physical activity, increased hip circumference and history of hypertension.AF prevention should include modification of lifestyle.
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Affiliation(s)
| | - B K Zholdin
- West Kazakhstan Marat Ospanov State Medical University
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23
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Verdecchia P, Angeli F, Reboldi G. Hypertension and Atrial Fibrillation: Doubts and Certainties From Basic and Clinical Studies. Circ Res 2019; 122:352-368. [PMID: 29348255 DOI: 10.1161/circresaha.117.311402] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hypertension and atrial fibrillation (AF) are 2 important public health priorities. Their prevalence is increasing worldwide, and the 2 conditions often coexist in the same patient. Hypertension and AF are strikingly related to an excess risk of cardiovascular disease and death. Hypertension ultimately increases the risk of AF, and because of its high prevalence in the population, it accounts for more cases of AF than other risk factors. Among patients with established AF, hypertension is present in about 60% to 80% of individuals. Despite the well-known association between hypertension and AF, several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. From an epidemiological standpoint, it is unclear whether the increasing risk of AF with blood pressure (BP) is linear or threshold. It is uncertain whether an intensive control of BP or the use of specific antihypertensive drugs, such as those inhibiting the renin-angiotensin-aldosterone system, reduces the risk of subsequent AF in hypertensive patients in sinus rhythm. Finally, in spite of the observational evidence suggesting a progressive relation between BP levels and the risk of thromboembolism and bleeding in patients with hypertension and AF, the extent to which BP should be lowered in these patients, including those who undergo catheter ablation, remains uncertain. This article summarizes the main basic mechanisms through which hypertension is believed to promote AF. It also explores epidemiological data supporting an evolutionary pathway from hypertension to AF, including the emerging evidence favoring an intensive BP control or the use of drugs, which inhibit the renin-angiotensin-aldosterone system to reduce the risk of AF. Finally, it examines the impact of non-vitamin K antagonist oral anticoagulants compared with warfarin in relation to hypertension.
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Affiliation(s)
- Paolo Verdecchia
- From the Struttura Complessa di Medicina, Dipartimento di Medicina, Ospedale di Assisi, Italy (P.V.); and Struttura Complessa di Cardiologia e Fisiopatologia Cardiovascolare, Dipartimento di Cardiologia (F.A.) and Dipartimento di Medicina Interna (G.R.), Università di Perugia, Italy.
| | - Fabio Angeli
- From the Struttura Complessa di Medicina, Dipartimento di Medicina, Ospedale di Assisi, Italy (P.V.); and Struttura Complessa di Cardiologia e Fisiopatologia Cardiovascolare, Dipartimento di Cardiologia (F.A.) and Dipartimento di Medicina Interna (G.R.), Università di Perugia, Italy
| | - Gianpaolo Reboldi
- From the Struttura Complessa di Medicina, Dipartimento di Medicina, Ospedale di Assisi, Italy (P.V.); and Struttura Complessa di Cardiologia e Fisiopatologia Cardiovascolare, Dipartimento di Cardiologia (F.A.) and Dipartimento di Medicina Interna (G.R.), Università di Perugia, Italy
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24
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Tsioufis C, Konstantinidis D, Nikolakopoulos I, Vemmou E, Kalos T, Georgiopoulos G, Vogiatzakis N, Ifantis A, Konstantinou K, Gennimata V, Tousoulis D. Biomarkers of Atrial Fibrillation in Hypertension. Curr Med Chem 2019; 26:888-897. [DOI: 10.2174/0929867324666171006155516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/05/2017] [Accepted: 12/30/2017] [Indexed: 12/20/2022]
Abstract
Background:
Atrial fibrillation (AF) is the most frequently encountered cardiac
arrhythmia globally and substantially increases the risk for thromboembolic disease.
Albeit, 20% of all cases of AF remain undiagnosed. On the other hand, hypertension amplifies
the risk for both AF occurrences through hemodynamic and non-hemodynamic
mechanisms and cerebrovascular ischemia. Under this prism, prompt diagnosis of undetected
AF in hypertensive patients is of pivotal importance.
Method:
We conducted a review of the literature for studies with biomarkers that could
be used in AF diagnosis as well as in predicting the transition of paroxysmal AF to sustained
AF, especially in hypertensive patients.
Results:
Potential biomarkers for AF can be broadly categorized into electrophysiological,
morphological and molecular markers that reflect the underlying mechanisms of adverse
atrial remodeling. We focused on P-wave duration and dispersion as electrophysiological
markers, and left atrial (LA) and LA appendage size, atrial fibrosis, left ventricular
hypertrophy and aortic stiffness as structural biomarkers, respectively. The heterogeneous
group of molecular biomarkers of AF encompasses products of the neurohormonal
cascade, including NT-pro BNP, BNP, MR-pro ANP, polymorphisms of the ACE and
convertases such as corin and furin. In addition, soluble biomarkers of inflammation (i.e.
CRP, IL-6) and fibrosis (i.e. TGF-1 and matrix metalloproteinases) were assessed for predicting
AF.
Conclusion:
The reviewed individual biomarkers might be a valuable addition to current
diagnostic tools but the ideal candidate is expected to combine multiple indices of atrial
remodeling in order to effectively detect both AF and adverse characteristics of high risk
patients with hypertension.
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Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Ilias Nikolakopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Evi Vemmou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Theodoros Kalos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Georgios Georgiopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikolaos Vogiatzakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Aris Ifantis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinou Konstantinou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Vasiliki Gennimata
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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25
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Pouwels S, Topal B, Knook MT, Celik A, Sundbom M, Ribeiro R, Parmar C, Ugale S. Interaction of obesity and atrial fibrillation: an overview of pathophysiology and clinical management. Expert Rev Cardiovasc Ther 2019; 17:209-223. [PMID: 30757925 DOI: 10.1080/14779072.2019.1581064] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Besir Topal
- Department of Cardiothoracic Surgery, Amsterdam, The Netherlands
| | - Mireille T. Knook
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
- Nederlandse Obesitas Kliniek West, The Hague, The Netherlands
| | | | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rui Ribeiro
- Centro Multidisciplinar da Doença Metabólica, Clínica de Santo António, Lisbon, Portugal
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, UK
| | - Surendra Ugale
- Bariatric & Metabolic Surgery Clinic, Kirloskar Hospital, Hyderabad, India
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26
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Huo Y, Chen H, Kassab GS. Acute Tachycardia Increases Aortic Distensibility, but Reduces Total Arterial Compliance Up to a Moderate Heart Rate. Front Physiol 2018; 9:1634. [PMID: 30510518 PMCID: PMC6252350 DOI: 10.3389/fphys.2018.01634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 10/29/2018] [Indexed: 12/02/2022] Open
Abstract
Background: The differential effects of rapid cardiac pacing on small and large vessels have not been well-established. The objective of this study was to investigate the effect of pacing-induced acute tachycardia on hemodynamics and arterial stiffness. Methods: The pressure and flow waves in ascending aorta and femoral artery of six domestic swine were recorded simultaneously at baseline and heart rates (HR) of 135 and 155 beats per minutes (bpm) and analyzed by the models of Windkessel and Womersley types. Accordingly, the flow waves were simultaneously measured at carotid and femoral arteries to quantify aortic pulse wave velocity (PWV). The arterial distensibility was identified in small branches of coronary, carotid and femoral arteries with diameters of 300–600 μm by ex vivo experiments. Results: The rapid pacing in HR up to 135 bpm reduced the total arterial compliance, stroke volume, systemic pulse pressure, and central systolic pressure by 36 ± 17, 38 ± 26, 29 ± 16, and 23 ± 12%, respectively, despite no statistical difference of mean aortic pressure, cardiac output, peripheral resistance, and vascular flow patterns. The pacing also resulted in a decrease of distensibility of small muscular arteries, but an increase of aortic distensibility. Pacing from 135 to 155 bpm had negligible effects on systemic and local hemodynamics and arterial stiffness. Conclusions: There is an acute mismatch in the response of aorta and small arteries to pacing from basal HR to 135 bpm, which may have important pathological implications under chronic tachycardia conditions.
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Affiliation(s)
- Yunlong Huo
- PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China.,Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Huan Chen
- California Medical Innovations Institute, San Diego, CA, United States
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
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27
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2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953-2041. [PMID: 30234752 DOI: 10.1097/hjh.0000000000001940] [Citation(s) in RCA: 1795] [Impact Index Per Article: 299.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Héctor Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
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28
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5622] [Impact Index Per Article: 937.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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29
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Colussi G, Catena C, Fagotto V, Darsiè D, Brosolo G, Bertin N, Sechi LA. Atrial fibrillation and its complications in arterial hypertension: The potential preventive role of ω-3 polyunsaturated fatty acids. Crit Rev Food Sci Nutr 2018; 59:1937-1948. [PMID: 29381383 DOI: 10.1080/10408398.2018.1434126] [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] [Indexed: 10/18/2022]
Abstract
Atrial fibrillation (AF) is the most common type of arrhythmia in the general population with a prevalence that reaches one third of patients with arterial hypertension. Several risk factors frequently associated with hypertension predispose the myocardium to AF by inducing atrial inflammation and fibrosis and altering atrial electrical and mechanical characteristics. AF influences the quality of life of hypertensive patients since it increases incidence of stroke and other thromboembolic events, and mortality. Polyunsaturated fatty acids of the ω-3 family (ω-3 PUFA) have been demonstrated to be beneficial in cardiovascular disease prevention by reducing plasma lipids and blood pressure levels and decreasing the risk of sudden death. These fatty acids can act as potent anti-inflammatory and anti-arrhythmic agents. Many studies have investigated a possible preventive effect of ω-3 PUFA on incident AF reporting contradictory results. This article overviews the evidence currently available on this important topic and provides some conclusive remarks on the possibility that these fatty acids could be beneficial in hypertensive patients.
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Affiliation(s)
- GianLuca Colussi
- a Division of Internal Medicine, Department of Medicine , University of Udine , Udine , Italy
| | - Cristiana Catena
- a Division of Internal Medicine, Department of Medicine , University of Udine , Udine , Italy
| | - Valentina Fagotto
- a Division of Internal Medicine, Department of Medicine , University of Udine , Udine , Italy
| | - Daniele Darsiè
- a Division of Internal Medicine, Department of Medicine , University of Udine , Udine , Italy
| | - Gabriele Brosolo
- a Division of Internal Medicine, Department of Medicine , University of Udine , Udine , Italy
| | - Nicole Bertin
- a Division of Internal Medicine, Department of Medicine , University of Udine , Udine , Italy
| | - Leonardo A Sechi
- a Division of Internal Medicine, Department of Medicine , University of Udine , Udine , Italy
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30
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Chen T, Xing J, Liu Y. Effects of telmisartan on vascular endothelial function, inflammation and insulin resistance in patients with coronary heart disease and diabetes mellitus. Exp Ther Med 2018; 15:909-913. [PMID: 29399098 PMCID: PMC5772733 DOI: 10.3892/etm.2017.5451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/01/2017] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the effects of telmisartan on vascular endothelial functions, inflammatory factors and insulin resistance of coronary heart disease patients complicated with diabetes mellitus. In total, 80 coronary heart disease patients complicated with type 2 diabetes mellitus, admitted and treated in the Zhangqiu Hospital from January 2016 to March 2017 were enrolled in the study. Each patient was randomly assigned to an observation (n=40) or a control group (n=40) using a random number table. Conventional symptomatic and supporting therapies were administered to all the patients in the two groups for 12 consecutive weeks, while additional telmisartan was given only to patients in the observation group. Markers of glucose metabolism, vascular endothelial function and inflammation were determined before and after intervention, to compare averages between groups. Results showed the levels of fasting blood glucose and blood glucose in the observation group were significantly lower than those in the control group (p<0.05) after 4 weeks of treatment. The levels of HOMA-IR in the observation group were clearly improved compared to those in the control group during the same period (p<0.05). After the intervention, the levels of FINS and HOMA-IR in the observation group improved significantly more compared with those in the control group (p<0.05), while the levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) were much lower than those in the control group (p<0.05). Furthermore, at the 4th, 8th and 12th week after starting the treatment, the vascular endothelin (ET) levels in the observation group were significantly lower than those in the control group (p<0.05). In addition, the brachial artery diameters in the basal state were significantly larger than those in the control group (p<0.05) for the same time-points. Coronary heart disease patients complicated with diabetes mellitus whose treatment includes telmisartan can better regulate their blood glucose, reduce the insulin resistance and body inflammatory responses and improve their vascular endothelial functions.
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Affiliation(s)
- Tao Chen
- Department of Cardiovascular Medicine, Zhangqiu Hospital of Traditional Chinese Medicine, Jinan, Shandong 250200, P.R. China
| | - Jieyong Xing
- Department of Cardiovascular Medicine, Zhangqiu Hospital of Traditional Chinese Medicine, Jinan, Shandong 250200, P.R. China
| | - Yanshao Liu
- Department of Cardiovascular Medicine, Zhangqiu Hospital of Traditional Chinese Medicine, Jinan, Shandong 250200, P.R. China
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31
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Kjeldsen SE, Wachtell K. Consensus document on hypertension and cardiac arrhythmias. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2017; 3:251-252. [PMID: 28922836 DOI: 10.1093/ehjcvp/pvx022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Sverre E Kjeldsen
- University of Oslo, Institute for Clinical Medicine, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
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32
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Cho ME, Craven TE, Cheung AK, Glasser SP, Rahman M, Soliman EZ, Stafford RS, Johnson KC, Bates JT, Burgner A, Taylor AA, Tamariz L, Tang R, Beddhu S. The association between insulin resistance and atrial fibrillation: A cross-sectional analysis from SPRINT (Systolic Blood Pressure Intervention Trial). J Clin Hypertens (Greenwich) 2017; 19:1152-1161. [PMID: 28866864 DOI: 10.1111/jch.13062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/01/2017] [Accepted: 06/04/2017] [Indexed: 01/12/2023]
Abstract
It is unclear whether metabolic syndrome (MetS) is associated with atrial fibrillation (AF) in an older population with greater cardiovascular risk, including those with chronic kidney disease. The authors investigated the association between MetS and AF in participants in SPRINT (Systolic Blood Pressure Intervention Trial). MetS was defined based on the Modified Third National Cholesterol Education Program. The baseline prevalence rate for MetS was 55%, while 8.2% of the participants had AF. In multivariate regression analyses, AF was not associated with presence of MetS in either chronic kidney disease or non-chronic kidney disease subgroups. Age, race, history of cardiovascular diseases, decreased triglycerides, decreased pulse pressure, and albuminuria remained significantly associated with AF risk. In contrast to the general population, MetS was not associated with AF in the older population with increased cardiovascular risk studied in SPRINT.
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Affiliation(s)
- Monique E Cho
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, UT, USA.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Timothy E Craven
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, UT, USA.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA.,Department of Nephrology, The Second Xiangya Hospital, Changsha, China
| | - Stephen P Glasser
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mahboob Rahman
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston Salem, NC, USA
| | | | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeffrey T Bates
- Division of General Internal Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Anna Burgner
- Division of Nephrology and Hypertension, Vanderbilt University, Nashville, TN, USA
| | - Addison A Taylor
- Baylor College of Medicine, Houston, TX, USA.,Division of Hypertension and Clinical Pharmacology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Leonardo Tamariz
- Division of General Internal Medicine, University of Miami, Miami, FL, USA
| | - Rocky Tang
- Division of Cardiothoracic and Abdominal Transplant Surgery, Columbia University, New York, NY, USA
| | - Srinivasan Beddhu
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, UT, USA.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
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Fenger-Grøn M, Overvad K, Tjønneland A, Frost L. Lean Body Mass Is the Predominant Anthropometric Risk Factor for Atrial Fibrillation. J Am Coll Cardiol 2017; 69:2488-2497. [PMID: 28521886 DOI: 10.1016/j.jacc.2017.03.558] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/27/2017] [Accepted: 03/14/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Obesity is repeatedly emphasized as a risk factor for atrial fibrillation or flutter (AF). However, the underlying evidence may be questioned, as the obvious correlations between various anthropometric measures hamper identification of the characteristics that are biologically driving AF risk, and recent studies suggest that fat carries limited or no independent risk of AF. OBJECTIVES This study sought to assess mutually adjusted associations among AF risk and height, weight, body mass index, hip and waist circumference, waist-to-hip ratio, and bioelectrical impedance-derived measures of fat mass, lean body mass, and fat percentage. METHODS Anthropometric measures and self-reported life-style information were collected from 1993 to 1997 in a population-based cohort including 55,273 persons age 50 to 64 years who were followed in Danish registers until June 2013. RESULTS During a median of 17 years of follow-up, 3,868 persons developed AF. Adjusted hazard ratios per population SD difference (HRs) showed highly statistically significant, positive associations for all 9 anthropometric measures (HRs ranging from 1.08 [95% confidence interval (CI): 1.05 to 1.12] for waist-to-hip ratio to 1.37 [95% CI: 1.33 to 1.42] for lean body mass). Pairwise mutual adjustment of the 9 measures left the association for lean body mass virtually unchanged (lowest HR: 1.33 [95% CI: 1.28 to 1.39] when adjusting for height), whereas no other association remained substantial when adjusted for lean body mass (highest HR: 1.05 [95% CI: 1.01 to 1.10] for height). CONCLUSIONS Lean body mass was the predominant anthropometric risk factor for AF, whereas no association was observed for either of the obesity-related anthropometric measures after adjustment for lean body mass.
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Affiliation(s)
- Morten Fenger-Grøn
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lars Frost
- Department of Clinical Medicine, Aarhus University, Silkeborg Hospital, Denmark
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Dzeshka MS, Shahid F, Shantsila A, Lip GYH. Hypertension and Atrial Fibrillation: An Intimate Association of Epidemiology, Pathophysiology, and Outcomes. Am J Hypertens 2017; 30:733-755. [PMID: 28338788 DOI: 10.1093/ajh/hpx013] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 01/18/2023] Open
Abstract
Atrial fibrillation (AF) is the most prevalent sustained arrhythmia found in clinical practice. AF rarely exists as a single entity but rather as part of a diverse clinical spectrum of cardiovascular diseases, related to structural and electrical remodeling within the left atrium, leading to AF onset, perpetuation, and progression. Due to the high overall prevalence within the AF population arterial hypertension plays a significant role in the pathogenesis of AF and its complications. Fibroblast proliferation, apoptosis of cardiomyocytes, gap junction remodeling, accumulation of collagen both in atrial and ventricular myocardium all accompany ageing-related structural remodeling with impact on electrical activity. The presence of hypertension also stimulates oxidative stress, systemic inflammation, rennin-angiotensin-aldosterone and sympathetic activation, which further drives the remodeling process in AF. Importantly, both hypertension and AF independently increase the risk of cardiovascular and cerebrovascular events, e.g., stroke and myocardial infarction. Given that both AF and hypertension often present with limited on patient wellbeing, treatment may be delayed resulting in development of complications as the first clinical manifestation of the disease. Antithrombotic prevention in AF combined with strict blood pressure control is of primary importance, since stroke risk and bleeding risk are both greater with underlying hypertension.
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Affiliation(s)
- Mikhail S Dzeshka
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
- Grodno State Medical University, Grodno, Belarus
| | - Farhan Shahid
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Alena Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Trevisan C, Maggi S, Curreri C, Nante G, Noale M, De Rui M, Perissinotto E, Sartori L, Zambon S, Crepaldi G, Manzato E, Sergi G. Anthropometric parameters and the incidence of atrial fibrillation in older people: the PRO.V.A study. Clin Cardiol 2017; 40:461-468. [PMID: 28191907 PMCID: PMC6490338 DOI: 10.1002/clc.22677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/15/2016] [Accepted: 01/03/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) has been associated with body size and central obesity, but the impact of different anthropometric measures in this relationship has been inadequately investigated. HYPOTHESIS In this study, we examined the association between baseline anthropometric parameters with the incidence of AF in older people, hypothesizing that body size could impact the onset of AF more than fat distribution. METHODS Our study included 1764 participants with a mean age of 74.3 ± 6.9 years and no AF at baseline. Body mass index (BMI), body height, body surface area (BSA), waist and hip circumference, waist-to-stature ratio, waist-to-hip ratio, and mid-upper arm circumference (MUAC) were measured by trained physicians. AF was assessed after a 4.4-year follow-up. RESULTS There were 115 new cases of AF observed after the follow-up. Taking lower values of these measures for reference, the adjusted AF risk was 2.42 (95% confidence interval [CI]:1.88-3.12) for the highest stature quartile, 1.36 (95% CI:1.15-1.62) for BMI ≥30 kg/m2 , 2.12 (95% CI:1.73-2.59) for the highest BSA quartile, 1.38 (95% CI: 1.21-1.56) for higher MUAC, and 1.39 (95% CI: 1.23-1.58, P < 0.0001) for higher hip circumference values. Central obesity did not seem to relevantly predict the onset of AF in our sample. Stature revealed the strongest impact on the onset of AF (5% higher risk of developing AF per 1 cm increase in height). CONCLUSIONS Body size, particularly tall stature and obesity, but not fat distribution, seems to be associated with the risk of AF in the elderly.
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Affiliation(s)
- Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics DivisionUniversity of PadovaPadovaItaly
| | - Stefania Maggi
- National Research Council, Neuroscience InstitutePadovaItaly
| | - Chiara Curreri
- Department of Medicine (DIMED), Geriatrics DivisionUniversity of PadovaPadovaItaly
| | - Giovanni Nante
- Department of Medicine (DIMED), Geriatrics DivisionUniversity of PadovaPadovaItaly
| | - Marianna Noale
- National Research Council, Neuroscience InstitutePadovaItaly
| | - Marina De Rui
- Department of Medicine (DIMED), Geriatrics DivisionUniversity of PadovaPadovaItaly
| | - Egle Perissinotto
- Departments of Cardiac, Thoracic, and Vascular Sciences, Biostatistics, Epidemiology, and Public Health UnitUniversity of PadovaPadovaItaly
| | - Leonardo Sartori
- Department of Medicine (DIMED), Clinica Medica IUniversity of PadovaPadovaItaly
| | - Sabina Zambon
- National Research Council, Neuroscience InstitutePadovaItaly
- Department of Medicine (DIMED), Clinica Medica IUniversity of PadovaPadovaItaly
| | | | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics DivisionUniversity of PadovaPadovaItaly
- National Research Council, Neuroscience InstitutePadovaItaly
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics DivisionUniversity of PadovaPadovaItaly
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Baek YS, Yang PS, Kim TH, Uhm JS, Park J, Pak HN, Lee MH, Joung B. Associations of Abdominal Obesity and New-Onset Atrial Fibrillation in the General Population. J Am Heart Assoc 2017; 6:JAHA.116.004705. [PMID: 28588091 PMCID: PMC5669144 DOI: 10.1161/jaha.116.004705] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Higher height and weight are known to be associated with higher risk of atrial fibrillation (AF); however, whether the risk of AF is related to abdominal obesity is unclear. METHODS AND RESULTS We studied 501 690 adults (mean age: 47.6±14.3 years; 250 664 women [50.0%]) without baseline AF in the National Sample Cohort released by the National Health Insurance Service in Korea. Body mass index (underweight defined as <18.5; normal, 18.5 to <25.0; overweight, 25.0 to <30.0; and obese, ≥30.0) and waist circumference (abdominal obesity defined as ≥90 cm for men and ≥80 cm for women) were evaluated. During a mean follow-up of 3.9±1.3 years, 3443 participants (1432 women [41.6%]) developed AF. In multivariable models adjusted for clinical variables, the AF risk of underweight, overweight, and obese individuals increased by 21% (95% confidence interval, 1.01-1.45, P=0.043), 14% (95% confidence interval, 1.06-1.23, P<0.001), and 52% (95% confidence interval, 1.30-1.78, P<0.001), respectively, compared with those with normal body mass index. AF risk with confounder-adjusted hazards for abdominal obesity was 18% (95% confidence interval, 1.10-1.27, P<0.001). The increased AF risk was present in abdominally obese individuals regardless of body mass index except for the obese group. In subgroup analysis, abdominal obesity by waist circumference conferred increased risk of new-onset AF, particularly in participants without comorbidities. CONCLUSIONS Abdominal obesity is an important, potentially modifiable risk factor for AF in nonobese Asian persons. These data suggest that interventions to decrease abdominal obesity may reduce the population burden of AF.
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Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Pil-Sung Yang
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
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Çimen T, Sunman H, Efe TH, Akyel A, Yayla K, Şahan HF, Bilgin M, Asarcıklı LD, Nallbani A, Doğan M, Açıkel S, Yeter E. Early changes in atrial conduction times in hypertensive patients with elevated pulse pressure. Rev Port Cardiol 2017; 36:453-459. [DOI: 10.1016/j.repc.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/09/2016] [Accepted: 10/13/2016] [Indexed: 11/25/2022] Open
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Early changes in atrial conduction times in hypertensive patients with elevated pulse pressure. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Atrial fibrillation is associated with an increased risk of myocardial infarction: Insights from a meta-analysis. Atherosclerosis 2016; 254:1-7. [PMID: 27673698 DOI: 10.1016/j.atherosclerosis.2016.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/25/2016] [Accepted: 09/09/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS The presence of atrial fibrillation (AF) markedly increases the risk of stroke and mortality in patients. Whether AF is a risk factor for myocardial infarction (MI) is discrepant from current studies. The aim of this meta-analysis was to ascertain the association of AF with incident MI. METHODS Studies were identified through PubMed, CENTRAL, EMBASE, reviews and reference lists of relevant papers. Results of the MI outcome were presented as hazard ratio (HR) and 95% confidence interval (CI). Statistical analyses were performed with Stata 12.0 (Stata Corp LP, College Station, Texas, USA). RESULTS Twelve studies, with a total of 169,306 patients, were included in the analysis. AF was associated with a 47% increased risk of MI (HR:1.47; 95% CI: 1.21-1.80; p = 0.000; I2 = 84.1%), while in patients free of coronary heart disease at baseline the risk could be increased by 71% (HR:1.71; 95% CI: 1.36-2.14; p = 0.000; I2 = 83.1%). Moreover, patients with AF had higher MI risk in the studies with lower mean age (<60 years) (HR:1.66; 95% CI: 1.26-2.20; p = 0.000; I2 = 82.9%) than in the studies with higher mean age (≥60 years) (HR:1.35; 95% CI: 1.00-1.82; p = 0.000; I2 = 84.9%). Sex difference also existed, and the association between AF and MI was stronger in women (HR:2.02; 95% CI: 1.60-2.56; p = 0.017; I2 = 61.0%) than in men (HR:1.44; 95% CI: 1.13-1.84; p = 0.000; I2 = 76.1%). CONCLUSIONS AF is associated with an increased risk of incident MI, especially in patients free of coronary heart disease at baseline, young patients and women. The findings need confirmation in well-designed observational trials.
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Kjeldsen SE, Aksnes TA, Wachtell K, Okin PM. Arterial Stiffness Predicts Incident Atrial Fibrillation in the Framingham Heart Study. Hypertension 2016; 68:555-7. [DOI: 10.1161/hypertensionaha.116.07671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sverre E. Kjeldsen
- From the University of Oslo, Institute for Clinical Medicine, Norway (S.E.K.); Department of Cardiology, Oslo University Hospital, Norway (S.E.K., T.A.A., K.W.); and Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York (P.M.O.)
| | - Tonje A. Aksnes
- From the University of Oslo, Institute for Clinical Medicine, Norway (S.E.K.); Department of Cardiology, Oslo University Hospital, Norway (S.E.K., T.A.A., K.W.); and Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York (P.M.O.)
| | - Kristian Wachtell
- From the University of Oslo, Institute for Clinical Medicine, Norway (S.E.K.); Department of Cardiology, Oslo University Hospital, Norway (S.E.K., T.A.A., K.W.); and Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York (P.M.O.)
| | - Peter M. Okin
- From the University of Oslo, Institute for Clinical Medicine, Norway (S.E.K.); Department of Cardiology, Oslo University Hospital, Norway (S.E.K., T.A.A., K.W.); and Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York (P.M.O.)
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Clinical significance of nutritional status in patients with atrial fibrillation: An overview of current evidence. J Cardiol 2016; 69:719-730. [PMID: 27520756 DOI: 10.1016/j.jjcc.2016.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/26/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is a well-known atherosclerosis risk factor; however, its role and the importance of undernutrition in atrial fibrillation (AF) pathogenesis are still not well understood. The aim of this study was to present the current state of knowledge on this issue in different groups of patients. METHODS Systematic review of papers published between 1980 and 2016. RESULTS The literature shows contradicting views regarding the impact of nutritional status on the risk, course, and complications of AF. On the one hand, it has been revealed that overweight, obesity, and high birth mass increase the risk of AF, and that their reduction is linked to an improved course of AF and reduced all-cause and cardiovascular mortality. On the other hand, a so-called obesity paradox has been found, which shows lower all-cause mortality in overweight patients with AF compared to those of normal weight or who are underweight. It has also been shown, although based on a small number of studies, that the relationship between nutritional status and risk of AF and its complication may be U-shaped, which means that not only patients with obesity, but also individuals with underweight, cachexia, and low birth weight may have an increased risk and poor outcome of AF. CONCLUSIONS The relationship between patients' nutritional status and the course of AF has become clearer but it requires further studies examining the importance of weight reduction on AF course.
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Karas MG, Yee LM, Biggs ML, Djoussé L, Mukamal KJ, Ix JH, Zieman SJ, Siscovick DS, Gottdiener JS, Rosenberg MA, Kronmal RA, Heckbert SR, Kizer JR. Measures of Body Size and Composition and Risk of Incident Atrial Fibrillation in Older People: The Cardiovascular Health Study. Am J Epidemiol 2016; 183:998-1007. [PMID: 27188936 DOI: 10.1093/aje/kwv278] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/05/2015] [Indexed: 01/22/2023] Open
Abstract
Various anthropometric measures, including height, have been associated with atrial fibrillation (AF). This raises questions about the appropriateness of using ratio measures such as body mass index (BMI), which contains height squared in its denominator, in the evaluation of AF risk. Among older adults, the optimal anthropometric approach to risk stratification of AF remains uncertain. Anthropometric and bioelectrical impedance measures were obtained from 4,276 participants (mean age = 72.4 years) free of cardiovascular disease in the Cardiovascular Health Study. During follow-up (1989-2008), 1,050 cases of AF occurred. BMI showed a U-shaped association, whereas height, weight, waist circumference, hip circumference, fat mass, and fat-free mass were linearly related to incident AF. The strongest adjusted association occurred for height (per each 1-standard-deviation increment, hazard ratio = 1.38, 95% confidence interval: 1.25, 1.51), which exceeded all other measures, including weight (hazard ratio = 1.21, 95% confidence interval: 1.13, 1.29). Combined assessment of log-transformed weight and height showed regression coefficients that departed from the 1 to -2 ratio inherent in BMI, indicating a loss of predictive information. Risk estimates for AF tended to be stronger for hip circumference than for waist circumference and for fat-free mass than for fat mass, which was explained largely by height. These findings highlight the prominent role of body size and the inadequacy of BMI as determinants of AF in older adults.
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Kjeldsen SE, Lund-Johansen P, Nilsson PM, Mancia G. Unattended Blood Pressure Measurements in the Systolic Blood Pressure Intervention Trial: Implications for Entry and Achieved Blood Pressure Values Compared With Other Trials. Hypertension 2016; 67:808-12. [PMID: 27001295 DOI: 10.1161/hypertensionaha.116.07257] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sverre E Kjeldsen
- From the Department of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway (S.E.K.); Department of Heart Diseases, University of Bergen, Haukeland Hospital, Bergen, Norway (P.L.-.J.); Department for Clinical Sciences, University of Lund, Malmö, Sweden (P.M.N.); and IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy (G.M.).
| | - Per Lund-Johansen
- From the Department of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway (S.E.K.); Department of Heart Diseases, University of Bergen, Haukeland Hospital, Bergen, Norway (P.L.-.J.); Department for Clinical Sciences, University of Lund, Malmö, Sweden (P.M.N.); and IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Peter M Nilsson
- From the Department of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway (S.E.K.); Department of Heart Diseases, University of Bergen, Haukeland Hospital, Bergen, Norway (P.L.-.J.); Department for Clinical Sciences, University of Lund, Malmö, Sweden (P.M.N.); and IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy (G.M.)
| | - Giuseppe Mancia
- From the Department of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway (S.E.K.); Department of Heart Diseases, University of Bergen, Haukeland Hospital, Bergen, Norway (P.L.-.J.); Department for Clinical Sciences, University of Lund, Malmö, Sweden (P.M.N.); and IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy (G.M.)
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Volpe M, Battistoni A, Savoia C, Tocci G. Understanding and treating hypertension in diabetic populations. Cardiovasc Diagn Ther 2015; 5:353-63. [PMID: 26543822 DOI: 10.3978/j.issn.2223-3652.2015.06.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hypertension and diabetes frequently occurs in the same individuals in clinical practice. Moreover, the presence of hypertension does increase the risk of new-onset diabetes, as well as diabetes does promote development of hypertension. Whatever the case, the concomitant presence of these conditions confers a high risk of major cardiovascular complications and promotes the use integrated pharmacological interventions, aimed at achieving the recommended therapeutic targets. While the benefits of lowering abnormal fasting glucose levels in patients with hypertension and diabetes have been consistently demonstrated, the blood pressure (BP) targets to be achieved to get a benefit in patients with diabetes have been recently reconsidered. In the past, randomized clinical trials have, indeed, demonstrated that lowering BP levels to less than 140/90 mmHg was associated to a substantial reduction of the risk of developing macrovascular and microvascular complications in hypertensive patients with diabetes. In addition, epidemiological and clinical reports suggested that "the lower, the better" for BP in diabetes, so that levels of BP even lower than 130/80 mmHg have been recommended. Recent randomized clinical trials, however, designed to evaluate the potential benefits obtained with an intensive antihypertensive therapy, aimed at achieving a target systolic BP level below 120 mmHg as compared to those obtained with less stringent therapy, have challenged the previous recommendations from international guidelines. In fact, detailed analyses of these trials showed a paradoxically increased risk of coronary events, mostly myocardial infarction, in those patients who achieved the lowest BP levels, particularly in the high-risk subsets of hypertensive populations with diabetes. In the light of these considerations, the present article will briefly review the common pathophysiological mechanisms, the potential sites of therapeutic interactions and the currently recommended BP targets to be achieved under pharmacological treatment in hypertension and diabetes.
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Affiliation(s)
- Massimo Volpe
- 1 Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Phycology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy ; 2 IRCCS Neuromed, Pozzilli (IS), Italy
| | - Allegra Battistoni
- 1 Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Phycology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy ; 2 IRCCS Neuromed, Pozzilli (IS), Italy
| | - Carmine Savoia
- 1 Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Phycology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy ; 2 IRCCS Neuromed, Pozzilli (IS), Italy
| | - Giuliano Tocci
- 1 Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Phycology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy ; 2 IRCCS Neuromed, Pozzilli (IS), Italy
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Associations of obesity and body fat distribution with incident atrial fibrillation in the biracial health aging and body composition cohort of older adults. Am Heart J 2015; 170:498-505.e2. [PMID: 26385033 DOI: 10.1016/j.ahj.2015.06.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/09/2015] [Indexed: 01/19/2023]
Abstract
UNLABELLED Obesity is a well-recognized risk factor for atrial fibrillation (AF), yet adiposity measures other than body mass index (BMI) have had limited assessment in relation to AF risk. We examined the associations of adiposity measures with AF in a biracial cohort of older adults. Given established racial differences in obesity and AF, we assessed for differences by black and white race in relating adiposity and AF. METHODS We analyzed data from 2,717 participants of the Health, Aging, and Body Composition Study. Adiposity measures were BMI, abdominal circumference, subcutaneous and visceral fat area, and total and percent fat mass. We determined the associations between the adiposity measures and 10-year incidence of AF using Cox proportional hazards models and assessed for their racial differences in these estimates. RESULTS In multivariable-adjusted models, 1-SD increases in BMI, abdominal circumference, and total fat mass were associated with a 13% to 16% increased AF risk (hazard ratio [HR] 1.14, 95% CI 1.02-1.28; HR 1.16, 95% CI 1.04-1.28; and HR 1.13, 95% CI 1.002-1.27). Subcutaneous and visceral fat areas were not significantly associated with incident AF. We did not identify racial differences in the associations between the adiposity measures and AF. CONCLUSION Body mass index, abdominal circumference, and total fat mass are associated with risk of AF for 10years among white and black older adults. Obesity is one of a limited number of modifiable risk factors for AF; future studies are essential to evaluate how obesity reduction can modify the incidence of AF.
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Siontis KC, Geske JB, Gersh BJ. Atrial fibrillation pathophysiology and prognosis: insights from cardiovascular imaging. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003020. [PMID: 26022381 DOI: 10.1161/circimaging.115.003020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Konstantinos C Siontis
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jeffrey B Geske
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN
| | - Bernard J Gersh
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN.
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Nyström PK, Carlsson AC, Leander K, de Faire U, Hellenius ML, Gigante B. Obesity, metabolic syndrome and risk of atrial fibrillation: a Swedish, prospective cohort study. PLoS One 2015; 10:e0127111. [PMID: 25978738 PMCID: PMC4433194 DOI: 10.1371/journal.pone.0127111] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/10/2015] [Indexed: 01/09/2023] Open
Abstract
Aim We aimed to investigate whether different measures of obesity could similarly predict atrial fibrillation, and whether the atrial fibrillation risk associated with obesity is dependent on presence of metabolic syndrome. Material and Methods We performed our study in a population-based longitudinal cardiovascular study, comprising 1 924 men and 2 097 women, aged 60 years, from Stockholm. Body mass index, waist circumference, sagittal abdominal diameter and components of metabolic syndrome (systolic- and diastolic blood pressure, fasting glucose, triglycerides, high-density lipoprotein-cholesterol) were recorded at baseline. Participants were classified by their body mass index (normal weight, overweight or obese), waist circumference (normal, semi-elevated or elevated), and according to presence of metabolic syndrome. Atrial fibrillation risk was estimated by Cox proportional hazards regression models, adjusted for common atrial fibrillation risk factors, expressed as HR and 95% CI. Results During a mean follow-up of 13.6 years, 285 incident atrial fibrillation cases were recorded. One standard deviation increment of each obesity measure was associated with increased atrial fibrillation risk as: body mass index 1.25 (1.12 – 1.40), waist circumference 1.35 (1.19 – 1.54) and sagittal abdominal diameter 1.28 (1.14 – 1.44). Compared to normal weight subjects without metabolic syndrome, increased atrial fibrillation risk was noted for overweight subjects with metabolic syndrome, 1.67 (1.16 – 2.41), obese subjects without metabolic syndrome, 1.75 (1.11 – 2.74) and obese subjects with metabolic syndrome, 1.92 (1.34 – 2.74). Compared to subjects with normal waist circumference without metabolic syndrome, subjects with elevated waist circumference and metabolic syndrome suffered increased atrial fibrillation risk, 2.03 (1.44 – 2.87). Conclusions Body mass index, waist circumference and sagittal abdominal diameter could similarly predict atrial fibrillation. Obesity was associated with an increased atrial fibrillation risk regardless of metabolic syndrome, whereas overweight and elevated waist circumference was associated with increased atrial fibrillation risk only if metabolic syndrome was present.
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Affiliation(s)
- Petter K. Nyström
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Axel C. Carlsson
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Karin Leander
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulf de Faire
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mai-Lis Hellenius
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Bruna Gigante
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
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Obesity and atrial fibrillation: A comprehensive review of the pathophysiological mechanisms and links. J Cardiol 2015; 66:361-9. [PMID: 25959929 DOI: 10.1016/j.jjcc.2015.04.002] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 03/15/2015] [Accepted: 04/02/2015] [Indexed: 12/15/2022]
Abstract
Obesity is a worldwide health problem with epidemic proportions that has been associated with atrial fibrillation (AF). Even though the underlying pathophysiological mechanisms have not been completely elucidated, several experimental and clinical studies implicate obesity in the initiation and perpetuation of AF. Of note, hypertension, diabetes mellitus, metabolic syndrome, coronary artery disease, and obstructive sleep apnea, represent clinical correlates between obesity and AF. In addition, ventricular adaptation, diastolic dysfunction, and epicardial adipose tissue appear to be implicated in atrial electrical and structural remodeling, thereby promoting the arrhythmia in obese subjects. The present article provides a concise overview of the association between obesity and AF, and highlights the underlying pathophysiological mechanisms.
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Pan G, Zhou X, Zhao J. Effect of telmisartan on atrial fibrillation recurrences in patients with hypertension: a systematic review and meta-analysis. Cardiovasc Ther 2015; 32:184-8. [PMID: 24645740 DOI: 10.1111/1755-5922.12073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The systematic review and meta-analysis are to evaluate the effect of t Telmisartan on atrial fibrillation (AF) recurrences in hypertensive patients with paroxysmal AF. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched. Random controlled trials (RCTs) were conducted in which telmisartan was compared to other antihypertensive drugs for AF recurrences prevention in hypertensive patients with paroxysmal AF. A systematic review and meta-analysis based on aggregate data extracted from the included studies were carried out to assess the telmisartan in preventing AF relapse. The efficacy outcome was the incidence of AF recurrences. Hazard ratios (HRs) were calculated from published summary statistics and combined to give pooled estimates of efficacy. RESULTS This meta-analysis comprised four studied including 1050 hypertensive patients (537 men and 513 women; mean age 63; mean blood pressure (BP) 156/94 mmHg). With the similar BP control, the AF recurrences rate was significantly lower in the telmisartan-treated patients than in the other antihypertensive drugs-treated patients (HR 0.54, CI 0.34-0.86, P < 0.05). CONCLUSION The results of this review and meta-analysis indicate that telmisartan seems to be more effective than other antihypertensive drugs in preventing AF recurrences among hypertensive patients with paroxysmal AF.
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Affiliation(s)
- Gaofeng Pan
- Department of Thoracic and Cardiovascular Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Jacobs V, Cutler MJ, Day JD, Bunch TJ. Atrial fibrillation and dementia. Trends Cardiovasc Med 2015; 25:44-51. [DOI: 10.1016/j.tcm.2014.09.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/07/2014] [Accepted: 09/09/2014] [Indexed: 12/21/2022]
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