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Øhman EA, Fossli M, Rasmussen KM, Winkvist A, Løland BF, Holven KB, Brekke HK. Effects of Breastfeeding Promotion Intervention and Dietary Treatment in Postpartum Women with Overweight and Obesity: Results from a Randomized Controlled Trial on Weight and Cardiometabolic Risk Factors. J Nutr 2024; 154:2448-2458. [PMID: 38901636 DOI: 10.1016/j.tjnut.2024.06.006] [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: 03/22/2024] [Revised: 05/27/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Childbearing increases the risk of weight gain and cardiometabolic disease. The reset hypothesis suggests that lactation has protective cardiometabolic effects on the mother. The hypothesis is based on observational studies, and the possible interacting role of weight loss needs to be elucidated. OBJECTIVES This study aimed to examine the individual and interaction effects of a breastfeeding promotion intervention (BPI) and dietary intervention for weight loss postpartum (Diet) on body weight and cardiometabolic risk factors at 6 mo postpartum. METHODS Pregnant women (n = 156) with a prepregnancy BMI of 25 to 35 kg/m2 were randomized to 4 groups in a 2 × 2 factorial design: BPI, Diet, both treatments, or no treatment. BPI consisted of individual counseling by a lactation consultant during pregnancy, at childbirth, and monthly thereafter or more frequently based on individual needs. Diet was initiated at 11 wk postpartum. Body weight, body composition, waist and hip circumferences, markers of lipid and glucose metabolism, and blood pressure were measured at 2 wk and 6 mo postpartum. We analyzed main and interaction effects using 2-way analysis of covariance adjusted for baseline values. RESULTS Among the participants attending both visits (n = 108), 99% practiced any breastfeeding at baseline and 97% at follow-up. The BPI did not affect rates of exclusive or partial breastfeeding, age at introduction of complementary foods, or have main effects on body weight or cardiometabolic risk factors. There was a main effect of Diet reducing body weight, fat mass, fat-free mass, percentage fat mass, waist and hip circumferences, fasting glucose, and insulin (all P ≤ 0.03), with no interactions between the treatments. CONCLUSIONS There were no effects of BPI on body weight or cardiometabolic risk factors at 6 mo postpartum. Diet caused weight loss and had favorable effects on risk factors for cardiovascular disease and type 2 diabetes. This study was registered at clinicaltrials.gov as NCT03580057.
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Affiliation(s)
- Elisabeth A Øhman
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Maria Fossli
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway
| | | | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Beate F Løland
- Cluster for Research and Analysis of the Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Hilde K Brekke
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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Machado Carvalhais R, Siochi C, Harutyunyan G, Segura Torres D, Shahmoradi V, Sobieraj P, Canuto Miller A, Jesmajian S. Differences in the Impact of Obesity and Bariatric Surgery on Patients Hospitalized for Atrial Flutter and Atrial Fibrillation: A Nationwide Analysis, 2016-2020. Cureus 2024; 16:e62284. [PMID: 39006678 PMCID: PMC11245680 DOI: 10.7759/cureus.62284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND The "obesity paradox" claims that although obesity is a risk factor for atrial fibrillation, obese patients have lower inpatient mortality when admitted due to atrial fibrillation. This study aims to analyze if the obesity paradox still holds true after weight loss from bariatric surgery. Methods: This study analyzed discharge data from the National Inpatient Sample, 2016-2020. Patients admitted due to atrial fibrillation or atrial flutter, with or without obesity, and with or without a past medical history of bariatric surgery were identified using ICD-10-CM and ICD-10-PCS codes. The primary outcome was mortality. Secondary outcomes included length of stay, resource utilization, necessity for endotracheal intubation, and necessity for cardioversion. STATA v.13 was used for univariate and multivariate analysis (StataCorp LLC, Texas, USA). RESULTS Among 2,292,194 patients who had a primary diagnosis of atrial fibrillation or atrial flutter, 494,830 were obese and 25,940 had bariatric surgery. Mortality was not significantly different in post-bariatric surgery patients when compared to the general population (OR 0.76; 95% [CI 0.482-1.2; p=0.24]). Mortality was significantly lower in obese patients when compared to the general population (OR 0.646; 95% [CI 0.583-0.717; p<0.001]). Therefore, post-bariatric surgery patients had a higher mortality than obese patients when compared to the general population. Obese patients spent more days in the hospital (regression 0.219; 95% [CI 0.19-0.248, p<0.001]), had higher resource utilization (regression 3491.995; 95% [CI 2870.085-4113.905, p<0.001]), more cardioversions (OR 1.434; 95% [CI 1.404-1.465; p<0.001]), and no difference in endotracheal intubation rate (OR 1.02; 95% [CI 0.92-1.127; p=0.724]) when compared to the general population. Post-bariatric patients had no difference in length of stay (regression -0.053; 95% [CI -0.137-0.031; p=0.218]) and resource utilization (regression 577.297; 95% [CI -1069.801-2224.396; p=0.492]), fewer endotracheal intubations (OR 0.583; 95% [CI 0.343-0.99; p=0.046]), and more cardioversions (OR 1.223; 95% [CI 1.134-1.32; p<0.001]) when compared to the general population. CONCLUSION Compared to the general population, post-bariatric patients had higher inpatient mortality than obese patients when admitted due to atrial fibrillation or atrial flutter. This research reinforces the presence of the obesity paradox following bariatric surgery with respect to mortality.
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Affiliation(s)
- Ricardo Machado Carvalhais
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Christian Siochi
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Gohar Harutyunyan
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Danny Segura Torres
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Vahe Shahmoradi
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Peter Sobieraj
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Aressa Canuto Miller
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Stephen Jesmajian
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
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Basolo A, Fierabracci P, Salvetti G, Santini F. Comment on: Semaglutide and cardiovascular outcomes in obesity without diabetes. J Endocrinol Invest 2024; 47:1047-1049. [PMID: 38157134 DOI: 10.1007/s40618-023-02290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Affiliation(s)
- A Basolo
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy.
| | - P Fierabracci
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - G Salvetti
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - F Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Nicholls SJ, Tofé S, le Roux CW, D'Alessio DA, Wiese RJ, Pavo I, Brown K, Weerakkody GJ, Zeytinoglu M, Romera IC. Reduction of prevalence of patients meeting the criteria for metabolic syndrome with tirzepatide: a post hoc analysis from the SURPASS Clinical Trial Program. Cardiovasc Diabetol 2024; 23:63. [PMID: 38341541 PMCID: PMC10859014 DOI: 10.1186/s12933-024-02147-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Metabolic syndrome is characterized as the co-occurrence of interrelated cardiovascular risk factors, including insulin resistance, hyperinsulinemia, abdominal obesity, dyslipidemia and hypertension. Once weekly tirzepatide is approved in the US and EU for the treatment of type 2 diabetes (T2D) and obesity. In the SURPASS clinical trial program for T2D, tirzepatide demonstrated greater improvements in glycemic control, body weight reduction and other cardiometabolic risk factors versus placebo, subcutaneous semaglutide 1 mg, insulin degludec, and insulin glargine. This post hoc analysis assessed the effect of tirzepatide use on the prevalence of patients meeting the criteria for metabolic syndrome across SURPASS 1-5. METHODS Metabolic syndrome was defined as having ≥ 3 of 5 criteria according to the US National Cholesterol Education Program: Adult Treatment Panel III. Analyses were based on on-treatment data at the primary endpoint from patients adherent to treatment (taking ≥ 75% study drug). A logistic regression model with metabolic syndrome status as the response variable, metabolic syndrome status at the baseline visit as an adjustment, and randomized treatment as fixed explanatory effect was used. The effect of tirzepatide use on the prevalence of patients meeting the criteria for metabolic syndrome by categorical weight loss, background medication and gender were assessed. RESULTS In SURPASS, the prevalence of patients meeting the criteria for metabolic syndrome at baseline was 67-88% across treatment groups with reductions at the primary endpoint to 38-64% with tirzepatide versus 64-82% with comparators. Reductions in the prevalence of patients meeting the criteria for metabolic syndrome was significantly greater with all tirzepatide doses versus placebo, semaglutide 1 mg, insulin glargine, and insulin degludec (p < 0.001). Individual components of metabolic syndrome were also reduced to a greater extent with tirzepatide vs comparators. Greater reductions in body weight were associated with greater reductions in the prevalence of patients meeting the criteria for metabolic syndrome and its individual components. Background SGLT2i or sulfonylurea use or gender did not impact the change in prevalence of patients meeting the criteria for metabolic syndrome. CONCLUSIONS In this post hoc analysis, tirzepatide at all doses studied was associated with a greater reduction in the prevalence of patients meeting the criteria for metabolic syndrome compared to placebo, semaglutide 1 mg, insulin degludec, and insulin glargine. Although more evidence is needed, these data would support greater potential improvement in cardiovascular risk factor profile with tirzepatide treatment in people across the continuum of T2D.
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Affiliation(s)
| | - Santiago Tofé
- Department of Endocrinology and Nutrition, University Hospital Son Espases, Palma, Spain
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, Dublin, Ireland
- Diabetes Research Centre, Ulster University, Coleraine, UK
| | - David A D'Alessio
- Division of Endocrinology, Department of Medicine, Duke Molecular Physiology Institute, Duke University, Durham, NC, USA
| | | | - Imre Pavo
- Eli Lilly Regional Operations GmbH, Vienna, Austria
| | | | | | | | - Irene C Romera
- Eli Lilly and Company, Avda. de La Industria 30, 28108, Alcobendas, Madrid, Spain.
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Lan NSR, Ali US, Larbalestier R, Dwivedi G, Fegan PG. Obesity in patients without diabetes undergoing coronary artery bypass graft surgery: Time to select patients for semaglutide. Obes Res Clin Pract 2024; 18:76-78. [PMID: 38331597 DOI: 10.1016/j.orcp.2024.02.001] [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] [Received: 11/20/2023] [Revised: 12/21/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
Patients undergoing coronary artery bypass graft (CABG) surgery require intensive secondary prevention. Semaglutide reduced cardiovascular events in patients with cardiovascular disease and overweight or obesity but without diabetes in the SELECT trial. In this real-world study of 1386 patients without diabetes undergoing CABG surgery in an Australian hospital, approximately 1 in 2 patients (53.3 %) were potentially eligible for semaglutide based on the SELECT trial criteria. These findings highlight that a significant percentage of this very high-risk cohort merit receiving semaglutide for weight management and cardiovascular risk reduction. The implications for optimal care, healthcare costs and clinical guidelines require further evaluation.
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Affiliation(s)
- Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, 6150 Perth, Western Australia, Australia; Harry Perkins Institute of Medical Research, The University of Western Australia, 5 Robin Warren Drive, Murdoch, 6150 Perth, Western Australia, Australia; Medical School, The University of Western Australia, 35 Stirling Highway, Crawley, 6009 Perth, Western Australia, Australia.
| | - Umar S Ali
- Medical School, The University of Western Australia, 35 Stirling Highway, Crawley, 6009 Perth, Western Australia, Australia; Department of Cardiothoracic Surgery, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, 6150 Perth, Western Australia, Australia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, 6150 Perth, Western Australia, Australia
| | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, 6150 Perth, Western Australia, Australia; Harry Perkins Institute of Medical Research, The University of Western Australia, 5 Robin Warren Drive, Murdoch, 6150 Perth, Western Australia, Australia; Medical School, The University of Western Australia, 35 Stirling Highway, Crawley, 6009 Perth, Western Australia, Australia
| | - P Gerry Fegan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, 6150 Perth, Western Australia, Australia; Medical School, Curtin University, Kent Street, Bentley, 6102 Perth, Western Australia, Australia
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Stumpf MAM, Cercato C, de Melo ME, Santos RD, Mancini MC. Down the rabbit hole: reviewing the evidence for primary prevention of cardiovascular disease in people with obesity. Eur J Prev Cardiol 2023; 30:1895-1905. [PMID: 37648659 DOI: 10.1093/eurjpc/zwad280] [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] [Received: 05/14/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023]
Abstract
Obesity is a prevalent chronic disorder and a well-known risk factor for cardiovascular disease. However, the evidence of treating obesity for primary prevention of major cardiovascular events is still scarce and controversial. In this review, we provided a comprehensive description of the current evidence in treating obesity regarding cardiovascular protection. Bariatric surgery appears to be the most robust method to reduce events in people without established cardiovascular disease. High compliance to lifestyle interventions can further reduce cardiovascular risk. Concerning pharmacological therapies, a post hoc analysis from SUSTAIN-6 and a meta-analysis from STEP trials suggest that semaglutide, a GLP-1 receptor agonist, could reduce cardiovascular events in people without established cardiovascular disease. The first study addressed specifically a high-risk population with diabetes and, the second, low- or intermediary-risk individuals without diabetes. Tirzepatide, a novel dual GIP/GLP-1 agonist, although not yet tested in specific cardiovascular outcomes trials, could be an alternative since it induces loss in weight similar to the achieved by bariatric surgery. Therefore, extrapolated data in distinct baseline cardiovascular risk populations suggest that these two drugs could be used in primary prevention with the aim of preventing cardiovascular events, but the grade of this evidence is still low. Specifically designed studies are needed to address this specific topic.
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Affiliation(s)
- Matheo A M Stumpf
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| | - Cintia Cercato
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| | - Maria E de Melo
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
- Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcio C Mancini
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
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Preda A, Carbone F, Tirandi A, Montecucco F, Liberale L. Obesity phenotypes and cardiovascular risk: From pathophysiology to clinical management. Rev Endocr Metab Disord 2023; 24:901-919. [PMID: 37358728 PMCID: PMC10492705 DOI: 10.1007/s11154-023-09813-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/27/2023]
Abstract
Obesity epidemic reached the dimensions of a real global health crisis with more than one billion people worldwide living with obesity. Multiple obesity-related mechanisms cause structural, functional, humoral, and hemodynamic alterations with cardiovascular (CV) deleterious effects. A correct assessment of the cardiovascular risk in people with obesity is critical for reducing mortality and preserving quality of life. The correct identification of the obesity status remains difficult as recent evidence suggest that different phenotypes of obesity exist, each one associated with different degrees of CV risk. Diagnosis of obesity cannot depend only on anthropometric parameters but should include a precise assessment of the metabolic status. Recently, the World Heart Federation and World Obesity Federation provided an action plan for management of obesity-related CV risk and mortality, stressing for the instauration of comprehensive structured programs encompassing multidisciplinary teams. In this review we aim at providing an updated summary regarding the different obesity phenotypes, their specific effects on CV risk and differences in clinical management.
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Affiliation(s)
| | - Federico Carbone
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy
| | - Amedeo Tirandi
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy.
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy.
| | - Luca Liberale
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy
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Kan H, Swindle JP, Bae J, Dunn JP, Buysman EK, Gronroos NN, Bengtson L, Chinthammit C, Ford J, Ahmad N. Weight management treatment modalities in patients with overweight or obesity: A retrospective cohort study of administrative claims data. OBESITY PILLARS (ONLINE) 2023; 7:100072. [PMID: 37990675 PMCID: PMC10661997 DOI: 10.1016/j.obpill.2023.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 11/23/2023]
Abstract
Background The purpose of this study was to describe demographic and clinical characteristics among patients who have medical encounters for weight management treatments and to investigate the association of those characteristics with treatment modality. Methods This was a retrospective database study using medical claims, pharmacy claims, and enrollment information from commercial and Medicare Advantage with Part D members in the Optum Research Database from 01/01/2011-2/29/2020. Adult patients with a claim for a weight management treatment from 01/01/2012-2/28/2019 were categorized into cohorts according to the highest intensity intervention received. To examine the association between patient characteristics and treatment modality received, a multinomial logit model was performed. Results Cohorts by increasing intensity included lifestyle intervention (LSI, n = 67,679), weight reduction pharmacotherapy (WRRx) with an anti-obesity medication (AOM, n = 6,905), weight reduction procedure (WRP, n = 1,172), and weight reduction surgery (WRS, n = 18,036). Approximately 32.1% and 16.6% of patients who received WRS or WRP had an LSI during the 12-month baseline, and only 0.6% and 0.4% had treatment with long-term AOMs. In a multinomial logit model, patients with type 2 diabetes (not including WRRx cohort), respiratory disorders, cardiovascular risk factors, pain disorders, and mental health conditions had increased odds of treatment with higher intensity intervention versus LSI. Patients who were male, received an intervention more recently (2016-2019), or had a Charlson comorbidity score of 1 (compared to 0) had decreased odds of treatment with higher intensity interventions. Conclusion In this study, age, sex, body mass index, obesity-related complications, and Charlson comorbidity score appeared to influence the type of weight management treatment modality received. This study improves understanding of weight management treatment utilization and identifies gaps and opportunities to improve obesity care with the appropriate use of different treatment modalities.
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Affiliation(s)
- Hong Kan
- Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
| | - Jason P. Swindle
- Evidera, 500 Totten Pond Rd, Waltham, MA, 02451, USA
- Formerly Optum, 11000 Optum Circle, Eden Prairie, MN, USA
| | - Jay Bae
- Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
| | | | | | | | - Lindsay Bengtson
- Boehringer Ingelheim, 900 Ridgebury Rd, Ridgefield, CT, USA
- Formerly Optum, 11000 Optum Circle, Eden Prairie, MN, USA
| | | | - Janet Ford
- Agios Pharmaceuticals, Inc., Cambridge, MA, USA
- Formally Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
| | - Nadia Ahmad
- Eli Lilly, 893 Delaware St, Indianapolis, IN, USA
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Abdul Wahab R, le Roux CW. A review of the evidence on cardiovascular outcomes from obesity treatment. OBESITY PILLARS (ONLINE) 2023; 7:100071. [PMID: 37990679 PMCID: PMC10661857 DOI: 10.1016/j.obpill.2023.100071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 11/23/2023]
Abstract
Background Obesity is a chronic disease with a myriad of complications including cardiovascular disease. There is a growing interest to examine if obesity treatment is associated with cardiovascular outcomes. Methods In this narrative review, we focused on randomized controlled trials (RCT) with cardiovascular outcomes (CVO) from lifestyle intervention, bariatric surgery, glucagon-like peptide-1 analogues (GLP-1a) and other pharmacotherapy. Additionally, we provide a comprehensive look into the RCT of sodium glucose cotransporter 2 inhibitors (SGLT2i) and CVO in obesity, while also summarizing several ongoing randomized cardiovascular outcome controlled trials for the pharmacological treatment of obesity. Results To date, the results from the randomized controlled trials supported the association between obesity treatment and cardiovascular outcomes. Studies have large sample sizes, conducted over long duration, with the majority demonstrating superiority in primary cardiovascular outcome end points compared to placebo. Conclusion Future data from several ongoing anti-obesity medications cardiovascular outcome trials such as SELECT, SURPASS, SUMMIT and SURMOUNT-MMO hold promises. Further studies are warranted to investigate the long term cardiovascular outcomes following lifestyle intervention and bariatric surgery.
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Affiliation(s)
- Roshaida Abdul Wahab
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
- Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, D04 NE02, Ireland
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Garvey WT, Frias JP, Jastreboff AM, le Roux CW, Sattar N, Aizenberg D, Mao H, Zhang S, Ahmad NN, Bunck MC, Benabbad I, Zhang XM. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 2023; 402:613-626. [PMID: 37385275 DOI: 10.1016/s0140-6736(23)01200-x] [Citation(s) in RCA: 115] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Weight reduction is essential for improving health outcomes in people with obesity and type 2 diabetes. We assessed the efficacy and safety of tirzepatide, a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, versus placebo, for weight management in people living with obesity and type 2 diabetes. METHODS This phase 3, double-blind, randomised, placebo-controlled trial was conducted in seven countries. Adults (aged ≥18 years) with a body-mass index (BMI) of 27 kg/m2 or higher and glycated haemoglobin (HbA1c) of 7-10% (53-86 mmol/mol) were randomly assigned (1:1:1), using a computer-generated random sequence via a validated interactive web-response system, to receive either once-weekly, subcutaneous tirzepatide (10 mg or 15 mg) or placebo for 72 weeks. All participants, investigators, and the sponsor were masked to treatment assignment. Coprimary endpoints were the percent change in bodyweight from baseline and bodyweight reduction of 5% or higher. The treatment-regimen estimand assessed effects regardless of treatment discontinuation or initiation of antihyperglycaemic rescue therapy. Efficacy and safety endpoints were analysed with data from all randomly assigned participants (intention-to-treat population). This trial is registered with ClinicalTrials.gov, NCT04657003. FINDINGS Between March 29, 2021, and April 10, 2023, of 1514 adults assessed for eligibility, 938 (mean age 54·2 years [SD 10·6], 476 [51%] were female, 710 [76%] were White, and 561 [60%] were Hispanic or Latino) were randomly assigned and received at least one dose of tirzepatide 10 mg (n=312), tirzepatide 15 mg (n=311), or placebo (n=315). Baseline mean bodyweight was 100·7 kg (SD 21·1), BMI 36·1 kg/m2 (SD 6·6), and HbA1c 8·02% (SD 0·89; 64·1 mmol/mol [SD 9·7]). Least-squares mean change in bodyweight at week 72 with tirzepatide 10 mg and 15 mg was -12·8% (SE 0·6) and -14·7% (0·5), respectively, and -3·2% (0·5) with placebo, resulting in estimated treatment differences versus placebo of -9·6% percentage points (95% CI -11·1 to -8·1) with tirzepatide 10 mg and -11·6% percentage points (-13·0 to -10·1) with tirzepatide 15 mg (all p<0·0001). More participants treated with tirzepatide versus placebo met bodyweight reduction thresholds of 5% or higher (79-83% vs 32%). The most frequent adverse events with tirzepatide were gastrointestinal-related, including nausea, diarrhoea, and vomiting and were mostly mild to moderate in severity, with few events leading to treatment discontinuation (<5%). Serious adverse events were reported by 68 (7%) participants overall and two deaths occurred in the tirzepatide 10 mg group, but deaths were not considered to be related to the study treatment by the investigator. INTERPRETATION In this 72-week trial in adults living with obesity and type 2 diabetes, once-weekly tirzepatide 10 mg and 15 mg provided substantial and clinically meaningful reduction in bodyweight, with a safety profile that was similar to other incretin-based therapies for weight management. FUNDING Eli Lilly and Company.
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Affiliation(s)
- W Timothy Garvey
- UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Juan P Frias
- Velocity Clinical Research, Los Angeles, CA, USA
| | - Ania M Jastreboff
- Department of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT, USA
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland; Diabetes Research Centre, Ulster University, Coleraine, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | | | - Huzhang Mao
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Shuyu Zhang
- Eli Lilly and Company, Indianapolis, IN, USA
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Visco V, Izzo C, Bonadies D, Di Feo F, Caliendo G, Loria F, Mancusi C, Chivasso P, Di Pietro P, Virtuoso N, Carrizzo A, Vecchione C, Ciccarelli M. Interventions to Address Cardiovascular Risk in Obese Patients: Many Hands Make Light Work. J Cardiovasc Dev Dis 2023; 10:327. [PMID: 37623340 PMCID: PMC10455377 DOI: 10.3390/jcdd10080327] [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: 05/29/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Obesity is a growing public health epidemic worldwide and is implicated in slowing improved life expectancy and increasing cardiovascular (CV) risk; indeed, several obesity-related mechanisms drive structural, functional, humoral, and hemodynamic heart alterations. On the other hand, obesity may indirectly cause CV disease, mediated through different obesity-associated comorbidities. Diet and physical activity are key points in preventing CV disease and reducing CV risk; however, these strategies alone are not always sufficient, so other approaches, such as pharmacological treatments and bariatric surgery, must support them. Moreover, these strategies are associated with improved CV risk factors and effectively reduce the incidence of death and CV events such as myocardial infarction and stroke; consequently, an individualized care plan with a multidisciplinary approach is recommended. More precisely, this review explores several interventions (diet, physical activity, pharmacological and surgical treatments) to address CV risk in obese patients and emphasizes the importance of adherence to treatments.
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Affiliation(s)
- Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Davide Bonadies
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Federica Di Feo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Giuseppe Caliendo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Francesco Loria
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Pierpaolo Chivasso
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy;
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Nicola Virtuoso
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy;
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
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13
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Asoudeh F, Mousavi SM, Keshteli AH, Hasani-Ranjbar S, Larijani B, Esmaillzadeh A, Adibi P. The association of plant-based dietary pattern with general and abdominal obesity: a large cross-sectional study. J Diabetes Metab Disord 2023; 22:469-477. [PMID: 37255813 PMCID: PMC10225380 DOI: 10.1007/s40200-022-01166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 06/01/2023]
Abstract
Purpose Only a few studies have studied the association between plant-based dietary index (PDI) and the prevalence of obesity. The purpose of this study was to investigate the association between PDI and the prevalence of general and abdominal obesity in a large sample of Iranian adults. Methods The current cross-sectional study was performed from 2010 to 2012 in Isfahan, Iran. This study comprised 6,724 adults between the ages of 18 and 55. We analyzed data from 6,724 participants who were classified as having general obesity and 5,203 individuals who were classified as having abdominal obesity. Dietary intake was assessed using a validated food frequency questionnaire. We determined the PDI by assigning plant foods positive scores and animal foods negative values using the method of Satija et al. General obesity was defined as having a body mass index (BMI) greater than 30 kg/m2, whereas abdominal obesity was classified as having a waist circumference (WC) greater than 88 cm for women and 102 cm for men. Data was examined using Chi-squared test and the analysis of variance (ANOVA and ANCOVA). Multivariable binary logistic regression analyses were performed to evaluate the association between PDI and risk of general as well as abdominal obesity. Results The mean age of the study participants was 36.8 ± 8.08 years, and 57% of them were female. General obesity prevalence was 9.6%, while abdominal obesity was 26.8%. In all the unadjusted and multivariable adjusted models of the total population, there was no significant association between highest vs. lowest adherence to the PDI and general obesity or abdominal obesity. No significant association was found when men and women were analyzed separately as well. Conclusion In the present study, no association was observed between PDI and general and abdominal obesity in the Iranian adult population.
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Affiliation(s)
- Farzaneh Asoudeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Mousavi
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shirin Hasani-Ranjbar
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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14
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Castañeda J, Gil-Lespinard M, Almanza-Aguilera E, Llaha F, Gómez JH, Bondonno N, Tjønneland A, Overvad K, Katzke V, Schulze MB, Masala G, Agnoli C, Santucci de Magistris M, Tumino R, Sacerdote C, Skeie G, Brustad M, Lasheras C, Molina-Montes E, Chirlaque MD, Barricarte A, Sonestedt E, da Silva M, Johansson I, Hultdin J, May AM, Forouhi NG, Heath AK, Freisling H, Weiderpass E, Scalbert A, Zamora-Ros R. Association between classes and subclasses of polyphenol intake and 5-year body weight changes in the EPIC-PANACEA study. Obesity (Silver Spring) 2023; 31:1146-1158. [PMID: 36693804 DOI: 10.1002/oby.23689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the associations among the intake of total polyphenols, polyphenol classes, and polyphenol subclasses and body weight change over 5 years. METHODS A total of 349,165 men and women aged 25 to 70 years were recruited in the Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home and Obesity (PANACEA) project of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort from nine European countries. Body weight was measured at baseline and at follow-up after a median time of 5 years. Polyphenol intake, including four main polyphenol classes and eighteen subclasses, was estimated using validated dietary questionnaires and Phenol-Explorer. Multilevel mixed linear regression models were used to estimate the associations. RESULTS Participants gained, on average, 2.6 kg (±5.0 kg) over 5 years. Total flavonoids intake was inversely associated with body weight change (-0.195 kg/5 years, 95% CI: -0.262 to -0.128). However, the intake of total polyphenols (0.205 kg/5 years, 95% CI: 0.138 to 0.272) and intake of hydroxycinnamic acids (0.324 kg/5 years, 95% CI: 0.267 to 0.381) were positively associated with body weight gain. In analyses stratified by coffee consumption, hydroxycinnamic acid intake was positively associated with body weight gain in coffee consumers (0.379 kg/5 years, 95% CI: 0.319 to 0.440), but not in coffee nonconsumers (-0.179 kg/5 years, 95% CI: -0.490 to 0.133). CONCLUSIONS Higher intakes of flavonoids and their subclasses are inversely associated with a modest body weight change. Results regarding hydroxycinnamic acids in coffee consumers require further investigation.
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Affiliation(s)
- Jazmin Castañeda
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain
| | - Mercedes Gil-Lespinard
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain
| | - Enrique Almanza-Aguilera
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain
| | - Fjorida Llaha
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain
| | - Jesús-Humberto Gómez
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Nicola Bondonno
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Anne Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Section of Environmental Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Verena Katzke
- Department of Cancer Epidemiology, German Cancer research Center (DKFZ), Heidelberg, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Department of Research, IRCCS National Cancer Institute Foundation, Milan, Italy
| | | | - Rosario Tumino
- Hyblean Association for Epidemiological Research (AIRE-ONLUS), Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Magritt Brustad
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- The Public Dental Health Service Competence Center of Northern Norway, Tromsø, Norway
| | - Cristina Lasheras
- Department of Functional Biology, University of Oviedo, Oviedo, Spain
| | - Esther Molina-Montes
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Nutrition and Food Science, Campus of Cartuja, University of Granada, Granada, Spain
- Biosanitary Research Institute of Granada - ibs.Granada, Granada, Spain
- Institute of Nutrition and Food Technology (INYTA) 'José Mataix', Biomedical Research Centre, University of Granada, Granada, Spain
| | - María-Dolores Chirlaque
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Aurelio Barricarte
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Marisa da Silva
- Register-based Epidemiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Johan Hultdin
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Heinz Freisling
- International Agency for Research on Cancer Nutrition (IARC-WHO), Lyon, France
| | | | - Augustin Scalbert
- International Agency for Research on Cancer Nutrition (IARC-WHO), Lyon, France
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain
- Department of Nutrition, Food Sciences, and Gastronomy, Food Innovation Network (XIA), Institute for Research on Nutrition and Food Safety (INSA), Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
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Furuta K, Tang X, Islam S, Tapia A, Chen ZB, Ibrahim SH. Endotheliopathy in the metabolic syndrome: Mechanisms and clinical implications. Pharmacol Ther 2023; 244:108372. [PMID: 36894027 PMCID: PMC10084912 DOI: 10.1016/j.pharmthera.2023.108372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
The increasing prevalence of the metabolic syndrome (MetS) is a threat to global public health due to its lethal complications. Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the MetS characterized by hepatic steatosis, which is potentially progressive to the inflammatory and fibrotic nonalcoholic steatohepatitis (NASH). The adipose tissue (AT) is also a major metabolic organ responsible for the regulation of whole-body energy homeostasis, and thereby highly involved in the pathogenesis of the MetS. Recent studies suggest that endothelial cells (ECs) in the liver and AT are not just inert conduits but also crucial mediators in various biological processes via the interaction with other cell types in the microenvironment both under physiological and pathological conditions. Herein, we highlight the current knowledge of the role of the specialized liver sinusoidal endothelial cells (LSECs) in NAFLD pathophysiology. Next, we discuss the processes through which AT EC dysfunction leads to MetS progression, with a focus on inflammation and angiogenesis in the AT as well as on endothelial-to-mesenchymal transition of AT-ECs. In addition, we touch upon the function of ECs residing in other metabolic organs including the pancreatic islet and the gut, the dysregulation of which may also contribute to the MetS. Finally, we highlight potential EC-based therapeutic targets for human MetS, and NASH based on recent achievements in basic and clinical research and discuss how to approach unsolved problems in the field.
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Affiliation(s)
- Kunimaro Furuta
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN, USA; Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Xiaofang Tang
- Department of Diabetes Complications & Metabolism, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Shahidul Islam
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Alonso Tapia
- Department of Diabetes Complications & Metabolism, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Zhen Bouman Chen
- Department of Diabetes Complications & Metabolism, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| | - Samar H Ibrahim
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN, USA; Division of Pediatric Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN, USA.
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Zhang W, Kong L, Zhong Z, Lin L, Li J, Zheng G. Short chain fatty acids increase fat oxidation and promote browning through β3-adrenergic receptor/AMP-activated protein kinase α signaling pathway in 3T3-L1 adipocytes. J Funct Foods 2023. [DOI: 10.1016/j.jff.2023.105488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
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17
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Lunger L, Melmer A, Sturm W, Lamina C, Tschoner A, Engl J, Hönlinger A, Engler C, Willeit P, Kiechl S, Willeit J, Öfner D, Wykypiel H, Laimer M, Tilg H, Ebenbichler C. Bariatric surgery prevents carotid wall thickness progression. Wien Klin Wochenschr 2023; 135:151-157. [PMID: 36205799 PMCID: PMC10020246 DOI: 10.1007/s00508-022-02090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/17/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND Bariatric surgery is a treatment option for patients with severe obesity and improves parameters of cardiovascular and/or metabolic disease. Carotid intima media thickness (C-IMT) is a surrogate measure of subclinical atherosclerosis. Previous studies showed short to mid-term arrest and even regression of C‑IMT progression following bariatric surgery. We aimed to investigate the long-term effect of weight loss on C‑IMT progression 10 years after bariatric surgery in comparison to a population-based control cohort. METHODS In total, 21 eligible patients were examined preoperatively, at 5 and 10 years after bariatric surgery. Anthropometric parameters, plasma triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), insulin, and glucose were assessed at all three study visits. C‑IMT was measured via B‑mode scans of the common carotid artery. C‑IMT progression was measured in an age-matched and BMI-matched cohort selected from the population-based Bruneck study to compare with changes in C‑IMT progression after bariatric surgery. RESULTS C‑IMT remained stable over the 10-year observation period after bariatric surgery. The control cohort showed a significant C‑IMT progression over 10 years. The difference in C‑IMT progression over 10 years was significant (p < 0.01) between both cohorts. CONCLUSION Weight loss induced by bariatric surgery halts the natural progression of C‑IMT over a 10-year observation period.
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Affiliation(s)
- Lukas Lunger
- Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
- Department of Urology, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Andreas Melmer
- Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Wolfgang Sturm
- Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Claudia Lamina
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Tschoner
- Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Julia Engl
- Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Armin Hönlinger
- Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Clemens Engler
- Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Centre of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Heinz Wykypiel
- Department of Visceral, Transplant and Thoracic Surgery, Centre of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Laimer
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Christoph Ebenbichler
- Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1288] [Impact Index Per Article: 1288.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Prioritizing obesity treatment: expanding the role of cardiologists to improve cardiovascular health and outcomes. Cardiovasc Endocrinol Metab 2023; 12:e0279. [PMID: 36777095 PMCID: PMC9911203 DOI: 10.1097/xce.0000000000000279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023]
Abstract
Obesity is a major risk factor for cardiovascular disease, yet management remains poor. Cardiologists and healthcare professionals treating people with high cardiovascular risk are in a position to address overweight and obesity to improve cardiovascular health. There are several treatment options for obesity, which are associated with numerous health benefits. Modest weight reductions of 5-10% improve cardiovascular risk factors, with greater weight loss bringing about greater benefits. Anti-obesity medications can support weight reduction when lifestyle modifications alone are insufficient. The weight loss induced by these treatments can improve cardiovascular risk, and some therapies - such as glucagon-like-peptide-1 analogues - may promote these benefits independently of weight loss. Bariatric surgery can induce greater weight losses than other treatment modalities and is associated with numerous health benefits, but newer medications such as semaglutide and those in development, such as tirzepatide, produce robust weight loss efficacy that is approaching that of bariatric surgery. Healthcare professionals must approach this disease with compassion and collaborate with patients to develop sustainable plans that improve health and maintain weight loss over the long term.
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Kosiborod MN, Bhatta M, Davies M, Deanfield JE, Garvey WT, Khalid U, Kushner R, Rubino DM, Zeuthen N, Verma S. Semaglutide improves cardiometabolic risk factors in adults with overweight or obesity: STEP 1 and 4 exploratory analyses. Diabetes Obes Metab 2023; 25:468-478. [PMID: 36200477 PMCID: PMC10092593 DOI: 10.1111/dom.14890] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 02/02/2023]
Abstract
AIMS Evaluate the effects of once-weekly subcutaneous semaglutide 2.4 mg on cardiometabolic risk factors in people with overweight/obesity without diabetes in the STEP 1 and 4 trials. MATERIALS AND METHODS STEP 1 and 4 were phase III, 68-week, placebo-controlled trials of once-weekly semaglutide 2.4 mg combined with lifestyle intervention; STEP 4 had a 20-week semaglutide run-in and 48-week randomized withdrawal period. Participants had a body mass index ≥30 kg/m2 or ≥27 kg/m2 with one or more weight-related comorbidity, without diabetes. Pre-specified endpoints were changes in waist circumference, systolic/diastolic blood pressure (SBP/DBP), lipids, fasting plasma glucose (FPG), fasting serum insulin and antihypertensive/lipid-lowering medication use. Post-hoc assessments included non-high-density lipoprotein (HDL) cholesterol, homeostatic model assessment of insulin resistance (HOMA-IR; STEP 1 only), atherosclerotic cardiovascular disease (ASCVD) risk (American College of Cardiology/American Heart Association algorithm; STEP 1 only) and cardiometabolic risk factors by weight loss achieved (<5%, 5% to <10%, 10% to <15%, or ≥15%) (STEP 1 only). RESULTS Of the 1961 participants in STEP 1 and 803 in STEP 4, most had one or more complication/comorbidity at baseline, with dyslipidaemia and hypertension most prevalent. In STEP 1, reductions in waist circumference, SBP, DBP, FPG, fasting serum insulin, lipids and HOMA-IR were greater with semaglutide versus placebo (p ≤ .001). Reductions in SBP, non-HDL cholesterol, low-density lipoprotein cholesterol and FPG were generally greater with semaglutide than placebo within weight-loss categories. Non-significant ASCVD risk reductions were observed with semaglutide versus placebo (p > .05). In STEP 4, improvements in waist circumference, SBP, FPG, fasting serum insulin and lipids during the semaglutide run-in (week 0-20) were maintained over week 20-68 with continued semaglutide, but deteriorated following the switch to placebo (p < .001 [week 20-68]). Net reductions in antihypertensive/lipid-lowering medication use occurred with semaglutide versus placebo (both trials). CONCLUSIONS Semaglutide may improve cardiometabolic risk factors and reduce antihypertensive/lipid-lowering medication use versus placebo in adults with overweight/obesity without diabetes. These potential benefits were not maintained after treatment discontinuation. CLINICALTRIALS GOV NUMBERS STEP 1 NCT03548935, STEP 4 NCT03548987.
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Affiliation(s)
- Mikhail N. Kosiborod
- Department of Cardiovascular DiseaseSaint Luke's Mid America Heart Institute and University of Missouri‐Kansas City School of MedicineKansas CityMissouriUSA
| | | | - Melanie Davies
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research CentreLeicesterUK
| | - John E. Deanfield
- Institute of Cardiovascular ScienceUniversity College LondonLondonUK
| | - W. Timothy Garvey
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | - Robert Kushner
- Division of Endocrinology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Domenica M. Rubino
- Washington Center for Weight Management and ResearchArlingtonVirginiaUSA
| | | | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health TorontoUniversity of TorontoTorontoOntarioCanada
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21
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On the relationship between CT measured abdominal fat parameters and three metabolic risk biomarkers. REV ROMANA MED LAB 2023. [DOI: 10.2478/rrlm-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Abstract
Introduction: Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, and there is a need for the development of adjacent markers to assess cardiovascular risk. In this study, we examined the relationship between the areas of abdominal fat compartments, as measured by computed tomography (CT)-based planar measurements, and laboratory-validated cardiovascular risk markers.
Methods: Fat distribution was measured on CT scans in 252 patients (M: F = 1.13) who underwent routine abdominal CT, using in-house and commercially available software. The included laboratory parameters were glucose, triglycerides, and the triglycerideglucose index.
Results: The visceral abdominal fat (VAF) area and VAF percentage were lower in females compared to the VAF area and VAF percentage in males, (p=0.001, and p<0.001 respectively). However, the total abdominal fat (TAF) area was not significantly different between genders. Visceral fat and triglyceride levels showed a weakly positive connection for females (r=0.447, p=0.002) but not for males (r=0.229, p=0.09). The glucose levels had a weak correlation with CT calculated abdominal fat parameters, with the strongest statistically significant correlation value being with TAF for females (r=0.331, p=0.003).
Conclusions: Areas of abdominal fat compartments correlate with metabolic parameters in the blood, and in the future, their assessment might be considered when constructing risk scores. Visceral fat content assessment for every abdominal computed tomography procedure might become a surrogate marker for cardio-vascular risk estimation after defining clear cut-off values and image analysis parameters.
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Lopez-Jimenez F, Almahmeed W, Bays H, Cuevas A, Di Angelantonio E, le Roux CW, Sattar N, Sun MC, Wittert G, Pinto FJ, Wilding JPH. Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation. Eur J Prev Cardiol 2022; 29:2218-2237. [PMID: 36007112 DOI: 10.1093/eurjpc/zwac187] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
The ongoing obesity epidemic represents a global public health crisis that contributes to poor health outcomes, reduced quality of life, and >2.8 million deaths each year. Obesity is relapsing, progressive, and heterogeneous. It is considered a chronic disease by the World Obesity Federation (WOF) and a chronic condition by the World Heart Federation (WHF). People living with overweight/obesity are at greater risk for cardiovascular (CV) morbidity and mortality. Increased adiposity (body fat), particularly visceral/abdominal fat, is linked to CV risk and CV disease (CVD) via multiple direct and indirect pathophysiological mechanisms. The development of CVD is driven, in part, by obesity-related metabolic, endocrinologic, immunologic, structural, humoral, haemodynamic, and functional alterations. The complex multifaceted nature of these mechanisms can be challenging to understand and address in clinical practice. People living with obesity and CVD often have concurrent chronic physical or psychological disorders (multimorbidity) requiring multidisciplinary care pathways and polypharmacy. Evidence indicates that intentional weight loss (particularly when substantial) lowers CVD risk among people with overweight/obesity. Long-term weight loss and maintenance require ongoing commitment from both the individual and those responsible for their care. This position paper, developed by the WOF and the WHF, aims to improve understanding of the direct and indirect links between overweight/obesity and CVD, the key controversies in this area and evidence relating to cardiometabolic outcomes with available weight management options. Finally, an action plan for clinicians provides recommendations to help in identifying and addressing the risks of obesity-related CVD (recognizing resource and support variances between countries).
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Affiliation(s)
| | - Wael Almahmeed
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Harold Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA
| | - Ada Cuevas
- Center for Advanced Metabolic Medicine and Nutrition (CAMMYN), School of Medicine University Finis Terrae, Santiago, Chile
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Data Science Centre, Human Technopole, Milan, Italy
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marie Chan Sun
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Mauritius, Mauritius
| | - Gary Wittert
- Freemasons Centre for Male Health and Wellbeing, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Office of the President, World Heart Federation, Geneva, Switzerland
| | - John P H Wilding
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Clinical Sciences Centre, Aintree University Hospital, Liverpool, UK
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Lin YK, Lin YH, Chiang CF, Yeh TM, Shih WL. Lactobacillus delbrueckii subsp. bulgaricus strain TCI904 reduces body weight gain, modulates immune response, improves metabolism and anxiety in high fat diet-induced obese mice. 3 Biotech 2022; 12:341. [PMCID: PMC9636364 DOI: 10.1007/s13205-022-03356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022] Open
Abstract
AbstractThe multiple probiotic characteristics of strain TCI904 isolated in this study from natural fermented milk were investigated using a mouse model. TCI904 was identified as Lactobacillus delbrueckii subsp. bulgaricu (LDB), a well-known lactic acid starter bacterium found in yogurt. TCI904 exhibited an outstanding pancreatic lipase inhibition activity among several strains of lactic acid bacteria in vitro. Its in vivo effects were further studied. In a comparison of mice fed a high-fat diet (HFD) and those fed a HFD combined with TCI904 for 9 weeks, differences were observed in various aspects of health, and the adverse effects of a HFD were prevented in the latter group. TCI904 effectively prevented fat and body weight accumulation without reducing food intake; it also modulated innate immunity and increased the level of IgA in feces, reversing the increased blood sugar and insulin levels and attenuated the hyperlipidemia caused by a HFD. Based on biochemical test data, compared with the HFD group, a HFD combined with TCI904 induced significant lowering of insulin resistance indicator, homeostasis model assessment-insulin resistance (HOMA-IR) and atherogenic indices of plasma (AIP), the atherogenic coefficient (AC) and cardiac risk ratio (CRR) and increased the cardioprotective index (CPI). In addition, the administration of TCI904 alleviated mood disorders caused by a HFD. Taking the recommended human dose of TCI904 did not affect the liver or kidney function, indicating that TCI904 has sufficient in vivo safety. Taken together, the results of the present study contributed towards validation of the probiotic benefits of lactic acid starter microflora. Orally taken TCI904 exhibited positive immune- and metabolic-modulating, and anxiolytic properties, especially in HFD-induced obesity.
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Qiao T, Luo T, Pei H, Yimingniyazi B, Aili D, Aimudula A, Zhao H, Zhang H, Dai J, Wang D. Association between abdominal obesity indices and risk of cardiovascular events in Chinese populations with type 2 diabetes: a prospective cohort study. Cardiovasc Diabetol 2022; 21:225. [PMID: 36320060 PMCID: PMC9628026 DOI: 10.1186/s12933-022-01670-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Waist circumference (WC), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) are considered surrogate indicators of abdominal fat deposition, but the longitudinal association of these indices with cardiovascular (CV) events in adults with type 2 diabetes (T2D) remains unclear. Our study aimed to examine the associations between abdominal obesity indices and incident CV events among people with T2D and to compare their predictive performance in risk assessment. METHODS The present study included 2328 individuals with T2D from the Xinjiang Multi-Ethnic Cohort. Multivariable Cox regression analyses were applied to assess the associations between abdominal obesity indices and CV events. Harrell's concordance statistic (C-statistic), net reclassification improvement (NRI) index, and integrated discrimination improvement (IDI) index were utilized to evaluate the predictive performance of each abdominal obesity index. RESULTS At a median follow-up period of 59 months, 289 participants experienced CV events. After multivariable adjustment, each 1-SD increase in WC, VAI, LAP, and CVAI was associated with a higher risk of CV events in people with T2D, with adjusted hazard ratios (HRs) being 1.57 [95% CI (confidence interval): 1.39-1.78], 1.11 (95% CI 1.06-1.16), 1.46 (95% CI 1.36-1.57), and 1.78 (95% CI 1.57-2.01), respectively. In subgroup analyses, these positive associations appeared to be stronger among participants with body mass index (BMI) < 25 kg/m2 compared to overweight/obese participants. As for the predictive performance, CVAI had the largest C-statistic (0.700, 95% CI 0.672-0.728) compared to VAI, LAP, WC, and BMI (C-statistic: 0.535 to 0.670, all P for comparison < 0.05). When the abdominal obesity index was added to the basic risk model, the CVAI index also showed the greatest incremental risk stratification (C-statistic: 0.751 vs. 0.701, P < 0.001; IDI: 4.3%, P < 0.001; NRI: 26.6%, P < 0.001). CONCLUSIONS This study provided additional evidence that all abdominal obesity indices were associated with the risk of CV events and highlighted that CVAI might be a valuable abdominal obesity indicator for identifying the high risk of CV events in Chinese populations with T2D. These results suggest that proactive assessment of abdominal obesity could be helpful for the effective clinical management of the diabetic population.
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Affiliation(s)
- Tingting Qiao
- grid.13394.3c0000 0004 1799 3993Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017 China ,grid.13394.3c0000 0004 1799 3993Department of Clinical Nursing, School of Nursing, Xinjiang Medical University, Urumqi, 830017 China
| | - Tao Luo
- grid.13394.3c0000 0004 1799 3993Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017 China
| | - Hualian Pei
- grid.416271.70000 0004 0639 0580Department of Nursing, Ningbo First Hospital, Ningbo, 315012 China
| | - Bahegu Yimingniyazi
- grid.13394.3c0000 0004 1799 3993Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017 China
| | - Dilihumaer Aili
- grid.13394.3c0000 0004 1799 3993Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017 China
| | - Aliya Aimudula
- grid.13394.3c0000 0004 1799 3993Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017 China
| | - Hui Zhao
- grid.13394.3c0000 0004 1799 3993Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017 China
| | - Huanwen Zhang
- grid.13394.3c0000 0004 1799 3993Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017 China
| | - Jianghong Dai
- grid.13394.3c0000 0004 1799 3993Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017 China
| | - Duolao Wang
- grid.48004.380000 0004 1936 9764Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA UK
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GLP-1 Agonist to Treat Obesity and Prevent Cardiovascular Disease: What Have We Achieved so Far? Curr Atheroscler Rep 2022; 24:867-884. [PMID: 36044100 DOI: 10.1007/s11883-022-01062-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To discuss evidence supporting the use of glucagon-like peptide 1 receptor agonists (GLP-1RA) to treat obesity and their role as a cardioprotective drug. Obesity is not just a hypertrophy of the adipose tissue because it may become dysfunctional and inflamed resulting in increased insulin resistance. Being overweight is associated with increased incidence of cardiovascular events and weight loss achieved through lifestyle changes lowers risk factors, but has no clear effect on cardiovascular outcomes. In contrast, treating obesity with GLP-1RA decreases cardiovascular risk and the possible mechanisms of cardioprotection achieved by this class of drugs are discussed. GLP-1RA were initially developed to treat type 2 diabetes patients, in whom the effects upon glycemia and, moreover, weight loss, especially with long-acting GLP-1RA, were evident. However, cardiovascular safety trials in type 2 diabetes patients, the majority presenting cardiovascular disease and excess weight, showed that GLP-1 receptor agonists were indeed capable of decreasing cardiovascular risk. RECENT FINDINGS Type 2 diabetes treatment with GLP-1RA liraglutide and semaglutide paved way to a ground-breaking therapy specific for obesity, as shown with the SCALE 3 mg/day liraglutide program and the STEP 2.4 mg/week semaglutide program. A novel molecule with superior performance is tirzepatide, a GLP-1 and GIP (Gastric Inhibitory Peptide) receptor agonist and recent results from the SURPASS and SURMOUNT programs are briefly described. Liraglutide was approved without a CVOT (Cardiovascular Outcome Trial) because authorities accepted the results from the LEADER study, designed for superiority. The SELECT study with semaglutide will report results only in 2023 and tirzepatide is being tested in patients with diabetes in the SURPASS-CVOT. Clinical studies highlight that GLP-1RA to treat obesity, alongside their concomitant cardioprotective effects, have become a hallmark in clinical science.
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Biomaterial-Based Therapeutic Strategies for Obesity and Its Comorbidities. Pharmaceutics 2022; 14:pharmaceutics14071445. [PMID: 35890340 PMCID: PMC9320151 DOI: 10.3390/pharmaceutics14071445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Abstract
Obesity is a global public health issue that results in many health complications or comorbidities, including type 2 diabetes mellitus, cardiovascular disease, and fatty liver. Pharmacotherapy alone or combined with either lifestyle alteration or surgery represents the main modality to combat obesity and its complications. However, most anti-obesity drugs are limited by their bioavailability, target specificity, and potential toxic effects. Only a handful of drugs, including orlistat, liraglutide, and semaglutide, are currently approved for clinical obesity treatment. Thus, there is an urgent need for alternative treatment strategies. Based on the new revelation of the pathogenesis of obesity and the efforts toward the multi-disciplinary integration of materials, chemistry, biotechnology, and pharmacy, some emerging obesity treatment strategies are gradually entering the field of preclinical and clinical research. Herein, by analyzing the current situation and challenges of various new obesity treatment strategies such as small-molecule drugs, natural drugs, and biotechnology drugs, the advanced functions and prospects of biomaterials in obesity-targeted delivery, as well as their biological activities and applications in obesity treatment, are systematically summarized. Finally, based on the systematic analysis of biomaterial-based obesity therapeutic strategies, the future prospects and challenges in this field are proposed.
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Burke LE, Kline CE, Mendez DD, Shiffman S, Chasens ER, Zheng Y, Imes CC, Cajita MI, Ewing L, Goode R, Mattos M, Kariuki JK, Kriska A, Rathbun SL. Nightly Variation in Sleep Influences Self-efficacy for Adhering to a Healthy Lifestyle: A Prospective Study. Int J Behav Med 2022; 29:377-386. [PMID: 34478106 PMCID: PMC10061542 DOI: 10.1007/s12529-021-10022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Self-efficacy, or the perceived capability to engage in a behavior, has been shown to play an important role in adhering to weight loss treatment. Given that adherence is extremely important for successful weight loss outcomes and that sleep and self-efficacy are modifiable factors in this relationship, we examined the association between sleep and self-efficacy for adhering to the daily plan. Investigators examined whether various dimensions of sleep were associated with self-efficacy for adhering to the daily recommended lifestyle plan among participants (N = 150) in a 12-month weight loss study. METHOD This study was a secondary analysis of data from a 12-month prospective observational study that included a standard behavioral weight loss intervention. Daily assessments at the beginning of day (BOD) of self-efficacy and the previous night's sleep were collected in real-time using ecological momentary assessment. RESULTS The analysis included 44,613 BOD assessments. On average, participants reported sleeping for 6.93 ± 1.28 h, reported 1.56 ± 3.54 awakenings, and gave low ratings for trouble sleeping (3.11 ± 2.58; 0: no trouble; 10: a lot of trouble) and mid-high ratings for sleep quality (6.45 ± 2.09; 0: poor; 10: excellent). Participants woke up feeling tired 41.7% of the time. Using linear mixed effects modeling, a better rating in each sleep dimension was associated with higher self-efficacy the following day (all p values < .001). CONCLUSION Our findings supported the hypothesis that better sleep would be associated with higher levels of reported self-efficacy for adhering to the healthy lifestyle plan.
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Affiliation(s)
- Lora E Burke
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, 415 Victoria Building, Pittsburgh, PA, 15261, USA.
| | - Christopher E Kline
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dara D Mendez
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Saul Shiffman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yaguang Zheng
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Mia I Cajita
- Department of Biobehavioral Health Science, University of Illinois, Chicago, IL, USA
| | - Linda Ewing
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel Goode
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Meghan Mattos
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Jacob K Kariuki
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen L Rathbun
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, GA, USA
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Esmaeili M, Ajami M, Barati M, Javanmardi F, Houshiarrad A, Mousavi Khaneghah A. The significance and potential of functional food ingredients for control appetite and food intake. Food Sci Nutr 2022; 10:1602-1612. [PMID: 35592279 PMCID: PMC9094468 DOI: 10.1002/fsn3.2783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 12/18/2022] Open
Abstract
Dramatically rising global levels of obesity have raised consumers’ commercial and public health interest in foods that may help control appetite and weight. The satiety cascade consists of sensory, cognitive, physical, and hormonal events following food intake, preventing overeating, and the desire to eat for a long time. Functional foods can be one of the most influential factors in reducing appetite as long as effective ingredients, such as fiber and protein, are used to design these products. Also, functional foods should be designed to reduce appetite at different levels of oral processing, stomach, small intestine, and large intestine by various mechanisms. Therefore, the satiety power of functional foods depends on the type of ingredients and their amount. Because each compound has a different mechanism of action, it is recommended to use different compounds to influence satiety in functional foods.
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Affiliation(s)
- Mina Esmaeili
- Department of Nutrition Research National Nutrition and Food Technology Research Institute/School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Marjan Ajami
- Department of Food and Nutrition Policy and Planning National Nutrition and Food Technology Research Institute School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Meisam Barati
- Department of Cellular and Molecular Nutrition Faculty of Nutrition and Food Technology National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Fardin Javanmardi
- Department of Food Science and Technology National Nutrition and Food Technology Research Institute/School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Anahita Houshiarrad
- Department of Nutrition Research National Nutrition and Food Technology Research Institute/School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Amin Mousavi Khaneghah
- Department of Food Science and Nutrition Faculty of Food Engineering University of Campinas (UNICAMP) Campinas Brazil
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Ghnenis A, Padmanabhan V, Vyas A. Sexual dimorphism in testosterone programming of cardiomyocyte development in sheep. Am J Physiol Heart Circ Physiol 2022; 322:H607-H621. [PMID: 35119334 PMCID: PMC8957338 DOI: 10.1152/ajpheart.00691.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
Abstract
Perturbed in utero hormone milieu leads to intrauterine growth retardation (IUGR), a known risk factor for left ventricular (LV) dysfunction later in life. Gestational testosterone (T) excess predisposes offspring to IUGR and leads to LV myocardial disarray and hypertension in adult females. However, the early impact of T excess on LV programming and if it is female specific is unknown. LV tissues were obtained at day 90 gestation from days 30-90 T-treated or control fetuses (n = 6/group/sex) and morphometric and molecular analyses were conducted. Gestational T treatment increased cardiomyocyte number only in female fetuses. T excess upregulated receptor expression of insulin and insulin-like growth factor. Furthermore, in a sex-specific manner, T increased expression of phosphatidylinositol 3-kinase (PI3K) while downregulating phosphorylated mammalian target of rapamycin (pmTOR)-to-mTOR ratio suggestive of compensatory response. T excess 1) upregulated atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), markers of stress and cardiac hypertrophy and 2) upregulated estrogen receptors1 (ESR1) and 2 (ESR2), but not in androgen receptor (AR). Thus, gestational T excess upregulated markers of cardiac stress and hypertrophy in both sexes while inducing cardiomyocyte hyperplasia only in females, likely mediated via insulin and estrogenic programming.NEW & NOTEWORTHY The present study demonstrates sex-specific effects of gestational T excess between days 30 and 90 of gestation on the cardiac phenotype. Furthermore, the sex-specific programming is likely secondary to perturbation in both estrogen and insulin signaling pathways collectively. These findings are supportive of the role of androgen excess to serve as early biomarkers of CVD and could be critical in identifying therapeutic targets for LV hypertrophy and predict long-term CVD.
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Affiliation(s)
- Adel Ghnenis
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | | - Arpita Vyas
- College of Human Medicine, California Northstate University, Elk Grove, California
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30
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Bloomgarden Z. The 5 th Annual Heart in Diabetes Conference (part 2). J Diabetes 2022; 14:93-96. [PMID: 35075783 PMCID: PMC9060037 DOI: 10.1111/1753-0407.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Zachary Bloomgarden
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone DiseaseIcahn School of Medicine at Mount SinaiNew YorkNYUSA
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31
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van Veldhuisen SL, Gorter TM, van Woerden G, de Boer RA, Rienstra M, Hazebroek EJ, van Veldhuisen DJ. OUP accepted manuscript. Eur Heart J 2022; 43:1955-1969. [PMID: 35243488 PMCID: PMC9123239 DOI: 10.1093/eurheartj/ehac071] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/12/2022] Open
Abstract
Aims Obesity is a global health problem, associated with significant morbidity and mortality, often due to cardiovascular (CV) diseases. While bariatric surgery is increasingly performed in patients with obesity and reduces CV risk factors, its effect on CV disease is not established. We conducted a systematic review and meta-analysis to evaluate the effect of bariatric surgery on CV outcomes, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Methods and results PubMed and Embase were searched for literature until August 2021 which compared bariatric surgery patients to non-surgical controls. Outcomes of interest were all-cause and CV mortality, atrial fibrillation (AF), heart failure (HF), myocardial infarction, and stroke. We included 39 studies, all prospective or retrospective cohort studies, but randomized outcome trials were not available. Bariatric surgery was associated with a beneficial effect on all-cause mortality [pooled hazard ratio (HR) of 0.55; 95% confidence interval (CI) 0.49–0.62, P < 0.001 vs. controls], and CV mortality (HR 0.59, 95% CI 0.47–0.73, P < 0.001). In addition, bariatric surgery was also associated with a reduced incidence of HF (HR 0.50, 95% CI 0.38–0.66, P < 0.001), myocardial infarction (HR 0.58, 95% CI 0.43–0.76, P < 0.001), and stroke (HR 0.64, 95% CI 0.53–0.77, P < 0.001), while its association with AF was not statistically significant (HR 0.82, 95% CI 0.64–1.06, P = 0.12). Conclusion The present systematic review and meta-analysis suggests that bariatric surgery is associated with reduced all-cause and CV mortality, and lowered incidence of several CV diseases in patients with obesity. Bariatric surgery should therefore be considered in these patients.
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Affiliation(s)
- Sophie L van Veldhuisen
- Department of Surgery/Vitalys Clinic, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas M Gorter
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Gijs van Woerden
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery/Vitalys Clinic, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Abstract
Obesity is a treatable chronic disease. Primary care providers play an essential role in diagnosis, treatment, and comprehensive care of patients with obesity. In recent years, treatment approaches have rapidly evolved, increasing effective and safe therapies. In this review, we provide practical information on the care of patients with obesity with a focus on antiobesity pharmacotherapy within the context of currently available therapeutic modalities such as intensive lifestyle interventions and bariatric surgery.
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Affiliation(s)
- Mona Gossmann
- Department of Internal Medicine (Endocrinology & Metabolism), Yale University School of Medicine, New Haven, CT, USA
| | - W Scott Butsch
- Department of Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Internal Medicine and Geriatrics, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ania M Jastreboff
- Department of Internal Medicine (Endocrinology & Metabolism), Yale University School of Medicine, New Haven, CT, USA; Department of Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT, USA.
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Li M, Qian M, Kyler K, Xu J. Adipose Tissue-Endothelial Cell Interactions in Obesity-Induced Endothelial Dysfunction. Front Cardiovasc Med 2021; 8:681581. [PMID: 34277732 PMCID: PMC8282205 DOI: 10.3389/fcvm.2021.681581] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
Obesity has a strong impact on the pathogenesis of cardiovascular disease, which raises enthusiasm to understand how excess adiposity causes vascular injury. Adipose tissue is an essential regulator of cardiovascular system through its endocrine and paracrine bioactive products. Obesity induces endothelial dysfunction, which often precedes and leads to the development of cardiovascular diseases. Connecting adipose tissue-endothelial cell interplay to endothelial dysfunction may help us to better understand obesity-induced cardiovascular disease. This Mini Review discussed (1) the general interactions and obesity-induced endothelial dysfunction, (2) potential targets, and (3) the outstanding questions for future research.
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Affiliation(s)
- Manna Li
- Department of Medicine, Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
| | - Ming Qian
- Department of Medicine, Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
| | - Kathy Kyler
- Office of Research Administration, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
| | - Jian Xu
- Department of Medicine, Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
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Zhang L, Liu Z, Liao S, He H, Zhang M. Cardiovascular safety of long-term anti-obesity drugs in subjects with overweight or obesity: a systematic review and meta-analysis. Eur J Clin Pharmacol 2021; 77:1611-1621. [PMID: 34043049 DOI: 10.1007/s00228-021-03160-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/13/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Anti-obesity therapy can reduce body weight; however, it is not clear whether it can reduce major adverse cardiovascular events (MACEs). We conducted a systematic review and meta-analysis to assess the effect of long-term anti-obesity drugs on MACEs in individuals with overweight or obesity. METHODS The MEDLINE, Embase, and Cochrane Library databases and clinical trial registries ( https://clinicaltrials.gov ) were searched up to 3 May 2021 for randomized controlled trials (RCT) that compared anti-obesity drugs with controls and reported cardiovascular events in subjects with overweight or obesity. Heterogeneity was described by the I2 value. The Mantel-Haenszel randomized effects model was adopted to calculate risk ratios (RR) and weighted mean differences (WMD). Sensitivity analysis was used to assess the stability of the effects. Publication bias was assessed by Begg's funnel plot and Egger's test. The Cochrane Collaboration risk-of-bias tool was used to evaluate the bias of each included RCT. RESULTS Twelve articles were included; 21,391 and 17,618 subjects were in the anti-obesity drug and placebo groups, respectively. There was no difference in MACEs between the anti-obesity drug and placebo groups (RR 0.99; 95% CI: 0.88-1.12). Compared with placebo, anti-obesity interventions reduced body weight (WMD: - 3.96 kg; 95% CI: - 4.89, - 3.03) and improved lipid and blood glucose profiles. The intervention also did not increase the incidence of depression or anxiety or the risk of suicidal ideation. CONCLUSION Long-term anti-obesity drugs did not show a benefit in lowering MACEs in overweight or obese subjects, although the drugs resulted in a decrease in body weight and improved cardiometabolic parameters.
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Affiliation(s)
- Lin Zhang
- Department of General Practice, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhi Liu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Shenling Liao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - He He
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Mei Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Rosa MI, Grande AJ, Lima LD, Dondossola ER, Uggioni MLR, Hernandez AV, Tse G, Liu T, Pontes-Neto OM, Biondi-Zoccai G, Neto MG, Durães AR, Sá MPBO, Resende ES, Roever L. Association Between Epicardial Adipose Tissue and Stroke. Front Cardiovasc Med 2021; 8:658445. [PMID: 33969022 PMCID: PMC8096977 DOI: 10.3389/fcvm.2021.658445] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022] Open
Abstract
Epicardial adipose tissue (EAT) is correlated with endothelial dysfunction, metabolic syndrome, increased mortality and recent studies showed a possible association with the increased risk of stroke. We performed a systematic review of studies evaluating the association between EAT and stroke. Eighty studies met the inclusion criteria and were consequently analyzed. The review had Five main findings. First, the increased epicardial fat thickness (EFT) may be associated with the stroke episode. Second, regardless of the imaging method (echocardiography, MRI, and CT) this association remains. Third, the association of metabolic syndrome and atrial fibrillation seems to increase the risk of stroke. Fourth, this systematic review was considered as low risk of bias. Despite being unable to establish a clear association between EAT and stroke, we have organized and assessed all the research papers on this topic, analyzing their limitations, suggesting improvements in future pieces of research and pointing out gaps in the literature. Furthermore, the mechanistic links between increased EAT and stroke incidence remains unclear, thus, further research is warranted.
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Affiliation(s)
- Maria Inês Rosa
- Laboratory of Biomedicine Translational, University of Extremo Sul Catarinense, Criciúma, Brazil
| | - Antonio José Grande
- Department of Medicine, State University of Mato Grosso Do Sul, Mato Grosso, Brazil
| | - Leticia Dorsa Lima
- Department of Medicine, State University of Mato Grosso Do Sul, Mato Grosso, Brazil
| | | | | | - Adrian V. Hernandez
- Hartford Hospital Evidence-Based Practice Center, University of Connecticut, Hartford, CT, United States
- Vicerrectorado de Investigacion, Universidad San Ignacio de Loyola, Lima, Peru
| | - Gary Tse
- Xiamen Cardiovascular Hospital, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Octávio Marques Pontes-Neto
- Stroke Service, Neurology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Mansueto Gomes Neto
- Mediterranea Cardiocentro, Naples, Italy
- Physical Therapy Department, Federal University of Bahia—Universidade Federal Da Bahia, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde—Universidade Federal Da Bahia, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - André Rodrigues Durães
- Physical Therapy Department, Federal University of Bahia—Universidade Federal Da Bahia, Salvador, Brazil
| | - Michel Pompeu B. O. Sá
- The GREAT Group, Salvador, Brazil
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- Department of Surgery, University of Pernambuco—Universidade de Pernambuco, Recife, Brazil
| | - Elmiro Santos Resende
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
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Richards P, Thornberry NA, Pinto S. The gut-brain axis: Identifying new therapeutic approaches for type 2 diabetes, obesity, and related disorders. Mol Metab 2021; 46:101175. [PMID: 33548501 PMCID: PMC8085592 DOI: 10.1016/j.molmet.2021.101175] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The gut-brain axis, which mediates bidirectional communication between the gastrointestinal system and central nervous system (CNS), plays a fundamental role in multiple areas of physiology including regulating appetite, metabolism, and gastrointestinal function. The biology of the gut-brain axis is central to the efficacy of glucagon-like peptide-1 (GLP-1)-based therapies, which are now leading treatments for type 2 diabetes (T2DM) and obesity. This success and research to suggest a much broader role of gut-brain circuits in physiology and disease has led to increasing interest in targeting such circuits to discover new therapeutics. However, our current knowledge of this biology is limited, largely because the scientific tools have not been available to enable a detailed mechanistic understanding of gut-brain communication. SCOPE OF REVIEW In this review, we provide an overview of the current understanding of how sensory information from the gastrointestinal system is communicated to the central nervous system, with an emphasis on circuits involved in regulating feeding and metabolism. We then describe how recent technologies are enabling a better understanding of this system at a molecular level and how this information is leading to novel insights into gut-brain communication. We also discuss current therapeutic approaches that leverage the gut-brain axis to treat diabetes, obesity, and related disorders and describe potential novel approaches that have been enabled by recent advances in the field. MAJOR CONCLUSIONS The gut-brain axis is intimately involved in regulating glucose homeostasis and appetite, and this system plays a key role in mediating the efficacy of therapeutics that have had a major impact on treating T2DM and obesity. Research into the gut-brain axis has historically largely focused on studying individual components in this system, but new technologies are now enabling a better understanding of how signals from these components are orchestrated to regulate metabolism. While this work reveals a complexity of signaling even greater than previously appreciated, new insights are already being leveraged to explore fundamentally new approaches to treating metabolic diseases.
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Affiliation(s)
- Paul Richards
- Kallyope, Inc., 430 East 29th, Street, New York, NY, 10016, USA.
| | | | - Shirly Pinto
- Kallyope, Inc., 430 East 29th, Street, New York, NY, 10016, USA.
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Incretin Hormones in Obesity and Related Cardiometabolic Disorders: The Clinical Perspective. Nutrients 2021; 13:nu13020351. [PMID: 33503878 PMCID: PMC7910956 DOI: 10.3390/nu13020351] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of obesity continues to grow rapidly worldwide, posing many public health challenges of the 21st century. Obese subjects are at major risk for serious diet-related noncommunicable diseases, including type 2 diabetes mellitus, cardiovascular disease, and non-alcoholic fatty liver disease. Understanding the mechanisms underlying obesity pathogenesis is needed for the development of effective treatment strategies. Dysregulation of incretin secretion and actions has been observed in obesity and related metabolic disorders; therefore, incretin-based therapies have been developed to provide new therapeutic options. Incretin mimetics present glucose-lowering properties, together with a reduction of appetite and food intake, resulting in weight loss. In this review, we describe the physiology of two known incretins—glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), and their role in obesity and related cardiometabolic disorders. We also focus on the available and incoming incretin-based medications that can be used in the treatment of the above-mentioned conditions.
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38
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Bays HE, Taub PR, Epstein E, Michos ED, Ferraro RA, Bailey AL, Kelli HM, Ferdinand KC, Echols MR, Weintraub H, Bostrom J, Johnson HM, Hoppe KK, Shapiro MD, German CA, Virani SS, Hussain A, Ballantyne CM, Agha AM, Toth PP. Ten things to know about ten cardiovascular disease risk factors. Am J Prev Cardiol 2021; 5:100149. [PMID: 34327491 PMCID: PMC8315386 DOI: 10.1016/j.ajpc.2021.100149] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The “American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update” is a summary document (updated yearly) regarding CVD risk factors. This “ASPC Top Ten CVD Risk Factors 2021 Update” summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the “ASPC Top Ten CVD Risk Factors 2021 Update” to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Medical Director / President, Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY USA
- Corresponding author.
| | - Pam R. Taub
- University of California San Diego Health, San Diego, CA USA
| | | | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard A. Ferraro
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison L. Bailey
- Chief, Cardiology, Centennial Heart at Parkridge, Chattanooga, TN USA
| | - Heval M. Kelli
- Northside Hospital Cardiovascular Institute, Lawrenceville, GA USA
| | - Keith C. Ferdinand
- Professor of Medicine, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA USA
| | - Melvin R. Echols
- Assistant Professor of Medicine, Department of Medicine, Cardiology Division, Morehouse School of Medicine, New Orleans, LA USA
| | - Howard Weintraub
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - John Bostrom
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - Heather M. Johnson
- Christine E. Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital/Baptist Health South Florida, Clinical Affiliate Associate Professor, Florida Atlantic University, Boca Raton, FL USA
| | - Kara K. Hoppe
- Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Charles A. German
- Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Aliza Hussain
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Christie M. Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Ali M. Agha
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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