Obesity as a risk factor for cardiac arrhythmias

Cross-validation of prediction equations for estimating the body mass index in adults without the use of body weight

INTRODUCTION

Body Mass Index (BMI) is a widely accepted measure by the World Health Organization for assessing body composition, as it provides critical insights into health risks, life expectancy, and quality of life. However, in resource-limited settings, access to weighing scales is often inadequate, and environmental conditions, such as unstable terrain, may hinder accurate weight measurements. In these contexts, alternative methods for estimating BMI become essential for effective health assessment. This study aimed to develop and validate equations to estimate BMI without relying on body weight, providing a practical tool for nutritional assessment where traditional methods are not feasible.

MATERIALS AND METHODS

Adults aged 18 to 59 of both sexes were included. Variables like waist circumference, height, hip circumference, age, and weight were used for equation development and validation. Participants were divided by sex, with regression and validation subgroups for each. Statistical tests included Student's t-tests, Pearson correlation, Stepwise Regression, Intraclass Correlation Coefficient, Weighted Kappa Coefficient, and Bland-Altman statistics.

RESULTS

The study included 810 adults, with 63% (576) women. No significant differences were found in paired comparisons between regression and validation subgroups for both sexes (p > 0.05). Four equations were proposed for BMI estimation: EM2 and EM3 for males, and EF2 and EF3 for females. All equations showed strong positive correlations (r > 0.90), significant at p < 0.05. Regression analysis revealed R2 values between 0.861 and 0.901 (p < 0.000). Intraclass Correlation Coefficient values indicated agreement of 0.961 and 0.972 (p < 0.05), with Weighted Kappa values showing substantial agreement of 0.658 and 0.711 for both sexes (p < 0.05).

CONCLUSION

Adopting the proposed equations for estimating BMI in adults without using body weight is safe and effective for measuring this body measure in this population, particularly when weighing these individuals is not feasible.

Proarrhythmic Lipid Inflammatory Mediators: Mechanisms in Obesity Arrhythmias

The prevalence of obesity and associated metabolic disorders such as diabetes is rapidly increasing; therefore, concerns regarding their cardiovascular consequences, including cardiac arrhythmias, are rising. As obesity progresses, the excessively produced lipids accumulate in unconventional areas such as the epicardial adipose tissue (EAT) around the myocardium. Metabolic alterations in obesity contribute to the transformation of these ectopic fat deposits into arrhythmogenic substrates. However, despite advances in therapeutic approaches, particularly in lowering EAT volume and thickness through sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, obese and diabetic patients still suffer from fatal arrhythmias that may lead to sudden cardiac death. Therefore, an investigation into how unappreciated underlying pathways such as lipid mediators contribute to the transformation of adipose tissues into proinflammatory and arrhythmogenic substrates is of significance. Leukotriene B4 (LTB4) is an eicosanoid derived from arachidonic acid and acts as a lipid mediator. LTB4 has recently been identified to be associated with cardiac ion channel modulations and arrhythmogenic conditions in diabetes. LTB4 increases circulatory free fatty acids (FFAs) and has been associated with adipocyte hypertrophy. LTB4 also interferes with insulin signaling pathways, instigating insulin resistance (IR). In addition, LTB4, as a potent chemoattractant, contributes to the mobilization of circulatory immune cells such as monocytes and promotes inflammatory macrophage polarization and macrophage dysfunction. Thus, this review provides a comprehensive overview of LTB4's underlying pathways in obesity; illustrates how these pathways might lead to alterations in cardiac ion channels, currents, and cardiac arrhythmias; and shows how they might pose a therapeutic target for metabolic-associated arrhythmias.

Sex Differences in Clinical Characteristics and Management of Non-valvular Atrial Fibrillation in a Resource-Limited Setting

Introduction: Non-valvular atrial fibrillation (NVAF), the most prevalent sustained arrhythmia, significantly increases the risk of complications such as stroke, heart failure, and mortality. Emerging evidence highlights notable sex-related differences in its clinical presentation and management. However, a substantial knowledge gap persists regarding these disparities in resource-limited settings, where data remain scarce and the burden of NVAF is rising. Objectives: This study aims to assess sex-related differences in clinical characteristics, risk factors, and therapeutic management - specifically anticoagulation use, rate control, and rhythm control strategies - among patients with NVAF. Methodology: This observational study included patients diagnosed with NVAF from April 2023 to November 2024. Patients were subsequently stratified by sex to evaluate differences in clinical, demographic, and therapeutic variables. Statistical analyses incorporated univariate, bivariate, and multivariate approaches, with statistical significance set at P < 0.05. Results: A total of 594 patients with NVAF were included, of whom 316 (53.2%) were male and 278 (46.8%) were female. Notably, female patients were generally older (77.8 vs. 75.3 years; P = 0.006), exhibited higher systolic blood pressure (130.1 vs. 124.2 mmHg; P = 0.007), had higher CHA2DS2-VA scores (3.38 vs. 3.1; P = 0.008), and displayed a lower prevalence of heart failure with reduced ejection fraction (15.1% vs. 24.4%; P = 0.005). In contrast, male patients presented a higher body mass index (BMI 26.2 vs. 24.5 kg/m²; P = 0.003) and elevated serum creatinine levels (1.3 vs. 1.09 mg/dL; P < 0.001). In the multivariate analysis, an age ≥75 years (odds ratio [OR] = 1.66; P = 0.026) and systolic blood pressure (OR = 1.01; P = 0.052) were positively associated with female sex, whereas higher BMI (OR = 0.96; P = 0.037) and increased serum creatinine levels (OR = 0.32; P < 0.001) were inversely associated. These findings underscore distinct differences in risk factors and clinical profiles between the sexes. Conclusions: Female patients frequently present at an advanced age, demonstrate suboptimal blood pressure control, and face an elevated risk of thromboembolism, whereas male patients exhibit a higher BMI and a greater prevalence of heart failure with reduced ejection fraction. These observations underscore the necessity of sex-specific therapeutic strategies.

Glucagon-like peptide-1 receptor agonist semaglutide reduces atrial fibrillation incidence: A systematic review and meta-analysis

BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are new anti-hyperglycaemic drugs with proven cardiovascular (CV) benefit in diabetic and non-diabetic patients at high CV risk. Despite a neutral class effect on arrhythmia risk, data on semaglutide suggest a possible drug-specific benefit in reducing atrial fibrillation (AF) occurrence.

OBJECTIVE

To perform a meta-analysis of randomized clinical trials (RCTs) to assess the risk of incident AF in patients treated with semaglutide compared to placebo.

METHODS AND RESULTS

Ten RCTs were included in the analysis. Study population encompassed 12,651 patients (7285 in semaglutide and 5366 in placebo arms), with median follow-up of 68 months. A random effect meta-analytic model was adopted to pool relative risk (RR) of incident AF. Semaglutide reduces the risk of AF by 42% (RR .58, 95% CI .40-.85), with low heterogeneity across the studies (I2 0%). At subgroup analysis, no differences emerged between oral and subcutaneous administration (oral: RR .53, 95% CI .23-1.24, I2 0%; subcutaneous: RR .59, 95% CI .39-.91, I2 0%; p-value .83). In addition, meta-regression analyses did not show any potential influence of baseline study covariates, in particular the proportion of diabetic patients (p-value .14) and body mass index (BMI) (p-value .60).

CONCLUSIONS

Semaglutide significantly reduces the occurrence of incident AF by 42% as compared to placebo in individuals at high CV risk, mainly affected by type 2 diabetes mellitus. This effect appears to be consistent independently of the route of administration of the drug (oral or subcutaneous), the presence of underlying diabetes and BMI.

The Prevalence of Arrhythmias, Including Premature Supraventricular and Ventricular Beats and Other Electrocardiographic Patterns, in 24-Hour Holter Monitoring in Patients with Overweight and Obesity

OBJECTIVES

this study aims to evaluate the prevalence of various arrhythmias and other electrocardiographic patterns within the group of individuals with overweight and obesity.

METHODS

One hundred eighty-one adults (90 females and 91 males) were qualified for inclusion in the experimental group. All participants had a body mass index (BMI) exceeding 25 kg/m2 (98 patients with obesity and 83 with overweight). The mean BMI in the obesity group was 33.6 kg/m2, and all participants had class 1 obesity. The control group comprised 69 individuals (56 females and 13 males) with normal BMI. The basic measurements were performed, and the participants filled out questionnaires describing their health conditions and lifestyles. Each participant underwent an electrocardiographic (ECG) examination and a 24 h Holter ECG examination.

RESULTS

In patients with class 1 obesity compared to the control patients, the average numbers of premature ventricular beats (PVBs) and premature supraventricular beats (SPBs) were statistically significantly higher (p = 0.030 and p = 0.042). There was a positive correlation between body weight and PVB (p = 0.028) and between body weight and SPB (p = 0.028). Moreover, BMI and waist circumference were correlated with SPB (p = 0.043 and p = 0.031). In the backward stepwise multivariate regression model considering 24 h Holter ECG monitoring, concerning SPB as the dependent variable, it was observed that BMI (especially obesity class 1), type 2 diabetes, and thyroid disease exhibited the highest regression coefficients.

CONCLUSIONS

obesity, even in class 1, might be a factor in a more frequent occurrence of abnormalities in electrocardiographic tests.

Supervised Machine Learning to Examine Factors Associated with Respiratory Sinus Arrhythmias and Ectopic Heart Beats in Adults: A Pilot Study

Background

There are many types of arrhythmias which may threaten health that are well-known or opaque. The purpose of this pilot study was to examine how different cardiac health risk factors rank together in association with arrhythmias in young, middle-aged, and older adults.

Methods

The analytic sample included 101 adults aged 50.6 ± 22.6 years. Several prominent heart-health-related risk factors were self-reported. Mean arterial pressure and body mass index were collected using standard procedures. Hydraulic handgrip dynamometry measured strength capacity. A 6 min single-lead electrocardiogram evaluated arrhythmias. Respiratory sinus arrhythmias (RSAs) and ectopic heart beats were observed and specified for analyses. Classification and Regression Tree analyses were employed.

Results

A mean arterial pressure ≥ 104 mmHg was the first level predictor for ectopic beats, while age ≥ 41 years was the first level predictor for RSAs. Age, heart rate, stress and anxiety, and physical activity emerged as important variables for ectopic beats (p < 0.05), whereas age, sodium, heart rate, and gender were important for RSAs (p < 0.05).

Conclusions

RSAs and ectopic arrhythmias may have unique modifiable and non-modifiable factors that may help in understanding their etiology for prevention and treatment as appropriate across the lifespan.

Adulthood weight changes, body mass index in youth, genetic susceptibility and risk of atrial fibrillation: a population-based cohort study

BACKGROUND

Epidemiological evidence on weight change and atrial fibrillation (AF) remains limited and inconsistent. Previous studies on body mass index (BMI) in youth and AF rarely considered subsequent BMI. This study aimed to assess the associations of AF with weight change and BMI in youth, as well as modified effect by genetic susceptibility of AF.

METHODS

The study included 21,761 individuals (mean age 57.8 years) from the Malmö Diet and Cancer cohort. Weight information was obtained at three time points, including recalled weight at age 20 years, measured weight at baseline (middle adulthood), and reported weight at 5-year follow-up examination (late middle adulthood). A weighted genetic risk score of AF was created using 134 variants.

RESULTS

During a median follow-up of 23.2 years, a total of 4038 participants developed AF. The association between weight change from early to middle adulthood and AF risk was modified by sex (Pinteraction = 0.004); weight loss was associated with a lower AF risk in females, but not in males. Conversely, weight gain was positively associated with AF risk in a linear manner in females, whereas increased AF risk appeared only when weight gain exceeded a threshold in males. Participants with weight gain of > 5 kg from middle to late middle adulthood had a 19% higher risk of AF relative to those with stable weight, whereas weight loss showed a null association. Compared to individuals with a lower BMI at age 20 years, those with a BMI above 25 kg/m2 had an increased risk of AF (HR = 1.14; 95% CI: 1.02-1.28), after controlling for baseline BMI; this association was more pronounced in males or those with a lower genetic risk of AF.

CONCLUSIONS

Weight gain in middle adulthood was associated with higher AF risk. Weight loss from early to middle adulthood, but not from middle to late middle adulthood, was associated with a lower risk of AF only in females. Higher BMI in youth was associated with an increased risk of AF, particularly among males or those with a lower genetic risk of AF.

Pharmacotherapy as an Augmentation to Bariatric Surgery for Obesity

A global obesity pandemic is one of the most significant health threats worldwide owing to its close association with numerous comorbidities such as type 2 diabetes mellitus, arterial hypertension, dyslipidemia, heart failure, cancer and many others. Obesity and its comorbidities lead to a higher rate of cardiovascular complications, heart failure and increased cardiovascular and overall mortality. Bariatric surgery is at present the most potent therapy for obesity, inducing a significant weight loss in the majority of patients. In the long-term, a substantial proportion of patients after bariatric surgery experience a gradual weight regain that may, in some, reach up to a presurgical body weight. As a result, anti-obesity pharmacotherapy may be needed in some patients after bariatric surgery to prevent the weight regain or to further potentiate weight loss. This article provides an overview of the use of anti-obesity medications as an augmentation to bariatric surgery for obesity. Despite relatively limited published data, it can be concluded that anti-obesity medication can serve as an effective adjunct therapy to bariatric surgery to help boost post-bariatric weight loss or prevent weight regain.

Adiposity, fat-free mass and incident heart failure in 500 000 individuals

BACKGROUND AND AIMS

The independent role of body fat distribution and fat-free mass in heart failure (HF) risk is unclear. We investigated the role of different body composition compartments in risk of HF.

METHODS

Present analyses include 428 087 participants (mean age 55.9 years, 44% male) from the UK Biobank. Associations of long-term average levels of body composition measures with incident HF were determined using adjusted Cox proportional hazards regression models.

RESULTS

Over a median follow-up of 13.8 years, there were 10 455 first-ever incident HF events. Overall, HF risk was more strongly associated with central adiposity (waist circumference (WC) adjusted for body mass index (BMI); HR 1.38, 95% CI 1.32 to 1.45) than general adiposity (BMI adjusted for WC; HR 1.22, 95% CI 1.16 to 1.27). Although dual X-ray absorptiometry-derived body fat remained positively related to HF after adjustment for fat-free mass (HR 1.37, 95% CI 1.18 to 1.59), the association of fat-free mass with HF was substantially attenuated by fat mass (HR 1.12, 95% CI 1.01 to 1.26) while visceral fat (VAT) remained associated with HF independent of subcutaneous fat (HR 1.20, 95% CI 1.09 to 1.33). In analyses of HF subtypes, HF with preserved ejection fraction was independently associated with all fat measures (eg, VAT: HR 1.23, 95% CI 1.12 to 1.35; body fat: HR 1.36, 95% CI 1.17 to 1.57) while HF with reduced ejection fraction was not independently associated with fat measures (eg, VAT: HR 1.29, 95% CI 0.98 to 1.68; body fat: HR 1.29, 95% CI 0.80 to 2.07).

CONCLUSIONS

This large-scale study shows that excess adiposity and fat mass are associated with higher HF risk while the association of fat-free mass with HF could be explained largely by its correlation with fat mass. The study also describes the independent relevance of body fat distribution to HF subtypes, suggesting different mechanisms may be driving their aetiopathogenesis.

Childhood maltreatment, genetic risk, and subsequent risk of arrhythmias: a prospective cohort study

Background: Emerging evidence has linked childhood maltreatment with cardiovascular disease risk; however, the association between childhood maltreatment and cardiac arrhythmias remains unclear. Moreover, any genetic predispositions to atrial fibrillation (AF), a common cardiac arrhythmia associated with an elevated risk of stroke, heart failure, and mortality, that modify such associations have been undocumented.Purpose: To examine the associations between childhood maltreatment and incident arrhythmias, and whether a genetic predisposition to arrhythmias modifies these associations.Methods: This prospective analysis included 151,741 participants from the UK Biobank (mean age 55.8 years, 43.4% male). Childhood maltreatment, including five types, was measured using the Childhood Trauma Screener (CTS). Incident arrhythmias (AF, ventricular arrhythmias [VA], and bradyarrhythmia [BA]) were documented through linked hospital admission and death registry. Weighted AF genetic risk score was calculated. Cox proportional hazard models were conducted to test for associations between childhood maltreatment and incident arrhythmias.Results: During a median follow-up of 12.21 years (interquartile range, 11.49-12.90 years), 6,588 AF, 2,093 BA, and 742 VA events occurred. Compared with the absence of childhood maltreatment, having 3-5 types of childhood maltreatment was associated with an increased risk of incident AF (HR, 1.23; 95%CI 1.09-1.37), VA (HR, 1.39; 95%CI 1.03-1.89), and BA (HR, 1.32; 95%CI 1.09-1.61) after adjusting demographic, socioeconomic and lifestyle factors. The associations between cumulative type of childhood maltreatment and the risk of AF (Poverall < .001; Pnonlinear = .674) and BA (Poverall = .007; Pnonlinear = .377) demonstrated a linear pattern. There was a gradient association between childhood maltreatment and AF risks across the intermediate and high genetic risk groups (both Ptrend < .05) but not within the low genetic risk group (Ptrend = .378), irrespective of non-significant interaction effect (Pinteraction = .204).Conclusion: Childhood maltreatment was associated with higher risks of incident arrhythmias, especially AF and BA. Genetic risk of AF did not modify these associations.

MicroRNAs in extracellular vesicles released from epicardial adipose tissue promote arrhythmogenic conduction slowing

Background

Patients with excess epicardial adipose tissue (EAT) are at increased risk of developing cardiac arrhythmias. EAT promotes arrhythmias by depolarizing the resting membrane of cardiomyocytes, which slows down conduction and facilitates re-entrant arrhythmias. We hypothesized that EAT slows conduction by secreting extracellular vesicles (EVs) and their microRNA (miRNA) cargo.

Objective

We aimed to determine the role of EAT-derived EVs and their miRNA cargo in conduction slowing.

Methods

EAT and subcutaneous adipose tissue (SAT) were collected from patients with atrial fibrillation. Adipose tissue explants were incubated in culture medium and secretome was collected. The numbers of EVs in the EAT and SAT secretome were measured by calibrated flow cytometry. EVs in the EAT secretome were isolated by size exclusion chromatography and miRNAs were sequenced. Pathway analysis was performed to predict candidates involved in cardiac electrophysiology. The candidates were validated in the EAT and SAT by quantitative real-time polymerase chain reaction. Finally, miRNA candidates were overexpressed in neonatal rat ventricular myocytes.

Results

The EV concentration was higher in the EAT secretome than in the SAT and control secretomes. miRNA sequencing of EAT-derived EVs detected a total of 824 miRNAs. Pathway analysis led to the identification of 7 miRNAs potentially involved in regulation of cardiac resting membrane potential. Validation of those miRNA candidates showed that they were all expressed in EAT, and that miR-1-3p and miR-133a-3p were upregulated in EAT in comparison with SAT. Overexpression of miR-1-3p and miR-133a-3p in neonatal rat ventricular myocytes led to conduction slowing and reduced Kcnj2 and Kcnj12 expression.

Conclusion

miR-1-3p and miR-133a-3p are potential mediators of EAT arrhythmogenicity.

Obesity and Cardiac Conduction Block Disease in China

Importance

Although a high body mass index (BMI) has been found to be associated with increased risk of cardiac conduction block (CCB) in older adults, no further studies have investigated the association between obesity and CCB in the general population.

Objective

To investigate the association between obesity and CCB, including its subtypes.

Design, Setting, and Participants

This cohort study used data from participants in the Kailuan Study in China (2006-2018) who had completed a physical examination in 2006 (baseline) and had not experienced CCB before baseline. Data analysis was conducted from March to September 2023.

Exposures

Obesity status was defined by BMI in 3 groups: normal weight (18.5 to <24), overweight (24 to <28), and obesity (≥28).

Main Outcome and Measures

The primary outcome was CCB, which was diagnosed from standard 12-lead electrocardiography. The primary end point included high-grade atrioventricular block (HAVB), complete right bundle branch block, complete left bundle branch block, left anterior fascicular block (LAFB), and left posterior fascicular block. First-degree atrioventricular block (FAVB), second-degree type 1 AVB, HAVB, complete and incomplete right and left bundle branch block, LAFB, and left posterior fascicular block were considered separately as secondary end points.

Results

Among 86 635 participants (mean [SD] age, 50.8 [11.9] years; 68 205 males [78.7%]), there were 33 259 individuals with normal weight (38.4%), 37 069 individuals with overweight (42.8%), and 16 307 individuals with obesity (18.8%). The mean (SD) follow-up was 10.6 (3.07) years. In the multivariable Cox proportional hazards regression analysis, obesity was associated with an increased risk of incident CCB (hazard ratio [HR], 1.21; 95% CI, 1.04-1.42) vs normal BMI. In secondary analysis, obesity was associated with an increased risk of FAVB (HR, 1.44; 95% CI, 1.21-1.73), HAVB (HR, 1.99; 95% CI, 1.03-3.82), and LAFB (HR, 1.29; 95% CI, 1.03-1.62) vs normal BMI. There was no association between obesity and other CCB subtypes. Obesity was associated with a greater increase in risk of CCB vs normal BMI in older (aged ≥65 years; HR, 1.44; 95% CI, 1.05-1.96) vs younger (aged <65 years; HR, 1.13; 95% CI, 0.96-1.34) participants (P for interaction < .001) and those with diabetes (HR, 2.16; 95% CI, 1.24-3.76) vs without diabetes (HR, 1.19; 95% CI, 1.02-1.39) (P for interaction = .02).

Conclusions and Relevance

This study found that obesity was associated with an increased risk of CCB, with greater increases in risk for FAVB, HAVB, and LAFB. Individuals who were older and those who had diabetes had larger increases in risk.

Cardiovascular and metabolic status in patients with primary hyperparathyroidism: a single-center experience

Introduction

Cardiovascular diseases (CVD) and metabolic disorders (MD) have retained leading positions in the structure of morbidity and mortality for many years. Primary hyperparathyroidism (PHPT) is also associated with a greater incidence of CVD and MD. The aim of the present study was to describe the prevalence and structure of CVD and MD in hospitalized patients with PHPT and to search for possible associations between these pathologies.

Methods

838 patients with a verified PHPT were included in the study. The studied cohort was divided into 2 groups according to their age at the time of admission: patients aged 18 to 49 years (group A, n = 150); patients aged 50 years and older (group B, n = 688).

Results

There were no significant differences between two groups in parameters of calcium-phosphorus metabolism. Obesity was diagnosed in 24.2% of patients in group A and in 35.9% in group B. Type 2 diabetes mellitus was more common in older patients (14.4% in group B vs. 2.6% in group A). Arterial hypertension, ischemic heart disease, chronic heart failure and brachiocephalic arteries atherosclerosis were more frequent in older patients, occurring in 79.1%, 10.8%, 8.4%, and 84% of cases respectively. The cutoff points that increased the risk of CVD detection turned out to be age above 56 years, eGFR below 92 ml/min/1.73m2, BMI above 28.3 kg/m2.

Discussion

The present study demonstrated a high incidence of some CVD, as well as disorders of lipid, carbohydrate and purine metabolism in patients with PHPT.