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Du Y, Qi L, Borné Y, Sonestedt E. Adulthood weight changes, body mass index in youth, genetic susceptibility and risk of atrial fibrillation: a population-based cohort study. BMC Med 2024; 22:345. [PMID: 39183287 PMCID: PMC11346199 DOI: 10.1186/s12916-024-03565-y] [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: 04/03/2024] [Accepted: 08/15/2024] [Indexed: 08/27/2024] Open
Abstract
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.
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Affiliation(s)
- Yufeng Du
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yan Borné
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
- Department of Food and Meal Science and the Research Environment MEAL, Faculty of Natural Science, Kristianstad University, Kristianstad, Sweden.
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2
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Petzl AM, Jabbour G, Cadrin-Tourigny J, Pürerfellner H, Macle L, Khairy P, Avram R, Tadros R. Innovative approaches to atrial fibrillation prediction: should polygenic scores and machine learning be implemented in clinical practice? Europace 2024; 26:euae201. [PMID: 39073570 PMCID: PMC11332604 DOI: 10.1093/europace/euae201] [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: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
Atrial fibrillation (AF) prediction and screening are of important clinical interest because of the potential to prevent serious adverse events. Devices capable of detecting short episodes of arrhythmia are now widely available. Although it has recently been suggested that some high-risk patients with AF detected on implantable devices may benefit from anticoagulation, long-term management remains challenging in lower-risk patients and in those with AF detected on monitors or wearable devices as the development of clinically meaningful arrhythmia burden in this group remains unknown. Identification and prediction of clinically relevant AF is therefore of unprecedented importance to the cardiologic community. Family history and underlying genetic markers are important risk factors for AF. Recent studies suggest a good predictive ability of polygenic risk scores, with a possible additive value to clinical AF prediction scores. Artificial intelligence, enabled by the exponentially increasing computing power and digital data sets, has gained traction in the past decade and is of increasing interest in AF prediction using a single or multiple lead sinus rhythm electrocardiogram. Integrating these novel approaches could help predict AF substrate severity, thereby potentially improving the effectiveness of AF screening and personalizing the management of patients presenting with conditions such as embolic stroke of undetermined source or subclinical AF. This review presents current evidence surrounding deep learning and polygenic risk scores in the prediction of incident AF and provides a futuristic outlook on possible ways of implementing these modalities into clinical practice, while considering current limitations and required areas of improvement.
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Affiliation(s)
- Adrian M Petzl
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
| | - Gilbert Jabbour
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
- Heartwise (heartwise.ai), Montreal Heart Institute, Montreal, Canada
| | - Julia Cadrin-Tourigny
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
| | - Helmut Pürerfellner
- Department of Internal Medicine 2/Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Laurent Macle
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
| | - Paul Khairy
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
| | - Robert Avram
- Heartwise (heartwise.ai), Montreal Heart Institute, Montreal, Canada
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Rafik Tadros
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada
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Chen D, Feng J, He H, Xiao W, Liu X. Classification, Diagnosis, and Treatment of Obesity-Related Heart Diseases. Metab Syndr Relat Disord 2024; 22:161-169. [PMID: 38294776 DOI: 10.1089/met.2023.0134] [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] [Indexed: 02/01/2024] Open
Abstract
Evidence-based medicine shows that obesity is associated with a wide range of cardiovascular (CV) diseases. Obesity can lead to changes in cardiac structure and function, which can lead to obese cardiomyopathy, subclinical cardiac dysfunction, and even heart failure. It also increases the risk of atrial fibrillation and sudden cardiac death. Many invasive and noninvasive diagnostic methods can detect obesity-related heart disease at an early stage, so that appropriate measures can be selected to prevent adverse CV events. However, studies have shown a protective effect of obesity on clinical outcomes of CV disease, a phenomenon that has been termed the obesity paradox. The "obesity paradox" essentially refers to the fact that the classification of obesity defined by body mass index (BMI) does not consider the impact of obesity heterogeneity on CV disease prognosis, but simply puts subjects with different clinical and biochemical characteristics into the same category. In any case, indicators such as waist-to-hip ratio, ectopic body fat qualitative and quantitative, and CV fitness have been shown to be able to distinguish different CV risks in patients with the same BMI, which is convenient for early intervention in an appropriate way. A multidisciplinary approach, including lifestyle modification, evidence-based generic and novel pharmacotherapy, and surgical intervention, can improve CV outcomes in overweight/obese patients.
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Affiliation(s)
- Dan Chen
- Department of Electrocardiogram, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Artificial Intelligence Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong, China
| | - Juan Feng
- Department of Echocardiography, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - HongYan He
- Department of Electrocardiogram, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, Shandong, China
| | - WeiPing Xiao
- Department of Acupuncture, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, Shandong, China
| | - XiaoJing Liu
- Department of Endocrinology and Metabolism, The Second Hospital of Shandong University, Jinan, Shandong, China
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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: 182] [Impact Index Per Article: 182.0] [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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5
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Frederiksen TC, Christiansen MK, Benjamin EJ, Overvad K, Olsen A, Dahm CC, Jensen HK. Five-year changes in weight and risk of atrial fibrillation in the Danish Diet, Cancer, and Health Cohort. Eur J Prev Cardiol 2024; 31:244-249. [PMID: 37708406 PMCID: PMC10809168 DOI: 10.1093/eurjpc/zwad300] [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: 06/02/2023] [Revised: 08/09/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
AIMS Obesity is a major risk factor for atrial fibrillation (AF). Compared with stable weight, gaining weight was associated with a higher risk of incident AF in observational studies. The results, however, are conflicting regarding weight loss and risk of AF. This study aimed to assess the association between 5-year weight changes and risk of incident AF. METHODS AND RESULTS The study was based on participants from the Danish Diet, Cancer, and Health Cohort. Body mass index (BMI) was assessed at a baseline examination and at a second examination 5 years later. Diagnoses of AF and co-morbidities were retrieved from the Danish National Patient Registry. In total, 43 758 participants without prior AF were included. The median age was 61 years and 54% were female. During a median follow-up of 15.7 years, 5312 individuals had incident AF (incidence rate 8.6/1000 person-years). Compared with stable weight, weight gain between 2.5 and 5 BMI units (kg/m2) was associated with a higher risk of AF [hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.09-1.41]. Weight gain of 5 or more BMI units (kg/m2) was associated with a HR of 1.95 (95% CI 1.48-2.56) of incident AF. However, there was no statistically significant association between weight loss and risk of AF. CONCLUSION Five-year weight gain was associated with greater risk of AF compared with stable weight in the Danish Diet, Cancer, and Health Cohort. There was no statistically significant association between weight loss and risk of AF.
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Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Morten Krogh Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Kim Overvad
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anja Olsen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Cancer Society Research Center, København Ø, Denmark
| | | | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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6
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Medina-Inojosa BJ, Lopez-Jimenez F. Are body mass index changes related to incident atrial fibrillation?-Results of the Danish Diet, Cancer, and Health Cohort. Eur J Prev Cardiol 2024; 31:214-215. [PMID: 37883698 DOI: 10.1093/eurjpc/zwad333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Betsy J Medina-Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Francisco Lopez-Jimenez
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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7
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Chand S, Patel J, Tripathi A, Thapa S, Frishman WH, Aronow WS. Exploring the Intricate Interplay Between Obesity and Atrial Fibrillation: Mechanisms, Management, and Clinical Implications. Cardiol Rev 2024:00045415-990000000-00195. [PMID: 38230951 DOI: 10.1097/crd.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Atrial fibrillation (AF) stands as a prevalent and escalating cardiac arrhythmia in the United States, with obesity emerging as a prominent modifiable risk factor. This article explores the intricate relationship between obesity and AF, delving into the multifaceted pathophysiological mechanisms linking the 2 conditions. Various factors, such as autonomic dysfunction, left atrial stretch, inflammation, and hormonal imbalances, contribute to the initiation and perpetuation of AF in obese individuals. The Atrial Fibrillation Better Care pathway, emphasizing lifestyle modifications and weight loss strategies, emerges as a practical guideline for managing AF in obesity. This comprehensive review underscores the critical role of obesity as a significant modifiable risk factor for AF, urging a proactive approach to its management. Implementing the Atrial Fibrillation Better Care approach, focusing on encouraging physical activity, promoting healthy dietary habits, and raising awareness about the risks associated with obesity prove essential in preventing and mitigating the burden of AF in the obese population.
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Affiliation(s)
- Swati Chand
- From the Departments of Cardiology
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Jay Patel
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Ashish Tripathi
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Sangharsha Thapa
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - William H Frishman
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- From the Departments of Cardiology
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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8
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Randhawa S, Da S, Aronow WS. Risk factors modification in atrial fibrillation: a brief review. Expert Rev Cardiovasc Ther 2024; 22:7-12. [PMID: 38108793 DOI: 10.1080/14779072.2023.2294728] [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: 08/28/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) is a supraventricular arrhythmia characterized by fibrillatory waves in the atria with an irregular ventricular rhythm. It is the most common arrhythmia treated in clinical practice. AF is associated with approximately five-fold increase in risk of cerebrovascular accident (stroke) and two-fold increase in cognitive dysfunction and all-cause mortality. AREAS COVERED Multiple risk factors have been identified for development of AF including age, hypertension, diabetes, and obesity. Primary and secondary prevention strategies aimed at reducing the incidence of AF can have a dramatic clinical and economic impact. Multiple studies have shown that lifestyle interventions can reduce predisposing factors, reverse the pathophysiology behind AF, and decrease disease burden. In this brief review we aim at exploring the current state of knowledge regarding risk factor modifications that decrease incidence and prevalence of AF. EXPERT OPINION This is an evolving field of research and further studies to elucidate the magnitude of effect of these interventions as well as the pathophysiological mechanisms driving these effects are underway.
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Affiliation(s)
- Sukhbir Randhawa
- Department of Graduate Medical Education, Samaritan Medical Center, Watertown, NY, USA
| | - Subrat Da
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
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Katsoulis M, Lai AG, Kipourou DK, Gomes M, Banerjee A, Denaxas S, Lumbers RT, Tsilidis K, Kostara M, Belot A, Dale C, Sofat R, Leyrat C, Hemingway H, Diaz-Ordaz K. On the estimation of the effect of weight change on a health outcome using observational data, by utilising the target trial emulation framework. Int J Obes (Lond) 2023; 47:1309-1317. [PMID: 37884665 PMCID: PMC10663146 DOI: 10.1038/s41366-023-01396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND/OBJECTIVES When studying the effect of weight change between two time points on a health outcome using observational data, two main problems arise initially (i) 'when is time zero?' and (ii) 'which confounders should we account for?' From the baseline date or the 1st follow-up (when the weight change can be measured)? Different methods have been previously used in the literature that carry different sources of bias and hence produce different results. METHODS We utilised the target trial emulation framework and considered weight change as a hypothetical intervention. First, we used a simplified example from a hypothetical randomised trial where no modelling is required. Then we simulated data from an observational study where modelling is needed. We demonstrate the problems of each of these methods and suggest a strategy. INTERVENTIONS weight loss/gain vs maintenance. RESULTS The recommended method defines time-zero at enrolment, but adjustment for confounders (or exclusion of individuals based on levels of confounders) should be performed both at enrolment and the 1st follow-up. CONCLUSIONS The implementation of our suggested method [adjusting for (or excluding based on) confounders measured both at baseline and the 1st follow-up] can help researchers attenuate bias by avoiding some common pitfalls. Other methods that have been widely used in the past to estimate the effect of weight change on a health outcome are more biased. However, two issues remain (i) the exposure is not well-defined as there are different ways of changing weight (however we tried to reduce this problem by excluding individuals who develop a chronic disease); and (ii) immortal time bias, which may be small if the time to first follow up is short.
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Affiliation(s)
- M Katsoulis
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK.
| | - A G Lai
- Institute of Health Informatics, University College London, London, UK
| | - D K Kipourou
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- AstraZeneca, London, UK
| | - M Gomes
- Department of Applied Health Research, University College London, London, UK
| | - A Banerjee
- Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - S Denaxas
- Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
| | - R T Lumbers
- Institute of Health Informatics, University College London, London, UK
| | - K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Maria Kostara
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - A Belot
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - C Dale
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - R Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - C Leyrat
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - H Hemingway
- Institute of Health Informatics, University College London, London, UK
| | - K Diaz-Ordaz
- Dept of Statistical Science, Faculty of Maths & Physical Sciences, University College London, London, UK
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Pereira JPS, Calafatti M, Martinino A, Ramnarain D, Stier C, Parmar C, Weiner S, Dekker LR, Hasenberg T, Wolf O, Pouwels S. Epicardial Adipose Tissue Changes After Bariatric and Metabolic Surgery: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:3636-3648. [PMID: 37801237 DOI: 10.1007/s11695-023-06848-0] [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: 05/18/2023] [Revised: 09/09/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
Epicardial adipose tissue (EAT) is a visceral fat depot located between the myocardium and visceral epicardium. Emerging evidence suggests that excessive EAT is linked to increased risk of cardiovascular conditions and other metabolic diseases. A literature search was conducted from the earliest studies to the 26th of November 2022 on PubMed, Embase, and the Cochrane. All the studies evaluating changes in EAT, pericardial adipose tissue (PAT), or total cardiac fat loss before and after BS were included. From 623 articles, 35 were eventually included in the systematic review. Twenty-one studies showed a significant reduction of EAT after BS, and only one study showed a non-significant reduction (p = 0.2).
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Affiliation(s)
| | - Matteo Calafatti
- Faculty of Medicine, Università la Sapienza di Roma, Rome, Italy
| | | | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
- Department of Intensive Care Medicine, Saxenburgh Medical Centre, Hardenberg, The Netherlands
| | - Christine Stier
- Department of Surgical Endoscopy, Sana Hospitals, Germany and Obesity Center NRW, Huerth, Germany
| | - Chetan Parmar
- Department of Surgery, Whittington Health NHS Trust, London, UK
- Apollo Hospitals Education and Research Foundation, Hyderabad, India
| | - Sylvia Weiner
- Department of Bariatric and Metabolic Surgery, Sana Klinikum, Offenbach am Main, Hessen, Germany
| | - Lukas R Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Till Hasenberg
- Helios Obesity Center West, Helios St. Elisabeth Hospital Oberhausen, Oberhausen, NRW, Germany
- Helios University Hospital Wuppertal, Wuppertal, NRW, Germany
- Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Olga Wolf
- Department of Plastic, Reconstructive and Aesthetic Surgery, Florence Nightingale Hospital, Düsseldorf, Germany
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
- Faculty of Health, University of Witten/Herdecke, Witten, Germany.
- Department of General, Abdominal Surgery and Coloproctology, Helios St. Elisabeth Klinik, Josefstraße 3, 46045, Oberhausen, NRW, Germany.
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11
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Hazarapetyan L, Zelveian PH, Grigoryan S. Inflammation and Coagulation are Two Interconnected Pathophysiological Pathways in Atrial Fibrillation Pathogenesis. J Inflamm Res 2023; 16:4967-4975. [PMID: 37927962 PMCID: PMC10625332 DOI: 10.2147/jir.s429892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Atrial fibrillation (AF) is associated with elevated levels of clotting factors such as tissue factor (TF) and factor XII (FXII). Various inflammation markers, such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF- α), and high-sensitive C-reactive protein (hs-CRP), have also been associated with AF. This study explores the relationship between inflammation markers and coagulation activity, including their impact on heart structural changes in these patients. Methods We observed 283 patients with nonvalvular AF who underwent a complete examination at admission, but only 183 patients have successful cardioversion. As a control group, similar patients without AF were examined. The markers of the coagulation and inflammation were studied by ELISA on the analyzer "Stat Fax 303 Plus". Studies were conducted using l statistical package SPSS 13.0. Results It was revealed that patients with AF had significantly higher levels of hs-CRP, IL-6, and TNF-α and had elevated levels of TF and FXII compared with control group. The moderate correlations were observed between IL-6 and left atrial diameter (LAD), IL-6 and LA stiffness, hs-CRP and left atrial volume (LAV), TF and LAV. Conclusion We have demonstrated that patients with AF have the relationship between elevated levels of inflammatory markers and coagulation activity, which contributes to structural atrial remodeling.
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Affiliation(s)
- Lusine Hazarapetyan
- Department of Cardiology, Yerevan State Medical University Named After M. Heratsi, Yerevan, Armenia
- Scientific Research Institute of Cardiology Named After L Hovhannisyan, Yerevan, Armenia
| | - Parounak H Zelveian
- Scientific Research Institute of Cardiology Named After L Hovhannisyan, Yerevan, Armenia
| | - Svetlana Grigoryan
- Department of Cardiology, Yerevan State Medical University Named After M. Heratsi, Yerevan, Armenia
- Scientific Research Institute of Cardiology Named After L Hovhannisyan, Yerevan, Armenia
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12
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Ahammed MR, Ananya FN. Impact of Weight Loss on Atrial Fibrillation. Cureus 2023; 15:e46232. [PMID: 37908920 PMCID: PMC10614082 DOI: 10.7759/cureus.46232] [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: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Atrial fibrillation (AF) is a prevalent and persistent irregular heart rhythm that is expected to dramatically increase in prevalence in the next few decades. Several established cardiovascular risk factors, including obesity, play a significant impact in developing AF. Obesity, characterized by a high body mass index (BMI), is particularly concerning as it directly elevates the risk of AF and other cardiovascular comorbidities. This review explores the complex interplay between obesity and AF, specifically highlighting the reversible nature of obesity-induced cardiac remodeling with weight loss. As we will soon discover, several insights from weight management offer promising strategies for AF prevention and management.
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Affiliation(s)
- Md Ripon Ahammed
- Internal Medicine, Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, New York City Health + Hospital, Queens, New York, USA
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13
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Frederiksen TC, Dahm CC, Preis SR, Lin H, Trinquart L, Benjamin EJ, Kornej J. The bidirectional association between atrial fibrillation and myocardial infarction. Nat Rev Cardiol 2023; 20:631-644. [PMID: 37069297 PMCID: PMC11380523 DOI: 10.1038/s41569-023-00857-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 04/19/2023]
Abstract
Atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI) and vice versa. This bidirectional association relies on shared risk factors as well as on several direct and indirect mechanisms, including inflammation, atrial ischaemia, left ventricular remodelling, myocardial oxygen supply-demand mismatch and coronary artery embolism, through which one condition can predispose to the other. Patients with both AF and MI are at greater risk of stroke, heart failure and death than patients with only one of the conditions. In this Review, we describe the bidirectional association between AF and MI. We discuss the pathogenic basis of this bidirectional relationship, describe the risk of adverse outcomes when the two conditions coexist, and review current data and guidelines on the prevention and management of both conditions. We also identify important gaps in the literature and propose directions for future research on the bidirectional association between AF and MI. The Review also features a summary of methodological approaches for the study of bidirectional associations in population-based studies.
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Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Sarah R Preis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ludovic Trinquart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Emelia J Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Jelena Kornej
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
- Framingham Heart Study, Framingham, MA, USA.
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14
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Shu H, Cheng J, Li N, Zhang Z, Nie J, Peng Y, Wang Y, Wang DW, Zhou N. Obesity and atrial fibrillation: a narrative review from arrhythmogenic mechanisms to clinical significance. Cardiovasc Diabetol 2023; 22:192. [PMID: 37516824 PMCID: PMC10387211 DOI: 10.1186/s12933-023-01913-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/02/2023] [Indexed: 07/31/2023] Open
Abstract
The prevalence of obesity and atrial fibrillation (AF), which are inextricably linked, is rapidly increasing worldwide. Obesity rates are higher among patients with AF than healthy individuals. Some epidemiological data indicated that obese patients were more likely to develop AF, but others reported no significant correlation. Obesity-related hypertension, diabetes, and obstructive sleep apnea are all associated with AF. Additionally, increased epicardial fat, systemic inflammation, and oxidative stress caused by obesity can induce atrial enlargement, inflammatory activation, local myocardial fibrosis, and electrical conduction abnormalities, all of which led to AF and promoted its persistence. Weight loss reduced the risk and reversed natural progression of AF, which may be due to its anti-fibrosis and inflammation effect. However, fluctuations in weight offset the benefits of weight loss. Therefore, the importance of steady weight loss urges clinicians to incorporate weight management interventions in the treatment of patients with AF. In this review, we discuss the epidemiology of obesity and AF, summarize the mechanisms by which obesity triggers AF, and explain how weight loss improves the prognosis of AF.
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Affiliation(s)
- Hongyang Shu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430000, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Jia Cheng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430000, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Na Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430000, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Zixuan Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430000, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Jiali Nie
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430000, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Yizhong Peng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430000, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430000, China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Ning Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave, Wuhan, 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, 430000, China.
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15
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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: 1446] [Impact Index Per Article: 1446.0] [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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Pontiroli AE, Centofanti L, Le Roux CW, Magnani S, Tagliabue E, Folli F. Effect of Prolonged and Substantial Weight Loss on Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15040940. [PMID: 36839298 PMCID: PMC9964297 DOI: 10.3390/nu15040940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Background. Overweight and obesity are associated with atrial fibrillation (AF), and bariatric surgery (BS), able to induce sustained and prolonged weight loss, might represent the ideal treatment in the prevention of AF. Previous studies could not definitely establish a role for weight loss and BS in preventing incident AF so far. During the last few years, several studies on the effect of bariatric surgery on cardiovascular diseases have been published, and we performed a systematic review and meta-analysis to evaluate the role of weight loss through BS in the prevention of incident AF in obesity. Methods. This meta-analysis followed the PRISMA guideline. Eligible studies were controlled trials evaluating the appearance of atrial fibrillation in patients undergoing weight loss through BS as compared with patients receiving medical treatment. Quality of studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale, and risk-of-bias was evaluated employing the Egger's test. All analyses were run by a random-effects model according to Hartung and Knapp and sensitivity analyses were performed. Heterogeneity was assessed through Q and I2 statistics for each comparison, and potential publication bias was formally investigated. Results. Ten studies were included in the meta-analysis, and the overall result was statistically significant [OR = 0.665 (0.475-0.929), p = 0.017], with significant heterogeneity (Q = 48.98, p < 0.001; I2 = 81.6%), but with no publication bias. In sensitivity analyses, the amount of weight loss, percentage of patients with diabetes and value of the Newcastle-Ottawa Quality Assessment Scale, were all associated with significance of effect. Since age was different in one study, a sensitivity analysis was performed by excluding this study; OR was similar [OR = 0.608 (0.454-0.814), p < 0.001]; heterogeneity was reduced but still significant (Q = 35.74, p < 0.001, I2 = 77.6%) and again no publication bias was detected. Conclusions. Bariatric surgery as compared to medical treatment is associated with reduced appearance of incident AF.
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Affiliation(s)
- Antonio E. Pontiroli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20133 Milan, Italy
- Correspondence:
| | - Lucia Centofanti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20133 Milan, Italy
| | - Carel W. Le Roux
- Diabetes Complications Research Centre, University College Dublin, D04 V1W8 Dublin, Ireland
| | | | - Elena Tagliabue
- IRCCS MultiMedica, Value-Based Healthcare Unit, 20099 Milan, Italy
| | - Franco Folli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20133 Milan, Italy
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17
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Glenister K, Bolitho L, Bourke L, Simmons D. Prevalence of atrial fibrillation in a regional Victoria setting, findings from the crossroads studies (2001-2003 and 2016-2018). Aust J Rural Health 2023; 31:80-89. [PMID: 35938603 PMCID: PMC10947292 DOI: 10.1111/ajr.12914] [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: 05/01/2022] [Revised: 07/17/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of atrial fibrillation (AF) in regional Victoria at two time points (2001-2003 and 2016-2018), and to assess the use of electrocardiogram rhythm strips in a rural, community-based study for AF investigation. DESIGN Repeated cross-sectional design involving survey of residents of randomly selected households and a clinic. Predictors of AF were assessed using Firth penalised logistic regression, as appropriate for rare events. SETTING Goulburn Valley, Victoria. PARTICIPANTS Household residents aged ≥16 years. Non-pregnant participants aged 18+ were eligible for the clinic. MAIN OUTCOME MEASURES Atrial fibrillation by 12 lead electrocardiogram (earlier study) or electrocardiogram rhythm strip (AliveCor® device) (recent study). RESULTS The age standardised prevalence of AF was similar between the two studies (1.6% in the 2001-2003 study and 1.8% in the 2016-2018 study, 95% confidence interval of difference -0.010, 0.014, p = 0.375). The prevalence in participants aged ≥65 years was 3.4% (1.0% new cases) in the recent study. Predictors of AF in the earlier study were male sex, older age and previous stroke, while in the recent study they were previous stroke and self-reported diabetes. AliveCor® traces were successfully classified by the in-built algorithm (91%) vs physician (100%). CONCLUSION The prevalence of AF among community-based participants in regional Victoria was similar to predominantly metropolitan-based studies, and was unchanged over time despite increased rates of risk factors. Electrocardiogram rhythm strip investigation was successfully utilised, and particularly benefited from physician overview.
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Affiliation(s)
- Kristen Glenister
- Department of Rural HealthUniversity of MelbourneWangarattaVic.Australia
| | - Leslie Bolitho
- Wangaratta Cardiology & Respiratory CentreWangarattaVic.Australia
| | - Lisa Bourke
- Department of Rural HealthUniversity of MelbourneSheppartonVic.Australia
| | - David Simmons
- Department of Rural HealthUniversity of MelbourneSheppartonVic.Australia
- School of MedicineWestern Sydney UniversityCampbelltownNSWAustralia
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18
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Zhao H, Li X, Yu P, Liu M, Ma J, Wang J, Zhu W, Liu X. Association between weight loss and outcomes in patients undergoing atrial fibrillation ablation: a systematic review and dose-response meta-analysis. Nutr Metab (Lond) 2023; 20:5. [PMID: 36721216 PMCID: PMC9890842 DOI: 10.1186/s12986-023-00724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/04/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Obesity is an strong risk factor for atrial fibrillation (AF), and obesity can affect the prognosis of AF. However, the role of weight loss on outcomes after ablation remains unclear. OBJECTIVES This study aims to determine the relationship between weight loss and outcomes in patients with AF ablation, as well as the potential dose-response relationship. METHODS The Cochrane Library, PubMed, and Embase databases were searched to identify studies that reported a relationship between weight loss and ablation up to August 17, 2021. Relative risks (RRs) were pooled using random-effects models. RESULTS One randomized, open-labeled clinical trial and seven cohort studies involving 1283 patients were included. The mean body mass index of all included studies was over 30 kg/m2. The clinical trial showed a non-significant benefit of weight loss intervention on AF recurrence (Odd risk [OR] = 1.02, 95% confidence interval [CI] 0.70-1.47). Meta-analysis based on observational studies showed that the recurrence rate of AF after ablation was significantly reduced (RR = 0.43, 95% CI 0.22-0.81, I2 = 97%) in relatively obese patients with weight loss compared with the control group. Each 10% reduction in weight was associated with a decreased risk of AF recurrence after ablation (RR = 0.54, 95% CI 0.33-0.88) with high statistical heterogeneity (I2 = 76%). An inverse linear association (Pnon-linearity = 0.27) between AF relapse and increasing weight loss was found. CONCLUSIONS Our results first suggest an inverse dose-response association between weight loss and risk of recurrent AF after ablation, with moderate certainty.
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Affiliation(s)
- Huilei Zhao
- Department of Anesthesiology, The Third Hospital of Nanchang, Nanchang, 330006, Jiangxi, China
| | - Xiaozhong Li
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Peng Yu
- Department of Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Menglu Liu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, 334000, Henan, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, 45267, Cincinnati, USA
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, 510120, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
| | - Xiao Liu
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, 510120, China.
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19
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Weight loss and atrial fibrillation: a review. Curr Opin Cardiol 2023; 38:6-10. [PMID: 36598444 DOI: 10.1097/hco.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW Despite technological advancements in catheter ablation, patients with atrial fibrillation often require multiple ablations, with diminishing returns depending on duration and persistence. Although early ablation is vital, modification of atrial fibrillation disease can be achieved with modification of existing risk factors. Obesity is an important modifiable risk factor, but there does not appear to be a consensus on the best method or goal for weight reduction. RECENT FINDINGS The relationship between atrial fibrillation and obesity has been acknowledged. This review examines the clinical evidence demonstrating the benefit of weight reduction in the management of atrial fibrillation. In particular, this review compares the different approaches of recent studies. SUMMARY On the basis of the literature, the authors recommend a structured weight loss programme with dietary and behavioural modifications individualized to each patient and including the implementation of physical activity. Consideration of bariatric surgery is appropriate in certain patients with obesity.
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20
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The interplay among body weight, blood pressure, and cardiorespiratory fitness in predicting atrial fibrillation. Hellenic J Cardiol 2022; 71:1-7. [PMID: 36528306 DOI: 10.1016/j.hjc.2022.12.005] [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: 10/21/2022] [Revised: 11/16/2022] [Accepted: 12/11/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hypertension, obesity, and low cardiorespiratory fitness (CRF) are known risk predictors for the development of atrial fibrillation (AF) that often interrelate with each other. We examined the interplay of these 3 risk indicators with the occurrence of AF in patients without known cardiovascular disease. METHODS A retrospective analysis of 13,042 patients underwent exercise stress testing (EST). The occurrence of AF during the median follow-up period of 6.8 years was investigated in relation to the presence of obesity (body mass index ≥30 kg/m2), hypertension (blood pressure ≥140/90 mmHg or history of hypertension), or low CRF (exercise capacity <8 metabolic equivalents). Cox proportional hazards models were used to evaluate the individual and combined association between the 3 risk indicators and AF. RESULTS The mean age of the study population was 58 ± 9 years; 49% were women. AF occurred in 499 patients (3.8%). Obesity [hazard ratio (95% confidence interval)], 1.36 (1.12-1.65), hypertension, 1.47 (1.19-1.82), and low CRF, 1.32 (1.06-1.64), were independent risk predictors for AF after multivariable adjustment, including after adjusting for each other and also when the risk predictors were analyzed as continuous variables. In a combined model, a gradual increase in the risk of AF was observed, reaching an adjusted hazard ratio of 2.53 (1.77-3.62) in those with all 3 compared with neither risk indicators. P-for-interaction between hypertension and obesity, or hypertension and low CRF was nonsignificant. CONCLUSIONS Obesity, low CRF, and hypertension are independently associated with an excess risk of developing AF in patients without known cardiovascular disease, both individually and more so when coexisting together.
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21
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Lee HA, Park H. Association between long-term weight-change trajectory and cardiovascular disease risk by physical activity level. Sci Rep 2022; 12:13754. [PMID: 35962125 PMCID: PMC9374698 DOI: 10.1038/s41598-022-17765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/30/2022] [Indexed: 12/02/2022] Open
Abstract
Using data from the Korean Genome and Epidemiology Study, we identified weight-change patterns during midlife using a group-based trajectory model, and evaluated their associations with the incidence of cardiovascular disease (CVD). At baseline, there were 8774 CVD-free participants. Group-based modeling was used to analyze patterns of weight change over about 16 years. Using multiple model, we evaluated the association between weight-change patterns and CVD risk. During the follow-up period, 741 new CVD cases were identified. The weight-change patterns were characterized as ‘gradual weight gain’, ‘stable weight’, ‘slight weight loss’, and ‘gradual weight loss’. The association between weight-change patterns and CVD risk differed depending on the level of physical activity (PA) at baseline (pinteraction < 0.05). Compared with the stable-weight group, the risk of all CVD (HR 2.5, 95% CI 1.5–4.3) and non-fatal CVD (HR 2.8, 95% CI 1.6–4.9) among the gradual-weight-loss group was apparent in the lowest PA quartile. In addition, on average, a decrease in skeletal-muscle-mass (SMM) levels was observed during the follow-up period, but the decrease in SMM in the gradual-weight-loss group was greater than in the gradual-weight-gain group. Our findings show that gradual weight loss was associated with CVD risk, which was dependent on PA levels.
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Affiliation(s)
- Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, 1071, Anyangcheon-ro, Yangcheon-ku, Seoul, 07985, Republic of Korea.
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.,Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
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22
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Nine-Year Trends in Atrial Fibrillation Prevalence among Romanian Adult Hypertensives: A Post-Hoc Analysis of SEPHAR II-IV Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159250. [PMID: 35954602 PMCID: PMC9368716 DOI: 10.3390/ijerph19159250] [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: 06/18/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022]
Abstract
Objectives: There are limited epidemiological data regarding atrial fibrillation (AF) in hypertensive (HT) Romanian adults. We sought to evaluate AF prevalence trends in the SEPHAR surveys (Study for Evaluation of Prevalence of Hypertension and Cardiovascular Risk in an Adult Population in Romania) during a nine-year interval (2012−2016−2021). Methods: Three consecutive editions of a national epidemiological survey regarding HT included representative samples of subjects stratified by age, gender and area of residence (SEPHAR II-IV—in total, 5422 subjects, mean age 48.69 ± 16.65 years, 57.5% (n = 3116) females). A post-hoc analysis of AF prevalence and oral anticoagulation (OAC) rates was performed. AF definition was based on a documented medical history of AF and/or AF documentation by study electrocardiogram. Results: General AF prevalence was 5.5% (n = 297). AF prevalence in HT subjects was 8.9% (n = 209) and has risen since SEPHAR II—7.2% (n = 57) and SEPHAR III—8.1% (n = 72) to SEPHAR IV—11.8% (n = 80), respectively (p = 0.001). AF prevalence has increased in HT males (SEPHAR II—5.3% (n = 19), SEPHAR III—7.6% (n = 26) and SEPHAR IV—11.7% (n = 35) (p = 0.010)) and in HT from urban areas (SEPHAR II—7.8% (n = 37), SEPHAR III—7.8% (n = 40), SEPHAR IV—14.7% (n = 50), p < 0.001). In SEPHAR III-IV, only 19.3% (n = 23) of HT AF patients with OAC indication were anticoagulated. Conclusions: AF prevalence has increased by ~64% in hypertensive Romanian adults between 2012 and 2021. However, anticoagulation strategies may be suboptimal in patients with cardioembolic risk.
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23
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Scarano Pereira JP, Owen E, Martinino A, Akmal K, Abouelazayem M, Graham Y, Weiner S, Sakran N, Dekker LR, Parmar C, Pouwels S. Epicardial adipose tissue, obesity and the occurrence of atrial fibrillation: an overview of pathophysiology and treatment methods. Expert Rev Cardiovasc Ther 2022; 20:307-322. [PMID: 35443854 DOI: 10.1080/14779072.2022.2067144] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Obesity is a chronic disease, which has significant health consequences and is a staggering burden to health care systems. Obesity can have harmful effects on the cardiovascular system, including heart failure, hypertension, coronary heart disease, and atrial fibrillation (AF). One of the possible substrates might be epicardial adipose tissue (EAT), which can be the link between AF and obesity. EAT is a fat deposit located between the myocardium and the visceral pericardium. Numerous studies have demonstrated that EAT plays a pivotal role in this relationship regarding atrial fibrillation. AREAS COVERED This review will focus on the role of obesity and the occurrence of atrial fibrillation (AF) and examine the connection between these and epicardial adipose tissue (EAT). The first part of this review will explain the pathophysiology of EAT and its association with the occurrence of AF. Secondly, we will review bariatric and metabolic surgery and its effects on EAT and AF. EXPERT COMMENTARY In this review, the epidemiology, pathophysiology, and treatments methods of AF are explained. Secondly the effects on EAT were elucidated. Due to the complex pathophysiological link between EAT, AF, and obesity, it is still uncertain which treatment strategy is superior.
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Affiliation(s)
| | - Eloise Owen
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Kiran Akmal
- Faculty of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Mohamed Abouelazayem
- Department of Surgery, Royal Free London Hospitals NHS Foundation, London, United Kingdom
| | - Yitka Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom.,Facultad de Psucologia, Universidad Anahuac Mexico, Mexico City, Mexico
| | - Sylvia Weiner
- Department of Bariatric and Metabolic Surgery, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Nasser Sakran
- Department of Surgery, Holy Family Hospital, Nazareth, Israel.,Azrieli, Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Lukas R Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Chetan Parmar
- Department of Surgery, Whittington Health NHS Trust, London, United Kingdom
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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24
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2620] [Impact Index Per Article: 1310.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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 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. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. 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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25
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Couselo-Seijas M, Rodríguez-Mañero M, González-Juanatey JR, Eiras S. Updates on epicardial adipose tissue mechanisms on atrial fibrillation. Obes Rev 2021; 22:e13277. [PMID: 34002458 DOI: 10.1111/obr.13277] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/19/2021] [Indexed: 02/06/2023]
Abstract
Obesity is a well-known risk factor for atrial fibrillation (AF). Local epi-myocardial or intra-myocardial adiposity caused by aging, obesity, or cardiovascular disease (CVD) is considered to be a better predictor of the risk of AF than general adiposity. Some of the described mechanisms suggest that epicardial adipose tissue (EAT) participates in structural remodeling owing to its endocrine activity or its infiltration between cardiomyocytes. Epicardial fat also wraps up the ganglionated plexi that reach the myocardium. Although the increment of volume/thickness and activity of EAT might modify autonomic activity, autonomic system dysfunction might also change the endocrine activity of epicardial fat in a feedback response. As a result, new preventive therapeutic strategies are focused on reducing adiposity and weight loss before AF ablation or inhibiting autonomic neurotransmitter secretion on fat pads during open-heart surgery to reduce the recurrence or postoperative risk of AF. In this manuscript, we review some of the novel findings regarding the pathophysiology and associated risk factors of AF, with special emphasis on the role of EAT in the electrical, structural, and molecular mechanisms of AF initiation and maintenance. In addition, we have included a brief note provided on epicardial fat preclinical models that could be useful for identifying new therapeutic targets.
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Affiliation(s)
- Marinela Couselo-Seijas
- Translational Cardiology group, Health Research Institute, Santiago de Compostela, Spain.,University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Moisés Rodríguez-Mañero
- Translational Cardiology group, Health Research Institute, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain.,Cardiovascular Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José R González-Juanatey
- University of Santiago de Compostela, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain.,Cardiovascular Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Cardiology group, Health Research Institute, Santiago de Compostela, Spain
| | - Sonia Eiras
- Translational Cardiology group, Health Research Institute, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain
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26
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Himmelreich JCL, Veelers L, Lucassen WAM, Schnabel RB, Rienstra M, van Weert HCPM, Harskamp RE. Prediction models for atrial fibrillation applicable in the community: a systematic review and meta-analysis. Europace 2021; 22:684-694. [PMID: 32011689 PMCID: PMC7526764 DOI: 10.1093/europace/euaa005] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/06/2020] [Indexed: 01/06/2023] Open
Abstract
Aims Atrial fibrillation (AF) is a common arrhythmia associated with an increased stroke risk. The use of multivariable prediction models could result in more efficient primary AF screening by selecting at-risk individuals. We aimed to determine which model may be best suitable for increasing efficiency of future primary AF screening efforts. Methods and results We performed a systematic review on multivariable models derived, validated, and/or augmented for AF prediction in community cohorts using Pubmed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) through 1 August 2019. We performed meta-analysis of model discrimination with the summary C-statistic as the primary expression of associations using a random effects model. In case of high heterogeneity, we calculated a 95% prediction interval. We used the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) checklist for risk of bias assessment. We included 27 studies with a total of 2 978 659 unique participants among 20 cohorts with mean age ranging from 42 to 76 years. We identified 21 risk models used for incident AF risk in community cohorts. Three models showed significant summary discrimination despite high heterogeneity: CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology) [summary C-statistic 0.71; 95% confidence interval (95% CI) 0.66–0.76], FHS-AF (Framingham Heart Study risk score for AF) (summary C-statistic 0.70; 95% CI 0.64–0.76), and CHA2DS2-VASc (summary C-statistic 0.69; 95% CI 0.64–0.74). Of these, CHARGE-AF and FHS-AF had originally been derived for AF incidence prediction. Only CHARGE-AF, which comprises easily obtainable measurements and medical history elements, showed significant summary discrimination among cohorts that had applied a uniform (5-year) risk prediction window. Conclusion CHARGE-AF appeared most suitable for primary screening purposes in terms of performance and applicability in older community cohorts of predominantly European descent.
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Affiliation(s)
- Jelle C L Himmelreich
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Lieke Veelers
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Wim A M Lucassen
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg/German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck, Martinistrasse 52, 20246 Hamburg, Germany
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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27
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Chan YH, Chen SW, Chao TF, Kao YW, Huang CY, Chu PH. The impact of weight loss related to risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium-glucose cotransporter 2 inhibitor. Cardiovasc Diabetol 2021; 20:93. [PMID: 33941171 PMCID: PMC8091721 DOI: 10.1186/s12933-021-01285-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background Sodium–glucose cotransporter 2 inhibitor (SGLT2i) use reduces body weight (BW) in patients with type 2 diabetes mellitus (T2DM). Obesity and T2DM are strong risk factors of new-onset atrial fibrillation (AF). However, whether BW loss following SGLT2i treatment reduces AF risk in patients with T2DM remains unclear. Methods We used a medical database from a multicenter health care provider in Taiwan, which included 10,237 patients with T2DM, from June 1, 2016 to December 31, 2018, whose BW data at baseline and at 12 weeks of SGLT2i treatment were available. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the SGLT2i, or the end of the study period, whichever occurred first. Results The patients’ baseline body mass index (BMI) was 28.08 \documentclass[12pt]{minimal}
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\begin{document}$$\pm$$\end{document}± 4.88 kg/m2. SGLT2i treatment was associated with a BW loss of 1.35 \documentclass[12pt]{minimal}
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\begin{document}$$\pm$$\end{document}± 4.47%). There were 37.4%, 47.0%, and 15.6% of patients experienced no-BW loss (n = 3832), BW loss 0.0–4.9% (n = 4814), and \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 5.0% (n = 1591) following SGLT2i treatment, respectively. Compared with patients with baseline BMI < 23 kg/m2, AF risk significantly increased in patients with baseline BMI \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 27.5 kg/m2 (P for trend = 0.015). Compared with those without BW loss after SGLT2i treatment, AF risk significantly decreased with a BW loss of \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 5.0% (adjusted hazard ratios [95% confidence intervals]: 0.39[0.22–0.68]). Use of diuretics, old age, high-dose SGLT2i, higher estimated glomerular filtration rate, and baseline BMI were independent factors associated with a BW loss of \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 5.0% following SGLT2i initiation. By contrast, neither baseline BMI nor BW loss after SGLT2i treatment predicted major cardiovascular adverse events or heart failure hospitalization risk (P for trend > 0.05). Conclusion BW loss of ≥ 5.0% following SGLT2i treatment was associated with a lower risk of new-onset AF in patients with T2DM in real-world practice.
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Affiliation(s)
- Yi-Hsin Chan
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.,Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.,Center for Big Data Analytics and Statistics, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Wei Kao
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
| | - Chien-Ying Huang
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan
| | - Pao-Hsien Chu
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
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28
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Dalmar A, Singh M, Heis Z, Cumpian TL, Ceretto C, Mortada ME, Bhatia A, Niazi I, Chua TY, Sra J, Jahangir A. Risk of Atrial Fibrillation and Stroke After Bariatric Surgery in Patients With Morbid Obesity With or Without Obstructive Sleep Apnea. Stroke 2021; 52:2266-2274. [PMID: 33878894 DOI: 10.1161/strokeaha.120.031920] [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] [Indexed: 12/26/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ahmed Dalmar
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.)
| | - Maharaj Singh
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.)
| | - Zoe Heis
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.)
| | - Tabitha L Cumpian
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.).,Center for Advanced Atrial Fibrillation Therapies, Advocate Aurora Health, Milwaukee, WI (T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.)
| | - Cheryl Ceretto
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.).,Center for Advanced Atrial Fibrillation Therapies, Advocate Aurora Health, Milwaukee, WI (T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.)
| | - M Eyman Mortada
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.).,Center for Advanced Atrial Fibrillation Therapies, Advocate Aurora Health, Milwaukee, WI (T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.)
| | - Atul Bhatia
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.).,Center for Advanced Atrial Fibrillation Therapies, Advocate Aurora Health, Milwaukee, WI (T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.)
| | - Imran Niazi
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.).,Center for Advanced Atrial Fibrillation Therapies, Advocate Aurora Health, Milwaukee, WI (T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.)
| | - Thomas Y Chua
- Bariatrics, SC, Aurora Sinai Medical Center, Milwaukee, WI (T.Y.C.)
| | - Jasbir Sra
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.).,Center for Advanced Atrial Fibrillation Therapies, Advocate Aurora Health, Milwaukee, WI (T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.)
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.).,Center for Advanced Atrial Fibrillation Therapies, Advocate Aurora Health, Milwaukee, WI (T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.)
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Poorthuis MHF, Sherliker P, de Borst GJ, Carter JL, Lam KBH, Jones NR, Halliday A, Lewington S, Bulbulia R. Joint Associations Between Body Mass Index and Waist Circumference With Atrial Fibrillation in Men and Women. J Am Heart Assoc 2021; 10:e019025. [PMID: 33853362 PMCID: PMC8174185 DOI: 10.1161/jaha.120.019025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
Background Associations between adiposity and atrial fibrillation (AF) might differ between sexes. We aimed to determine precise estimates of the risk of AF by body mass index (BMI) and waist circumference (WC) in men and women. Methods and Results Between 2008 and 2013, over 3.2 million adults attended commercial screening clinics. Participants completed health questionnaires and underwent physical examination along with cardiovascular investigations, including an ECG. We excluded those with cardiovascular and cardiac disease. We used multivariable logistic regression and determined joint associations of BMI and WC and the risk of AF in men and women by comparing likelihood ratio χ2 statistics. Among 2.1 million included participants 12 067 (0.6%) had AF. A positive association between BMI per 5 kg/m2 increment and AF was observed, with an odds ratio of 1.65 (95% CI, 1.57-1.73) for men and 1.36 (95% CI, 1.30-1.42) for women among those with a BMI above 20 kg/m2. We found a positive association between AF and WC per 10 cm increment, with an odds ratio of 1.47 (95% CI, 1.36-1.60) for men and 1.37 (95% CI, 1.26-1.49) for women. Improvement of likelihood ratio χ2 was equal after adding BMI and WC to models with all participants. In men, WC showed stronger improvement of likelihood ratio χ2 than BMI (30% versus 23%). In women, BMI showed stronger improvement of likelihood ratio χ2 than WC (23% versus 12%). Conclusions We found a positive association between BMI (above 20 kg/m2) and AF and between WC and AF in both men and women. BMI seems a more informative measure about risk of AF in women and WC seems more informative in men.
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Affiliation(s)
- Michiel H. F. Poorthuis
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- Department of Vascular SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Paul Sherliker
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- Medical Research Council Population Health Research UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Gert J. de Borst
- Department of Vascular SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Jennifer L. Carter
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Nicholas R. Jones
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUnited Kingdom
| | - Alison Halliday
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUnited Kingdom
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- Medical Research Council Population Health Research UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
- Now with UKM Medical Molecular Biology Institute (UMBI)Universiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Richard Bulbulia
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- Medical Research Council Population Health Research UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
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30
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Taylor KS, Mahtani KR, Aronson JK. Dealing with categorical risk data when extracting data for meta-analysis. BMJ Evid Based Med 2021; 26:43-45. [PMID: 33441471 DOI: 10.1136/bmjebm-2020-111649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Kathryn S Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal R Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jeffrey K Aronson
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
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31
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Albaugh VL, Kindel TL, Nissen SE, Aminian A. Cardiovascular Risk Reduction Following Metabolic and Bariatric Surgery. Surg Clin North Am 2021; 101:269-294. [PMID: 33743969 DOI: 10.1016/j.suc.2020.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in developed countries, with worsening pandemics of type 2 diabetes mellitus and obesity as major cardiovascular (CV) risk factors. Clinical trials of nonsurgical obesity treatments have not shown benefits in CVD, although recent diabetes trials have demonstrated major CV benefits. In many retrospective and prospective cohort studies, however, metabolic (bariatric) surgery is associated with substantial and reproducible CVD benefits. Despite a lack of prospective, randomized clinical trials, data suggest metabolic surgery may be the most effective modality for CVD risk reduction, likely through weight loss and weight loss-independent mechanisms.
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Affiliation(s)
- Vance L Albaugh
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH 44195, USA.
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32
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3176] [Impact Index Per Article: 1058.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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 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. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 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, policy makers, 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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Wilson R, Aminian A, Tahrani AA. Metabolic surgery: A clinical update. Diabetes Obes Metab 2021; 23 Suppl 1:63-83. [PMID: 33621412 DOI: 10.1111/dom.14235] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/11/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
Metabolic and bariatric surgery has grown beyond 'experimental' weight-loss surgery. As techniques have advanced over the last few decades, so has the growing body of research and evidence, proving that both weight-loss and metabolic health improvement are induced. Metabolic surgery has become the more appropriate term for weight-loss surgery because of the altered gastrointestinal anatomy and subsequent beneficial metabolic effects. Although the tool of metabolic surgery has been well refined, a large portion of the global population does not have adequate access to it. This clinical update aims to (a) inform healthcare providers from all disciplines about the myriad of benefits of metabolic surgery and (b) equip them with the necessary knowledge to bridge the gap between patients in need of metabolic treatment and the therapies in metabolic surgery available to them.
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Key Words
- adjustable gastric banding, atrial fibrillation, bariatric surgery, cancer, cardiovascular disease, gastric bypass, heart failure, hypertension, mortality, obesity, obstructive sleep apnoea, reflux disease, sleeve gastrectomy, type 2 diabetes
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Affiliation(s)
- Rickesha Wilson
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
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Johansson C, Lind MM, Eriksson M, Johansson L. Weight, height, weight change, and risk of incident atrial fibrillation in middle-aged men and women. J Arrhythm 2020; 36:974-981. [PMID: 33335612 PMCID: PMC7733566 DOI: 10.1002/joa3.12409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Anthropometric factors are reported to be risk factors for atrial fibrillation (AF), but it is unclear whether weight change in mid-life is associated with AF. We aimed to study the possible associations of weight, height, and weight change with the risk of incident AF in men and women. METHODS Our study cohort included 108 417 persons (51% women) who participated in a population-based health examination in northern Sweden at 30, 40, 50, or 60 years of age. The health examination included weight and height measurement and collection of data regarding cardiovascular risk factors. Within this cohort, 40 275 participants underwent two health examinations with a 10-year interval. We identified cases with a first-ever diagnosis of AF through the Swedish National Patient Registry. RESULTS During a total follow-up of 1 469 820 person-years, 5154 participants developed incident AF. The mean age at inclusion was 46.3 years, and mean age at AF diagnosis was 66.6 years. After adjustment for potential confounders, height, weight, body mass index (BMI), and body surface area (BSA) were positively associated with risk of incident AF in both men and women. Among participants who underwent two health examinations 10 years apart, 1142 persons developed AF. The mean weight change from baseline was a gain of 4.8%. Weight gain or weight loss was not significantly associated with risk of incident AF. CONCLUSIONS Height, weight, BMI, and BSA showed positive associations with risk of incident AF in both men and women. Midlife weight change was not significantly associated with AF risk.
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Affiliation(s)
- Cecilia Johansson
- Skellefteå Research UnitDepartment of Public Health and Clinical MedicineUmeå UniversitySkellefteåSweden
| | - Marcus M. Lind
- Skellefteå Research UnitDepartment of Public Health and Clinical MedicineUmeå UniversitySkellefteåSweden
| | | | - Lars Johansson
- Skellefteå Research UnitDepartment of Public Health and Clinical MedicineUmeå UniversitySkellefteåSweden
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Koutoukidis DA, Jones NR, Taylor CJ, Casadei B, Aveyard P. Obesity, self-reported symptom severity, and quality of life in people with atrial fibrillation: A community-based cross-sectional survey. Nutr Metab Cardiovasc Dis 2020; 30:2221-2229. [PMID: 32917499 DOI: 10.1016/j.numecd.2020.07.009] [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: 02/20/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Intentional weight loss may reduce symptom severity of atrial fibrillation (AF) in relatively young AF patients with overweight. We examined whether symptom severity and quality of life (QoL) are associated with weight status in the general population with AF. METHODS AND RESULTS Patients with electrocardiogram-confirmed AF completed validated questionnaires: the EuroQol 5 Dimensions QoL questionnaire and the Toronto Atrial Fibrillation Severity Scale (AFSS). The AFSS assessed the AF burden scoring on AF-related symptoms and the total AF burden measured as a combination of duration, frequency, and severity of an irregular heartbeat. Generalized liner models examined the association of body mass index (BMI) with AF severity and QoL adjusting for confounders. Between 2018 and 2019, 882 of 1901 (46%) mailed questionnaires were returned completed. Participants had a mean (SD) age of 74 (10) years old and a BMI of 27.4 (5.6) kg/m2. Sixteen percent reported having never experienced an irregular heartbeat. A 5 kg/m2 higher BMI was associated with a 0.65 (95%CI: 0.25 to 1.06) higher symptom score, where 3 points represent a clinically relevant change in state. A 5 kg/m2 higher BMI was associated with a -1.61 (95%CI: -2.72 to -0.50) lower QoL score. The coefficient of the total AF burden for a 5 kg/m2 higher BMI was 0.17 (95% CI: -0.01 to 0.68). CONCLUSION BMI was positively associated with symptoms and negatively associated with one of the two measures of QoL, but not with the total AF burden. However, the strength of association was small and not clinically meaningful.
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Affiliation(s)
- Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Nicholas R Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Barbara Casadei
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK.
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
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Prestgaard E, Mariampillai J, Engeseth K, Erikssen J, Bodegård J, Liestøl K, Kjeldsen S, Grundvold I, Berge E. Change in Body Weight and Long-Term Risk of Stroke and Death in Healthy Men. Stroke 2020; 51:1435-1441. [DOI: 10.1161/strokeaha.119.027233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background and Purpose—
The importance of weight change for the risk of stroke is not well known. We examined the associations between early- and mid-life weight change and risks of stroke and death during long-term follow-up of healthy men.
Methods—
We recruited healthy men aged between 40 and 59 years and performed a cardiovascular examination at baseline and again at 7 years. We collected data on weight change since the age of 25 (early-life weight change) and measured weight change from baseline to the visit at 7 years (mid-life weight change). For both weight change periods, participants were divided into the following categories: weight loss, weight gain 0 to 4.9 kg, weight gain 5 to 9.9 kg, and weight gain ≥10 kg. Data on stroke and death were collected up to 35 years, from study visits, hospital records, and the National Cause of Death Registry. We used Cox regression to analyze the associations between weight change during early-life and mid-life and risks of stroke and death.
Results—
Of the 2014 participants, 2014 (100%) had data on early-life weight change and were followed for a median of 30.1 years, while 1403 had data on mid-life weight change and were followed for a median of 24.6 years. During early-life, compared with those who had weight gain 0 to 4.9 kg, hazard ratio for stroke was 1.46 (95% CI, 1.09–1.95) among those with weight gain 5 to 9.9 kg, 1.39 (95% CI, 1.03–1.87) for those with weight gain ≥10 kg, and 1.46 (95% CI, 0.99–2.11) among those with weight loss. For all-cause death, the hazard ratios were 1.08 (95% CI, 0.92–1.23), 1.14 (95% CI, 0.98–1.33), and 1.29 (95% CI, 1.06–1.56), respectively. During mid-life, there were no significant differences in risk of stroke or death between the groups.
Conclusions—
Weight increase during early-life, but not mid-life, seems to be associated with increased long-term risk of stroke in healthy men. If these findings can be confirmed, efforts to prevent weight increase should target the younger population.
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Affiliation(s)
- Erik Prestgaard
- From the Institute of Clinical Medicine (E.P., J.E., S.K.), University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., S.K., I.G., E.B.)
| | - Julian Mariampillai
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., S.K., I.G., E.B.)
| | - Kristian Engeseth
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., S.K., I.G., E.B.)
| | - Jan Erikssen
- From the Institute of Clinical Medicine (E.P., J.E., S.K.), University of Oslo, Norway
| | - Johan Bodegård
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., S.K., I.G., E.B.)
| | - Knut Liestøl
- Department of Informatics (K.L.), University of Oslo, Norway
| | - Sverre Kjeldsen
- From the Institute of Clinical Medicine (E.P., J.E., S.K.), University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., S.K., I.G., E.B.)
| | - Irene Grundvold
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., S.K., I.G., E.B.)
| | - Eivind Berge
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., S.K., I.G., E.B.)
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Dwivedi AK, Dubey P, Cistola DP, Reddy SY. Association Between Obesity and Cardiovascular Outcomes: Updated Evidence from Meta-analysis Studies. Curr Cardiol Rep 2020; 22:25. [DOI: 10.1007/s11886-020-1273-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Malik AH, Yandrapalli S, Shetty S, Aronow WS, Jain D, Frishman WH, Cooper HA, Panza JA. Impact of weight on the efficacy and safety of direct-acting oral anticoagulants in patients with non-valvular atrial fibrillation: a meta-analysis. Europace 2020; 22:361-367. [PMID: 31985781 DOI: 10.1093/europace/euz361] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/05/2019] [Accepted: 12/13/2019] [Indexed: 09/20/2023] Open
Abstract
AIMS This study sought to determine the impact of weight and body mass index (BMI) on the safety and efficacy of direct-acting oral anticoagulants (DOACs) compared with warfarin in patients with non-valvular atrial fibrillation. METHODS AND RESULTS A systematic literature search was employed in PubMed, Embase, and Cochrane clinical trials with no language or date restrictions. Randomized trials or their substudies were assessed for relevant outcome data for efficacy that included stroke or systemic embolization (SSE), and safety including major bleeding and all-cause mortality. Binary outcome data and odds ratios from the relevant articles were used to calculate the pooled relative risk. For SSE, the data from the four Phase III trials showed that DOACs are better or similarly effective with low BMI 0.73 (0.56-0.97), normal BMI 0.72 (0.58-0.91), overweight 0.87 (0.76-0.99), and obese 0.87 (0.76-1.00). The risk of major bleeding was also better or similar with DOACs in all BMI subgroups with low BMI 0.62 (0.37-1.05), normal BMI 0.72 (0.58-0.90), overweight 0.83 (0.71-0.96), and obese 0.91 (0.81-1.03). There was no impact on mortality in all the subgroups. In a meta-regression analysis, the effect size advantage of DOACs compared with warfarin in terms of safety and efficacy gradually attenuated with increasing weight. CONCLUSION Our findings suggest that a weight-based dosage adjustment may be necessary to achieve optimal benefits of DOACs for thromboembolic prevention in these patients with non-valvular atrial fibrillation. Further dedicated trials are needed to confirm these findings. PROSPERO 2019 CRD42019140693. Available from: https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42019140693.
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Affiliation(s)
- Aaqib H Malik
- Department of Medicine, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Srikanth Yandrapalli
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Suchith Shetty
- Department of Medicine, University of Iowa Healthcare, Carver College of Medicine, Iowa City, IA, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Diwakar Jain
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - William H Frishman
- Department of Medicine, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Howard A Cooper
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Changes in hemodynamics associated with metabolic syndrome are more pronounced in women than in men. Sci Rep 2019; 9:18377. [PMID: 31804574 PMCID: PMC6895092 DOI: 10.1038/s41598-019-54926-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/18/2019] [Indexed: 01/09/2023] Open
Abstract
The increase in cardiovascular risk associated with metabolic syndrome (MS) seems higher in women than in men. We examined hemodynamics during head-up tilt in 252 men and 250 women without atherosclerosis, diabetes, or antihypertensive medication, mean age 48 years, using whole-body impedance cardiography and radial pulse wave analysis. MS was defined according to Alberti et al. 2009. Men and women with MS presented with corresponding elevations of systolic and diastolic blood pressure (10-14%, p ≤ 0.001) versus controls. Supine pulse wave velocity (16-17%, p < 0.001) and systemic vascular resistance (7-9%, p ≤ 0.026), and upright cardiac output (6-11%, p ≤ 0.008) were higher in both MS groups than controls. Elevation of supine aortic characteristic impedance was higher in women than in men with MS (16% vs. 8%, p = 0.026), and in contrast to men, no upright impedance reduction was observed in women. When upright, women but not men with MS showed faster return of reflected pressure wave (p = 0.036), and smaller decrease in left cardiac work (p = 0.035) versus controls. The faster upright return of reflected pressure, lower upright decrease in left cardiac work, and higher elevation of aortic characteristic impedance may contribute to the greater increase in MS-related cardiovascular risk in women than in men.
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