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Vandenberk B, Haemers P, Morillo C. The autonomic nervous system in atrial fibrillation-pathophysiology and non-invasive assessment. Front Cardiovasc Med 2024; 10:1327387. [PMID: 38239878 PMCID: PMC10794613 DOI: 10.3389/fcvm.2023.1327387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
The autonomic nervous system plays a crucial role in atrial fibrillation pathophysiology. Parasympathetic hyperactivity result in a shortening of the action potential duration, a reduction of the conduction wavelength, and as such facilitates reentry in the presence of triggers. Further, autonomic remodeling of atrial myocytes in AF includes progressive sympathetic hyperinnervation by increased atrial sympathetic nerve density and sympathetic atrial nerve sprouting. Knowledge on the pathophysiological process in AF, including the contribution of the autonomic nervous system, may in the near future guide personalized AF management. This review focuses on the role of the autonomic nervous system in atrial fibrillation pathophysiology and non-invasive assessment of the autonomic nervous system.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Peter Haemers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Carlos Morillo
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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Sha R, Baines O, Hayes A, Tompkins K, Kalla M, Holmes AP, O'Shea C, Pavlovic D. Impact of Obesity on Atrial Fibrillation Pathogenesis and Treatment Options. J Am Heart Assoc 2024; 13:e032277. [PMID: 38156451 PMCID: PMC10863823 DOI: 10.1161/jaha.123.032277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. AF increases the risk of stroke, heart failure, dementia, and hospitalization. Obesity significantly increases AF risk, both directly and indirectly, through related conditions, like hypertension, diabetes, and heart failure. Obesity-driven structural and electrical remodeling contribute to AF via several reported mechanisms, including adiposity, inflammation, fibrosis, oxidative stress, ion channel alterations, and autonomic dysfunction. In particular, expanding epicardial adipose tissue during obesity has been suggested as a key driver of AF via paracrine signaling and direct infiltration. Weight loss has been shown to reverse these changes and reduce AF risk and recurrence after ablation. However, studies on how obesity affects pharmacologic or interventional AF treatments are limited. In this review, we discuss mechanisms by which obesity mediates AF and treatment outcomes, aiming to provide insight into obesity-drug interactions and guide personalized treatment for this patient subgroup.
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Affiliation(s)
- Rina Sha
- Institute of Cardiovascular Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Olivia Baines
- Institute of Cardiovascular Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Abbie Hayes
- Institute of Cardiovascular Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Katie Tompkins
- Institute of Cardiovascular Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Manish Kalla
- Institute of Cardiovascular Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Andrew P. Holmes
- Institute of Cardiovascular Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Christopher O'Shea
- Institute of Cardiovascular Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of BirminghamBirminghamUnited Kingdom
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3
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Gawałko M, Saljic A, Li N, Abu-Taha I, Jespersen T, Linz D, Nattel S, Heijman J, Fender A, Dobrev D. Adiposity-associated atrial fibrillation: molecular determinants, mechanisms, and clinical significance. Cardiovasc Res 2023; 119:614-630. [PMID: 35689487 PMCID: PMC10409902 DOI: 10.1093/cvr/cvac093] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/22/2022] [Accepted: 03/23/2022] [Indexed: 12/12/2022] Open
Abstract
Obesity is an important contributing factor to the pathophysiology of atrial fibrillation (AF) and its complications by causing systemic changes, such as altered haemodynamic, increased sympathetic tone, and low-grade chronic inflammatory state. In addition, adipose tissue is a metabolically active organ that comprises various types of fat deposits with discrete composition and localization that show distinct functions. Fatty tissue differentially affects the evolution of AF, with highly secretory active visceral fat surrounding the heart generally having a more potent influence than the rather inert subcutaneous fat. A variety of proinflammatory, profibrotic, and vasoconstrictive mediators are secreted by adipose tissue, particularly originating from cardiac fat, that promote atrial remodelling and increase the susceptibility to AF. In this review, we address the role of obesity-related factors and in particular specific adipose tissue depots in driving AF risk. We discuss the distinct effects of key secreted adipokines from different adipose tissue depots and their participation in cardiac remodelling. The possible mechanistic basis and molecular determinants of adiposity-related AF are discussed, and finally, we highlight important gaps in current knowledge, areas requiring future investigation, and implications for clinical management.
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Affiliation(s)
- Monika Gawałko
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-197 Warsaw, Poland
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Arnela Saljic
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Na Li
- Department of Medicine (Section of Cardiovascular Research), Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
- Cardiovascular Research Institute, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Issam Abu-Taha
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Port Road, SA 5000 Adelaide, Australia
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Stanley Nattel
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- Medicine and Research Center, Montréal Heart Institute and University de Montréal, 3655 Promenade Sir William Osler, Montreal, QC H3G 1Y6, Canada
- IHU LIRYC Institute, Avenue du Haut Lévêque, 33600 Pessac, Bordeaux, France
| | - Jordi Heijman
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Anke Fender
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
- Medicine and Research Center, Montréal Heart Institute and University de Montréal, 3655 Promenade Sir William Osler, Montreal, QC H3G 1Y6, Canada
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Walker AE, Cole JA, Krishna Kumaran S, Kato JI, Zhuang X, Wolf JR, Henson GD, McCully BH. INFLUENCE OF OBESITY ON VASCULAR DYSFUNCTION AFTER TRAUMATIC HEMORRHAGE. Shock 2023; 59:318-325. [PMID: 36731028 DOI: 10.1097/shk.0000000000001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Background: Obesity increases the risk for morbidity and mortality after trauma. These complications are associated with profound vascular damage. Traumatic hemorrhage acutely attenuates vascular responsiveness, but the impact of obesity on this dysfunction is not known. The local inflammatory response in vascular cells is also unknown. We hypothesized that obesity potentiates trauma-induced vascular inflammation and dysfunction. Methods: Male Sprague-Dawley rats (~250 g) were fed normal chow (NC; 13.5% kcal fat, n = 20) or high-fat (HF; 60% kcal fat, n = 20) diets for 6 to 8 weeks. Under anesthesia, hemorrhage was induced by a mesenteric artery laceration, a Grade V splenic injury, and hypotension (MAP = 30-40 mm Hg) for 30 minutes. Vascular responsiveness was assessed ex vivo in isolated mesenteric arteries prehemorrhage and posthemorrhage. Gene expression for IL-1β, and IL-6, prooxidant nicotinamide adenine dinucleotide phosphate oxidase 2 (NOX2), and α-adrenergic receptor were assessed in carotid artery endothelial cells (ECs) and non-ECs (media + adventitia). Results: In NC rats, hemorrhage attenuated norepinephrine-induced vasoconstriction and endothelium-dependent vasodilation to acetylcholine. In HF rats, baseline norepinephrine-induced vasoconstriction was attenuated compared with NC, but vasoconstriction and endothelium-dependent vasodilation did not change prehemorrhage to posthemorrhage. Hemorrhage led to elevated IL-1β gene expression in ECs and elevated IL1β, IL-6, NOX2, and α-adrenergic receptor gene expression in the media + adventitia compared with sham. HF rats had greater EC IL-1 β and NOX2 gene expression compared with NC rats. The hemorrhage-induced elevation of IL-1β in the media + adventitia was greatest in HF rats. Conclusion: Traumatic hemorrhage attenuates vascular responsiveness and induces vascular inflammation. The attenuated vascular responsiveness after hemorrhage is absent in obese rats, while the elevated vascular inflammation persists. A HF diet amplifies the arterial inflammation after hemorrhage. Altered vascular responsiveness and vascular inflammation may contribute to worse outcomes in obese trauma patients.
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Affiliation(s)
- Ashley E Walker
- Department of Human Physiology, University of Oregon, Eugene, OR
| | - Jazmin A Cole
- Department of Human Physiology, University of Oregon, Eugene, OR
| | | | - Jonathan I Kato
- Department of Human Physiology, University of Oregon, Eugene, OR
| | - Xinhao Zhuang
- Department of Human Physiology, University of Oregon, Eugene, OR
| | - Julia R Wolf
- Department of Human Physiology, University of Oregon, Eugene, OR
| | - Grant D Henson
- Department of Human Physiology, University of Oregon, Eugene, OR
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5
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Yao Y, Xue J, Li B. Obesity and sudden cardiac death: Prevalence, pathogenesis, prevention and intervention. Front Cell Dev Biol 2022; 10:1044923. [PMID: 36531958 PMCID: PMC9757164 DOI: 10.3389/fcell.2022.1044923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/24/2022] [Indexed: 02/04/2024] Open
Abstract
Obesity and sudden cardiac death (SCD) share common risk factors. Obesity, in and of itself, can result in the development of SCD. Numerous epidemiologic and clinical studies have demonstrated the close relationships between obesity and SCD, however, the underlying mechanisms remain incompletely understood. Various evidences support the significance of excess adiposity in determining the risk of SCD, including anatomical remodeling, electrical remodeling, metabolic dysfunction, autonomic imbalance. Weight reduction has improved obesity related comorbidities, and reversed abnormal cardiac remodeling. Indeed, it is still unknown whether weight loss contributes to decreased risk of SCD. Further high-quality, prospective trials are needed to strengthen our understanding on weight management and SCD.
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Affiliation(s)
- Yan Yao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Sharma G, Mooventhan A, Naik G, Nivethitha L. A Review on Role of Yoga in the Management of Patients with Cardiac Arrhythmias. Int J Yoga 2021; 14:26-35. [PMID: 33840974 PMCID: PMC8023436 DOI: 10.4103/ijoy.ijoy_7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/01/2020] [Accepted: 07/16/2020] [Indexed: 11/08/2022] Open
Abstract
Evidence suggests that yoga is safe and effective in improving various risk factors, quality of life (QoL), and psychological burden that is related to arrhythmia. However, this is the first-ever systematic review performed to report the role of yoga in arrhythmia. We have performed a literature search using Cochrane Library, Medline/PubMed, Web of Science Core Collection, and IndMED electronic databases up to 3, January 2018. Of 240 articles, 6 potentially eligible articles were identified and included in the review. Results showed that yoga could be considered an efficient adjuvant in reducing arrhythmia (paroxysmal atrial fibrillation, ventricular tachyarrhythmia, and palpitation) related health problems; blood pressure, heart rate, depression and anxiety scores; and in improving health-related QoL of arrhythmia patients. However, there is a lack of randomized controlled trials and a clear mechanism behind the effect of yoga; studies had relatively a small sample size and different yoga protocols.
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Affiliation(s)
- Gautam Sharma
- Department of Cardiology, Center for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - A Mooventhan
- Department of Research and Development, Government Yoga and Naturopathy Medical College, Chennai, Tamil Nadu, India
| | - Gitismita Naik
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - L Nivethitha
- Department of Naturopathy, Government Yoga and Naturopathy Medical College, Chennai, Tamil Nadu, India
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7
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Zhang HX, Zhang CS, Huang RZ, Cao X, Dai XQ, Zuo CY, Lv P, Zhu LJ, Yu SG. Oral administration of MnCl 2 attenuated hyperlipidemia-related cardiac remodeling in ApoE -/- mice. J Pharmacol Sci 2021; 145:167-174. [PMID: 33451751 DOI: 10.1016/j.jphs.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/19/2020] [Accepted: 11/20/2020] [Indexed: 12/29/2022] Open
Abstract
Manganese chloride (MnCl2) has been shown to inhibit the Yes-associated protein (YAP) in high-fat diet-fed ApoE-/- mice. Although YAP has been implicated in atherogenesis, there are limited data on the effects of MnCl2 on cardiac remodeling. In this study, we discovered, by electrocardiography, that hyperlipidemia led to spontaneous supraventricular arrhythmia (SVA) in ApoE-/- (KO) mice, with 3 of 9 KO + MnCl2 mice (33%) exhibiting lower incidence of spontaneous SVA than KO mice (6 of 10 mice, 60%). Echocardiography revealed that reduced systolic function in KO mice was reversed by MnCl2 treatment. Oil Red O staining of the aortas and biochemical analysis of lipid levels showed that MnCl2 inhibited plaque formation in a lipid metabolism-independent manner. MnCl2 inhibited inflammatory cell infiltration and reduced fibrosis, as evidenced by hematoxylin and eosin, immunohistochemical and Masson's trichrome staining, respectively. Our findings demonstrate that spontaneous SVA and reduced systolic function were blocked by MnCl2. Our findings show that MnCl2 was useful in delaying cardiac remodeling and reducing susceptibility to spontaneous SVA in a mouse model of hyperlipidemia.
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Affiliation(s)
- Han-Xiao Zhang
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37 Shi-er-qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Cheng-Shun Zhang
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37 Shi-er-qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Rui-Zhen Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, 39 Shi-er-qiao Road, Jinniu District, Chengdu, 610072, Sichuan, China
| | - Xin Cao
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37 Shi-er-qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China.
| | - Xiao-Qin Dai
- Department of Traditional Chinese Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, China.
| | - Chuan-Yi Zuo
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37 Shi-er-qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Peng Lv
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37 Shi-er-qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Li-Juan Zhu
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37 Shi-er-qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Shu-Guang Yu
- Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37 Shi-er-qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
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Gowen BH, Reyes MV, Joseph LC, Morrow JP. Mechanisms of Chronic Metabolic Stress in Arrhythmias. Antioxidants (Basel) 2020; 9:antiox9101012. [PMID: 33086602 PMCID: PMC7603089 DOI: 10.3390/antiox9101012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiac arrhythmias are responsible for many cardiovascular disease-related deaths worldwide. While arrhythmia pathogenesis is complex, there is increasing evidence for metabolic causes. Obesity, diabetes, and chronically consuming high-fat foods significantly increase the likelihood of developing arrhythmias. Although these correlations are well established, mechanistic explanations connecting a high-fat diet (HFD) to arrhythmogenesis are incomplete, although oxidative stress appears to be critical. This review investigates the metabolic changes that occur in obesity and after HFD. Potential therapies to prevent or treat arrhythmias are discussed, including antioxidants.
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Affiliation(s)
| | | | | | - John P. Morrow
- Correspondence: ; Tel.: +1-212-305-5553; Fax: +1-212-305-4648
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Chen C, Wang W, Zhou W, Jin J, Chen W, Zhu D, Bi Y. Nocturnal ventricular arrhythmias are associated with the severity of cardiovascular autonomic neuropathy in type 2 diabetes. J Diabetes 2019; 11:794-801. [PMID: 30767398 DOI: 10.1111/1753-0407.12908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cardiovascular autonomic neuropathy (CAN) is a risk factor for arrhythmias and adverse cardiovascular events, but the relationship between CAN severity and nocturnal arrhythmias needs to be clarified. This study evaluated the association between nocturnal arrhythmias and CAN severity in patients with type 2 diabetes (T2D). METHODS In all, 219 T2D patients were recruited from January 2017 to May 2018. Subjects were classified into no CAN (NCAN), early CAN (ECAN), definite CAN (DCAN), or advanced CAN (ACAN) based on cardiovascular autonomic reflex tests (CARTs). A 24-hour electrocardiogram was recorded and daytime (0700-2300 hours) and night-time (2300-0700 hours) heartbeats were analyzed separately. RESULTS After adjusting for age, the incidence of ventricular arrhythmias increased with CAN severity at night-time (18.6%, 29.9%, 36.2%, and 60.0% in the NCAN, ECAN, DCAN, and ACAN groups, respectively; Ptrend = 0.034). Patients with nocturnal ventricular arrhythmias (NVAs) had higher CART scores (2.0 ± 1.0 vs 1.5 ± 0.9; P < 0.001) and lower heart rate variability (HRV) during deep breathing (9.5 ± 5.7 vs 11.6 ± 6.6 b. p. m; P = 0.021), HRV during the Valsalva maneuver (1.2 ± 0.1 vs 1.2 ± 0.2; P = 0.006), and postural blood pressure change (-8.8 ± 15.5 vs -4.1 ± 11.2 mmHg; P = 0.023). Multivariate regression analysis revealed that CAN stage (odds ratio 1.765; 95% confidence interval 1.184-2.632; P = 0.005) was independently associated with NVAs. CONCLUSIONS In T2D, CAN stage was independently associated with the presence of NVAs. Early detection, diagnosis, and treatment of CAN may help predict and prevent adverse cardiovascular events and cardiovascular mortality in diabetes.
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Affiliation(s)
- Chuhui Chen
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
- Department of Endocrinology, Drum Tower Clinical Medical College, Nanjing Medical University, Jiangsu, China
| | - Weimin Wang
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Wen Zhou
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Jiewen Jin
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Wei Chen
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Dalong Zhu
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Yan Bi
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
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High prevalence of hyperlipidaemia in patients with AV re-entry tachycardia and AV nodal re-entry tachycardia. Sci Rep 2019; 9:11502. [PMID: 31395917 PMCID: PMC6687730 DOI: 10.1038/s41598-019-47940-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/24/2019] [Indexed: 01/11/2023] Open
Abstract
Diet rich in lipids and hyperlipidaemia increases incidence of atrial premature beats and all supraventricular arrhythmias. The aim of the study was to investigate the prevalence of hyperlipidaemia in patients with AV re-entry tachycardia (AVRT) and AV nodal re-entry tachycardia (AVNRT). We conducted a retrospective, cross-sectional, case-control study that included all consecutive patients for whom AVRT or AVNRT was confirmed during electrophysiology study. Age and gender-matched patients admitted to hospital or outpatient clinic for various reasons were randomly included and served as a control group. Hyperlipidaemia was defined according to 2016 European Society of Cardiology guidelines. A total of 1448 subjects were included: 725 patients with AVRT/AVNRT and 723 controls. AVRT/AVNRT patients had high hyperlipidaemia prevalence, which was significantly higher when compared to the control group (50.1 vs. 35.8%, p < 0.001). AVRT patients, with median age of 37.5 years, had hyperlipidaemia prevalence of 45.7%. In a multivariate analysis, hyperlipidaemia was independently associated with AVRT/AVNRT (OR 2.128, p < 0.001), both with AVNRT (OR 1.878, p < 0.001) and AVRT (OR 2.786, p < 0.001). Hypercholesterolemia was significantly more prevalent in patients with AVNRT and AVRT, while this was not the case for hypertriglyceridemia. There were no differences between the AVRT and AVNRT patients regarding hyperlipidaemia prevalence (51.9 vs. 45.7%, p = 0.801), even though AVRT patients were significantly younger (37.5 vs. 48.5, p < 0.001). In conclusion, this is the first study that investigated hyperlipidaemia prevalence in patients with AVRT or AVNRT. AVRT/AVNRT patients had higher prevalence of hyperlipidaemia and higher total and LDL cholesterol levels.
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11
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Chen H, Deng Y, Li S. Relation of Body Mass Index Categories with Risk of Sudden Cardiac Death. Int Heart J 2019; 60:624-630. [DOI: 10.1536/ihj.18-155] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hui Chen
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Nanchang University
| | - Yuqing Deng
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Nanchang University
| | - Shunhui Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Nanchang University
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12
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Shiga T, Kohro T, Yamasaki H, Aonuma K, Suzuki A, Ogawa H, Hagiwara N, Yamazaki T, Nagai R, Kasanuki H. Body Mass Index and Sudden Cardiac Death in Japanese Patients After Acute Myocardial Infarction: Data From the JCAD Study and HIJAMI-II Registry. J Am Heart Assoc 2018; 7:JAHA.118.008633. [PMID: 29982233 PMCID: PMC6064840 DOI: 10.1161/jaha.118.008633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Although an “obesity paradox” exists in patients after myocardial infarction, the association between obesity and the risk of sudden cardiac death (SCD) is limited. The aim of this study was to determine whether obesity is associated with an increased risk of SCD in Japanese survivors of acute myocardial infarction. Methods and Results Pooled data from 2 cohort studies in Japan, JCAD (Japanese Coronary Artery Disease) study and the Heart Institute of Japan Acute Myocardial Infarction‐II (HIJAMI‐II) registry, comprising of 6216 patients (mean age 65±11 years, 75.2% male) with acute myocardial infarction who were discharged alive, were studied. The patients were categorized into the following body mass index (BMI) groups at baseline according to the World Health Organization classification for Asian populations: BMI <18.5 kg/m2 (n=335), 18.5 to 23 kg/m2 (n=2371), 23 to 27.5 kg/m2 (n=2823), and ≥27.5 kg/m2 (n=687). The main outcomes were all‐cause mortality and SCD. During an average follow‐up period of 3.6±1.4 years, all‐cause mortality was 10.1%, and SCD was 1.2%. Patients with BMI <18.5 kg/m2 had the highest rate of all‐cause mortality (adjusted hazard ratio, 1.61; 95% confidence interval, 1.20–2.16), but high BMI (≥27.5 kg/m2) was not associated with mortality compared with patients in the group with BMI ≥18.5 and <23 kg/m2. However, the long‐term risk of SCD was increased in the group with BMI ≥27.5 kg/m2 (adjusted hazard ratio, 2.97; 95% confidence interval, 1.24–7.15). Multivariate analysis revealed that BMI ≥27.5 kg/m2 was associated with an increased risk of SCD (hazard ratio, 2.78; 95% confidence interval, 1.35–5.74). Conclusions Obesity (BMI ≥27.5 kg/m2) was associated with the risk of SCD in Japanese patients after myocardial infarction, although an obesity paradox was found for all‐cause mortality.
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Affiliation(s)
- Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahide Kohro
- Department of Clinical Informatics, Jichi Medical University, Shimotsuke, Japan
| | - Hiro Yamasaki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Ogawa
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsutomu Yamazaki
- Clinical Research Support Center, University of Tokyo Hospital, Tokyo, Japan
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13
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Csige I, Ujvárosy D, Szabó Z, Lőrincz I, Paragh G, Harangi M, Somodi S. The Impact of Obesity on the Cardiovascular System. J Diabetes Res 2018; 2018:3407306. [PMID: 30525052 PMCID: PMC6247580 DOI: 10.1155/2018/3407306] [Citation(s) in RCA: 221] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/12/2018] [Accepted: 09/27/2018] [Indexed: 12/11/2022] Open
Abstract
Obesity is a growing health problem worldwide. It is associated with an increased cardiovascular risk on the one hand of obesity itself and on the other hand of associated medical conditions (hypertension, diabetes, insulin resistance, and sleep apnoea syndrome). Obesity has an important role in atherosclerosis and coronary artery disease. Obesity leads to structural and functional changes of the heart, which causes heart failure. The altered myocardial structure increases the risk of atrial fibrillation and sudden cardiac death. However, obesity also has a protective effect on the clinical outcome of underlying cardiovascular disease, the phenomenon called obesity paradox. The improved cardiac imaging techniques allow the early detection of altered structure and function of the heart in obese patients. In this review, we attempt to summarize the relationship between obesity and cardiovascular diseases and outline the underlying mechanisms. The demonstrated new techniques of cardiac diagnostic procedures allow for the early detection and treatment of subclinical medical conditions and, therefore, the prevention of cardiovascular events.
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Affiliation(s)
- Imre Csige
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Dóra Ujvárosy
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - István Lőrincz
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - György Paragh
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Mariann Harangi
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Sándor Somodi
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
- Division of Clinical Pharmacology, Faculty of Pharmacy, University of Debrecen, Hungary
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14
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Zhong P, Quan D, Huang Y, Huang H. CaMKII Activation Promotes Cardiac Electrical Remodeling and Increases the Susceptibility to Arrhythmia Induction in High-fat Diet-Fed Mice With Hyperlipidemia Conditions. J Cardiovasc Pharmacol 2017; 70:245-254. [PMID: 28662005 PMCID: PMC5642343 DOI: 10.1097/fjc.0000000000000512] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/08/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Obesity/hyperlipidemia is closely related to both atrial and ventricular arrhythmias. CaMKII, a multifunctional serine/threonine kinase, has been involved in cardiac arrhythmias of different etiologies. However, its role in obesity/hyperlipidemia-related cardiac arrhythmia is unexplored. The aim of this was to determine the involvement of CaMKII in the process. METHODS Adult male APOE mice were fed a high-fat diet (HFD), administrated with KN93 (10 mg·kg·2d), a specific inhibitor of CaMKII. Serum lipid and glucose profile, cardiac function, and surface electrocardiogram were determined. Electrophysiological study and epicardial activation mapping were performed in Langendorff-perfused heart. Expression of cardiac ion channels, gap junction proteins, Ca handling proteins, and CaMKII were evaluated, coupled with histological analysis. RESULTS A hyperlipidemia condition was induced by HFD in the APOE mice, which was associated with increased expression and activity of CaMKII in the hearts. In Langendorff-perfused hearts, HFD-induced heart showed increased arrhythmia inducibility, prolonged action potential duration, and decreased action potential duration alternans thresholds, coupled with slow ventricular conduction, connexin-43 upregulation, and interstitial fibrosis. Downregulation of ion channels including Cav1.2 and Kv4.2/Kv4.3 and disturbed Ca handling proteins were also observed in HFD-induced heart. Interestingly, all these alterations were significantly inhibited by KN93 treatment. CONCLUSION Our results demonstrated an adverse effect of metabolic components on cardiac electrophysiology and implicated an important role of CaMKII underlying this process.
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Affiliation(s)
- Peng Zhong
- Department of Cardiology, Renming Hospital of Wuhan University, Wuhan, PR China
- Cardiovascular Research Institute, Wuhan University, Wuhan, PR China; and
- Huei Key Laboratory of Cardiology, Wuhan, PR China
| | - Dajun Quan
- Department of Cardiology, Renming Hospital of Wuhan University, Wuhan, PR China
- Cardiovascular Research Institute, Wuhan University, Wuhan, PR China; and
- Huei Key Laboratory of Cardiology, Wuhan, PR China
| | - Yan Huang
- Department of Cardiology, Renming Hospital of Wuhan University, Wuhan, PR China
- Cardiovascular Research Institute, Wuhan University, Wuhan, PR China; and
- Huei Key Laboratory of Cardiology, Wuhan, PR China
| | - He Huang
- Department of Cardiology, Renming Hospital of Wuhan University, Wuhan, PR China
- Cardiovascular Research Institute, Wuhan University, Wuhan, PR China; and
- Huei Key Laboratory of Cardiology, Wuhan, PR China
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15
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Luppi M, Al-Jahmany AA, Del Vecchio F, Cerri M, Di Cristoforo A, Hitrec T, Martelli D, Perez E, Zamboni G, Amici R. Wake-sleep and cardiovascular regulatory changes in rats made obese by a high-fat diet. Behav Brain Res 2017; 320:347-355. [PMID: 28011172 DOI: 10.1016/j.bbr.2016.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022]
Abstract
Obesity is known to be associated with alterations in wake-sleep (WS) architecture and cardiovascular parameters. This study was aimed at assessing the possible influence of diet-induced obesity (DIO) on sleep homeostasis and on the WS state-dependent levels of arterial pressure (AP) and heart rate in the rat. Two groups of age-matched Sprague-Dawley rats were fed either a high-fat hypercaloric diet, leading to DIO, or a normocaloric standard diet (lean controls) for 8 weeks. While under general anesthesia, animals were implanted with instrumentation for the recording of electroencephalogram, electromyogram, arterial pressure, and deep brain temperature. The experimental protocol consisted of 48h of baseline, 12h of gentle handling, enhancing wake and depressing sleep, and 36-h post-handling recovery. Compared to lean controls, DIO rats showed: i) the same amount of rapid-eye movement (REM) and non-REM (NREM) sleep in the rest period, although the latter was characterized by more fragmented episodes; ii) an increase in both REM sleep and NREM sleep in the activity period; iii) a comparable post-handling sleep homeostatic response, in terms of either the degree of Delta power increase during NREM sleep or the quantitative compensation of the REM sleep loss at the end of the 36-h recovery period; iv) significantly higher levels of AP, irrespectively of the different WS states and of the changes in their intensity throughout the experimental protocol. Overall, these changes may be the reflection of a modification in the activity of the hypothalamic areas where WS, autonomic, and metabolic regulations are known to interact.
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Affiliation(s)
- Marco Luppi
- Department of Biomedical and Neuromotor Sciences-Physiology, Alma Mater Studiorum - University of Bologna, Piazza di Porta San Donato, 2, 40126, Bologna, Italy.
| | - Abed A Al-Jahmany
- Department of Biomedical and Neuromotor Sciences-Physiology, Alma Mater Studiorum - University of Bologna, Piazza di Porta San Donato, 2, 40126, Bologna, Italy.
| | - Flavia Del Vecchio
- Department of Biomedical and Neuromotor Sciences-Physiology, Alma Mater Studiorum - University of Bologna, Piazza di Porta San Donato, 2, 40126, Bologna, Italy.
| | - Matteo Cerri
- Department of Biomedical and Neuromotor Sciences-Physiology, Alma Mater Studiorum - University of Bologna, Piazza di Porta San Donato, 2, 40126, Bologna, Italy.
| | - Alessia Di Cristoforo
- Department of Biomedical and Neuromotor Sciences-Physiology, Alma Mater Studiorum - University of Bologna, Piazza di Porta San Donato, 2, 40126, Bologna, Italy.
| | - Timna Hitrec
- Department of Biomedical and Neuromotor Sciences-Physiology, Alma Mater Studiorum - University of Bologna, Piazza di Porta San Donato, 2, 40126, Bologna, Italy.
| | - Davide Martelli
- Department of Biomedical and Neuromotor Sciences-Physiology, Alma Mater Studiorum - University of Bologna, Piazza di Porta San Donato, 2, 40126, Bologna, Italy; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, 3052, Australia.
| | - Emanuele Perez
- Department of Biomedical and Neuromotor Sciences-Physiology, Alma Mater Studiorum - University of Bologna, Piazza di Porta San Donato, 2, 40126, Bologna, Italy.
| | - Giovanni Zamboni
- Department of Biomedical and Neuromotor Sciences-Physiology, Alma Mater Studiorum - University of Bologna, Piazza di Porta San Donato, 2, 40126, Bologna, Italy.
| | - Roberto Amici
- Department of Biomedical and Neuromotor Sciences-Physiology, Alma Mater Studiorum - University of Bologna, Piazza di Porta San Donato, 2, 40126, Bologna, Italy.
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16
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Gardner RT, Ripplinger CM, Myles RC, Habecker BA. Molecular Mechanisms of Sympathetic Remodeling and Arrhythmias. Circ Arrhythm Electrophysiol 2016; 9:e001359. [PMID: 26810594 DOI: 10.1161/circep.115.001359] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Ryan T Gardner
- From the Department of Physiology and Pharmacology and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (R.T.G., B.A.H.); Department of Pharmacology, School of Medicine, University of California, Davis (C.M.R.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (R.C.M.)
| | - Crystal M Ripplinger
- From the Department of Physiology and Pharmacology and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (R.T.G., B.A.H.); Department of Pharmacology, School of Medicine, University of California, Davis (C.M.R.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (R.C.M.)
| | - Rachel C Myles
- From the Department of Physiology and Pharmacology and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (R.T.G., B.A.H.); Department of Pharmacology, School of Medicine, University of California, Davis (C.M.R.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (R.C.M.)
| | - Beth A Habecker
- From the Department of Physiology and Pharmacology and Knight Cardiovascular Institute, Oregon Health and Science University, Portland (R.T.G., B.A.H.); Department of Pharmacology, School of Medicine, University of California, Davis (C.M.R.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (R.C.M.).
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17
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Zhang F, Hartnett S, Sample A, Schnack S, Li Y. High fat diet induced alterations of atrial electrical activities in mice. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2016; 6:1-9. [PMID: 27073731 PMCID: PMC4788723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/22/2015] [Indexed: 06/05/2023]
Abstract
Obesity is a well-known risk factor for various cardiovascular diseases. Recent clinical data showed that overweight and obese patients have higher incidence of atrial fibrillation (AF) compared with individuals with normal body weights, but the underlying mechanisms remain to be elucidated. In this study, we investigated the effects of a high fat diet on atrial activities in mice. ICR male mice were fed a regular diet (RD) or a high fat diet (HFD) for 8 weeks. Mice fed HFD showed significantly greater body weight gains and visceral fat accumulation compared with RD mice. Under anesthetic condition, baseline arterial blood pressure and heart rate were not significantly different between RD and HFD groups. Although no spontaneous or atrial stimulation-induced atrial fibrillation was observed, this study revealed several alterations in the activities and protein levels in the atria in HFD mice. Surface electrocardiogram (ECG) revealed significantly shortened PR interval in HFD mice. In the atrial stimulation experiments, the sinoatrial (SA) node recovery time was significantly prolonged whereas the atrial effective refractory period was significantly reduced in HFD mice as compared with RD mice. Western blot showed protein levels of two major potassium channels, Kv1.5 and Kv4.2/3, were significantly increased in atria of HFD mice. These data indicate that HFD induces atrial electrophysiological remodeling in mice, which may be a potential mechanism underlying the increased risk for atrial arrhythmias in obesity and metabolic disorders.
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Affiliation(s)
- Fan Zhang
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota Vermillion, SD 57069, USA
| | - Sigurd Hartnett
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota Vermillion, SD 57069, USA
| | - Alex Sample
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota Vermillion, SD 57069, USA
| | - Sabrina Schnack
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota Vermillion, SD 57069, USA
| | - Yifan Li
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota Vermillion, SD 57069, USA
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18
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Liu F, Li Y, Xu Y. Weight loss to prevent atrial fibrillation: The role of epicardial adipose tissue. Int J Cardiol 2016; 204:124-5. [PMID: 26657604 DOI: 10.1016/j.ijcard.2015.08.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Fengli Liu
- Medical College of Hebei University of Engineering, Handan, Hebei, China
| | - Yan Li
- Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China.
| | - Yanli Xu
- Medical College of Hebei University of Engineering, Handan, Hebei, China
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19
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Freud LR, Webster G, Costello JM, Tsao S, Rychlik K, Backer CL, Deal BJ. Growth and Obesity Among Older Single Ventricle Patients Presenting for Fontan Conversion. World J Pediatr Congenit Heart Surg 2015; 6:514-20. [PMID: 26467864 PMCID: PMC7050720 DOI: 10.1177/2150135115598212] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Long-term growth outcomes and the prevalence of obesity among older single ventricle (SV) patients have not been well characterized. We investigated these parameters, as well as the impact of obesity on survival, in an older cohort of SV patients presenting for Fontan conversion. METHODS We analyzed preoperative height, weight, and body mass index (BMI) of patients who underwent Fontan conversion. Overweight and obese were defined as BMI ≥85 percentile and ≥95 percentile for patients <20 years and BMI 25 to 30 kg/m(2) and ≥30 kg/m(2) for patients ≥20 years, respectively. Postoperative transplant-free survival was assessed among obese, overweight, and normal weight patients. RESULTS We evaluated 139 patients presenting for Fontan conversion at a median age of 23.2 years. Patients had shorter stature compared to the normal population (mean Z score -0.6, P < .001). Younger patients had lower BMI compared to the normal population (<20 years: mean Z score -0.5, P = .02), while older patients had elevated BMI (≥20 years: mean Z score +0.4, P < .001). The mean BMI among older patients approached overweight at 24.6 kg/m(2). The prevalence of obesity increased with advancing age, with 36% overweight and 14% obese at >30 years. At a median of 8.2 years following Fontan conversion, obesity and overweight status were not associated with transplant-free survival. CONCLUSION Older SV patients presenting for Fontan conversion had shorter stature compared to the normal population as well as a high prevalence of overweight and obesity. Although there was no relationship between weight status and early postoperative survival, further investigation of long-term outcomes is warranted.
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Affiliation(s)
- Lindsay R Freud
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Webster
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John M Costello
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sabrina Tsao
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen Rychlik
- Biostatistics Research Core, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carl L Backer
- Department of Surgery, Division of Cardiovascular Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Barbara J Deal
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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20
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Lambert EA, Straznicky NE, Dixon JB, Lambert GW. Should the sympathetic nervous system be a target to improve cardiometabolic risk in obesity? Am J Physiol Heart Circ Physiol 2015; 309:H244-58. [DOI: 10.1152/ajpheart.00096.2015] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/11/2015] [Indexed: 02/03/2023]
Abstract
The sympathetic nervous system (SNS) plays a key role in both cardiovascular and metabolic regulation; hence, disturbances in SNS regulation are likely to impact on both cardiovascular and metabolic health. With excess adiposity, in particular when visceral fat accumulation is present, sympathetic activation commonly occurs. Experimental investigations have shown that adipose tissue releases a large number of adipokines, cytokines, and bioactive mediators capable of stimulating the SNS. Activation of the SNS and its interaction with adipose tissue may lead to the development of hypertension and end-organ damage including vascular, cardiac, and renal impairment and in addition lead to metabolic abnormalities, especially insulin resistance. Lifestyle changes such as weight loss and exercise programs considerably improve the cardiovascular and metabolic profile of subjects with obesity and decrease their cardiovascular risk, but unfortunately weight loss is often difficult to achieve and sustain. Pharmacological and device-based approaches to directly or indirectly target the activation of the SNS may offer some benefit in reducing the cardiometabolic consequences of obesity. Preliminary evidence is encouraging, but more trials are needed to investigate whether sympathetic inhibition could be used in obesity to reverse or prevent cardiometabolic disease development. The purpose of this review article is to highlight the current knowledge of the role that SNS plays in obesity and its associated metabolic disorders and to review the potential benefits of sympathoinhibition on metabolic and cardiovascular functions.
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Affiliation(s)
- Elisabeth A. Lambert
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Physiology, Monash University, Clayton, Australia
| | - Nora E. Straznicky
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - John B. Dixon
- Clinical Obesity Research Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; and
| | - Gavin W. Lambert
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
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21
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Zhao LY, Li J, Yuan F, Li M, Zhang Q, Huang YY, Pang JY, Zhang B, Sun FY, Sun HS, Li Q, Cao L, Xie Y, Lin YC, Liu J, Tan HM, Wang GL. Xyloketal B attenuates atherosclerotic plaque formation and endothelial dysfunction in apolipoprotein e deficient mice. Mar Drugs 2015; 13:2306-26. [PMID: 25874925 PMCID: PMC4413213 DOI: 10.3390/md13042306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/30/2015] [Accepted: 04/03/2015] [Indexed: 12/31/2022] Open
Abstract
Our previous studies demonstrated that xyloketal B, a novel marine compound with a unique chemical structure, has strong antioxidant actions and can protect against endothelial injury in different cell types cultured in vitro and model organisms in vivo. The oxidative endothelial dysfunction and decrease in nitric oxide (NO) bioavailability are critical for the development of atherosclerotic lesion. We thus examined whether xyloketal B had an influence on the atherosclerotic plaque area in apolipoprotein E-deficient (apoE-/-) mice fed a high-fat diet and investigated the underlying mechanisms. We found in our present study that the administration of xyloketal B dose-dependently decreased the atherosclerotic plaque area both in the aortic sinus and throughout the aorta in apoE-/- mice fed a high-fat diet. In addition, xyloketal B markedly reduced the levels of vascular oxidative stress, as well as improving the impaired endothelium integrity and NO-dependent aortic vasorelaxation in atherosclerotic mice. Moreover, xyloketal B significantly changed the phosphorylation levels of endothelial nitric oxide synthase (eNOS) and Akt without altering the expression of total eNOS and Akt in cultured human umbilical vein endothelial cells (HUVECs). Here, it increased eNOS phosphorylation at the positive regulatory site of Ser-1177, while inhibiting phosphorylation at the negative regulatory site of Thr-495. Taken together, these findings indicate that xyloketal B has dramatic anti-atherosclerotic effects in vivo, which is partly due to its antioxidant features and/or improvement of endothelial function.
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MESH Headings
- Animals
- Antioxidants/adverse effects
- Antioxidants/pharmacology
- Antioxidants/therapeutic use
- Aorta/drug effects
- Aorta/metabolism
- Aorta/physiopathology
- Aorta/ultrastructure
- Apolipoproteins E/deficiency
- Apolipoproteins E/metabolism
- Cardiovascular Agents/adverse effects
- Cardiovascular Agents/pharmacology
- Cardiovascular Agents/therapeutic use
- Cells, Cultured
- Diet, High-Fat/adverse effects
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Endothelium, Vascular/ultrastructure
- Human Umbilical Vein Endothelial Cells/cytology
- Human Umbilical Vein Endothelial Cells/drug effects
- Human Umbilical Vein Endothelial Cells/metabolism
- Humans
- Lipid Metabolism, Inborn Errors/drug therapy
- Lipid Metabolism, Inborn Errors/metabolism
- Lipid Metabolism, Inborn Errors/pathology
- Lipid Metabolism, Inborn Errors/physiopathology
- Male
- Mice, Knockout
- Nitric Oxide Synthase Type III/genetics
- Nitric Oxide Synthase Type III/metabolism
- Oxidative Stress/drug effects
- Phosphorylation/drug effects
- Plaque, Atherosclerotic/etiology
- Plaque, Atherosclerotic/prevention & control
- Protein Processing, Post-Translational/drug effects
- Proto-Oncogene Proteins c-akt/genetics
- Proto-Oncogene Proteins c-akt/metabolism
- Pyrans/adverse effects
- Pyrans/pharmacology
- Pyrans/therapeutic use
- Specific Pathogen-Free Organisms
- Vasodilation/drug effects
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Affiliation(s)
- Li-Yan Zhao
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (L.-Y.Z.); (F.Y.); (Y.X.); (J.L.)
| | - Jie Li
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510080, China; E-Mail:
| | - Feng Yuan
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (L.-Y.Z.); (F.Y.); (Y.X.); (J.L.)
| | - Mei Li
- VIP Healthcare Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China; E-Mail:
| | - Quan Zhang
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (Q.Z.); (Q.L.); (L.C.)
| | - Yun-Ying Huang
- Department of Pharmacy, The fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510182, China; E-Mail:
| | - Ji-Yan Pang
- Department of Applied Chemistry, School of Chemistry and Chemical Engineering, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (J.-Y.P.); (Y.-C.L.)
- Department of Education of Guangdong Province, Guangdong Province Key Laboratory of Functional Molecules in Oceanic Microorganism, Sun Yat-sen University, Guangzhou 510080, China
| | - Bin Zhang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China; E-Mail:
| | - Fang-Yun Sun
- Lab for Basic Research of Life Science, School of Medicine, Tibet Institute for Nationalities, Xianyang 712082, China; E-Mails:
| | - Hong-Shuo Sun
- Departments of Surgery and Physiology, Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1G6, Canada; E-Mail:
| | - Qian Li
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (Q.Z.); (Q.L.); (L.C.)
| | - Lu Cao
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (Q.Z.); (Q.L.); (L.C.)
| | - Yu Xie
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (L.-Y.Z.); (F.Y.); (Y.X.); (J.L.)
| | - Yong-Cheng Lin
- Department of Applied Chemistry, School of Chemistry and Chemical Engineering, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (J.-Y.P.); (Y.-C.L.)
- Department of Education of Guangdong Province, Guangdong Province Key Laboratory of Functional Molecules in Oceanic Microorganism, Sun Yat-sen University, Guangzhou 510080, China
| | - Jie Liu
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (L.-Y.Z.); (F.Y.); (Y.X.); (J.L.)
| | - Hong-Mei Tan
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (Q.Z.); (Q.L.); (L.C.)
- Department of Education of Guangdong Province, Guangdong Province Key Laboratory of Functional Molecules in Oceanic Microorganism, Sun Yat-sen University, Guangzhou 510080, China
- Authors to whom correspondence should be addressed; E-Mails: (H.-M.T.); (G.-L.W.); Tel./Fax: +86-020-8733-4055 (H.-M.T.); Tel.: +86-020-8733-0300 (G.-L.W.); Fax: +86-020-8733-1155 (G.-L.W.)
| | - Guan-Lei Wang
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (L.-Y.Z.); (F.Y.); (Y.X.); (J.L.)
- Department of Education of Guangdong Province, Guangdong Province Key Laboratory of Functional Molecules in Oceanic Microorganism, Sun Yat-sen University, Guangzhou 510080, China
- Authors to whom correspondence should be addressed; E-Mails: (H.-M.T.); (G.-L.W.); Tel./Fax: +86-020-8733-4055 (H.-M.T.); Tel.: +86-020-8733-0300 (G.-L.W.); Fax: +86-020-8733-1155 (G.-L.W.)
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Diet-induced obesity prevents the development of acute traumatic coagulopathy. J Trauma Acute Care Surg 2015; 77:873-7; discussion 878. [PMID: 25423535 DOI: 10.1097/ta.0000000000000461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity and hemorrhagic shock following trauma are predictors of mortality but have conflicting effects on coagulation. Following hemorrhage, tissue injury and hypoperfusion lead to acute traumatic coagulopathy (ATC), producing a hypocoagulable state. Inversely, obesity promotes clotting and impairs fibrinolysis to yield a hypercoagulable state. High rates of venous thromboembolism, organ failure, and early mortality may be caused by hypercoagulability in obese patients. We hypothesize that obesity prevents the development of ATC following injury-induced hemorrhagic shock. METHODS Male Sprague-Dawley rats (250-275 g) were fed a high-fat diet (32%kcal from fat) for 4 weeks to 6 weeks and diverged into obesity-resistant (OR, n = 9) and obesity-prone (OP, n = 9) groups. Age-matched control (CON) rats were fed normal diet (10% kcal from fat, n = 9). Anesthetized rats were subjected to an uncontrolled hemorrhage by a Grade V splenic injury to a mean arterial pressure (MAP) of 40 mm Hg. Hypotension (MAP, 30-40 mm Hg) was maintained for 30 minutes to induce shock. MAP, heart rate, lactate, base excess, cytokines, blood loss, and thrombelastography (TEG) parameters were measured before and after hemorrhagic shock. RESULTS At baseline, OP rats exhibited a shorter time to 20-mm clot (K), and higher rate of clot formation (α angle), clot strength (maximal amplitude), and coagulation index, compared with the CON rats (p < 0.05), indicating enhanced coagulation. Physiologic parameters following shock were similar between groups. In the CON and OR rats, shock prolonged the time to clot initiation (R) and K and decreased α angle and coagulation index (all p < 0.05 vs. baseline). In contrast, shock had no effect on these TEG parameters in the OP rats. Maximal amplitude was the only TEG parameter affected by shock in the OP rats, which was decreased in all groups. CONCLUSION Obesity prevents the development of ATC following hemorrhage shock. Complications associated with obesity following hemorrhagic shock may be attributed to the preserved hypercoagulable state.
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The Implications of Obesity for Cardiac Arrhythmia Mechanisms and Management. Can J Cardiol 2015; 31:203-10. [DOI: 10.1016/j.cjca.2014.10.027] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 01/02/2023] Open
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Pellegrino MJ, McCully BH, Habecker BA. Leptin stimulates sympathetic axon outgrowth. Neurosci Lett 2014; 566:1-5. [PMID: 24561183 DOI: 10.1016/j.neulet.2014.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/27/2014] [Accepted: 02/07/2014] [Indexed: 12/28/2022]
Abstract
The neurohormone leptin regulates energy homeostasis. Circulating levels of leptin secreted by adipose tissue act on hypothalamic neurons in the brain leading to decreased appetite and increased energy expenditure. Although leptin signaling in the central nervous system (CNS) is fundamental to its ability to regulate the body's metabolic balance, leptin also has a variety of effects in many peripheral tissues including the heart, the liver, and the sympathetic nervous system. Leptin stimulation of the hypothalamus can stimulate glucose uptake via the sympathetic nervous system in heart, muscle, and brown adipose tissue. Leptin receptors (Ob-Rb) are also expressed by peripheral sympathetic neurons, but their functional role is not clear. In this study, we found that leptin stimulates axonal growth of both adult and neonatal sympathetic neurons in vitro. Leptin stimulates acute activation of the transcription factor STAT3 via phosphorylation of tyrosine 705. STAT3 phosphorylation is required for leptin-stimulated sympathetic axon outgrowth. Thus, circulating levels of leptin may enhance sympathetic nerve innervation of peripheral tissues.
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Affiliation(s)
- Michael J Pellegrino
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Belinda H McCully
- Trauma Research Institute of Oregon, Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Beth A Habecker
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR 97239, USA.
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Abreu AR, de Abreu AR, Santos LT, de Souza AA, da Silva LG, Chianca DA, de Menezes RC. Blunted GABA-mediated inhibition within the dorsomedial hypothalamus potentiates the cardiovascular response to emotional stress in rats fed a high-fat diet. Neuroscience 2014; 262:21-30. [PMID: 24397951 DOI: 10.1016/j.neuroscience.2013.12.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/23/2013] [Accepted: 12/24/2013] [Indexed: 11/25/2022]
Abstract
Rats fed a high-fat diet (HFD) present an exaggerated endocrine response to stress conditions, which, like obesity, show a high correlation with cardiovascular diseases. Meanwhile the GABAergic neurotransmission within the dorsomedial hypothalamus (DMH) is involved in the regulation of the physiological responses during emotional stress. Here we evaluated the influence of obesity, induced by a HFD, on the cardiovascular responses induced by air jet stress in rats, and the role of the GABAergic tonus within the DMH in these changes. Our results showed that consumption of a HFD (45% w/w fat) for 9 weeks induced obesity and increases in baseline mean arterial pressure (MAP) and heart rate (HR). Moreover, obesity potentiated stress responsiveness, evidenced by the greater changes in MAP and HR induced by stress in obese rats. The injection of muscimol into the DMH reduced the maximal increases in HR and MAP induced by stress in both groups; however, the reduction in the maximal increases in MAP in the HFD group was less pronounced. Moreover, the injection of muscimol into the DMH of obese rats was less effective in reducing the stress-induced tachycardia, since the HR attained the same levels at the end of the stress paradigm as after the vehicle injection. Injection of bicuculline into DMH induced increases in MAP and HR in both groups. Nevertheless, obesity shortened the tachycardic response to bicuculline injection. These data show that obesity potentiates the cardiovascular response to stress in rats due to an inefficient GABAA-mediated inhibition within the DMH.
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Affiliation(s)
- A R Abreu
- Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, MG, Brazil.
| | - A R de Abreu
- Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, MG, Brazil.
| | - L T Santos
- Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, MG, Brazil.
| | - A A de Souza
- Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, MG, Brazil.
| | - L G da Silva
- Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, MG, Brazil.
| | - D A Chianca
- Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, MG, Brazil.
| | - R C de Menezes
- Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, MG, Brazil.
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