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Aoki J, Kimura K. The Body Mass Index as a Determinant of Acute Ischemic Location in Mild Non-cardioembolic Stroke Patients. Intern Med 2024; 63:2613-2620. [PMID: 38432968 DOI: 10.2169/internalmedicine.2926-23] [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: 03/05/2024] Open
Abstract
Objective Although the body mass index (BMI) is considered a meaningful parameter for evaluating obesity, the association between the BMI and acute non-cardioembolic stroke remains unclear. We investigated how the BMI was related to patients' background, type of infarction, and infarction location in patients with non-cardioembolic stroke using an acute dual study (ADS) cohort. Methods The ADS trial was conducted between May 2011 and June 2017 in Japan. The BMI classifications were those proposed by the World Health Organization classification: underweight, <18.5 kg/m2; normal weight, 18.5-24.9 kg/m2; overweight, 25-29.9 kg/m2; and obese, ≥30 kg/m2. Results Data from 1,136 patients were analyzed. The median BMI was 23.6 kg/m2 (interquartile range: 21.6-25.8 kg/m2), with a BMI ≥30 kg/m2 in 63 patients (6%), 25-29.9 kg/m2 in 321 (28%), 18.5-24.9 kg/m2 in 692 (61%), and <18.5 kg/m2 in 60 (5%). The group with a BMI ≥30 kg/m2 was the youngest, and the group with a BMI <18.5 kg/m2 was the oldest (p<0.001). The proportion of patients with a history of hypertension (p<0.001), diabetes (p<0.001), dyslipidemia (p<0.001), and statin therapy (p=0.005) increased with increasing BMI. Pontine infarcts were frequent in the following order: obese, overweight, normal weight, and underweight (24%, 18%, 14%, and 13%, respectively; p=0.034). In contrast, cortical infarct were frequent in the order of underweight, normal weight, overweight, and obese at 20%, 19%, 14%, and 3%, respectively (p=0.007). Conclusion Acute stroke patients with a high BMI have more atherosclerosis-related factors in their backgrounds than those with lower BMIs. In addition, the BMI may be a determinant of infarct location in patients with acute stroke.
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Affiliation(s)
- Junya Aoki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
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Grubić Rotkvić P, Rotkvić L, Đuzel Čokljat A, Cigrovski Berković M. Sodium-dependent glucose transporter 2 inhibitors effects on myocardial function in patients with type 2 diabetes and asymptomatic heart failure. World J Cardiol 2024; 16:448-457. [PMID: 39221192 PMCID: PMC11362810 DOI: 10.4330/wjc.v16.i8.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Sodium-dependent glucose transporter 2 inhibitors (SGLT2i) have shown efficacy in reducing heart failure (HF) burden in a very heterogeneous groups of patients, raising doubts about some contemporary assumptions of their mechanism of action. We previously published a prospective observational study that evaluated mechanisms of action of SGLT2i in patients with type 2 diabetes who were in HF stages A and B on dual hypoglycemic therapy. Two groups of patients were included in the study: the ones receiving SGLT2i as an add-on agent to metformin and the others on dipeptidyl peptidase-4 inhibitors as an add-on to metformin due to suboptimal glycemic control.
AIM To evaluate the outcomes regarding natriuretic peptide, oxidative stress, inflammation, blood pressure, heart rate, cardiac function, and body weight.
METHODS The study outcomes were examined by dividing each treatment arm into two subgroups according to baseline parameters of global longitudinal strain (GLS), N-terminal pro-brain natriuretic peptide, myeloperoxidase (MPO), high-sensitivity C-reactive protein (hsCRP), and systolic and diastolic blood pressure. To evaluate the possible predictors of observed changes in the SGLT2i arm during follow-up, a rise in stroke volume index, body mass index (BMI) decrease, and lack of heart rate increase, linear regression analysis was performed.
RESULTS There was a greater reduction of MPO, hsCRP, GLS, and blood pressure in the groups with higher baseline values of mentioned parameters irrespective of the therapeutic arm after 6 months of follow-up. Significant independent predictors of heart rate decrease were a reduction in early mitral inflow velocity to early diastolic mitral annular velocity at the interventricular septal annulus ratio and BMI, while the predictor of stroke volume index increase was SGLT2i therapy itself.
CONCLUSION SGLT2i affect body composition, reduce cardiac load, improve diastolic/systolic function, and attenuate the sympathetic response. Glycemic control contributes to the improvement of heart function, blood pressure control, oxidative stress, and reduction in inflammation.
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Affiliation(s)
- Petra Grubić Rotkvić
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Luka Rotkvić
- Department of Cardiology, Magdalena Clinic for Cardiovascular Disease, Krapinske Toplice 49217, Croatia
| | - Ana Đuzel Čokljat
- Department of Internal Medicine, General Hospital Dubrovnik, Dubrovnik 20000, Croatia
| | - Maja Cigrovski Berković
- Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology, Zagreb 10000, Croatia
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Chandrasekaran P, Weiskirchen R. The signaling pathways in obesity-related complications. J Cell Commun Signal 2024; 18:e12039. [PMID: 38946722 PMCID: PMC11208128 DOI: 10.1002/ccs3.12039] [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: 01/25/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Obesity, a rapidly expanding epidemic worldwide, is known to exacerbate many medical conditions, making it a significant factor in multiple diseases and their associated complications. This threatening epidemic is linked to various harmful conditions such as type 2 diabetes mellitus, hypertension, metabolic dysfunction-associated steatotic liver disease, polycystic ovary syndrome, cardiovascular diseases (CVDs), dyslipidemia, and cancer. The rise in urbanization and sedentary lifestyles creates an environment that fosters obesity, leading to both psychosocial and medical complications. To identify individuals at risk and ensure timely treatment, it is crucial to have a better understanding of the pathophysiology of obesity and its comorbidities. This comprehensive review highlights the relationship between obesity and obesity-associated complications, including type 2 diabetes, hypertension, (CVDs), dyslipidemia, polycystic ovary syndrome, metabolic dysfunction-associated steatotic liver disease, gastrointestinal complications, and obstructive sleep apnea. It also explores the potential mechanisms underlying these associations. A thorough analysis of the interplay between obesity and its associated complications is vital in developing effective therapeutic strategies to combat the exponential increase in global obesity rates and mitigate the deadly consequences of this polygenic condition.
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Affiliation(s)
| | - Ralf Weiskirchen
- Institute of Molecular PathobiochemistryExperimental Gene Therapy and Clinical Chemistry (IFMPEGKC)RWTH University Hospital AachenAachenGermany
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Rahmouni K. Neural Circuits Underlying Reciprocal Cardiometabolic Crosstalk: 2023 Arthur C. Corcoran Memorial Lecture. Hypertension 2024; 81:1233-1243. [PMID: 38533662 PMCID: PMC11096079 DOI: 10.1161/hypertensionaha.124.22066] [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] [Indexed: 03/28/2024]
Abstract
The interplay of various body systems, encompassing those that govern cardiovascular and metabolic functions, has evolved alongside the development of multicellular organisms. This evolutionary process is essential for the coordination and maintenance of homeostasis and overall health by facilitating the adaptation of the organism to internal and external cues. Disruption of these complex interactions contributes to the development and progression of pathologies that involve multiple organs. Obesity-associated cardiovascular risks, such as hypertension, highlight the significant influence that metabolic processes exert on the cardiovascular system. This cardiometabolic communication is reciprocal, as indicated by substantial evidence pointing to the ability of the cardiovascular system to affect metabolic processes, with pathophysiological implications in disease conditions. In this review, I outline the bidirectional nature of the cardiometabolic interaction, with special emphasis on the impact that metabolic organs have on the cardiovascular system. I also discuss the contribution of the neural circuits and autonomic nervous system in mediating the crosstalk between cardiovascular and metabolic functions in health and disease, along with the molecular mechanisms involved.
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Affiliation(s)
- Kamal Rahmouni
- Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Obesity Research and Education Initiative, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Gupta RD, Parray AA, Kothadia RJ, Pulock OS, Pinky SD, Haider SS, Akonde M, Haider MR. The association between body mass index and abdominal obesity with hypertension among South Asian population: findings from nationally representative surveys. Clin Hypertens 2024; 30:3. [PMID: 38297370 PMCID: PMC10832172 DOI: 10.1186/s40885-023-00257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/06/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE This study aimed to determine the association between body mass index (BMI) and abdominal obesity with hypertension among the South Asian adults (18-69 years). METHODS This study utilized the nationally representative WHO STEPwise approach to surveillance data (n = 24,413) from Afghanistan, Bangladesh, Bhutan, Nepal, and Sri Lanka. Hypertension was defined as having a systolic blood pressure of 140 mmHg or higher, a diastolic blood pressure of 90 mmHg or higher, and/or taking antihypertensive medications. A waist circumference ≥ 90 cm in men and ≥ 80 cm in women was considered as abdominal obesity. BMI was categorized according to Asia-specific cutoff and overweight was defined as BMI of 23.0-27.5 kg/m2 and obesity was defined as BMI ≥ 27.5 kg/m2. Multivariable logistic regression analyses were conducted to identify the association between BMI and abdominal obesity with hypertension. The odds ratio (OR) with a 95% confidence interval (CI) was reported. RESULTS Abdominal obesity increased the odds of hypertension 31%-105% compared to those who did not have abdominal obesity (OR: Afghanistan: 2.05; 95% CI: 1.27-3.31; Bangladesh: 1.55; 95% CI: 1.18-2.04; Bhutan: 1.31; 95% CI: 1.03-1.66; Nepal: 1.69; 95% CI: 1.31-2.18; Sri Lanka:1.55; 95% CI: 1.23-1.95). The odds increased among participants with both overweight/obesity and abdominal obesity. In all five countries under study, participants with both overweight and abdominal obesity (OR: Afghanistan: 2.75; 95% CI: 1.75-4.34; Bangladesh: 2.53; 95% CI: 1.90-3.37; Bhutan: 2.22; 95% CI: 1.64-3.00; Nepal: 2.08; 95% CI: 1.54-2.81; Sri Lanka: 2.29; 95% CI: 1.77-2.98), as well as those with obesity and abdominal obesity (OR: Afghanistan: 6.94; 95% CI: 4.68-10.30; Bangladesh: 2.95; 95% CI: 2.19-3.97; Bhutan: 3.02; 95% CI: 2.23-4.09; Nepal: 4.40; 95% CI: 3.05-6.34; Sri Lanka: 3.96; 95% CI: 2.94-5.32), exhibited higher odds of having hypertension as compared to participants with a normal BMI and no abdominal obesity. CONCLUSION Having both abdominal obesity and overweight/obesity increased the odds of hypertension among South Asian adults. Preventing overweight/obesity and abdominal obesity is necessary for preventing the burden of hypertension in South Asia.
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Affiliation(s)
- Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Ateeb Ahmad Parray
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615N Wolfe St, Baltimore, MD, 21205, USA
| | - Rohan Jay Kothadia
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Orindom Shing Pulock
- Department of Medicine, Chittagong Medical College Hospital, K B Fazlul Kader Road, Panchlaish, Chattogram, 4203, Bangladesh
| | - Susmita Dey Pinky
- Department of Cardiology, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, W12 0HS, UK
| | - Shams Shabab Haider
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA
| | - Maxwell Akonde
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Wright Hall 301B 100 Foster Rd, Athens, GA, 30602, USA
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Okyere J, Ayebeng C, Owusu BA, Dickson KS. Fruits and vegetable consumption, and its association with hypertension among women in Ghana: a cross-sectional study. Public Health Nutr 2023; 27:e19. [PMID: 38148174 PMCID: PMC10830364 DOI: 10.1017/s1368980023002896] [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: 02/06/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE This study aimed to examine the association between fruit and vegetable consumption (FVC) and the risk of hypertension among women in Ghana. DESIGN Data from the 2014 Ghana Demographic and Health Survey were used. Bivariate and multivariate logistic regression analyses were performed using Stata version 14. The study reports the adjusted OR (AOR) and CI. SETTING Ghana. PARTICIPANTS A total sample of 4168 women was used in the analysis. RESULTS Among women who met the WHO's recommended intake of FVC, 13·1 % had hypertension. The intake of the recommended servings of fruit and vegetables was not significantly associated with hypertension. However, the likelihood of being hypertensive was significantly associated with increasing age (AOR = 6·1; 95 % CI = 4·29, 8·73), being married (AOR = 1·7; 95 % CI = 1·14, 2·57) or formerly married (AOR = 2·3; 95 % CI = 1·44, 3·70), and being overweight (AOR = 1·6; 95 % CI = 1·24, 2·07) or obese (AOR = 2·4; 95 % CI = 1·82, 3·20). CONCLUSION The study concludes that there is no significant association between FVC and hypertension risk among women in Ghana. While this study did not find a significant association between FVC and hypertension risk among women in Ghana, it underscores the point that other multifaceted factors influence hypertension risk. As such, public health campaigns should emphasise a balanced and holistic approach to promoting cardiovascular health, including factors beyond FVC. The findings also highlight the need to target high-risk populations (i.e. older women, married and formerly married women, and overweight or obese women) with hypertension prevention education and related interventions.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, University Post Office, PMB, Ghana
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, University Post Office, PMB, Ghana
| | - Bernard Afriyie Owusu
- Department of Population and Health, University of Cape Coast, Cape Coast, University Post Office, PMB, Ghana
| | - Kwamena Sekyi Dickson
- Department of Population and Health, University of Cape Coast, Cape Coast, University Post Office, PMB, Ghana
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Wyse BA, Salehi R, Russell SJ, Sangaralingam M, Jahangiri S, Tsang BK, Librach CL. Obesity and PCOS radically alters the snRNA composition of follicular fluid extracellular vesicles. Front Endocrinol (Lausanne) 2023; 14:1205385. [PMID: 37404312 PMCID: PMC10315679 DOI: 10.3389/fendo.2023.1205385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/29/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction The ovarian follicle consists of the oocyte, somatic cells, and follicular fluid (FF). Proper signalling between these compartments is required for optimal folliculogenesis. The association between polycystic ovarian syndrome (PCOS) and extracellular vesicular small non-coding RNAs (snRNAs) signatures in follicular fluid (FF) and how this relates to adiposity is unknown. The purpose of this study was to determine whether FF extracellular vesicle (FFEV)-derived snRNAs are differentially expressed (DE) between PCOS and non-PCOS subjects; and if these differences are vesicle-specific and/or adiposity-dependent. Methods FF and granulosa cells (GC) were collected from 35 patients matched by demographic and stimulation parameters. FFEVs were isolated and snRNA libraries were constructed, sequenced, and analyzed. Results miRNAs were the most abundant biotype present, with specific enrichment in exosomes (EX), whereas in GCs long non-coding RNAs were the most abundant biotype. In obese PCOS vs. lean PCOS, pathway analysis revealed target genes involved in cell survival and apoptosis, leukocyte differentiation and migration, JAK/STAT, and MAPK signalling. In obese PCOS FFEVs were selectively enriched (FFEVs vs. GCs) for miRNAs targeting p53 signalling, cell survival and apoptosis, FOXO, Hippo, TNF, and MAPK signalling. Discussion We provide comprehensive profiling of snRNAs in FFEVs and GCs of PCOS and non-PCOS patients, highlighting the effect of adiposity on these findings. We hypothesize that the selective packaging and release of miRNAs specifically targeting anti-apoptotic genes into the FF may be an attempt by the follicle to reduce the apoptotic pressure of the GCs and stave off premature apoptosis of the follicle observed in PCOS.
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Affiliation(s)
- Brandon A. Wyse
- Research Department, CReATe Fertility Centre, Toronto, ON, Canada
| | - Reza Salehi
- Research Department, CReATe Fertility Centre, Toronto, ON, Canada
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Departments of Obstetrics and Gynecology & Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Sahar Jahangiri
- Research Department, CReATe Fertility Centre, Toronto, ON, Canada
- CReATe Biobank, Toronto, ON, Canada
| | - Benjamin K. Tsang
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Departments of Obstetrics and Gynecology & Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Clifford L. Librach
- Research Department, CReATe Fertility Centre, Toronto, ON, Canada
- CReATe Biobank, Toronto, ON, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Biological Sciences, DAN Women & Babies Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
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Parasiliti-Caprino M, Lopez C, Bollati M, Bioletto F, Sola C, Di Carlo MC, Ponzetto F, Gesmundo I, Settanni F, Ghigo E, Mengozzi G, Maccario M, Giordano R. A retrospective study on the association between urine metanephrines and cardiometabolic risk in patients with nonfunctioning adrenal incidentaloma. Sci Rep 2022; 12:14913. [PMID: 36050396 PMCID: PMC9436965 DOI: 10.1038/s41598-022-19321-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/26/2022] [Indexed: 11/09/2022] Open
Abstract
Several studies argued that cardiovascular evaluation of patients with nonfunctioning adrenal incidentaloma is of particular importance. Therefore, we aimed to evaluate the possibility of stratifying the cardiometabolic risk using metanephrine levels in this setting of patients. A retrospective cross-sectional study was designed, collecting data of metanephrine values in 828 patients with nonfunctioning adrenal incidentaloma, referred to our Division within the University of Turin between 2007 and 2021. The univariate analysis showed associations between urine metanephrines and cardiometabolic variables/parameters, particularly considering the noradrenaline metabolite. At the univariate regression, normetanephrine was associated with metabolic syndrome (OR = 1.13, p = 0.002), hypertensive cardiomyopathy (OR = 1.09, p = 0.026), microalbuminuria (OR = 1.14, p = 0.024), and eGFR < 60 mL/min/1.73 m2 (OR = 1.11, p = 0.013), while metanephrine was associated with microalbuminuria (OR = 1.50, p = 0.008). At multivariate regression, considering all major cardiovascular risk factors as possible confounders, normetanephrine retained a significant association with metabolic syndrome (OR = 1.10, p = 0.037). Moreover, metanephrine retained a significant association with the presence of microalbuminuria (OR = 1.66, p = 0.003). The present study showed a further role for metanephrines in the cardiovascular risk stratification of patients with nonfunctioning adrenal incidentaloma. Individuals with high levels of these indirect markers of sympathetic activity should be carefully monitored and may benefit from an aggressive treatment to reduce their additional cardiometabolic burden.
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Affiliation(s)
- Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - Chiara Lopez
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Martina Bollati
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Fabio Bioletto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Chiara Sola
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Maria Chiara Di Carlo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Federico Ponzetto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Iacopo Gesmundo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Fabio Settanni
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - Ezio Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Giulio Mengozzi
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - Mauro Maccario
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Roberta Giordano
- Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
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Maciel de Oliveira C, França da Rosa F, de Oliveira Alvim R, Mourão Junior CA, Bacells M, Liu C, Pavani J, Capasso R, Lavezzo Dias FA, Eduardo Krieger J, Costa Pereira A. Body mass index is superior to other body adiposity indexes in predicting incident hypertension in a highly admixed sample after 10-year follow-up: The Baependi Heart Study. J Clin Hypertens (Greenwich) 2022; 24:731-737. [PMID: 35543312 PMCID: PMC9180336 DOI: 10.1111/jch.14480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 01/20/2023]
Abstract
Hypertension is the leading cause of overall mortality in low- and middle-income countries. In Brazil, there is paucity of data on the determinants of incident hypertension and related risk factors. We aimed to determine the incidence of hypertension in a sample from the Brazilian population and investigate possible relationships with body adiposity indexes. We assessed risk factors associated with cardiovascular disease, including adiposity body indexes and biochemical analysis, in a sample from the Baependi Heart Study before and after a 10-year follow-up. Hypertension was defined by the presence of systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg or the use of antihypertensive drugs. From an initial sample of 1693 participants, 498 (56% women; mean age 38 ± 13 years) were eligible to be included. The overall hypertension incidence was 24.3% (22.3% in men and 25.6% in women). Persons who developed hypertension had higher prevalence of obesity, higher levels for blood pressure, higher frequency of dyslipidemia, and higher body adiposity indexes at baseline. The best prediction model for incident hypertension includes age, sex, HDL-c, SBP, and Body Mass Index (BMI) [AUC = 0.823, OR = 1.58 (95% CI 1.23-2.04)]. BMI was superior in its predictive capacity when compared to Body Adiposity Index (BAI), Body Roundness Index (BRI), and Visceral Adiposity Index (VAI). Incident hypertension in a sample from the Brazilian population was 24.3% after 10-year follow-up and BMI, albeit the simpler index to be calculated, is the best anthropometric index to predict incident hypertension.
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Affiliation(s)
- Camila Maciel de Oliveira
- School of MedicineStanford UniversityStanfordUSA
- Laboratory of Genetics and Molecular CardiologyHeart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
- Department of Integrative MedicineFederal University of ParanaCuritibaPRBrazil
| | | | | | | | - Mercedes Bacells
- Institute for Medical Engineering and ScienceMassachusetts Institute of TechnologyCambridgeUSA
- Bioengineering DepartmentInstitut Quimic de SarriaRamon Llull UnivBarcelonaSpain
| | - Chunyu Liu
- Framingham Heart StudyFraminghamUSA
- Department of BiostatisticsBoston UniversityBostonUSA
| | - Jessica Pavani
- Department of Statistics of PontificiaUniversidad Católica de ChileSantiagoChile
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10
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Sinha MK, Maiya GA, Moga AM, K N S, Shankar N R, K V. Exercise dose-response relationship with heart rate variability in individuals with overweight and obesity: protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e047821. [PMID: 35470179 PMCID: PMC9039408 DOI: 10.1136/bmjopen-2020-047821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Obesity is a chronic relapsing disease process and serious public health concern that can lead to chronic diseases, medical complications and a higher risk of disability. Another significant feature of obesity is dysfunction in cardiac autonomic function, which leads to changes in parasympathetic and sympathetic regulation, which can be measured using heart rate variability (HRV). The objective of this review is to estimate the extent to which exercise doses impacts on HRV among individuals living with overweight and obesity class I and II. METHODS AND ANALYSIS A systematic literature search will be performed using PubMed/Medline, Scopus, EMBASE, ProQuest, CINAHL, Web of Science and the Cochrane Library for articles dating from 1965 to December 2021. Inclusion criteria include studies designed as parallel-arm randomised trials, enrolling adolescent and adult individuals with overweight (body mass index, BMI≥25 to ≤29.9) and obesity (class I BMI: 30-34.9 and class II BMI: 35-39.9) undergoing aerobic or resistance training or concurrent exercise training. For data synthesis, sensitivity analysis, subgroup analysis and risk of bias assessment, Stata V.13.0 software will be used. ETHICS AND DISSEMINATION Formal ethical approval is not required. This systematic review will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019104154.
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Affiliation(s)
- Mukesh Kumar Sinha
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - G Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ana Maria Moga
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Shivashankar K N
- Department of Medicine, Kasturba Medical college, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravi Shankar N
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Vaishali K
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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11
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Dalmasso C, Leachman JR, Ghuneim S, Ahmed N, Schneider ER, Thibault O, Osborn JL, Loria AS. Epididymal Fat-Derived Sympathoexcitatory Signals Exacerbate Neurogenic Hypertension in Obese Male Mice Exposed to Early Life Stress. Hypertension 2021; 78:1434-1449. [PMID: 34601958 PMCID: PMC8516729 DOI: 10.1161/hypertensionaha.121.17298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/19/2021] [Indexed: 01/06/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Carolina Dalmasso
- Department of Pharmacology and Nutritional Sciences, College of Medicine (C.D., J.R.L., S.G., N.A., O.T., A.S.L.), University of Kentucky, Lexington
| | - Jacqueline R. Leachman
- Department of Pharmacology and Nutritional Sciences, College of Medicine (C.D., J.R.L., S.G., N.A., O.T., A.S.L.), University of Kentucky, Lexington
| | - Sundus Ghuneim
- Department of Pharmacology and Nutritional Sciences, College of Medicine (C.D., J.R.L., S.G., N.A., O.T., A.S.L.), University of Kentucky, Lexington
| | - Nermin Ahmed
- Department of Pharmacology and Nutritional Sciences, College of Medicine (C.D., J.R.L., S.G., N.A., O.T., A.S.L.), University of Kentucky, Lexington
| | - Eve R. Schneider
- Department of Biology, College of Arts and Sciences (E.R.S., J.L.O.), University of Kentucky, Lexington
| | - Olivier Thibault
- Department of Pharmacology and Nutritional Sciences, College of Medicine (C.D., J.R.L., S.G., N.A., O.T., A.S.L.), University of Kentucky, Lexington
| | - Jeffrey L. Osborn
- Department of Biology, College of Arts and Sciences (E.R.S., J.L.O.), University of Kentucky, Lexington
| | - Analia S. Loria
- Department of Pharmacology and Nutritional Sciences, College of Medicine (C.D., J.R.L., S.G., N.A., O.T., A.S.L.), University of Kentucky, Lexington
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12
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Increased Adiposity Appraised with CUN-BAE Is Highly Predictive of Incident Hypertension. The SUN Project. Nutrients 2021; 13:nu13103309. [PMID: 34684310 PMCID: PMC8537177 DOI: 10.3390/nu13103309] [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: 08/01/2021] [Revised: 08/28/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022] Open
Abstract
Overweight and obesity are growing worldwide and strongly associated with hypertension. The Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index is proposed as an optimal indicator of body fatness. We aimed to investigate the association of body fat as captured by the CUN-BAE index with incident hypertension in a Mediterranean population. We assessed 15,950 participants of the SUN (Seguimiento Universidad de Navarra) prospective cohort (63.7% women) initially free of hypertension. Participants completed follow-up questionnaires biennially. A validated 136-item food-frequency questionnaire was administered at baseline. We used Cox models adjusted for multiple confounders. Among 12.3 years of median follow-up (interquartile range: 8.3, 15.0 years), 2160 participants reported having received a diagnosis of hypertension. We observed a strong direct association between progressively higher the CUN-BAE index at baseline and incident hypertension during follow-up in multivariable-adjusted models for men and women, even after further adjustment for BMI ≥ 30 kg/m2, showing a significant association also in non-obese participants. For each 2-unit increase in the CUN-BAE index, hypertension risk increased by 27% and 29% in men and women, respectively. The results remained significant when considering longitudinal repeated measures of changes in body fat assessed with the CUN-BAE index among the different biennial follow-up questionnaires. Our results emphasize the importance of reducing and maintaining a low body fat to prevent hypertension.
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13
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Wang L, Lin M, Yu J, Fan Z, Zhang S, Lin Y, Chen X, Peng F. The Impact of Bariatric Surgery Versus Non-Surgical Treatment on Blood Pressure: Systematic Review and Meta-Analysis. Obes Surg 2021; 31:4970-4984. [PMID: 34519991 DOI: 10.1007/s11695-021-05671-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to compare bariatric surgery versus non-surgical treatment on blood pressure for patients with obesity. Nineteen RCTs (1353 total patients) were included. In the pooled analyses, bariatric surgery reduces more systolic blood pressure (WMD: - 3.937 mmHg, CI95%: - 6.000 to - 1.875, p < 0.001, I2 = 0%), diastolic blood pressure (WMD: - 2.690 mmHg, CI95%: - 3.994 to - 1.385, P < 0.001, I2 = 0%) and more antihypertensives. In subgroup analyses, patients after Roux-en-Y gastric bypass, with poor control of hypertension (BP > 130/80 mmHg) and diabetes mellitus (HbA1C > 7.0%, FPG > 7.0 mmol/L), elder patients (> 45 years), non-severe obesity (BMI < 40 kg/cm2, body weight < 120 kg), less waist circumference (< 115 cm) tend to decrease more blood pressure. Besides, patients after surgery also lost more weight (p < 0.001), decreased more waist circumference (p < 0.001), fasting plasma glucose (p < 0.001), glycosylated hemoglobin (p < 0.001), triglycerides (p < 0.001), hsCRP (p = 0.001), increased more high-density lipoprotein cholesterol (p < 0.001), and had better remission of metabolic syndrome (p < 0.001). Changes in total cholesterol, low-density lipoprotein cholesterol, renal function, resting heart rate, and 6-min walking test were not significantly different. Therefore, bariatric surgery is more effective than non-surgical treatment in controlling patients' blood pressure.
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Affiliation(s)
- Laicheng Wang
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Meihua Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Jianjian Yu
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Zongcheng Fan
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Shunpeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Yunchai Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Xin Chen
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China
| | - Feng Peng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, Fujian, China.
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14
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Valensi P. Autonomic nervous system activity changes in patients with hypertension and overweight: role and therapeutic implications. Cardiovasc Diabetol 2021; 20:170. [PMID: 34412646 PMCID: PMC8375121 DOI: 10.1186/s12933-021-01356-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
The incidence and prevalence of hypertension is increasing worldwide, with approximately 1.13 billion of people currently affected by the disease, often in association with other diseases such as diabetes mellitus, chronic kidney disease, dyslipidemia/hypercholesterolemia, and obesity. The autonomic nervous system has been implicated in the pathophysiology of hypertension, and treatments targeting the sympathetic nervous system (SNS), a key component of the autonomic nervous system, have been developed; however, current recommendations provide little guidance on their use. This review discusses the etiology of hypertension, and more specifically the role of the SNS in the pathophysiology of hypertension and its associated disorders. In addition, the effects of current antihypertensive management strategies, including pharmacotherapies, on the SNS are examined, with a focus on imidazoline receptor agonists.
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Affiliation(s)
- Paul Valensi
- Unit of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, CINFO, CRNH-IdF, AP-HP, Paris Nord University, Avenue du 14 Juillet, 93140, Bondy, France.
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15
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Bunsawat K, Ratchford SM, Alpenglow JK, Stehlik J, Smith AS, Richardson RS, Wray DW. Sympathoinhibitory effect of sacubitril-valsartan in heart failure with reduced ejection fraction: A pilot study. Auton Neurosci 2021; 235:102834. [PMID: 34186274 DOI: 10.1016/j.autneu.2021.102834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/07/2021] [Accepted: 06/13/2021] [Indexed: 01/08/2023]
Abstract
Chronic sympathetic nervous system (SNS) overactivity, characteristic of heart failure (HF) with reduced ejection fraction (HFrEF), is associated with poor prognosis and contributes to increased mortality risk. Sacubitril-valsartan is a recently approved, first-in-class, angiotensin receptor neprilysin inhibitor (ARNI) drug that markedly reduces the risks of death from cardiovascular causes and hospitalization for HF in patients with HFrEF, but the physiological mechanisms underlying these benefits are not fully understood. This single-arm, open-label, prospective study sought to test the hypothesis that short-term treatment with sacubitril-valsartan reduces SNS activity, measured directly via muscle sympathetic nerve activity (MSNA), in patients with HFrEF. MSNA, heart rate (HR), and arterial blood pressure (BP) were assessed in stable Class II and III patients with HFrEF (n = 9, 69 ± 8 yrs.; 28.6 ± 3.6 kg/m2) on contemporary, guideline-directed medical treatment who were subsequently started on sacubitril-valsartan. These measurements were repeated after two months of treatment with sacubitril-valsartan. Sacubitril-valsartan reduced MSNA burst frequency (baseline: 43 ± 10 bursts/min; 2-month: 36 ± 10 bursts/min, p = 0.05) and burst incidence (baseline: 68 ± 16 bursts/100 heartbeats; 2-month: 55 ± 16 bursts/100 heartbeats, p = 0.02), while HR and BP were unchanged following of treatment (p > 0.05). These preliminary findings provide new evidence regarding the ability of sacubitril-valsartan to rapidly reduce SNS activity in patients with HFrEF, suggesting the presence of a novel sympathoinhibitory effect of this new drug class.
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Affiliation(s)
- Kanokwan Bunsawat
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, United States of America.
| | - Stephen M Ratchford
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, United States of America; Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America; Department of Health and Exercise Science, Appalachian State University, Boone, NC, United States of America
| | - Jeremy K Alpenglow
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States of America
| | - Josef Stehlik
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Adam S Smith
- Department of Pharmacy Services, University of Utah, Salt Lake City, UT, United States of America
| | - Russell S Richardson
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, United States of America; Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America; Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States of America
| | - D Walter Wray
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, United States of America; Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America; Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States of America
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16
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Sorimachi H, Burkhoff D, Verbrugge FH, Omote K, Obokata M, Reddy YNV, Takahashi N, Sunagawa K, Borlaug BA. Obesity, venous capacitance, and venous compliance in heart failure with preserved ejection fraction. Eur J Heart Fail 2021; 23:1648-1658. [PMID: 34053158 DOI: 10.1002/ejhf.2254] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/22/2021] [Accepted: 05/26/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS Circulating blood volume is functionally divided between the unstressed volume, which fills the vascular space, and stressed blood volume (SBV), which generates vascular wall tension and intravascular pressure. With decreases in venous capacitance, blood functionally shifts to the SBV, increasing central venous pressure and pulmonary venous pressures. Obesity is associated with both elevated venous pressure and heart failure with preserved ejection fraction (HFpEF). To explore the mechanisms underlying this association, we evaluated relationships between blood volume distribution, venous compliance, and body mass in patients with and without HFpEF. METHODS AND RESULTS Subjects with HFpEF (n = 62) and non-cardiac dyspnoea (NCD) (n = 79) underwent invasive haemodynamic exercise testing with echocardiography. SBV was estimated (eSBV) from measured haemodynamic variables fit to a comprehensive cardiovascular model. Compared to NCD, patients with HFpEF displayed a leftward-shifted central venous pressure-dimension relationship, indicating reduced venous compliance. eSBV was 81% higher at rest and 69% higher during exercise in HFpEF than NCD (both P < 0.0001), indicating reduced venous capacitance. Despite greater augmented eSBV with exercise, the increase in cardiac output was reduced in HFpEF, suggesting operation on the plateau of the Starling curve. Exercise eSBV was directly correlated with higher body mass index (r = 0.77, P < 0.0001) and inversely correlated with right ventricular-pulmonary arterial coupling (r = -0.57, all P < 0.0001). CONCLUSIONS Patients with HFpEF display reductions in systemic venous compliance and increased eSBV related to reduced venous capacitance, abnormalities in right ventricular-pulmonary artery interaction, and increased body fat. These data provide new evidence supporting an important role of venous dysfunction in obesity-related HFpEF and suggest that therapies that improve venous function may hold promise to improve clinical status in this cohort.
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Affiliation(s)
- Hidemi Sorimachi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York Biomedical Research Institute, New York, NY, USA
| | - Frederik H Verbrugge
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Kenji Sunagawa
- Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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17
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Association of Urine Metanephrine Levels with CardiometaBolic Risk: An Observational Retrospective Study. J Clin Med 2021; 10:jcm10091967. [PMID: 34064307 PMCID: PMC8125207 DOI: 10.3390/jcm10091967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 01/20/2023] Open
Abstract
No research has explored the role of catecholamine metabolites in the stratification of cardiovascular risk. We aimed to evaluate the relationship between urine metanephrines and cardiometabolic risk/complications. In this retrospective cross-sectional study, we collected the data of 1374 patients submitted to the evaluation of urine metanephrines at the City of Health and Science University Hospital of Turin between 2007 and 2015, mainly for investigating the suspicion of secondary hypertension or the secretion of an adrenal lesion. The univariate analysis showed associations between metanephrines and cardiometabolic variables/parameters, particularly considering noradrenaline metabolite. At univariate regression, normetanephrine was associated with hypertensive cardiomyopathy (OR = 1.18, 95% CI 1.11–1.25; p < 0.001) and metabolic syndrome (OR = 1.11, 95% CI 1.03–1.20; p = 0.004), while metanephrine was associated with hypertensive cardiomyopathy (OR = 1.23, 95% CI 1.06–1.43; p = 0.006) and microalbuminuria (OR = 1.30, 95% CI 1.03–1.60; p = 0.018). At multivariate regression, considering all major cardiovascular risk factors as possible confounders, normetanephrine retained a significant association with hypertensive cardiomyopathy (OR = 1.14, 95% CI 1.07–1.22; p < 0.001) and metabolic syndrome (OR = 1.10, 95% CI 1.02–1.19; p = 0.017). Moreover, metanephrine retained a significant association with the presence of hypertensive cardiomyopathy (OR = 1.18, 95% CI 1.01–1.41; p = 0.049) and microalbuminuria (OR = 1.34, 95% CI 1.03–1.69; p = 0.019). The study showed a strong relationship between metanephrines and cardiovascular complications/metabolic alterations. Individuals with high levels of these indirect markers of sympathetic activity should be carefully monitored, and they may benefit from an aggressive treatment to reduce the cardiometabolic risk.
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18
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Abstract
OBJECTIVE The microneurographic technique has shown that sympathetic overactivity may characterize patients with the metabolic syndrome. However, technical and methodological limitations of the studies prevented to draw definite conclusions. The present meta-analysis evaluated 16 microneurographic studies including 650 individuals, 444 metabolic syndrome patients and 206 healthy controls, respectively. The analysis was primarily based on muscle sympathetic nerve traffic (MSNA) quantified by microneurography in metabolic syndrome. METHODS Assessment was extended to the relationships of MSNA with an indirect neuroadrenergic marker, such as heart rate (HR), anthropometric variables, as BMI, waist-hip ratio and metabolic profile. RESULTS Metabolic syndrome individuals displayed MSNA values (means ± SEM) significantly greater than controls (58.6 ± 4.8 versus 41.6 ± 4.1 bursts/100 heart beats, P < 0.01). This result was independent on the concomitant presence of sleep apnea and drug treatment. MSNA was directly and significantly related to clinic SBP (r = 0.91, P < 0.01) but not to BMI (r = 0.17, P = NS), whereas no significant relationship was found between MSNA and metabolic variables included in the definition of metabolic syndrome. No significant correlation was found between MSNA and HR. CONCLUSION These data provide evidence that metabolic syndrome is characterized by a marked increase (about 30%) in MSNA. They also show that among the variables included in metabolic syndrome definition and related to the sympathetic overdrive blood pressure appears to be the most important one, at variance from what described in obesity in which metabolic and anthropometric factors play a major role. Finally in metabolic syndrome HR does not appear to represent a faithful mirror of the occurring sympathetic activation.
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19
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Comparison of effect of aquatic interventions on cardiac modulation of obese young males in motion. A crossover trial. BIOMEDICAL HUMAN KINETICS 2021. [DOI: 10.2478/bhk-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Study aim: The study aimed to compare the effects of passive Watsu therapy and immersion on cardiac locomotor synchronization of obese young males.
Material and methods: Twenty-six volunteer obese males participated in this study (age 18.3 ± 0.32, BMI 36.9 ± 6.52). Heart rate variability parameters were recorded in different positions by the Polar H7 heart rate sensor and HRV+ software. Participants were assigned to two groups, randomly, in a single-blinded crossover design. Kubios HRV 2.2 and MATLAB were used to analyze the bio-signals. Statistical analysis was performed via t-test and ANOVA (analysis of variance) using SPSS. For the significance in results and group comparison, the paired t-test and the independent t-test were used respectively.
Results: Combined results indicated that Watsu therapy increased 3 HRV vertical position parameters and immersion increased 3 HRV non-locomotor parameters, significantly (p < 0.05).
Conclusion: The findings show that Watsu and immersion improved the specific autonomic cardiac modulation. However, non-contact immersion seemed to provide better synchronization of cardiac control and locomotion. The close contact Watsu approach provided improvements in autonomic cardiac regulation. Collectively, these improvements suggest the combination of both therapies in maximizing the cardiac benefits sought by aquatic therapy programs.
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20
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Zwack CC, McDonald R, Tursunalieva A, Cooray A, Lambert GW, Lambert EA. Does autonomic nervous system dysfunction influence cardiovascular disease risk in young adults with intellectual disability? Am J Physiol Heart Circ Physiol 2020; 320:H891-H900. [PMID: 33566748 DOI: 10.1152/ajpheart.00807.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
People with intellectual disability (ID) experience cardiometabolic-related morbidity and mortality. However, it has been suggested that this population presents and lives with underestimated cardiovascular risk factors at a younger age, hence affecting their overall health and quality of life and contributing to early mortality. We assessed autonomic nervous system function in subjects with ID (n = 39), aged 18-45 yr, through measures of sudomotor function, heart rate and systolic blood pressure variability, and cardiac baroreflex function. Traditional clinical cardiovascular measurements and a biochemical analysis were also undertaken. We found that young adults with ID presented with sudomotor dysfunction, impaired cardiac baroreflex sensitivity, and systolic blood pressure variability, when compared with age-matched control subjects (n = 38). Reduced hand and feet electrochemical skin conductance and asymmetry were significantly associated with having a moderate-profound ID. Autonomic dysfunction in individuals with ID persisted after controlling for age, sex, and other metabolic parameters. Subjects in the ID group also showed significantly increased blood pressure, body mass index, and waist/hip circumference ratio, as well as increased plasma hemoglobin A1c and high-sensitivity C-reactive protein levels. We conclude that autonomic dysfunction is present in young adults with ID and is more marked in those with more severe disability. These finding have important implications in developing preventative strategies to reduce the risk of cardiovascular disease in people with ID.NEW & NOTEWORTHY Adults with intellectual disability experience higher risk of premature death than the general population. Our investigation highlights increased cardiovascular risk markers and autonomic dysfunction in young adults with intellectual disability compared with control adults. Autonomic dysfunction was more marked in those with a more severe disability but independent of cardiovascular parameters. Assessment of autonomic nervous system (ANS) function may provide insight into the mechanisms of cardiometabolic disease development and progression in young adults with intellectual disability.
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Affiliation(s)
- Clara C Zwack
- Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Rachael McDonald
- Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Ainura Tursunalieva
- Department of Econometrics and Business Statistics, Monash University, Clayton, Victoria, Australia
| | - Amali Cooray
- Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Elisabeth A Lambert
- Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
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21
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Valenzuela PL, Carrera-Bastos P, Gálvez BG, Ruiz-Hurtado G, Ordovas JM, Ruilope LM, Lucia A. Lifestyle interventions for the prevention and treatment of hypertension. Nat Rev Cardiol 2020; 18:251-275. [PMID: 33037326 DOI: 10.1038/s41569-020-00437-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
Hypertension affects approximately one third of the world's adult population and is a major cause of premature death despite considerable advances in pharmacological treatments. Growing evidence supports the use of lifestyle interventions for the prevention and adjuvant treatment of hypertension. In this Review, we provide a summary of the epidemiological research supporting the preventive and antihypertensive effects of major lifestyle interventions (regular physical exercise, body weight management and healthy dietary patterns), as well as other less traditional recommendations such as stress management and the promotion of adequate sleep patterns coupled with circadian entrainment. We also discuss the physiological mechanisms underlying the beneficial effects of these lifestyle interventions on hypertension, which include not only the prevention of traditional risk factors (such as obesity and insulin resistance) and improvements in vascular health through an improved redox and inflammatory status, but also reduced sympathetic overactivation and non-traditional mechanisms such as increased secretion of myokines.
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Affiliation(s)
| | - Pedro Carrera-Bastos
- Centre for Primary Health Care Research, Lund University/Region Skane, Skane University Hospital, Malmö, Sweden
| | - Beatriz G Gálvez
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Research Institute of the Hospital Universitario 12 de Octubre (imas12), Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José M Ordovas
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.,IMDEA Alimentacion, Madrid, Spain
| | - Luis M Ruilope
- Research Institute of the Hospital Universitario 12 de Octubre (imas12), Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain. .,Research Institute of the Hospital Universitario 12 de Octubre (imas12), Madrid, Spain.
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22
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Malik V, Mishima R, D Elliott A, H Lau D, Sanders P. The "Road" to Atrial Fibrillation: The Role of the Cardiac Autonomic Nervous System. J Atr Fibrillation 2020; 13:2400. [PMID: 33024501 DOI: 10.4022/jafib.2400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/16/2020] [Accepted: 03/18/2020] [Indexed: 01/04/2023]
Abstract
At the population level, there is a parallel escalation in the healthcare burden of both, atrial fibrillation (AF) as well its risk factors. Compounding this relationship, AF is associated with escalating burden at an individual level, due its self-perpetuating and progressive nature. The mechanisms by which these risk factors interact to produce atrial remodelling and subsequent AF are unclear. This intersection is critical to the development of strategies to combat this disease at both the individual and population-level. It is well known that AF can manifest from disturbances in autonomic activity. At the population level, there is growing data to suggest a role of the autonomic nervous system in the future incidence of AF. Here, we provide an overview of the association of cardiac autonomic dysfunction with the incidence of AF, review the role of the autonomic nervous system (ANS) as an intermediary between risk factors and the development of AF and finally, we discuss the bidirectional relationship between AF and cardiac autonomic nervous system dysfunction; to determine whether this is implicated in the progression of AF.
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Affiliation(s)
- Varun Malik
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ricardo Mishima
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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23
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Jennings JR, Muldoon MF, Allen B, Ginty AT, Gianaros PJ. Cerebrovascular function in hypertension: Does high blood pressure make you old? Psychophysiology 2020; 58:e13654. [PMID: 32830869 DOI: 10.1111/psyp.13654] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/22/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022]
Abstract
The majority of individuals over an age of 60 have hypertension. Elevated blood pressure and older age are associated with very similar changes in brain structure and function. We review the parallel brain changes associated with increasing age and blood pressure. This review focuses on joint associations of aging and elevated blood pressure with neuropsychological function, regional cerebral blood flow responses to cognitive and metabolic challenges, white matter disruptions, grey matter volume, cortical thinning, and neurovascular coupling. Treatment of hypertension ameliorates many of these changes but fails to reverse them. Treatment of hypertension itself appears more successful with better initial brain function. We show evidence that sympathetic and renal influences known to increase blood pressure also impact brain integrity. Possible central mechanisms contributing to the course of hypertension and aging are then suggested. An emphasis is placed on psychologically relevant factors: stress, cardiovascular reactions to stress, and diet/obesity. The contribution of some of these factors to biological aging remains unclear and may provide a starting point for defining the independent and interacting effects of aging and increasing blood pressure on the brain.
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Affiliation(s)
- J Richard Jennings
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew F Muldoon
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ben Allen
- Department of Psychology, University of Tennessee, Knoxville, TN, USA
| | - Annie T Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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Shariq OA, McKenzie TJ. Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery. Gland Surg 2020; 9:80-93. [PMID: 32206601 DOI: 10.21037/gs.2019.12.03] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Obesity is a significant public health challenge worldwide and is inextricably linked to adverse cardiovascular outcomes. The relationship between excess adiposity and increased blood pressure is well established, and it is estimated that obesity accounts for 65-78% of cases of primary hypertension. The mechanisms through which obesity causes hypertension are complex and include sympathetic nervous system overactivation, stimulation of the renin-angiotensin-aldosterone system, alterations in adipose-derived cytokines, insulin resistance, and structural and functional renal changes. Weight loss is the primary goal of treatment for obesity-related hypertension, although few individuals achieve success with nonpharmacological management alone. Specific considerations apply when selecting the most appropriate pharmacological therapy for obese hypertensive patients. Metabolic surgery has proved to be the most effective means of ensuring substantial and sustained weight loss and has also been shown to confer beneficial effects in type 2 diabetes mellitus. Increasing evidence suggests that metabolic surgery may also be an effective treatment for obesity-related hypertension, although prospective data on long-term blood pressure outcomes are awaited. This review will discuss the pathophysiological mechanisms that link obesity with hypertension and will provide an overview of treatment strategies, with a focus on metabolic surgery.
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Zupo R, Castellana F, Boninfante B, Lampignano L, Lattanzio A, Sardone R, Giannelli G, De Pergola G. Uric Acid and Potassium Serum Levels Are Independent Predictors of Blood Pressure Non-Dipping in Overweight or Obese Subjects. Nutrients 2019; 11:nu11122970. [PMID: 31817392 PMCID: PMC6950029 DOI: 10.3390/nu11122970] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Obesity and sleeping blood pressure (BP) abnormalities are well recognized as some of the main risk factors for hypertension and cardiovascular diseases (CVDs). The primary objective of this study was to evaluate the prevalence of hypertension and non-dipping profile in overweight/obese subjects. Methods: A sample of 100 consecutive healthy overweight/obese subjects, aged 20–69 years and never treated with antihypertensive drugs was examined. Ambulatory 24 h BP monitoring was performed to diagnose hypertension and a non-dipping profile. Anthropometric, metabolic and routine hematochemical parameters were assessed. All subjects underwent ultrasound measurement of common carotid intima–media thickness. Results: Hypertension was demonstrated in 69% (n = 69) and 27% of the sample (n = 27) had a non-dipping profile. Among the hematochemical variables, estimated glomerular filtration rate (eGFR) (p = 0.02) and FT4 (p = 0.01) serum levels were higher in the hypertensive group than in the normotensive group. Lower potassium and uric acid serum levels (p = 0.05) were independent predictive factors of a non-dipping BP profile. Conclusions: This study shows, for the first time, that 1) an unexpectedly high percentage (69%) of overweight/obese subjects is affected by hypertension; 2) early hypertensive subjects have an increased eGFR and higher FT4 serum levels; 3) lower potassium and uric acid levels are independent predictors of pathological nocturnal non-dipping.
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Affiliation(s)
- Roberta Zupo
- Research Unit on Frailty Phenotypes, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.Z.); (F.C.); (L.L.); (R.S.)
| | - Fabio Castellana
- Research Unit on Frailty Phenotypes, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.Z.); (F.C.); (L.L.); (R.S.)
| | | | - Luisa Lampignano
- Research Unit on Frailty Phenotypes, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.Z.); (F.C.); (L.L.); (R.S.)
| | - Antonio Lattanzio
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, 70124 Bari, Italy;
| | - Rodolfo Sardone
- Research Unit on Frailty Phenotypes, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.Z.); (F.C.); (L.L.); (R.S.)
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy;
| | - Giovanni De Pergola
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, 70124 Bari, Italy;
- Correspondence: ; Tel.: +39-080-5592909; Fax: +39-080-5478831
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26
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Kang Y, Ding L, Dai H, Wang F, Zhou H, Gao Q, Xiong X, Zhang F, Song T, Yuan Y, Zhu G, Zhou Y. Intermedin in Paraventricular Nucleus Attenuates Ang II-Induced Sympathoexcitation through the Inhibition of NADPH Oxidase-Dependent ROS Generation in Obese Rats with Hypertension. Int J Mol Sci 2019; 20:ijms20174217. [PMID: 31466304 PMCID: PMC6747263 DOI: 10.3390/ijms20174217] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 12/19/2022] Open
Abstract
Increased reactive oxygen species (ROS) induced by angiotensin II (Ang II) in the paraventricular nucleus (PVN) play a critical role in sympathetic overdrive in hypertension (OH). Intermedin (IMD), a bioactive peptide, has extensive clinically prospects in preventing and treating cardiovascular diseases. The study was designed to test the hypothesis that IMD in the PVN can inhibit the generation of ROS caused by Ang II for attenuating sympathetic nerve activity (SNA) and blood pressure (BP) in rats with obesity-related hypertension (OH). Male Sprague-Dawley rats (160-180 g) were used to induce OH by feeding of a high-fat diet (42% kcal as fat) for 12 weeks. The dynamic changes of sympathetic outflow were evaluated as the alterations of renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) responses to certain chemicals. The results showed that the protein expressions of Ang II type 1 receptor (AT1R), calcitonin receptor-like receptor (CRLR) and receptor activity-modifying protein 2 (RAMP2) and RAMP3 were markedly increased, but IMD was much lower in OH rats when compared to control rats. IMD itself microinjection into PVN not only lowered SNA, NADPH oxidase activity and ROS level, but also decreased Ang II-caused sympathetic overdrive, and increased NADPH oxidase activity, ROS levels and mitogen-activated protein kinase/extracellular signal regulated kinase (MAPK/ERK) activation in OH rats. However, those effects were mostly blocked by the adrenomedullin (AM) receptor antagonist AM22-52 pretreatment. The enhancement of SNA caused by Ang II can be significantly attenuated by the pretreatment of AT1R antagonist lorsatan, superoxide scavenger Tempol and NADPH oxidase inhibitor apocynin (Apo) in OH rats. ERK activation inhibitor U0126 in the PVN reversed Ang II-induced enhancement of SNA, and Apo and IMD pretreatment in the PVN decreased Ang II-induced ERK activation. Chronic IMD administration in the PVN resulted in significant reductions in basal SNA and BP in OH rats. Moreover, IMD lowered NADPH oxidase activity and ROS level in the PVN; reduced the protein expressions of AT1R and NADPH oxidase subunits NOX2 and NOX4, and ERK activation in the PVN; and decreased Ang II levels-inducing sympathetic overactivation. These results indicated that IMD via AM receptors in the PVN attenuates SNA and hypertension, and decreases Ang II-induced enhancement of SNA through the inhibition of NADPH oxidase activity and ERK activation.
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Affiliation(s)
- Ying Kang
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Lei Ding
- Department of Pathophysiology, Xuzhou Medical University, Xuzhou 221004, China
| | - Hangbing Dai
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Fangzheng Wang
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Hong Zhou
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Qing Gao
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Xiaoqing Xiong
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Feng Zhang
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Tianrun Song
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Yan Yuan
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Guoqing Zhu
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Yebo Zhou
- Department of Physiology, Nanjing Medical University, Nanjing 211166, China.
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