The paradigm change from reactive medical services to 3PM in ischemic stroke: a holistic approach utilising tear fluid multi-omics, mitochondria as a vital biosensor and AI-based multi-professional data interpretation

Worldwide stroke is the second leading cause of death and the third leading cause of death and disability combined. The estimated global economic burden by stroke is over US$891 billion per year. Within three decades (1990-2019), the incidence increased by 70%, deaths by 43%, prevalence by 102%, and DALYs by 143%. Of over 100 million people affected by stroke, about 76% are ischemic stroke (IS) patients recorded worldwide. Contextually, ischemic stroke moves into particular focus of multi-professional groups including researchers, healthcare industry, economists, and policy-makers. Risk factors of ischemic stroke demonstrate sufficient space for cost-effective prevention interventions in primary (suboptimal health) and secondary (clinically manifested collateral disorders contributing to stroke risks) care. These risks are interrelated. For example, sedentary lifestyle and toxic environment both cause mitochondrial stress, systemic low-grade inflammation and accelerated ageing; inflammageing is a low-grade inflammation associated with accelerated ageing and poor stroke outcomes. Stress overload, decreased mitochondrial bioenergetics and hypomagnesaemia are associated with systemic vasospasm and ischemic lesions in heart and brain of all age groups including teenagers. Imbalanced dietary patterns poor in folate but rich in red and processed meat, refined grains, and sugary beverages are associated with hyperhomocysteinaemia, systemic inflammation, small vessel disease, and increased IS risks. Ongoing 3PM research towards vulnerable groups in the population promoted by the European Association for Predictive, Preventive and Personalised Medicine (EPMA) demonstrates promising results for the holistic patient-friendly non-invasive approach utilising tear fluid-based health risk assessment, mitochondria as a vital biosensor and AI-based multi-professional data interpretation as reported here by the EPMA expert group. Collected data demonstrate that IS-relevant risks and corresponding molecular pathways are interrelated. For examples, there is an evident overlap between molecular patterns involved in IS and diabetic retinopathy as an early indicator of IS risk in diabetic patients. Just to exemplify some of them such as the 5-aminolevulinic acid/pathway, which are also characteristic for an altered mitophagy patterns, insomnia, stress regulation and modulation of microbiota-gut-brain crosstalk. Further, ceramides are considered mediators of oxidative stress and inflammation in cardiometabolic disease, negatively affecting mitochondrial respiratory chain function and fission/fusion activity, altered sleep-wake behaviour, vascular stiffness and remodelling. Xanthine/pathway regulation is involved in mitochondrial homeostasis and stress-driven anxiety-like behaviour as well as molecular mechanisms of arterial stiffness. In order to assess individual health risks, an application of machine learning (AI tool) is essential for an accurate data interpretation performed by the multiparametric analysis. Aspects presented in the paper include the needs of young populations and elderly, personalised risk assessment in primary and secondary care, cost-efficacy, application of innovative technologies and screening programmes, advanced education measures for professionals and general population-all are essential pillars for the paradigm change from reactive medical services to 3PM in the overall IS management promoted by the EPMA.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

A synthesis of pathways linking diet, metabolic risk and cardiovascular disease: a framework to guide further research and approaches to evidence-based practice

Cardiovascular disease (CVD) is the most common non-communicable disease occurring globally. Although previous literature has provided useful insights into the important role that diet plays in CVD prevention and treatment, understanding the causal role of diets is a difficult task considering inherent and introduced weaknesses of observational (e.g. not properly addressing confounders and mediators) and experimental research designs (e.g. not appropriate or well designed). In this narrative review, we organised current evidence linking diet, as well as conventional and emerging physiological risk factors, with CVD risk, incidence and mortality in a series of diagrams. The diagrams presented can aid causal inference studies as they provide a visual representation of the types of studies underlying the associations between potential risk markers/factors for CVD. This may facilitate the selection of variables to be considered and the creation of analytical models. Evidence depicted in the diagrams was systematically collected from studies included in the British Nutrition Task Force report on diet and CVD and database searches, including Medline and Embase. Although several markers and disorders linked to conventional and emerging risk factors for CVD were identified, the causal link between many remains unknown. There is a need to address the multifactorial nature of CVD and the complex interplay between conventional and emerging risk factors with natural and built environments, while bringing the life course into the spotlight.

Association Between Body Weight Changes and Subsequent Development of Out-of-Hospital Cardiac Arrest: A Population-Based Nested Case-Control Study

BACKGROUND

Body weight is a modifiable demographic factor. Although the association of body mass index (BMI) categories with sudden cardiac death was reported, dynamic changes of BMI and the risk of cardiac arrest remain unknown. This study aimed to evaluate the association between the out-of-hospital cardiac arrest (OHCA) occurrence within a year and the percent changes of BMI preceding the OHCA.

METHODS

This population-based nested case-control study used the National Health Insurance Service Data of Korea. In all, 24,465 patients with non-traumatic OHCA between 2010 and 2018, who underwent national health check-up twice (one within a year and the other within 2-4 years before OHCA) and 32,434 controls without OHCA, were matched for age and sex. The association between the risk of OHCA and BMI percent change stratified by sex was investigated.

RESULTS

All the BMI percent changes of ≥ 5% significantly increased the OHCA occurrence with a reverse J-shaped association. Compared to individuals with a stable weight, those with severe (> 15%) BMI decrease had the highest odds ratio (OR) of 4.29 (95% confidence intervals [CIs], 3.72-4.95) for OHCA occurrence followed by those with moderate (10-15%) weight loss (OR, 2.80; 95% CI, 2.55-3.08) and those with severe (> 15%) weigh gain (OR, 2.24; 95% CI, 1.96-2.57), respectively. The impact of weight loss on the cardiac arrest occurrence was more prominent in men, while the impact of weight gain was more prominent in women.

CONCLUSION

Significant weight changes increase the risk of OHCA within a year with a reverse J-shaped association. Significant weight loss might be a warning sign for OHCA especially for men.

Causal influence of sleeping phenotypes on the risk of coronary artery disease and sudden cardiac arrest: A Mendelian randomization analysis

OBJECTIVES

To assess the causal influence of sleep and circadian traits on coronary artery disease and sudden cardiac arrest with adjustment for obesity through a two-sample Mendelian randomization study.

METHODS

We used summary statistics of 5 sleep and circadian traits for genome-wide association studies, including chronotype, sleep duration, long sleep (≥9 h a day), short sleep (<7 h a day), and insomnia (sample size range: 237,622-651,295). Coronary artery disease genome-wide association studies with 60,801 cases and 123,504 controls, sudden cardiac arrest genome-wide association studies with 3939 cases and 25,989 controls, and obesity genome-wide association studies with 806,834 individuals were also used. Multivariable Mendelian randomization was performed to estimate the causality.

RESULTS

After adjusting for obesity, genetically predicted short sleep (odds ratio = 1.87 and p = .02), and genetically predicted insomnia (odds ratio = 1.17 and p = .001) were causally associated with increased odds of coronary artery disease. Genetically predicted long sleep (odds ratio = 0.06 and p = .02) and genetically predicted longer sleep duration (odds ratio = 0.36 for per-hour increase in sleep duration and p = .0006) were causally associated with decreased odds of sudden cardiac arrest.

CONCLUSIONS

The findings of this Mendelian randomization study indicate that insomnia and short sleep contribute to the development of coronary artery disease, whereas a longer sleep duration protects from sudden cardiac arrest, independent of the influence of obesity. The mechanisms underlying these associations warrant further investigation.

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Obesity in young sudden cardiac death: Rates, clinical features, and insights into people with body mass index >50kg/m2

•

55.0% of young sudden cardiac death (SCD) patients in Victoria, Australia are obese.

•

This obesity prevalence exceeds that in the age-matched general Australian population, with all classes of obesity over-represented in our SCD cohort.

•

Patients with BMI>50 kg/m² represented 8.5% of young SCD. Almost two thirds of patients with BMI>50 kg/m² died from left ventricular hypertrophy, with fewer than 10% dying from coronary disease.

Objective

To contextualize obesity rates in young sudden cardiac death (SCD) against the age-matched national population, and identify clinical and pathologic features in WHO class II and III obesity.

Methods

A prospective state-wide out-of-hospital cardiac arrest registry included all SCDs in Victoria, Australia from 2019–2021. Body mass indices (BMIs) of patients 18-50 years were compared to age-referenced general population. Characteristics of SCD patients with WHO Class II obesity (BMI ≥30kg/m²) and non-obesity (BMI<30kg/m²) were compared. Clinical characteristics of people with BMI>50kg/m² were assessed.

Results

504 patients were included. Obesity was strongly over-represented in young SCD compared to the age-matched general population (55.0% vs 28.7%, p<0.0001). Obese SCD patients more frequently had hypertension, diabetes and obstructive sleep apnoea (p<0.0001, p=0.009 and p=0.001 respectively), ventricular fibrillation as their arrest rhythm (p=0.008) and left ventricular hypertrophy (LVH) (p<0.0001). Obese patients were less likely to have toxicology positive for illicit substances (22.0% vs 32.6%, p=0.008) or history of alcohol abuse (18.8% vs 26.9%, p=0.030). Patients with BMI>50 kg/m² represented 8.5% of young SCD. LVH (n=26, 60.5%) was their predominant cause of death and only 10 (9.3%) patients died from coronary disease.

Conclusion

Over half of young Australian SCD patients are obese, with all obesity classes over-represented compared to the general population. Obese patients had more cardiac risk factors. Almost two thirds of patients with BMI>50 kg/m² died from LVH, with fewer than 10% dying from coronary disease.

Risk and Protective Factors for Sudden Cardiac Death: An Umbrella Review of Meta-Analyses

Background

Sudden cardiac death (SCD) is a global public health issue, accounting for 10–20% of deaths in industrialized countries. Identification of modifiable risk factors may reduce SCD incidence.

Methods

This umbrella review systematically evaluates published meta-analyses of observational and randomized controlled trials (RCT) for the association of modifiable risk and protective factors of SCD.

Results

Fifty-five meta-analyses were included in the final analysis, of which 31 analyzed observational studies and 24 analyzed RCTs. Five associations of meta-analyses of observational studies presented convincing evidence, including three risk factors [diabetes mellitus (DM), smoking, and early repolarization pattern (ERP)] and two protective factors [implanted cardiac defibrillator (ICD) and physical activity]. Meta-analyses of RCTs identified five protective factors with a high level of evidence: ICDs, mineralocorticoid receptor antagonist (MRA), beta-blockers, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with HF. On the contrary, other established, significant protective agents [i.e., amiodarone and statins along with angiotensin-converting enzyme (ACE) inhibitors in heart failure (HF)], did not show credibility. Likewise, risk factors as left ventricular ejection fraction in HF, and left ventricular hypertrophy, non-sustain ventricular tachycardia, history of syncope or aborted SCD in pediatric patients with hypertrophic cardiomyopathy, presented weak or no evidence.

Conclusions

Lifestyle risk factors (physical activity, smoking), comorbidities like DM, and electrocardiographic features like ERP constitute modifiable risk factors of SCD. Alternatively, the use of MRA, beta-blockers, SGLT-2 inhibitors, and ICD in patients with HF are credible protective factors. Further investigation targeted in specific populations will be important for reducing the burden of SCD.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020216363, PROSPERO CRD42020216363.

Pharmacological Management of Obesity: A Century of Expert Opinions in Cecil Textbook of Medicine

BACKGROUND

Innovations in drug therapy for obesity have had a limited impact on the body mass index, prevalence of medical complications, quality of life, and work potential of a substantial majority of affected persons.

STUDY QUESTION

What are the milestones of the changes in the expert approach to the pharmacological management of obesity in the past century?

STUDY DESIGN

To determine the changes in the experts' approach to the management of obesity, as presented in a widely used textbook in the United States.

DATA SOURCES

The primary sources were chapters describing the management of obesity in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. Secondary sources were publications retrieved from Medline that clarified technical issues related to the development, regulatory approval, and use of the drugs mentioned in the Cecil Textbook of Medicine.

RESULTS

Pharmacological interventions aimed at increasing caloric expenditures through thermogenesis were recommended from 1927 through 1943. Thyroid extracts were prescribed even in the absence of demonstrated hypothyroidism or decreased basal metabolic rate throughout this period. Dinitrophenol was mentioned in 1937, but was banned soon thereafter. Appetite suppression with amphetamine was considered useful from 1943 through 1988, after which the drug was replaced with other centrally acting molecules, such as fenfluramine in 1988, sibutramine in 2000, and rimonabant in 2008, which were in turn withdrawn because of major adverse effects. In the past decade, obesity has been treated with the appetite suppressants phentermine-topiramate, bupropion-naltrexone, lorcaserin, and liraglutide, and with orlistat, a drug promoting fat malabsorption. The change in weight produced by these drugs is generally modest and transient.

CONCLUSIONS

The pharmacological management of obesity has remained frustratingly inefficient. The reasons for the relative lack of success may reside in the ever-growing access to dense, palatable, and relatively inexpensive food, coupled with the decrease in energy expenditure created by a sedentary lifestyle.

Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Anthropometric indices and the risk of incident sudden cardiac death among adults with and without diabetes: over 15 years of follow-up in The Tehran Lipid and Glucose Study

BACKGROUND

We investigated the association of anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and hip circumference (HC) with the risk of incident sudden cardiac death (SCD) among Iranian population with and without type 2 diabetes mellitus (T2DM).

METHODS

The study population included 9,089 subjects without and 1,185 subjects with T2DM, aged ≥ 20 years. Participants were recruited in 1999-2001 or 2001-2005, and followed for incident SCD annually, up to 20 March 2018. Multivariate Cox proportional hazard models, adjusted for traditional risk factors of cardiovascular disease, were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of anthropometric indices (as continuous and categorical variables).

RESULTS

During a follow-up of over 15 years, 144 (1.58%) and 86 (7.26%) incident SCD occurred in non-T2DM and T2DM groups, respectively. Among non-T2DM group, a 1 standard deviation (SD) increase in WHtR was associated with higher risk of incident SCD by a HR of 1.23 (95% CI: 1.00-1.50) in the multivariable model. From the first quartile to the fourth quartile of WHtR, the trend of SCD risk was significant in age- and sex-adjusted analysis (P-value for trend: 0.041). Other indices did not show significant associations with SCD. Among T2DM group, a 1 SD increase in WHR had a HR of 1.36 (1.05-1.76) in the multivariable model. Considering WHR as categorical variables, the trend of SCD risk across quartiles of WHR was significant. Furthermore, a 1 SD increase in HC led to reduced risk of incident SCD with a HR of 0.75 (0.58-0.97) in multivariable analysis; this lower risk remained significant even after adjustment for WC. Compared to the first quartile, the fourth quartile of HC also showed a HR of 0.50 (0.25-0.99) (P-value for trend = 0.018). BMI, WC, and WHtR did not have significant associations with incident SCD.

CONCLUSION

In our long-term population-based study, we demonstrated central but not general obesity (as assessed by WHR in participants with T2DM, and WHtR in participants without T2DM) as a herald of incident SCD. Moreover, HC can have an inverse association with SCD among participants with T2DM.

Assessment of electrocardiogram abnormality and associated factors among apparently healthy adult type 2 diabetic patients on follow-up at Jimma Medical Center, Southwest Ethiopia: Cross-sectional study

Background

Diabetes mellitus is a group of metabolic disorders causing long-term damage to the cardiovascular system which remains asymptomatic among diabetic patients. An electrocardiograph is a simple and first-line tool in the screening of cardiovascular diseases.

Objective

To assess electrocardiogram abnormality and associated factors among apparently healthy adult type 2 diabetes patients on follow-up at Jimma Medical Center, 2019.

Materials and methods

Institutional based cross-sectional study was conducted from April 1 to May 30, 2019, at Jimma Medical Center among selected type 2 diabetes patients. Systematic random sampling was employed to select the study participants. The World Health Organization stepwise approach and interviewer-administered semi-structured questionnaires were employed to collect basic data. Resting Electrocardiography was done using a standard 12-lead electrocardiograph machine. The collected data were checked for completeness, coded, entered into the Epi-data Version 4.0.2. and exported to SPSS Version 21. Descriptive statistics like frequencies, percentages, mean and standard deviations were carried out. Binary and multiple logistic regression was done and a p value of less than 0.05 was used as a level of significance.

Results

A total of 344 type 2 diabetes patients were interviewed and underwent electrocardiography making a 100% response rate. Electrocardiographic abnormality was identified among 209 (61%) of the respondents. Not attending formal education [AOR = 3.07, 95%, CI = 1.37–6.87], solid oil use, [AOR = 1.79, 95%, CI = 1.07–2.98], body mass index ≥ 25 kg/m² [AOR = 2.74, 95%, CI = 1.67–4.50] and long duration of diabetes ≥ 10 years [AOR = 3.36, 95%, CI = 1.46–7.71] were associated with electrocardiogram abnormality.

Conclusions

and recommendation

In this study, the majority (3/5th) of the participant had electrocardiogram abnormality. Not attending formal education, longer duration of diabetes ≥ 10 years, solid oil use, and increased body mass index ≥ 25 kg/m² were independent predictors of electrocardiographic abnormality. Integrating electrocardiogram screening in routine diabetic management can pick cardiac complications of diabetes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02110-6.

Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease.

RESULTS

Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Cutoff value for hypertrophic heart weight in the Japanese population

BACKGROUND

Cardiac hypertrophy is a clinical risk factor for cardiovascular death (CVD) frequently recorded in autopsy reports, but the diagnostic criteria for the condition have not been clearly-established for autopsy. This study aimed to estimate the cutoff value for hypertrophic heart weight that can efficiently assist the postmortem diagnosis of CVD.

METHODS

We analyzed accumulated autopsy data from 3534 individuals aged 0-101 years.

RESULTS

We found that heart weight increased linearly with a person's age until 20 years, after which it remained stable. The mean heart weight in CVD cases was 473 g in men and 379 g in women. The mean heart weight in non-CVD cases was 385 g in men and 320 g in women. Receiver operating characteristic curve analysis for CVD assessment revealed that the cutoff value of heart weight was 407 g (odds ratio of 4.2) in men and 327 g (2.6) in women, and that of heart weight/body height was 2.38 g/cm (4.0) in men and 2.15 g/cm (2.6) in women, respectively. Overall, heart weight was a more useful predictor of CVD in men than in women. In logistic regression analysis, the predictive power of heart weight for CVD was higher than that of body mass index in both sexes.

CONCLUSION

Thus, the criteria for hypertrophic heart weight are practical and useful for autopsy recordings, and it can be helpful for postmortem diagnosis of CVD. Our report is the first to reveal the cutoff value for hypertrophic heart weight in the Japanese population.

Obesity Paradox: Laboratory Findings in Uncomplicated Obesity. Is Bias a Plausible Explanation?

OBJECTIVES

Obesity predisposes to multiple diseases, such as heart disease, diabetes, stroke, arthritis, and malignancy. However, obese patients have better outcomes than normal-weight patients with some of these disorders, including those admitted to critical care units. We compared the results for common laboratory tests in patients with uncomplicated obesity against the findings in normal-weight patients.

METHODS

Patients who had a comprehensive metabolic profile test were identified. Patients with acute and/or chronic debilitating disorders were excluded, and the laboratory parameters were compared among 4 groups based on body mass index.

RESULTS

With the exception of elevated triglycerides and lower high-density lipoprotein in obese and morbidly obese patients, laboratory findings were not meaningfully different from those in normal-weight patients.

CONCLUSIONS

The obesity paradox of better outcomes in obese patients admitted to critical care units could not be explained on the basis of lower additional disease burden necessitating critical care admission due to abnormal laboratory values at the baseline. It is conceivable that unconscious bias against obese patients, with lower disease burden than normal-weight patients, triggers their admission to critical care, thus creating the appearance of better outcomes.

Underweight Predicts Greater Risk of Cardiac Mortality Post Acute Myocardial Infarction

Increased body mass index (BMI) is a well-established risk factor for cardiovascular disease; however, patients with elevated BMI, in comparison to those with low BMI, seem to have better survival, a phenomenon reported as "obesity paradox," which remains controversial. We investigated the effect of BMI on cardiac mortality post acute myocardial infarction (AMI).In this analysis, 3562 AMI patients were included and classified into four groups based on BMI values. The primary endpoint was cardiac death. Compared to normoweight group, overweight and obese group subjects were younger, mostly men, and more likely to receive percutaneous coronary intervention (PCI) and had higher levels of glucose and lipids, but lower level of NTproBNP. Subjects in the underweight group were older, were mostly women, had lower Barthel index (BI), were less likely to receive PCI, and had lower levels of glucose and lipids, but higher level of N-terminal pro-brain natriuretic peptide (NTproBNP) and higher rates of left ventricular ejection fraction (LVEF) < 50%. During a median follow-up period of 1.9 years, cardiac death occurred significantly more in the underweight group (30.0%, 10.6%, 7.0%, and 5.0% among the four groups from underweight to obese; P < 0.001 for trend). The Cox analysis revealed that underweight was an independent predictor of subsequent cardiac death (odds ratio (OR), 1.86; 95% confidence interval (CI), 1.07-3.25) and identified that older age, BI < 60, higher levels of cardiac troponin I (cTnI), LVEF < 50%, and not receiving PCI were independently associated with increased risk of cardiac death.Patients who were underweight were at greater risk of cardiac death post AMI. In addition, older age, frail, higher levels of cTnI, LVEF < 50%, and not receiving PCI also independently predicted cardiac mortality post AMI.

Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta-analysis

Body roundness index (BRI) is a new anthropometric index developed to predict both body fat and the percentage of visceral adipose tissue. Our aim was to investigate whether BRI is superior to traditional anthropometric indices in predicting metabolic syndrome (MetS). This systematic review and meta-analysis was conducted using Pubmed, Scopus and Web of Sciences databases. The estimated pooled areas under curve (AUCs) for BRI predicting MetS was higher than body mass index (BMI), waist-to-hip ratio (WHR), body shape index (ABSI) and body adiposity index (BAI), similar to waist circumference (WC) and lower than waist-to-height ratio (WHtR). However, the difference between BRI and BMI, WC and WHtR predicting MetS was statistically non-significant. Similar results were found with the summary receiver operating characteristic curve (AUC-SROC). In addition, the non-Chinese population had pooled AUCs greater than the Chinese population for all indices. Pooled ORs showed that BRI is associated with an increased MetS risk. In conclusion, BRI had good discriminatory power for MetS in adults of both sexes from diverse populations (AUC > 0.7; AUC-SROC>0.7). However, WC and WHtR offer the best performance when screening for MetS, and non-significant differences were found with BRI. In contrast, BRI was superior to BMI, WHR, ABSI and BAI in predicting MetS.