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Cioffi G, Viapiana O, Tarantini L, Orsolini G, Idolazzi L, Sonographer FO, Dalbeni A, Gatti D, Fassio A, Rossini M, Giollo A. Clinical profile and outcome of patients with chronic inflammatory arthritis and metabolic syndrome. Intern Emerg Med 2021; 16:863-874. [PMID: 33083946 PMCID: PMC8195765 DOI: 10.1007/s11739-020-02520-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/25/2020] [Indexed: 01/28/2023]
Abstract
Systemic chronic inflammation may favor the onset of metabolic syndrome (MetS) which represents a risk factor for CV events. Rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are disorders with high prevalence of MetS. We assessed the factors associated with MetS and its prognostic role in non-selected RA/AS/PsA patients. Between March 2014 and April 2016, 458 patients (228 RA, 134 PsA, 96 AS) selected for a primary prevention program for cardiovascular diseases were analyzed. Primary and co-primary end points were a composite of all-cause death/all-cause hospitalization and CV death/CV hospitalization, respectively. MetS was diagnosed according to the IDF Task Force on Epidemiology and Prevention. Patients were divided into MetS + (73 = 16%) and MetS - (385 = 84%). At multivariate logistic analysis, cancer, moderate/high disease activity, higher LV mass (LVM) and degree of LV diastolic dysfunction were independently associated with MetS. At 36-month follow-up, the event rate for primary/co-primary end point was 52/15% in MetS + vs 23/7% in MetS - (both p < 0.001). At multivariate Cox regression analysis, MetS was related to primary end point (HR 1.52 [CI 1.01-2.47], p = 0.04) together with higher LVM, disease duration and higher prevalence of biologic DMARDs refractoriness, and to co-primary end point (HR 2.05 [CI 1.16-3.60], p = 0.01) together with older age and higher LVM. The RA/AS/PsA phenotype MetS + is a subject with moderate/high disease activity, LV structural and functional abnormalities at increased risk for cancer. MetS + identifies RA/AS/PsA patients at higher risk for CV and non-CV events, independently of traditional CV risk factors analyzed individually and traditional indexes of inflammation.
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Affiliation(s)
- Giovanni Cioffi
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy.
| | - Ombretta Viapiana
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Luigi Tarantini
- Department of Cardiology, Ospedale Civile S. Martino, Belluno, Italy
| | - Giovanni Orsolini
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Idolazzi
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | | | - Andrea Dalbeni
- Department of Medicine, General Medicine and Hypertension Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Davide Gatti
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Angelo Fassio
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
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Left and right ventricular function by echocardiography, tissue Doppler imaging, carotid intima-media thickness, and asymmetric dimethyl arginine levels in obese adolescents with metabolic syndrome. Cardiol Young 2019; 29:310-318. [PMID: 30688191 DOI: 10.1017/s1047951118002329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
UNLABELLED PurposeThe aim of our study was to assess left ventricle and right ventricle systolic and diastolic functions in obese adolescents with metabolic syndrome using conventional echocardiography and pulsed-wave tissue Doppler imaging and to investigate carotis intima-media thickness, and asymmetric dimethyl arginine levels. METHODS A total of 198 obese adolescents were enrolled in the study. The obese patients were divided into metabolic syndrome group and non-metabolic syndrome group. All subjects underwent laboratory blood tests, including asymmetric dimethyl arginine, complete two-dimensional, pulsed, and tissue Doppler echocardiography, and measurement of the carotid intima-media thickness. RESULTS Obese adolescents were characterised by enlarged left end-diastolic, end-systolic and left atrial diameters, thicker left and right ventricular walls compared with non-obese adolescents. The metabolic syndrome group had normal left ventricle systolic function, impaired diastolic function, and altered global systolic and diastolic myocardial performance. In the metabolic syndrome obese group patients, left ventricle mass was found positively correlated with body mass index, waist and hip circumferences, diastolic blood pressure, age, and waist-to-hip circumference ratio. The carotid intima-media thickness was found positively correlated with waist and hip circumferences and total cholesterol levels. Asymmetric dimethyl arginine levels were found positively correlated with systolic blood pressure, waist-to-hip circumference ratio, and diastolic blood pressure. CONCLUSIONS The results of this study demonstrate that metabolic syndrome in adolescence is associated with significant changes in myocardial geometry and function. In addition, it has been associated with a high level of asymmetric dimethyl arginine concentration and thicker carotid intima-media thickness reflecting endothelial dysfunction.
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Liu X, Luo X, Liu Y, Sun X, Han C, Zhang L, Wang B, Ren Y, Zhao Y, Zhang D, Hu D, Zhang M. Resting heart rate and risk of metabolic syndrome in adults: a dose-response meta-analysis of observational studies. Acta Diabetol 2017; 54:223-235. [PMID: 27885415 DOI: 10.1007/s00592-016-0942-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 11/09/2016] [Indexed: 01/13/2023]
Abstract
The magnitude of the risk of metabolic syndrome (MetS) with increased resting heart rate (RHR) has been inconsistently reported in some observational studies, and whether a dose-response relationship exists between RHR and MetS is unclear. We performed a meta-analysis including dose-response analysis to quantitatively evaluate this association in adults. We searched PubMed, Web of Knowledge, China National Knowledge Infrastructure, and WanFang databases for articles published up to April 2, 2016. A random-effects model was used to pool relative risks (RRs) and 95% confidence intervals (CIs); restricted cubic spline function was used to assess the dose-response relationship. Seven prospective cohort studies and 10 cross-sectional studies with a total of 169,786 participants were included. The pooled RR was 2.10 (95% CI 1.80-2.46, I 2 = 79.8%, n = 13) for the highest versus reference RHR category and 1.28 (95% CI 1.23-1.34, I 2 = 87.7%, n = 15) for each 10 beats per minute (bpm) increment in RHR. We found no evidence of a nonlinear dose-response association between RHR and MetS (P nonlinearity = 0.201). The relationship was consistent in most subgroup analyses and robust on sensitivity analysis. No significant publication bias was observed. This meta-analysis suggests that risk of MetS may be increased with elevated RHR.
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Affiliation(s)
- Xuejiao Liu
- Department of Preventive Medicine, Health Sciences Center, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, Guangdong, China
| | - Xinping Luo
- Department of Preventive Medicine, Health Sciences Center, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, Guangdong, China
| | - Yu Liu
- The Affiliated Luohu Hospital, Health Sciences Center, Shenzhen University, 47 Youyi Road, Shenzhen, 518001, Guangdong, China
| | - Xizhuo Sun
- The Affiliated Luohu Hospital, Health Sciences Center, Shenzhen University, 47 Youyi Road, Shenzhen, 518001, Guangdong, China
| | - Chengyi Han
- Department of Preventive Medicine, Health Sciences Center, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, Guangdong, China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Lu Zhang
- Department of Preventive Medicine, Health Sciences Center, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, Guangdong, China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Bingyuan Wang
- Department of Preventive Medicine, Health Sciences Center, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, Guangdong, China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Yongcheng Ren
- Department of Preventive Medicine, Health Sciences Center, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, Guangdong, China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Yang Zhao
- Department of Preventive Medicine, Health Sciences Center, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, Guangdong, China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Dongdong Zhang
- Department of Preventive Medicine, Health Sciences Center, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, Guangdong, China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Dongsheng Hu
- Department of Preventive Medicine, Health Sciences Center, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, Guangdong, China
- The Affiliated Luohu Hospital, Health Sciences Center, Shenzhen University, 47 Youyi Road, Shenzhen, 518001, Guangdong, China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Ming Zhang
- Department of Preventive Medicine, Health Sciences Center, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, Guangdong, China.
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Habek JC, Lakusic N, Kruzliak P, Sikic J, Mahovic D, Vrbanic L. Left ventricular diastolic function in diabetes mellitus type 2 patients: correlation with heart rate and its variability. Acta Diabetol 2014; 51:999-1005. [PMID: 25274395 DOI: 10.1007/s00592-014-0658-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/19/2014] [Indexed: 01/20/2023]
Abstract
AIMS To assess the prevalence of left ventricular diastolic dysfunction in a population of patients with type 2 diabetes mellitus; to determine correlation of diastolic dysfunction with heart rate and its variability. METHODS The study included 202 patients with type 2 diabetes mellitus. Echocardiography was performed with special reference to diastolic function, and heart rate variability was analysed using standard deviation of normal RR intervals, root mean square of successive differences and percentage of successive R-R intervals greater than 50 ms (pNN 50 %) in a 24-h electrocardiogram recording. RESULTS Diastolic dysfunction is present in 79 % of type 2 diabetes mellitus patients: grade 1 in 52 %, grade 2 in 26 % and grade 3 in 1 % of patients. The subjects with grade 1 diastolic dysfunction had a statistically significantly higher heart rate variability compared with those with grade 2 diastolic dysfunction (LSD, post hoc test, p = 0.001). In the group with diastolic dysfunction, grade 2 reduced heart rate variability was recorded in 83 % of patients (37 and 7 % for grade 1 and normal diastolic function). An increase in the severity of diastolic dysfunction was associated with decreased heart rate variability and increased heart rate. CONCLUSION Progression of diastolic dysfunction is associated with a significantly greater prevalence of reduced heart rate variability, which is accompanied by increased heart rate.
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Affiliation(s)
- Jasna Cerkez Habek
- Department of Cardiology, Croatian Catholic University, University Hospital Sveti Duh, Zagreb, Croatia
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