The Impact of Obesity in Heart Failure

Yoga in Obesity Management: Reducing cardiovascular risk and enhancing well-being- A review of the current literature

BACKGROUND

Obesity, a global epidemic, significantly increases cardiovascular disease (CVD) risk. Conventional treatments often lack long-term efficacy, emphasizing the need for integrative, sustainable approaches.

OBJECTIVE

This review assesses the role of yoga as a complementary intervention in obesity management and its effectiveness in reducing cardiovascular risk.

METHODS

We systematically reviewed literature up to March 2024 from Medline/PubMed, Scopus, Embase and the Cochrane Central Library. The focus was on randomized controlled trials (RCTs), observational studies, systematic reviews and meta-analyses evaluating the impact of yoga on obesity-related outcomes and cardiovascular risk factors. Studies were reviewed for quality, outcomes, and both physiological and psychological effects of yoga on obese individuals.

RESULTS

Yoga interventions consistently yielded positive results in reducing body mass index (BMI), waist circumference, and body fat. These physical changes correlate with significant improvements in cardiovascular markers, including blood-pressure, cholesterol levels, endothelial and autonomic functions. Yoga also enhances stress management and psychological well-being, addressing both mental and physical facets of obesity. The benefits extend beyond mere weight reduction, affecting systemic inflammation and metabolic health, crucial for mitigating CVD risks.

CONCLUSION

Yoga represents a promising, non-pharmacological approach to obesity management and CVD risk reduction. Its holistic impact on physical and psychological health makes it a viable adjunct therapy in comprehensive obesity management, fostering sustainable lifestyle changes and long-term health benefits.

IMPLICATIONS

Incorporating yoga into standard obesity management protocols could enhance therapeutic outcomes. Future research should standardize yoga interventions to better integrate them into modern healthcare and explore their long-term cardiovascular effects.

Challenges in Prognostication of an Older Adult with Severe Obesity and End-Stage Heart Failure: A Case Study

In this report, we present the case of an older adult with severe obesity and multiple comorbidities, including heart failure with preserved ejection fraction (HFpEF), who experienced a prolonged decline complicated by recurrent hospitalizations and skilled nursing facility stays during the two years preceding death. This case highlights challenges in prognostication attributed to severe obesity complicated by HFpEF, which likely delayed goals of care conversations, and access to palliative care and hospice, despite high symptom burden. We discuss prognostic uncertainty among those with severe obesity and outline potential future directions.

Myocardial mechanical changes before and after bariatric surgery in individuals with obesity and diabetes: a 1-year follow-up study

Bariatric surgery may have an effect on myocardial mechanics in individuals with obesity and diabetes. In this study, two-dimensional speckle-tracking echocardiography was applied to evaluate the changes of left ventricular myocardial mechanics in individuals with obesity and diabetes before and after bariatric surgery. A total of 58 individuals with obesity were divided into an obesity-only group (30 patients) and an obesity + diabetes group (28 patients). Routine echocardiographic parameters and left ventricular global longitudinal strain (GLS) were compared between the two groups at baseline and 6 and 12 months postoperatively. At all three time points, GLS was lower in the obesity + diabetes group than in the obesity-only group. In both groups, the GLS increased successively at 6 and 12 months postoperatively. The change in GLS (∆GLS) from baseline to 6 months was higher than the △GLS from 6 to 12 months in both groups. The △GLS from baseline to 6 months was lower in the obesity + diabetes group than in the obesity-only group. Therefore, obese individuals can benefit from bariatric surgery, which includes improved heart function, delayed disease progression.

The Association Between Serum Uric Acid Levels and the Risk of Cognitive Dysfunction in Patients With Atrial Fibrillation

Patients with atrial fibrillation (AF) are linked to an increased risk of cognitive dysfunction, and serum uric acid levels play an important factor in cognitive dysfunction. However, the optimal serum uric acid level in patients with AF remains unclear. Therefore, we aimed to explore the relationship between serum uric acid and cognitive dysfunction. 583 patients were conducted in the Affiliated Hospital of Jining Medical University. Cognitive dysfunction was assessed by the Montreal Cognitive Assessment (MoCA). The relationship between serum uric acid levels and the risk of cognitive dysfunction in patients with AF was analyzed using the smoothing spline fitting model and threshold analysis. The average serum uric acid level was (383.26 ± 110.11) μmol/L, and the incidence of cognitive dysfunction was 79.76%. There was a non-linear relationship between serum uric acid levels and the risk of cognitive dysfunction in patients with AF, and the inflection point was 352 μmol/L. At the left of the inflection point, the relationship was significant (OR = 1.02, 95% CI = 1.00-1.04). At the right of the inflection point, there was no statistical difference (p=0.101). When serum uric acid levels are less than 352 μmol/L, the risk of cognitive dysfunction increases by 2% for each unit increase in serum uric acid levels in patients with AF. The study provides evidence for the treatment of serum uric acid levels in patients with AF.

Relevance of Indian Traditional Herbal Brews for Gut Microbiota Balance

The considerable changes in lifestyle patterns primarily affect the human gut microbiota and result in obesity, diabetes, dyslipidemia, renal complications, etc. though there are few traditional safeguards such as herbal brews to maintain the ecological stability under intestinal dysbiosis. The present article is designed to collect all the scientific facts in a place to decipher the role of the Indian traditional herbal brews used to balance gut health for centuries. Computerized databases, commercial search engines, research papers, articles, and books were used to search by using different keywords to select the most appropriate published articles from 2000 onward to September 2023. A total of 1907 articles were scrutinized, 46 articles were finally selected from the 254 screened, and targeted information was compiled. Interaction of herbal brews to the gut microflora and resulting metabolites act as prebiotics due to antimicrobial, anti-inflammatory, and antioxidant properties, and modulate the pH of the gut. The effect of brews on gut microbiota has a drastic impact on various gut-related diseases and has gained popularity as an alternative to antibiotics against bacteria, fungi, viruses, parasites, and boosting the immune system and strengthening the intestinal barrier. Berberine, kaempferol, piperine, and quercetin have been found in more than one brew discussed in the present article. Practically, these brews balance the gut microbiota, prevent chronic and degenerative diseases, and reduce organ inflammation, though, there is a knowledge gap on the molecular mechanism to explain their efficacy. Indian traditional herbal brews used to reboot and heal the gut microbiota since centuries-old practice with successful history without toxicity. The systematic consumption of these brews under specific dietary prescriptions has a hope of arrays for a healthy human gut microbiome in the present hasty lifestyle with overall health and well-being.

Graphical Abstract

Preadmission metformin use increased the incidence of hyperlactatemia at admission and 30-day in-hospital mortality among T2D patients with heart disease at high risk of hypoxia

BACKGROUND

Surprisingly, despite the high prevalence of metformin use in type 2 diabetes (T2D) patients with heart disease, limited safety data is available regarding metformin use in patients with acute and critical heart disease.

METHODS

In this single-center retrospective study, patients admitted to the cardiology department for heart failure (HF) or acute coronary syndrome (ACS) between December 2013 and December 2021 and who underwent arterial blood gas analysis at admission with an estimated glomerular clearance rate of ≥45 ml/min/1.73 m2 were identified. The incidences of hyperlactatemia, acidosis, and 30-day in-hospital mortality were compared between preadmission metformin users and nonusers.

RESULTS

Of 526 admissions, 193/193 metformin users/nonusers were selected in a propensity score-matched model. Metformin users had greater lactate levels (2.55 ± 2.07 mmol/l vs. 2.00 ± 1.80 mmol/l P < 0.01), a greater incidence of hyperlactatemia [odds ratio (OR) = 2.55; 95% confidence interval (CI), 1.63-3.98; P < 0.01] and acidosis (OR = 1.78; 95% CI, 1.00-3.16; P < 0.05) at admission and a greater incidence of in-hospital mortality (OR = 3.83; 95% CI, 1.05-13.94; P < 0.05), especially those with HF/acute myocardial infarction, elderly age, or without preadmission insulin use.

CONCLUSIONS

Our results suggest that, compared to metformin nonusers, preadmission use of metformin may be associated with a greater incidence of hyperlactatemia and acidosis at admission and greater 30-day in-hospital mortality among T2D patients with HF or ACS at high risk of hypoxia, particularly those without preadmission insulin use. The safety of metformin in this population needs to be confirmed in prospective controlled trials.

Potential utilization of ferulic acid and its derivatives in the management of metabolic diseases and disorders: An insight into mechanisms

Metabolic diseases are abnormal conditions that impair the normal metabolic process, which involves converting food into energy at a cellular level, and cause difficulties like obesity and diabetes. The study aimed to investigate how ferulic acid (FA) and its derivatives could prevent different metabolic diseases and disorders and to understand the specific molecular mechanisms responsible for their therapeutic effects. Information regarding FA associations with metabolic diseases and disorders was compiled from different scientific search engines, including Science Direct, Wiley Online, PubMed, Scopus, Web of Science, Springer Link, and Google Scholar. This review revealed that FA exerts protective effects against metabolic diseases such as diabetes, diabetic retinopathy, neuropathy, nephropathy, cardiomyopathy, obesity, and diabetic hypertension, with beneficial effects on pancreatic cancer. Findings also indicated that FA improves insulin secretion by increasing Ca2+ influx through the L-type Ca2+ channel, thus aiding in diabetes management. Furthermore, FA regulates the activity of inflammatory cytokines (TNF-α, IL-18, and IL-1β) and antioxidant enzymes (CAT, SOD, and GSH-Px) and reduces oxidative stress and inflammation, which are common features of metabolic diseases. FA also affects various signaling pathways, including the MAPK/NF-κB pathways, which play an important role in the progression of diabetic neuropathy and other metabolic disorders. Additionally, FA regulates apoptosis markers (Bcl-2, Bax, and caspase-3) and exerts its protective effects on cellular destruction. In conclusion, FA and its derivatives may act as potential medications for the management of metabolic diseases.

Systematic Brain Natriuretic Peptide Measurement for Cardiac Screening in Patients with Severe Obesity: The OLECOEUR Study

INTRODUCTION

Heart failure (HF) is difficult to diagnose in obese patients because of cardiovascular and pulmonary comorbidities associated with physical deconditioning, all of which lead to dyspnea.

METHODS

The OLECOEUR study is a prospective screening for HF using systematic brain natriuretic peptide (BNP) measurement in ambulatory patients with obesity from a department of Nutrition (Paris, France). Clinical, biological, and echocardiographic data were extracted from electronic medical records.

RESULTS

We included 1,506 patients middle-aged (mean age: 47.2 ± 14.6 years old) with severe obesity (mean body mass index: 40.4 ± 6.6 kg/m2). Patients with BNP ≥35 pg/mL had left heart remodeling including thicker interventricular septum (10.4 ± 2.0 vs. 9.6 ± 1.8 mm; p = 0.0008), higher left ventricular mass (89.9 ± 24.3 vs. 77.2 ± 20.0 g/m2; p = 0.0009), and significant changes in both left and right atria consistent with a higher proportion of prior atrial fibrillation. Markers of right heart remodeling on echocardiography were also significantly higher (pulmonary artery systolic pressure: 33.3 ± 17.3 vs. 24.5 ± 6.3 mm Hg; p = 0.0002).

CONCLUSION

The OLECOEUR study shows left and right subclinical cardiac remodeling in obese patients screened for HF with systematic dosing of BNP with usual cut-off of 35 pg/mL.

A comprehensive review of medicinal Toxicodendron (Anacardiaceae): Botany, traditional uses, phytochemistry and pharmacology

ETHNOPHARMACOLOGICAL RELEVANCE

Comprising of about 30 species, the genus Toxicodendron (Anacardiaceae) are mainly distributed in East Asia and North America. Among them, 13 species have been traditionally used as folk medicines in Asia and other parts of the world to treat blood diseases, abnormal bleeding, skin diseases, gastrointestinal diseases, liver diseases, bone injury, lung diseases, neurological diseases, cardiovascular diseases, tonic, cancer, eye diseases, menstrual irregularities, inflammation, rheumatism, diabetes mellitus, rattlesnake bite, internal parasites, contraceptive, vomiting and diarrhea.

AIM OF THE STUDY

To date, no comprehensive review on Toxicodendron has been published and the scientific basis of the traditional medicinal benefits of Toxicodendron have been less reported. Therefore, this review aims to provide a reference for further research and development on medicinal purpose of Toxicodendron by summarizing the works (from 1980 to 2023), and focusing on its botany, traditional uses, phytochemistry and pharmacology.

MATERIALS AND METHODS

The names of the species were from The Plant List Database (http://www.theplantlist.org), World Flora Online (http://www.worldfloraonline.org), Catalogue of Life Database (https://www.catalogueoflife.org/) and Plants for A Future Database (https://pfaf.org/user/Default.aspx). And the search terms "Toxicodendron" and "the names of 31 species and their synonyms" were used to search for information from electronic databases such as Web of Science, Scopus, Google Scholar, Science Direct, PubMed, Baidu Scholar, Springer, and Wiley Online Library. Moreover, PhD and MSc dissertations were also used to support this work.

RESULTS

These species on Toxicodendron are widely used in folkloric medicine and modern pharmacological activities. So far, approximately 238 compounds, mainly phenolic acids and their derivatives, urushiols, flavonoids and terpenoids, are extracted and isolated from Toxicodendron plants, commonly, T. trichocarpum, T. vernicifluum, T. succedaneum, and T. radicans. Among them, phenolic acids and flavonoids are the main compound classes that show pharmacological activities in Toxicodendron plants both in vitro and in vivo. Furthermore, the extracts and single compounds of these species show a wide range of activities, such as antioxidant, antibacterial, anti-inflammatory, anti-tumor, liver protection, fat reduction, nerve protection, and treatment of blood diseases.

CONCLUSIONS

Selected species of Toxicodendron have been used as herbal medicines in the Southeast Asian for a long time. Furthermore, some bioactive constituents have been identified from them, so plants in this genus may be potential new drugs. The existing research on Toxicodendron has been reviewed, and the phytochemistry and pharmacology provide theoretical basis for some of the traditional medicinal uses. Therefore, in this review, the traditional medicinal, phytochemical and modern pharmacology of Toxicodendron plants are summarized to help future researchers to find new drug leads or to get a better understanding of structure-activity relationships.

Current Research Status and Implication for Further Study of Real-World Data on East Asian Traditional Medicine for Heart Failure: A Scoping Review

This study used real-world data (RWD) to explore the long-term effects of East Asian traditional medicine (EATM) on heart failure (HF). A comprehensive search was conducted across five databases to identify relevant studies, which were then reviewed using the Arksey and O'Malley scoping review framework. The analysis focused on a descriptive examination of the long-term outcomes associated with EATM intervention. Methodologically, the study explored various aspects, including study subjects, interventions, applied clinical outcomes, and statistical methods. Out of 258 studies, 12 were selected. Eight studies involved patients with HF, while the others used HF as an outcome. Datasets from the National Health Insurance Research Database were used in Taiwan, while electronic medical record data were used in China and Japan. EATM interventions have been found to be associated with lower mortality and readmission rates. One study indicated that an increased dose of Fuzi, a botanical drug, or prompt use of Fuzi after diagnosis led to a decreased mortality hazard ratio. In two studies examining readmission rates, a significant increase was observed in the non-exposed group, with odds ratios of 1.28 and 1.18. Additionally, in patients with breast cancer, the subdistribution hazard ratio for the occurrence of doxorubicin-induced HF was reduced to 0.69. Although cohort studies with survival analysis were common, methodological flaws, such as issues with statistical methods and HF diagnosis, were identified. Despite these challenges, the study observed an association between EATM and improved clinical outcomes in patients with HF, emphasizing the potential of RWD studies to complement randomized controlled trials, especially for longer-term follow-ups. These results provide foundational data for future RWD research.

Effects of weight loss in heart failure patients with overweight and obesity: a systematic review and meta-analysis

AIMS

To perform a systematic review and meta-analysis to evaluate the impact of weight loss (WL) on the prognosis of overweight and obese patients with heart failure (HF).

METHODS AND RESULTS

We reviewed the literature up to 1 February 2023 from PubMed, Web of Science, Embase, Cochrane Library, and Chinese databases for cohort studies, and randomized controlled trials (RCTs). Data from eligible studies were extracted, and statistical analyses were performed using Review Manager 5.3. A total of 19 studies (involving 449 882 patients) were included in the systematic review and meta-analyses. The results showed that WL did not reduce the mortality and rehospitalization rates in overweight and obese HF patients, but could improve the quality of life (P = 0.002), cardiac function (P = 0.0001), and exercise capacity (P = 0.03). The subgroup analysis showed that WL from bariatric surgery (BS) reduced the risk of death (P < 0.00001), WL from medication or exercise was not significantly associated with the risk of death (P = 0.18), and WL was associated with a higher mortality in the subgroup with unspecified WL modality or unintentional WL (P < 0.00001). In addition, it did not reduce the risk of short-term rehospitalization (P = 0.11), but reduced the rehospitalization rates over the long-term (P = 0.03).

CONCLUSION

WL improves the long-term rehospitalization (>3 months), quality of life, cardiac function, and exercise capacity in overweight and obese HF patients. Although overall WL is not proven effective, subgroup analysis shows that BS can reduce mortality.

Relationship Between Epicardial Adipose Tissue and Biventricular Longitudinal Strain and Strain Rate in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Epicardial adipose tissue (EAT) has been reported to be increased in patients with type 2 diabetes mellitus (T2DM). EAT thickness may impact left ventricular (LV) diastolic function. However, the association between EAT and right ventricular (RV) function in T2DM is unclear. We hypothesized an association between EAT volume and biventricular longitudinal strain and strain rate in patients with T2DM.

MATERIALS AND METHODS

A total of 20 controls and 69 T2DM patients with preserved LV ejection fraction (EF) who underwent cardiac magnetic resonance (CMR) were included. Biventricular function was evaluated by CMR Tissue-Tracking derived strain analysis, including LV global peak systolic longitudinal strain (LVGLS), peak diastolic longitudinal strain rate (LVLSR), RVGLS and RVLSR.

RESULTS

Compared to controls, patients with T2DM had significantly higher EAT volumes with lower LVGLS, LVLSR, RVGLS and RVLSR (all p<0.05). EAT volume was significantly correlated with LVGLS, LVLSR, RVGLS and RVLSR in T2DM patients (r=-0.45, -0.39, -0.59, -0.50, all p<0.001). Multivariate linear regression analysis revealed that EAT volume was significantly associated with LVGLS (β=0.38, p=0.001), LVLSR (β=-0.35, p=0.003), RVGLS (β=0.64, p<0.001) and RVLSR (β=-0.43, p<0.001) independently of traditional risk factors in patients with T2DM.

CONCLUSION

Patients with T2DM had higher EAT levels and lower biventricular function than controls. EAT volume was independently associated with biventricular longitudinal strain and strain rate in T2DM patients.