Obesity and coronary artery disease: evaluation and treatment

Obesity paradox in coronary artery disease: national inpatient sample analysis

BACKGROUND

Although existing literature highlights obesity as a significant predictor for coronary artery disease (CAD), the impact of BMI on hospital outcomes among CAD patients remains unclear.

METHODS

We extracted data from the National Inpatient Sample database for adult patients with CAD from 2018 to 2020. The study cohort was stratified into six BMI categories: underweight, normal weight, overweight, class I obesity, class II obesity, and class III obesity. Using multivariable logistic and linear regression, we assessed the impact of BMI on in-hospital mortality, length of stay (LOS), and inflation-adjusted total charges.

RESULTS

We identified a total of 3 693 570 hospitalizations (mean age: 69 ± 12 years). Underweight individuals had the highest in-hospital mortality rate (6.8%), followed by normal weight (5.2%), overweight (3.2%), class III obese (2.5%), class I obese (1.9%), and class II obese (1.8%) individuals. After adjusting for covariates, underweight patients had higher odds of in-hospital mortality compared to normal-weight individuals [odds ratio (OR), 1.38; 95% confidence interval (CI), 1.31-1.45; P < 0.001], while overweight or obese individuals had lower odds: overweight (OR, 0.75; 95% CI, 0.70-0.79; P < 0.001), obese class I: (OR, 0.54; 95% CI, 0.51-0.57; P < 0.001), obese class II: (OR, 0.56; 95% CI, 0.53-0.59; P < 0.001), obese class III: (OR, 0.78; 95% CI, 0.74-0.82; P < 0.001). Normal weight and underweight patients had the longest median LOS [5 days (3.0-9.0)]. Overweight patients incurred the highest total charges [$53 730 (28 587-105 184)].

CONCLUSION

Underweight patients experienced higher, while overweight and obese patients experienced lower in-hospital mortality than normal-weight patients, suggesting a protective effect of higher BMI against mortality in CAD.

Association between body mass index and electrocardiogram indices: A Mendelian randomization study

INTRODUCTION

Cardiovascular diseases (CVDs) remain a global health concern, and body mass index (BMI) is known to be associated with an increased risk of CVD, but the exact mechanisms underlying this relationship remain unclear. This study employs Mendelian randomization (MR) to investigate the causal association between BMI and electrocardiogram (ECG) indices, providing insights into potential pathways linking obesity to CVD.

METHODS

We conducted a comprehensive MR study utilizing large-scale genetic and ECG data from diverse populations. Instrumental variables were selected from genome-wide association studies, ensuring their relevance to BMI. Causal relationships between BMI and ECG indices, including P wave duration, PR interval, QRS duration, and QT interval, were assessed using various MR methods, with inverse variance weighted (IVW) considered as the primary analysis.

RESULTS

Our MR analysis revealed a significant positive causal association between higher BMI and P wave duration (β = 8.078, 95% CI: 5.322 to 10.833, p < 0.001), suggesting a potential mechanism through which higher BMI may contribute to arrhythmogenic risks. However, no significant causal associations were observed between BMI and PR interval, QRS duration, or QT interval (all p > 0.005). In addition, our study also found that there is no horizontal pleiotropy between BMI and P wave duration, PR interval, QRS duration, and QT interval, suggesting that the conclusions of this study are robust.

CONCLUSION

This study supports a causal relationship between elevated BMI and prolonged P wave duration, a marker of increased atrial arrhythmogenic risk. Further investigations are still needed to elucidate the underlying mechanisms.

Combining various acupuncture therapies with multimodal analgesia to enhance postoperative pain management following total knee arthroplasty: a network meta-analysis of randomized controlled trials

OBJECTIVE

This study aims to evaluate the efficacy and safety of various acupuncture treatments in conjunction with multimodal analgesia (MA) for managing postoperative pain and improving knee function in patients undergoing total knee arthroplasty (TKA), based on the findings from clinical research indicating the potential benefits of acupuncture-related therapies in this context.

METHODS

We searched Web of Science, PubMed, SCI-hub, Embase, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Scientific Journal Database (VIP) to collect randomized controlled trials of acupuncture-related therapies for post-TKA pain. After independent screening and data extraction, the quality of the included literature was evaluated. The potential for bias in the studies incorporated in the analysis was assessed according to the guidelines outlined in the Cochrane Handbook 5.1. Network meta-analysis (NMA) was conducted using RevMan 5.4 and Stata 16.0 software, with primary outcome measures including visual analog scale (VAS), pain pressure threshold (PPT), hospital for special surgery knee score (HSS), and knee joint range of motion (ROM). Furthermore, the interventions were ranked based on the SUCRA value.

RESULTS

We conducted an analysis of 41 qualifying studies encompassing 3,003 patients, examining the efficacy of four acupuncture therapies (acupuncture ACU, electroacupuncture EA, transcutaneous electrical acupoint stimulation TEAS, and auricular acupoint therapy AAT) in conjunction with multimodal analgesia (MA) and MA alone. The VAS results showed no significant difference in efficacy among the five interventions for VAS-3 score. However, TEAS+MA (SMD: 0.67; 95%CI: 0.01, 1.32) was more effective than MA alone for VAS-7 score. There was no significant difference in PPT score among the three interventions. ACU + MA (SMD: 6.45; 95%CI: 3.30, 9.60), EA + MA (SMD: 4.89; 95%CI: 1.46, 8.32), and TEAS+MA (SMD: 5.31; 95%CI: 0.85, 9.78) were found to be more effective than MA alone for HSS score. For ROM score, ACU + MA was more efficacious than EA + MA, TEAS+MA, and AAT + MA, MA. Regarding the incidence of postoperative adverse reactions, nausea and vomiting were more prevalent after using only MA. Additionally, the incidence of postoperative dizziness and drowsiness following ACU + MA (OR = 4.98; 95%CI: 1.01, 24.42) was observed to be higher compared to that after AAT + MA intervention. Similarly, the occurrence of dizziness and drowsiness after MA was found to be significantly higher compared to the following interventions: TEAS+MA (OR = 0.36; 95%CI: 0.18, 0.70) and AAT + MA (OR = 0.20; 95%CI: 0.08, 0.50). The SUCRA ranking indicated that ACU + MA, EA + MA, TEAS+MA, and AAT + MA displayed superior SUCRA scores for each outcome index, respectively.

CONCLUSION

For the clinical treatment of post-TKA pain, acupuncture-related therapies can be selected as a complementary and alternative therapy. EA + MA and TEAS+MA demonstrate superior efficacy in alleviating postoperative pain among TKA patients. ACU + MA is the optimal choice for promoting postoperative knee joint function recovery in TKA patients. AAT + MA is recommended for preventing postoperative adverse reactions.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/, identifier (CRD42023492859).

Obesity: current state of the problem, multidisciplinary approach. (based on the consensus of the World Gastroenterological Organization “Obesity 2023” and the European guideline on obesity care in patients with gastrointestinal and liver diseases, 2022)

Obesity is the largest pandemic in the world, and its prevalence continues to increase. The purpose of the presented publication is to raise awareness of doctors about modern methods of diagnosing obesity and approaches to therapy, using an interdisciplinary team approach similar to that used in other chronic diseases, such as diabetes, heart disease and cancer. The article presents data from the World Gastroenterological Organization (2023) and the European Guidelines for the Treatment of Obesity in patients with diseases of the gastrointestinal tract and liver (2022). According to modern approaches, obesity should be considered as a chronic recurrent progressive disease, the treatment of which requires a comprehensive interdisciplinary approach involving psychologists and psychiatrists, nutritionists/nutritionists, therapists, endoscopists and surgeons, including lifestyle changes, a well-defined diet and exercise regimen, drug therapy, endoscopic or surgical methods of treatment. Conclusions. In order to stop the growing wave of obesity and its many complications and costs, doctors, insurance companies and health authorities should make systematic efforts to raise public awareness of both the adverse health risks associated with obesity and the potential reduction of risks through a comprehensive approach to therapy.

Digital Health in Diabetes and Cardiovascular Disease

BACKGROUND

Digital health technologies are rapidly evolving and transforming the care of diabetes and cardiovascular disease (CVD).

PURPOSE OF THE REVIEW

In this review, we discuss emerging approaches incorporating digital health technologies to improve patient outcomes through a more continuous, accessible, proactive, and patient-centered approach. We discuss various mechanisms of potential benefit ranging from early detection to enhanced physiologic monitoring over time to helping shape important management decisions and engaging patients in their care. Furthermore, we discuss the potential for better individualization of management, which is particularly important in diseases with heterogeneous and complex manifestations, such as diabetes and cardiovascular disease. This narrative review explores ways to leverage digital health technology to better extend the reach of clinicians beyond the physical hospital and clinic spaces to address disparities in the diagnosis, treatment, and prevention of diabetes and cardiovascular disease.

CONCLUSION

We are at the early stages of the shift to digital medicine, which holds substantial promise not only to improve patient outcomes but also to lower the costs of care. The review concludes by recognizing the challenges and limitations that need to be addressed for optimal implementation and impact. We present recommendations on how to navigate these challenges as well as goals and opportunities in utilizing digital health technology in the management of diabetes and prevention of adverse cardiovascular outcomes.

Challenges in Cardiovascular Evaluation and Management of Obese Patients: JACC State-of-the-Art Review

Many unique clinical challenges accompany the diagnosis and treatment of cardiovascular disease (CVD) in people living with overweight/obesity. Similarly, physicians encounter numerous complicating factors when managing obesity among people with CVD. Diagnostic accuracy in CVD medicine can be hampered by the presence of obesity, and pharmacological treatments or cardiac procedures require careful adjustment to optimize efficacy. The obesity paradox concept remains a source of confusion within the clinical community that may cause important risk factors to go unaddressed, and body mass index is a misleading measure that cannot account for body composition (eg, lean mass). Lifestyle modifications that support weight loss require long-term commitment, but cardiac rehabilitation programs represent a potential opportunity for structured interventions, and bariatric surgery may reduce CVD risk factors in obesity and CVD. This review examines the key issues and considerations for physicians involved in the management of concurrent obesity and CVD.

Weight changes following antidiabetic mediation use: Real-world evidence from health system data

Objective

Newer antidiabetic medications such as sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1RA) result in weight loss in clinical trials. However, the real-world effectiveness remains unclear. The magnitude of weight change associated with antidiabetic medication using real-world data was examined.

Methods

Patients with diabetes who initiated SGLT2i (n = 906), GLP1RA (n = 782), dipeptidyl peptidase-4 inhibitors (DPP4i, n = 1881), or sulfonylureas (n = 3255) in Geisinger Health System were identified. Outcomes were percent weight change per year and time to 5% weight loss. Propensity scores were used to account for differences across groups.

Results

The mean ± SD age of patients was 57.5 ± 14.1 years, 3381 (49.5%) were female, and 6450 (94.5%) had body mass index ≥25 kg/m2. Compared with sulfonylureas, newer antidiabetic medications were associated with significant weight loss (-3.2% [95% confidence interval: -3.8%, -2.6%] per year for SGLT2i; -2.9% [-3.6%, -2.3%] per year for GLP1RA; and -1.7% [-2.1%, -1.3%] per year for DPP4i). SGLT2i and GLP1RA were also associated with significant weight loss compared with DPP4i. Among patients with overweight or obesity, SGLT2i and GLP1RA users were more likely to achieve 5% weight loss compared with sulfonylureas and DPP4i.

Conclusions

In real-world practice, SGLT2i and GLP1RA were associated with significant weight loss compared with sulfonylureas and DPP4i. These results may further motivate uptake of SGLT2i and GLP1RA, especially among patients who were overweight or had obesity.

Determination of 12 anti-obesity drugs in human plasma by a 96-well protein precipitation plate using HPLC-MS

An analytical method was developed and validated for the simultaneous determination of 12 anti-obesity drugs (methylephedrine (MER), amphetamine (AMP), fenfluramine (FEN), bupropion (BUP), fluoxetine (FLU), sibutramine (SIBU), bisacodyl (BISA), bumetanide (BUM), lovastatin (LOVA), simvastatin (SIM), rimonabant (RIMO), and fenofibrate (FENO)) in human plasma by a 96-well protein precipitation plate combined with high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS). The 96-well protein precipitation plate was chosen for simultaneous pretreatment of large sample volumes, making the whole process more efficient and faster. Drugs were separated on an Agilent Poroshell 120 EC-C18 column, and detected by MS/MS under multiple reaction monitoring (MRM) mode. The developed method was validated in terms of linearity, matrix effect, accuracy and precision. A good linearity was obtained in the range of 0.1-20.0 ng mL-1 for fenfluramine, bupropion, fluoxetine, sibutramine, bisacodyl, and rimonabant; and 0.5-20.0 ng mL-1 for methylephedrine, amphetamine, bumetanide, lovastatin, simvastatin, and fenofibrate with a correlation coefficient above 0.995. The method was fully validated with an acceptable accuracy of 75.63-108.21%, matrix effect of 80.41-117.71% except for fenofibrate (76.07% at low concentration levels), and precision of 0.32-13.12%. Owing to the advantages of simple operation, high accuracy and sensitivity, this method is suitable for the rapid and simultaneous detection of 12 anti-obesity drugs in human plasma, providing support for clinically monitoring the development of adverse reactions and guiding the rational and appropriate use of weight-loss drugs for obese people.

Obesity among type 2 diabetes mellitus at Sidama Region, Southern Ethiopia

Background

Type 2 diabetes is becoming highly prevalent worldwide and it is one of the leading causes of mortality. The cause of mortality among these patients is mostly related to the dominant presence of modifiable cardiovascular risk factors such as obesity. The aim of the current study is therefore to determine the prevalence of obesity and its associated factors among patients with type 2 diabetes mellitus at Sidama region, Ethiopia.

Method

Institution-based cross-sectional study design was implemented to determine the prevalence of obesity and its associated factor among patients with type two diabetes at Hawassa University Comprehensive Specialized Hospital and Yirgalem General Hospital from October 16 2018 to December 21, 2018. A simple random sampling technique was implemented to select 314 study participants. After obtaining consent, different patients’ related data were collected using a questionnaire. Patients’ records were also reviewed. 4ml of the blood sample was collected from each study participant and analyzed for lipid profile test. Blood glucose level was done using COBAS INTEGRA 6000. A binary logistic regression was used to assess factors that have an association with obesity. A P-value of <0.05 was considered statistically significant.

Result

The majority of the study participants (67.2%) were male and 61.8% of the study participants were aged >45years. The overall prevalence of overweight and obesity among the study participants was 36.3% and 18.8% respectively. About 41% of the study participants have a normal BMI. Females were more obese (28.2% Vs 14.2%) than males and BMI stratification by sex was statistically significant (P = 0.02). Sex (AOR = 3.0, CI = 1.6–5.7, P-Value = 0.001) and TG (AOR = 3.6, CI = 1.6–8.3, P-Value = 0.003) are factors that were independently associated with obesity among type 2 DM patients.

Conclusion

Overweight and obesity among type two diabetic patients were prevalent. In addition, obesity and overweight disorder are common among T2DM and gender and triglycerides levels were associated with obesity.

Effect of Platelet Inhibition by Cangrelor Among Obese Patients Undergoing Coronary Stenting: Insights From CHAMPION

BACKGROUND

In randomized trials, cangrelor reduced periprocedural ischemic events related to percutaneous coronary intervention without increasing GUSTO severe bleeding. However, some antiplatelet agents have shown a differential treatment effect by body mass index (BMI).

METHODS

Patients from the 3 CHAMPION trials (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition) who were randomized to cangrelor versus clopidogrel during percutaneous coronary intervention were stratified by BMI. The primary efficacy end point was a composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis within 48 hours. The principal safety outcome was GUSTO moderate or severe bleeding at 48 hours, although more sensitive bleeding measures such as Thrombolysis in Myocardial Infarction major bleeding were also assessed. We examined obese patients (defined as BMI≥30) versus nonobese patients.

RESULTS

There were 24 893 patients, with 8979 (36.1%) having BMI of ≥30. There was no significant difference in the primary efficacy end point among obese versus nonobese patients (4.3% versus 4.2%; rate ratio, 1.01 [95% CI, 0.89-1.15]; P=0.82). There was a consistent benefit in the primary efficacy end point in patients who received cangrelor versus placebo who were obese (3.9% versus 4.7%, rate ratio, 0.83 [95% CI, 0.68-1.02]; P=0.07) and not obese (3.8% versus 4.7%; rate ratio, 0.81 [95% CI, 0.69-0.94]; P=0.0053); interaction P=0.77. There was no difference in GUSTO moderate or severe bleeding among patients who received cangrelor versus placebo who were obese (0.6% versus 0.6%; rate ratio, 0.99 [95% CI, 0.58-1.67]; P=0.96).

CONCLUSIONS

Cangrelor at the time of percutaneous coronary intervention is effective and safe in obese and nonobese patients. There was no difference in short-term efficacy between obese and nonobese patients. Periprocedural cangrelor is an effective and safe antiplatelet agent, irrespective of BMI.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT01156571, NCT00385138, NCT00305162.

Obesity history, physical exam, laboratory, body composition, and energy expenditure: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on History, Physical Exam, Body Composition and Energy Expenditure is intended to provide clinicians an overview of the clinical and diagnostic evaluation of patients with pre-obesity/obesity.

Methods

The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

This CPS outlines important components of medical, dietary, and physical activity history as well as physical exams, with a focus on specific aspects unique to managing patients with pre-obesity or obesity. Patients with pre-obesity/obesity benefit from the same preventive care and general laboratory testing as those without an increase in body fat. In addition, patients with pre-obesity/obesity may benefit from adiposity-specific diagnostic testing - both generally and individually - according to patient presentation and clinical judgment. Body composition testing, such as dual energy x-ray absorptiometry, bioelectrical impedance, and other measures, each have their own advantages and disadvantages. Some patients in clinical research, and perhaps even clinical practice, may benefit from an assessment of energy expenditure. This can be achieved by several methods including direct calorimetry, indirect calorimetry, doubly labeled water, or estimated by equations. Finally, a unifying theme regarding the etiology of pre-obesity/obesity and effectiveness of treatments of obesity centers on the role of biologic and behavior efficiencies and inefficiencies, with efficiencies more often associated with increases in fat mass and inefficiencies more often associated with decreases in fat mass.

Conclusion

The Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on History, Physical Exam, Body Composition and Energy Expenditure is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of pre-obesity/obesity.

Randomized Clinical Trial to Evaluate the Morphological Changes in the Adventitial Vasa Vasorum Density and Biological Markers of Endothelial Dysfunction in Subjects with Moderate Obesity Undergoing a Very Low-Calorie Ketogenic Diet

Weight loss after bariatric surgery decreases the earlier expansion of the adventitial vasa vasorum (VV), a biomarker of early atheromatous disease. However, no data are available regarding weight loss achieved by very low calorie ketogenic diets (VLCKD) on VV and lipid-based atherogenic indices. A randomized clinical trial was performed to examine changes in adventitial VV density in 20 patients with moderate obesity who underwent a 6-month very low calorie ketogenic diet (VLCKD, 600-800 kcal/day), and 10 participants with hypocaloric diet based on the Mediterranean Diet (MedDiet, estimated reduction of 500 kcal on the usual intake). Contrast-enhanced carotid ultrasound was used to assess the VV. Body composition analysis was also used. The atherogenic index of plasma (log (triglycerides to high-density lipoprotein cholesterol ratio)) and the triglyceride-glucose index were calculated. Serum concentrations of soluble intercellular adhesion molecule 1 (sICAM-1), and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. The impact of weight on quality of life-lite (IWQOL-Lite) questionnaire was administered. Participants of intervention groups displayed a similar VV values. Significant improvements of BMI (-5.3 [-6.9 to -3.6] kg/m2, p < 0.001), total body fat (-7.0 [-10.7 to -3.3] %, p = 0.003), and IWQOL-Lite score (-41.4 [-75.2 to -7.6], p = 0.027) were observed in VLCKD group in comparison with MedDiet group. Although after a 6-months follow-up period VV density (mean, right and left sides) did not change significantly in any group, participants in the VLCKD exhibited a significantly decrease both in their atherogenic index of plasma and serum concentration of sICAM-1. A 6-month intervention with VLCKD do not impact in the density of the adventitial VV in subjects with moderate obesity, but induces significant changes in markers of endothelial dysfunction and CV risk.

Germacrone: A Potent Secondary Metabolite with Therapeutic Potential in Metabolic Diseases, Cancer and Viral Infections

Natural products, an infinite reserve of bioactive molecules, will continue to serve humans as an important source of therapeutic agents. Germacrone is a bioactive natural compound found in the traditional medicinal plants of family Zingiberaceae. This multifaceted chemical entity has become a point of focus during recent years due to its numerous pharmacological applications, e.g., anticancer, anti-inflammatory, antiviral, antioxidant, anti-adipogenic, anti-androgenic, antimicrobial, insecticidal, and neuroprotective. Germacrone is an effective inducer of cell cycle arrest and apoptosis in various cancers (breast, brain, liver, skin, prostate, gastric, and esophageal) via modulation of different cell signaling molecules and pathways involved in cancer proliferation. This is the first report highlighting the wide spectrum of pharmacological activities exhibited by germacrone. The reported data collected from various shreds of evidences recommend that this multifaceted compound could serve as a potential drug candidate in the near future.

Visceral fat index: a novel predictor for coronary collateral circulation

Objective This study was designed to investigate the role of visceral adiposity along with other clinical parameters in predicting poor coronary collateral circulation (CCC) among patients with severe obstructive coronary artery disease (CAD). Subjects and methods A total of 135 patients with severe obstructive CAD and good (n = 70) or poor (n = 65) CCC were included. Data on angiographically detected CCC, the quality criteria for CCC (Rentrop scores) and visceral fat index (VFI) obtained via bioelectrical impedance were compared between good and poor CCC groups. Independent predictors of poor CCC, the correlation between VFI and Rentrop score and the role of VFI in the identification of CCC were analyzed. Results A significant negative correlation was noted between VFI and Rentrop scores (r = -0.668, < 0.001). The presence of hypertension (OR 4.244, 95% CI 1.184 to 15.211, p = 0.026) and higher VFI (OR 1.955, 95% CI 1.342 to 2.848, p < 0.001) were shown to be independent predictors of an increased risk for poor CCC. ROC analysis revealed a VFI > 9 (AUC [area under the curve] (95% CI): 0.898 (0.834-0.943), p < 0.0001) to be a potential predictor of poor CCC with a sensitivity of 95.38% and specificity of 85.71%. Conclusion In conclusion, our findings revealed comorbid hypertension and higher VFI to significantly predict the risk of poor CCC in patients with severe obstructive CAD.

Central blood pressure in morbid obesity and after bariatric surgery

Various mechanisms are related to arterial hypertension in obesity. Central blood pressure (BP) seems to correlate more than peripheral BP with future cardiovascular risk. Bariatric surgery is an effective method to reduce BP along with weight loss in patients with morbid obesity. The study of the relationship between weight modification after bariatric surgery and ambulatory BP measurement, not only peripheral BP, but also central BP, could provide information regarding the mechanisms of organic damage associated with elevated BP in obesity. In this review we analyze the available evidence regarding the association between central BP with obesity and its modifications after bariatric surgery.

Influence of Morbid Obesity and Bariatric Surgery Impact on the Carotid Adventitial Vasa Vasorum Signal

INTRODUCTION/PURPOSE

Adventitial vasa vasorum (VV) expansion to the avascular intima precedes an increase in carotid intima-media thickness. However, factors involved in the development of the atherosclerotic process and its reversibility remain unclear. We aimed to evaluate the VV signal in both morbid obesity and after bariatric surgery (BS).

MATERIALS/METHODS

We conducted a case-control study to examine the VV signal in the carotid of 40 morbidly obese patients and 40 non-obese controls. The effect of BS was evaluated in 33 patients. Contrast-enhanced carotid ultrasound was used to assess the VV signal.

RESULTS

The mean VV density was higher in obese than in non-obese subjects (0.739 ± 0.117 vs. 0.570 ± 0.111, p < 0.001). The VV signal positively correlated with BMI (p < 0.001) and waist circumference (p = 0.001) but was not related to cIMT. The stepwise multivariate regression analysis revealed that waist circumference (beta = 0.507, p < 0.001) together with fasting plasma glucose (beta = 0.229, p = 0.024) were independently associated with the VV signal (R² = 0.382). Before BS, the median VV signal correlated with soluble intercellular adhesion molecule 1 (p = 0.022). After a 12-month follow-up, a 12.0% decrease in VV (0.731 ± 0.126 vs. 0.643 ± 0.115, p = 0.003) was observed. In the univariate analysis, the decrease in VV was associated with the baseline VV density (p < 0.001), baseline systolic blood pressure (p = 0.019) and a decrease in sICAM (p = 0.005). However, only baseline systolic pressure (beta = 0.417, p = 0.024) independently predicted the absolute change in VV signal (R² = 0.174).

CONCLUSIONS

Morbidly obesity is associated with increased VV density. In addition, BS appears to reduce the earlier expansion of the adventitial vasa vasorum.

Epicardial adipose tissue as a metabolic transducer: role in heart failure and coronary artery disease

Obesity and diabetes are strongly associated with metabolic and cardiovascular disorders including dyslipidemia, coronary artery disease, hypertension, and heart failure. Adipose tissue is identified as a complex endocrine organ, which by exerting a wide array of regulatory functions at the cellular, tissue and systemic levels can have profound effects on the cardiovascular system. Different terms including "epicardial," "pericardial," and "paracardial" have been used to describe adipose tissue deposits surrounding the heart. Epicardial adipose tissue (EAT) is a unique and multifaceted fat depot with local and systemic effects. The functional and anatomic proximity of EAT to the myocardium enables endocrine, paracrine, and vasocrine effects on the heart. EAT displays a large secretosome, which regulates physiological and pathophysiological processes in the heart. Perivascular adipose tissue (PVAT) secretes adipose-derived relaxing factor, which is a "cocktail" of cytokines, adipokines, microRNAs, and cellular mediators, with a potent effect on paracrine regulation of vascular tone, vascular smooth muscle cell proliferation, migration, atherosclerosis-susceptibility, and restenosis. Although there are various physiological functions of the EAT and PVAT, a phenotypic transformation can lead to a major pathogenic role in various cardiovascular diseases. The equilibrium between the physiological and pathophysiological properties of EAT is very delicate and susceptible to the influences of intrinsic and extrinsic factors. Various adipokines secreted from EAT and PVAT have a profound effect on the myocardium and coronary arteries; targeting these adipokines could be an important therapeutic approach to counteract cardiovascular disease.

Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017

BACKGROUND

Cardiovascular disease (CVD) is a common comorbidity in type 2 diabetes (T2DM). CVD's prevalence has been growing over time.

PURPOSE

To estimate the current prevalence of CVD among adults with T2DM by reviewing literature published within the last 10 years (2007-March 2017).

METHODS

We searched Medline, Embase, and proceedings of major scientific meetings for original research documenting the prevalence of CVD in T2DM. CVD included stroke, myocardial infarction, angina pectoris, heart failure, ischemic heart disease, cardiovascular disease, coronary heart disease, atherosclerosis, and cardiovascular death. No restrictions were placed on country of origin or publication language. Two reviewers independently searched for articles and extracted data, adjudicating results through consensus. Data were summarized descriptively. Risk of bias was examined by applying the STROBE checklist.

RESULTS

We analyzed data from 57 articles with 4,549,481 persons having T2DM. Europe produced the most articles (46%), followed by the Western Pacific/China (21%), and North America (13%). Overall in 4,549,481 persons with T2DM, 52.0% were male, 47.0% were obese, aged 63.6 ± 6.9 years old, with T2DM duration of 10.4 ± 3.7 years. CVD affected 32.2% overall (53 studies, N = 4,289,140); 29.1% had atherosclerosis (4 studies, N = 1153), 21.2% had coronary heart disease (42 articles, N = 3,833,200), 14.9% heart failure (14 studies, N = 601,154), 14.6% angina (4 studies, N = 354,743), 10.0% myocardial infarction (13 studies, N = 3,518,833) and 7.6% stroke (39 studies, N = 3,901,505). CVD was the cause of death in 9.9% of T2DM patients (representing 50.3% of all deaths). Risk of bias was low; 80 ± 12% of STROBE checklist items were adequately addressed.

CONCLUSIONS

Globally, overall CVD affects approximately 32.2% of all persons with T2DM. CVD is a major cause of mortality among people with T2DM, accounting for approximately half of all deaths over the study period. Coronary artery disease and stroke were the major contributors.

Effect of dual antiplatelet on recurrent stroke in minor stroke or TIA depends on bodyweight

Objective

To assess whether bodyweight influences the efficacy and safety of dual antiplatelet therapy (DAT) in male patients with minor stroke or transient ischemic attack patients.

Materials and methods

All 3,420 male participants coming from the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events trial were divided into 3 groups based on bodyweight (<65 kg, 65–75 kg, and ≥75 kg). The stroke outcomes included stroke recurrence, combined vascular events, and bleeding events during 90 days of follow-up. The interaction of the treatment effects of DAT among patients with different bodyweight was assessed by Cox proportional hazards models.

Results

DAT is superior to mono antiplatelet therapy (MAT) for reducing stroke recurrence among patients with weight <65 kg (5.0% vs 11.7%; hazard ratio [HR], 0.41; 95% CI: 0.22–0.76) and 65–75 kg (6.7% vs 10.8%, HR, 0.62; 95% CI: 0.43–0.89). However, no significant difference was found in stroke recurrence between DAT and MAT in patients with weight ≥75 kg (9.4% vs 11.6%; HR, 0.80; 95% CI: 0.58–1.10). A significant interaction was observed between weight and antiplatelet therapy on stroke recurrence (p<0.05). Similar result was found for combined vascular events. More bleeding events were found in DAT group among patients with <65 kg (3.7% vs 2.2%), but with no significant difference.

Conclusion

DAT does not show benefit in patients with higher weight, compared with MAT. Bleeding events found in the DAT group were not more than the MAT group among patients with lower weight.

Clinical trial registration

URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00979589.

Sedentary Behavior, Cadence, and Physical Activity Outcomes after Knee Arthroplasty

PURPOSE

This study comprehensively examined sedentary behavior and physical activity patterns in people with severe knee osteoarthritis awaiting total knee arthroplasty (TKA) and in individuals after TKA.

METHODS

Preoperative (n = 32, mean ± SD = 69.9 ± 5.3 yr) and 1-yr postoperative participants with TKA (n = 38, 67.9 ± 7.3 yr) wore ActiGraph GT3X+ activity monitors for 6.8 ± 0.6 d. Total sedentary time, time in long sedentary bouts (≥30 min), and physical activity outcomes (steps, time in moderate-to-vigorous physical activity [MVPA], cadence) were examined.

RESULTS

There were no differences between pre- and postoperative groups for total sedentary time (9.3 ± 1.4 vs 9.2 ± 1.4 h·d, P = 0.62) and number of long sedentary bouts per day (median [interquartile range] = 3.4 [1.9] vs 3.1 [2.0], P = 0.37). Daily steps, peak 30-min cadence, and peak 1-min cadence values were greater in people after TKA compared with those awaiting surgery (5935 [3316] vs 3724 [2338], 55.6 [31.0] vs 35.9 [19.3], and 91.5 ± 20.6 vs 70.0 ± 23.7, respectively, all P < 0.01). There were no differences in lifestyle MVPA between groups. The number of bouts of Freedson MVPA was greater in postoperative participants, but the differences were not substantial (one bout per week).

CONCLUSION

Patients report less knee pain and improved function after TKA; however, sedentary behavior does not differ and physical activity is only marginally increased compared with those awaiting surgery. After TKA, daily walking at slow, moderate, and brisk paces and engagement in MVPA do not match levels seen in healthy older adults, which, when combined with high levels of sedentary behavior, leaves patients at increased risk for physical disability and cardiovascular disease.

Hyperinsulinemia and obese phenotype differently influence blood pressure in young normotensive patients with polycystic ovary syndrome

To differentiate the impact of insulin levels/resistance per se from that of excess weight on blood pressure (BP) daily changes, we evaluated, using 24-h ambulatory blood pressure monitoring (ABPM), systolic blood pressure (SBP) and diastolic blood pressure (DBP) in a cohort of young normotensive patients affected by polycystic ovary syndrome (PCOS). A cross-sectional study was performed. Fifty-four patients were studied according to (a) insulinemic state: 32 hyperinsulinemic and/or insulin-resistant (h-INS) and 22 normoinsulinemic (n-INS) patients; and (b) body mass index (BMI): 22 obese (BMI > 30) and 32 lean (18.0 < BMI < 24.9) patients. Each subject's SBP and DBP and heart rate (HR) were measured by ABPM. Supine and upright plasma renin activity (PRA), and aldosterone levels were also assayed. Patients in the h-INS group showed higher 24-h, daytime, and nighttime diastolic blood pressure (DBP), higher nighttime systolic blood pressure (SBP) levels, as well as an increased 24-h, daytime and nighttime HR, compared to both obese and lean patients in the n-INS group. In relation to BMI, only 24-h, daytime, and nighttime DBP were higher in obese than in lean patients. At variance, when both h-INS and obesity were considered, 24-h SBP and DBP were higher in h-INS obese subjects than in the other groups. In multivariate analysis, insulin (max peak), area under the curve of insulin and insulin sensitivity index was independently associated with SBP. (1) Within a normotensive range, hyperinsulinemia and/or insulin resistance influence daily BP variation more than obesity does, suggesting a pivotal role of insulin on BP control in PCOS; (2) altered insulinemic state and ABPM-derived higher nighttime BP and HR may represent early markers to identify PCOS subjects prone to high cardiovascular risk.

Body Mass Index Is Associated With Differential Rates of Coronary Revascularization After Cardiac Catheterization

BACKGROUND

The association of obesity with coronary revascularization procedures is not clear. We examined rates of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) associated with obesity while accounting for the severity of coronary disease and diabetes status.

METHODS

Patients who underwent cardiac catheterization were stratified according to coronary anatomy risks and diabetes status. Within each stratum, using normal body mass index (BMI) (18.5-24.9 kg/m²) as a reference, the associations of overweight (25.0-29.9 kg/m²), obese class I (30.0-34.9 kg/m²), obese class II (35.0-39.9 kg/m²), and obese class III (≥ 40.0 kg/m²) with the likelihood of receiving CABG and PCI were assessed while adjusting for clinical covariates.

RESULTS

Of 56,722 patients analyzed, overall use of revascularization was higher in the overweight, obese class I, and obese class II groups (overweight: adjusted hazard ratio [aHR], 1.10; 95% confidence interval [CI], 1.06-1.13; obese class I: aHR, 1.08; 95% CI, 1.05-1.12; obese class II: aHR,1.05; 95% CI, 1.01-1.10), whereas it was lower in the obese class III group (aHR, 0.91; 95% CI, 0.85-0.97) compared with normal BMI. In the subgroup with high-risk coronary anatomy and diabetes, all obese classes had higher rates of PCI (obese class I: aHR,1.24; 95% CI, 1.08-1.42; obese class II: aHR,1.27; 95% CI, 1.07-1.49, obese class III: aHR,1.37; 95% CI, 1.12-1.67) than the normal BMI group.

CONCLUSIONS

Our results showed that BMI is associated with differential rates of coronary revascularization. In patients with high-risk coronary anatomy and diabetes, clinical appropriateness of higher rates of PCI associated with obesity warrants further investigation.

Prognostic value of non-invasive stress testing for coronary artery disease in obese patients

Detecting coronary artery disease (CAD) in obese patients remains a challenge but can have substantial prognostic implications for this patient group. Until now, sufficient data was not available on which to base the selection of the imaging modality in obese patients. The decision on which imaging modality to use should therefore follow the general guidelines. In this article, the authors discuss the prognostic value of the different non-invasive stress testing methods for CAD in obese patients.

Intravenous injection of microvesicle-delivery miR-130b alleviates high-fat diet-induced obesity in C57BL/6 mice through translational repression of PPAR-γ

BACKGROUND

We have shown previously that microvesicle (MV)-delivered miR-130b (miR-130b-MV) is able to target PPAR-γ and subsequently reduce the lipid accumulation in vitro. However, the in vivo effect of miR-130b on fat deposition and glucose homeostasis remains unknown.

RESULTS

Three-week-old C57BL/6 mice were fed a high-fat diet for 8 weeks and then intravenously injected with MV-packaged scrambled control microRNA (miRNA) or miR-130b every other day for 10 days. Glucose tolerance test was performed and body weight, epididymal fat weight, as well as the expression of lipid metabolic genes were determined. We showed that mice fed on high-fat diet for 8 weeks demonstrated significantly higher body weight, elevated blood glucose and impaired glucose tolerance. miR-130b-MV injection significantly reduced body weight and epididymal fat weight and partly restored glucose tolerance. miR-130b expression was significantly increased in the epididymal fat after miR-130b-MV injection while the protein content of its target gene PPAR-γ was significantly suppressed, together with a significant up-regulation of the lipolysis genes, hormone sensitive lipase, monoglyceride lipase and leptin. Moreover, miR-130b-MV injection increased the expression of miR-378a and miR-378-3p that are reported to participate in the regulation of fat deposition.

CONCLUSION

Our results indicate that miR-130b-MV is able to reduce the epididymal fat deposition and partly restore glucose tolerance, through translational repression of PPAR-γ in a high-fat diet-induced obese mouse model.