Bariatric surgery is associated with reduced admission for aortic dissection: a nationwide case-control analysis

Aortic Dissection Incidence and Risk Factor Analysis: Findings from the China Kadoorie Biobank

OBJECTIVE

Data on the incidence of aortic dissection (AD) from population based prospective studies are scarce and its risk factors are not well studied in China. The aim of this study was to investigate the relatively accurate incidence of AD in ten regions of China and to identify its potential risk factors using a population based prospective study.

METHODS

Data from a prospective cohort study involving ∼510 000 middle aged adults in ten regions of China from 2004 - 2008 (the China Kadoorie Biobank) were used. The incidence of AD was calculated and the association between potential risk factors (body mass index [BMI], hypertension, and diabetes) and the occurrence of AD was evaluated using competing risk analysis.

RESULTS

The study included 512 724 participants (59.0% female, median age 51.5 years). During a median follow up of 121 months, 119 participants developed AD. The incidence of AD was 2.35 (95% confidence interval [CI] 1.93 - 2.77), 3.97 (95% CI 3.10 - 4.83), and 1.25 (95% CI 0.86 - 1.65) per 100 000 person years for the whole cohort, male participants, and female participants, respectively. Competing risk analysis identified female sex (hazard ratio [HR] 0.35, 95% CI 0.24 - 0.52; p < .001) and hypertension (HR 6.21, 95% CI 3.94 - 9.80; p < .001) as independent predictors of AD. BMI, diabetes, and random blood glucose were not associated with AD.

CONCLUSION

In contrast to previous data and clinical observations, there was no significant correlation between diabetes (or random blood glucose) or BMI and the occurrence of AD. Male sex and hypertension were independently associated with the occurrence of AD.

Reduction of oxidative stress response and protection of liver and renal cell functions by reduced glutathione in lower limb arterial ischemia-reperfusion in New Zealand white rabbits with high triglyceride levels

Objective

Acute liver and kidney injury is the most common complication after aortic surgery, which seriously affects the survival and safety of perioperative patients. The presence of chronic preoperative liver and renal insufficiency, presence of preoperative blood inflammation indicators, duration of intraoperative extracorporeal circulation, and volume of red blood cell transfusion are the main influencing factors for acute postoperative liver and kidney injuries. In recent years, with the research progress on oxidative stress, a growing body of evidence has demonstrated that oxidative stress may cause tissue damage after ischemia-reperfusion (IR). However, the impact of the oxidative stress of distal tissues caused by IR on liver and renal cells after arterial surgeries has not yet been elucidated.

Methods

New Zealand white rabbits were used for the experiments and were divided into three groups. Among them, two groups were fed high-fat feed to establish a white rabbit model of hypertriglyceridemia, whereas the control group was provided with ordinary feed. In the experiment, white rabbits were subjected to occlusion of the infrarenal aorta abdominalis to simulate IR of the lower limbs. The effects of high triglyceride levels after the arterial IR of the lower limbs were investigated using the contents of reactive oxygen species (ROS) and malondialdehyde (MDA), a fat metabolite, in ischemic muscle tissues and blood tissues. One of the groups receiving high-fat feed received intervention with reduced glutathione (GSH) before IR of the lower limbs. Pathological studies were performed to identify the expression levels of inflammatory factors and inflammatory cells in liver and renal cells as well as cell apoptosis. The effects of GSH administration before IR on reducing the oxidative stress in adipose tissues and alleviating liver and kidney damage after stress response were investigated.

Results

After IR, the increases in ROS and MDA in ischemic muscle tissues and blood tissues were higher in white rabbits with high triglyceride levels than in those that only received ordinary feed or received intervention with GSH. In addition, for white rabbits with high triglyceride levels, the TNF-α expression levels in the liver increased after IR. Moreover, a considerable increase in the expression of TNF-α, IL-6, macrophages, and T lymphocytes were observed in renal cells. A large number of inflammatory cells and the formation of immune complexes were also noted in the glomeruli; in addition, cell apoptosis was promoted.

Conclusion

This study showed that high triglyceride levels enhanced the oxidative stress response and increased ROS production in New Zealand white rabbits after arterial IR of the lower limbs. High ROS levels activated the expression of inflammatory factors and inflammatory cells in the liver and kidney, which affected cell functions and promoted apoptosis. At high triglyceride levels, GSH downregulated ROS production in oxidative stress after IR, thereby protecting liver and kidney functions.

Morbid obesity impacts mortality among inpatients with type a aortic dissection: an analysis of the national inpatient sample

BACKGROUND

Stanford type A aortic dissection (T(A)AD) is one of the most dangerous cardiovascular diseases and morbid obesity is associated with the prognosis of many cardiovascular diseases. The aim of this study is to investigate the impact of morbid obesity on in-hospital mortality, total hospital costs and discover the prevalence of morbid obesity among inpatients with T(A)AD.

METHODS

Patients with a primary diagnosis of T(A)AD were identified from the National Inpatient Sample database (NIS) from 2008 to 2017. These patients were categorized into non-obesity, obesity and morbid obesity. Multivariable regression models were utilized to assess the association between obesity/morbid obesity and in-hospital mortality, total cost and other clinical factors. The temporal trend in prevalence of obesity/morbid obesity in T(A)ADs and the trend of in-hospital mortality among different weight categories were also explored.

RESULTS

From the NIS database 8489 T(A)AD inpatients were identified, of which 7230 (85.2%) patients were non-obese, 822 (9.7%) were obese and 437 (5.1%) were morbid obese. Morbid obesity was associated with increased risk of in-hospital mortality (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.03-1.86), 8% higher total cost compared with the non-obese patients. From 2008 to 2017, the rate of obesity and morbid obesity in patients with T(A)AD have significantly increased from 7.36 to 11.33% (P < 0.001) and from 1.95 to 7.37% (P < 0.001). Factors associated with morbid obesity in T(A)ADs included age, female, elective admission, hospital region, dyslipidemia, smoking, rheumatoid arthritis/collagen vascular diseases, chronic pulmonary disease, diabetes and hypertension.

CONCLUSIONS

Morbid obesity are connected with worse clinical outcomes and more health resource utilization in T(A)AD patients. Appropriate medical resource orientation and weight management education for T(A)AD patients may be necessary.