Overweight and obesity are associated with cardiac adverse structure remodeling in Chinese elderly with hypertension

GLP-1RA may have varying effects on cardiac structure in patients with ASCVD depending on BMI

Background

Glucagon-like peptide-1 receptor agonist(GLP-1RA) is commonly used in patients with cardiovascular disease due to its significant improvement in the prognosis of atherosclerotic cardiovascular disease (ASCVD). However, previous studies have primarily focused on obese patients, leaving uncertainty regarding whether GLP-1RA can yield similar cardiovascular benefits in individuals with normal or low body weight.

Methods

In this study, we enrolled patients with ASCVD to establish a retrospective cohort. Patients receiving GLP-1RA treatment were assigned to the GLP-1RA group, while a control group was formed by matching age and body mass index (BMI) among patients not receiving GLP-1RA treatment. Each group was further divided into subgroups based on baseline BMI levels: normal weight, overweight, and obesity. A six-month follow-up was conducted to assess changes in patient weight, metabolic indicators, and cardiac structure and function.

Results

Among the normal weight subgroup, no significant weight change was observed after six months of GLP-1RA treatment (57.4 ± 4.8 vs. 58.7 ± 9.2, p = 0.063). However, significant weight reduction was observed in the other two subgroups (Overweight group: 70.0 ± 9.1 vs. 73.1 ± 8.2, p = 0.003, Obesity group: 90.5 ± 14.3 vs. 95.5 ± 16.6, p<0.001). Regardless of baseline BMI levels, GLP-1RA demonstrated significant glucose-lowering effects in terms of metabolic indicators. However, GLP-1RA have a more significant effect on improving blood lipids in overweight and obese patients. The effects of GLP-1RA on cardiac structure exhibited variations among patients with different baseline BMI levels. Specifically, it was observed that the improvement in atrial structure was more prominent in patients with normal body weight(LAD: 33.0 (30.3, 35.5) vs. 35.0 (32.5, 37.1), p = 0.018, LAA (18.0 (16.0, 21.5) vs. 18.5 (16.5, 20.5), p = 0.008), while the enhancement in ventricular structure was more significant in obese subjects(LEVDD: 49.8 ± 5.8 vs. 50.2 ± 5.0, p < 0.001, LVMI: 65.1 (56.2, 71.4) vs. 65.8 (58.9, 80.4), p < 0.039).

Conclusion

According to the study, it was found that the administration of GLP-1RA can have different effects on cardiac structure in patients with different baseline BMI, In obese patients, improvements in ventricular remodeling may be more associated with weight loss mechanisms, while in patients with normal or low BMI, GLP-1RA may directly improve atrial remodeling through GLP-1 receptors in atrial tissue.

Higher neutrophil to lymphocyte ratio is associated with renal dysfunction and cardiac adverse remodeling in elderly with metabolic syndrome

Background

Previous studies have shown that metabolic syndrome (MetS) is associated with increased systemic inflammation and cardiac mortality in elderly subjects. However, information on the association of inflammation markers with cardiac adverse remodeling is limited in the elderly with MetS. Therefore, we investigated whether the inflammatory marker neutrophil/lymphocyte ratio (NLR) is associated with the cardiac adverse remodeling in Chinese elderly with MetS.

Methods

A total of 1,087 hospitalized Chinese elderly (aged ≥ 65 years) with MetS were collected retrospectively. The cross-sectional data of echocardiography and clinical parameters were compared among quartile NLR groups.

Results

In the elderly with MetS, higher quartile NLR (≥3.83) was found to be associated with male gender, older age, lower estimated glomerular filtration rate (eGFR), and cardiac left ventricular (LV) dilatation (all p <0.05).

Conclusion

Higher NLR is associated with male gender, older age, renal dysfunction, and cardiac adverse remodeling in Chinese elderly with MetS.

The Effect of Whole-Grain Diet on the Gut Microbiota of the Elderly Individuals

A whole-grain (WG) diet affects human health in multiple ways. However, the effect of WG on the gut microbiota of the elderly individuals is still largely unknown. In this study, WG did not affect the microbial α-diversity but had a profound impact on the microbes' abundance in the elderly individuals. WG increased the abundance of Verrucomicrobia and decreased the abundance of Firmicutes. The prediction of microbial function showed that glucose metabolism and lipid metabolism were inhibited. In addition, the effects of WG on the gut microbiota of normal-weight (NW) and overweight (OW) individuals were different. WG increased Verrucomicrobia in the NW group and decreased Firmicutes in the OW group. Meanwhile, the effect of WG on gut microbiota showed gender characteristics, Firmicutes/Bacteroidetes ratio was decreased in women, while Verrucomicrobia abundance was increased in men. The use of WG could improve the microbial composition and promote the growth of beneficial microbes, which may be beneficial to the health of the elderly individuals.

Parallel improvement of systolic function with surgical weight loss in patients with heart failure and reduced ejection fraction: a systematic review and patient-level meta-analysis

BACKGROUND

Morbid obesity (MO) is an increasingly common condition in patients with heart failure with reduced ejection fraction (HFrEF). Although substantial weight loss in morbidly obese patients has proved to slow the progression of heart failure, parallel alteration of ejection fraction (EF) and New York Heart Association (NYHA) functional class along with post-bariatric surgery weight loss is yet to be determined.

OBJECTIVES

This systematic review aimed to measure the effect of bariatric weight loss on EF and NYHA functional class in patients with HFrEF.

METHODS

A systematic literature review was performed in Medline/PubMed to identify studies in patients with MO and pre-existing HFrEF, who underwent bariatric surgery.

RESULTS

A total of 11 studies encompassing 136 patients with HFrEF undergoing bariatric surgery for MO were included. Six studies provided patient-level data on 37 cases. Patients lost an average body mass index (BMI) of 12.9 ± 4.2 kg/m² (5.1 to 23 kg/m²) after an average follow up of 22.43 ± 18.6 months (2-89 mo). There was a direct correlation between BMI loss and EF improvement (r = 0.61, P < .0001), but not between BMI loss and NYHA functional class changes (r = 0.17, P = .4).

CONCLUSION

Weight loss induced by bariatric surgery results in parallel EF increase in patients with MO and HFrEF. However, current data does not indicate a parallel improvement of clinical symptoms (NYHA functional class) along with such an increase in EF in this population of patients.

Association between renal function and cardiovascular mortality: a retrospective cohort study of elderly from health check-up

OBJECTIVES

This study aimed to investigate the relationship between cardiovascular mortality in elderly Asians and decline in renal function.

DESIGN

A retrospective cohort study.

SETTING

Community-based health examination database from Taipei city.

PARTICIPANTS

At the beginning, the database included 315 045 health check-up visits of 97 803 elderly persons aged ≥65 years old from 2005 to 2012. After excluding missing values and outliers, there were 64 732 elderly persons with at least two visits retained for further analyses.

PRIMARY OUTCOME MEASURES

Kidney function indicators include estimated glomerular filtration rate (eGFR) and urine protein, and rapid decline in eGFR was defined as slope ≤ -5 mL/min/1.73 m² per year. The endpoint outcome was defined as the cardiovascular deaths registered in the death registry encoded by the International Classification of Diseases. We applied a Cox proportional hazards model to analyse the association between renal function and cardiovascular mortality.

RESULTS

In this study, we found 1264 elderly persons died from cardiovascular diseases, for whom the data included 4055 previous health check-up visits. We observed significant and independent associations of eGFR <60 mL/min/1.73 m² (HR (95% CI) of 60>eGFR≥45 and eGFR<45 in males: 2.85 (1.33 to 6.09) and 3.98 (1.84 to 8.61); in females: 3.66 (1.32 to 10.15) and 6.77 (2.41 to 18.99)), positive proteinuria (HR (95% CI) of +/-, +,++ and +++, ++++ in males: 1.51 (1.29 to 1.78) and 2.31 (1.51 to 3.53); in females: 1.93 (1.54 to 2.42) and 4.23 (2.34 to 7.65)) and rapid decline in eGFR (HR (95% CI) in males: 3.24 (2.73 to 3.85); in females: 2.83 (2.20 to 3.64) with higher risk of cardiovascular mortality. The joint effect of increased concentration of urine protein and reduced eGFR was associated with a higher risk of cardiovascular mortality.

CONCLUSIONS

Renal function and rapid decline in renal function are independent risk factors for cardiovascular mortality in the elderly.

Low body mass is associated with reduced left ventricular mass in Chinese elderly with severe COPD

There is limited information on the association of body mass index (BMI) with left ventricular (LV) remodeling corresponding to severity of reduced lung function in patients with chronic obstructive pulmonary disease (COPD). Therefore, we investigated whether BMI is associated with cardiac atrial and ventricular dimensions according to severity of lung functional impairment in Chinese COPD elderly. A total of 563 hospitalized COPD patients with lung function impairment and 184 patients with non-COPD (aged 65–92 years) were collected retrospectively in a cross-sectional study in a university affiliated tertiary hospital in China. BMI and cardiac echocardiographic parameters were compared according to severity of lung functional impairment in COPD patients. BMI was 22.9 ± 3.9 kg/m² in COPD patients, 24.0 ± 4.1 kg/m² in non-COPD patients respectively. Reduced BMI, LV mass index, LV wall thickness and left atrial diameter, and dilated right ventricle (RV) existed in COPD patients with severe lung dysfunction as compared the COPD patients with mild to moderate lung functional reduction and non-COPD patients (P < 0.05), while there were no differences in BMI and echocardiographic parameters between the COPD patients with mild to moderate lung functional decline and non-COPD patients (P > 0.05). Logistic regression analysis showed that low BMI (BMI < 18.5 kg/m²) was correlated with reduced LV mass and wall thickness, dilated RV and reduced lung function in the COPD patients with severe lung dysfunction. In conclusion, this study demonstrates that lower BMI is associated not only with dilated RV and impaired pulmonary function, but also it is related to reduced LV mass in Asian COPD elderly with severe lung dysfunction.

Glomerular Filtration Dysfunction is Associated with Cardiac Adverse Remodeling in Menopausal Diabetic Chinese Women

Background

Previous studies have showed that nephropathy was associated with cardiac structural changes and dysfunction among diabetic adults. However, information on the association of glomerular filtration dysfunction with the cardiac adverse remodeling is still limited in menopausal diabetic women. Therefore, we investigated whether impaired glomerular filtration function is associated with the cardiac adverse remodeling in menopausal Chinese women with type 2 diabetes mellitus (DM).

Methods

A total of 1231 hospitalized menopausal Chinese women with type 2 DM were collected retrospectively. The cross-sectional data of echocardiography were compared among estimated glomerular filtration rate (eGFR) categorized groups.

Results

In menopausal diabetic women, moderate to severe glomerular filtration dysfunction (eGFR <60 mL/min per 1.73m²) was found to be associated with enlarged left-side atrioventricular chambers, increased ventricular wall thickness, decreased cardiac function and dilated right ventricle (All P < 0.05).

Conclusion

Glomerular filtration dysfunction is associated with cardiac adverse structural remodeling and dysfunction in menopausal Chinese women with type 2 DM.

African American Ethnicity, Hypertension, Diabetes, and Arthritis Independently Predict Co-occurring Depression and Obesity among Community-dwelling Older Adult Alabamians

Although obesity and depression are quite common among older adults, surprisingly published literature has not examined factors associated with co-occurring depression and obesity among older adults. The knowledge that fills this gap would be advantageous for public health social workers and other health professionals who provide health care and public health services to older adults. The objectives of this study were to access the prevalence of and independent predictors of co-occurring depression and obesity among older adults in the state of Alabama. A retrospective analysis was conducted using a statewide survey of Alabamian community-dwelling older adults (n = 1,166). Binomial logistic regression was used to examine predictors of co-occurring depression and obesity. The prevalence of co-occurring depression and obesity among older adults was 16%. In the multivariate analysis, African American ethnicity (OR = 1.505, CI: 1.019-2.223), hypertension (OR = 1.593, CI: 1.050-2.416), diabetes (OR = 1.768, CI: 1.188-2.632), and arthritis (OR = 1.640, CI: 1.096-2.454) were positively associated with co-occurring depression and obesity). Older age (OR = 0.963, CI: 0.942-0.985) and higher levels of physical activity (OR = 1.640, CI: 1.096-2.454) were negatively associated with co-occurring depression and obesity. There is a need for the development and implementation of suitable interventions to prevent and manage co-occurring depression and obesity among older adults, particularly older adults with arthritis, hypertension, diabetes, or of African American ethnicity.

Phospho-ablation of cardiac sodium channel Nav1.5 mitigates susceptibility to atrial fibrillation and improves glucose homeostasis under conditions of diet-induced obesity

BACKGROUND

Atrial fibrillation (AF) is the most common sustained arrhythmia, with growing evidence identifying obesity as an important risk factor for the development of AF. Although defective atrial myocyte excitability due to stress-induced remodeling of ion channels is commonly observed in the setting of AF, little is known about the mechanistic link between obesity and AF. Recent studies have identified increased cardiac late sodium current (I_Na,L) downstream of calmodulin-dependent kinase II (CaMKII) activation as an important driver of AF susceptibility.

METHODS

Here, we investigated a possible role for CaMKII-dependent I_Na,L in obesity-induced AF using wild-type (WT) and whole-body knock-in mice that ablates phosphorylation of the Na_v1.5 sodium channel and prevents augmentation of the late sodium current (S571A; SA mice).

RESULTS

A high-fat diet (HFD) increased susceptibility to arrhythmias in WT mice, while SA mice were protected from this effect. Unexpectedly, SA mice had improved glucose homeostasis and decreased body weight compared to WT mice. However, SA mice also had reduced food consumption compared to WT mice. Controlling for food consumption through pair feeding of WT and SA mice abrogated differences in weight gain and AF inducibility, but not atrial fibrosis, premature atrial contractions or metabolic capacity.

CONCLUSIONS

These data demonstrate a novel role for CaMKII-dependent regulation of Na_v1.5 in mediating susceptibility to arrhythmias and whole-body metabolism under conditions of diet-induced obesity.