The Impact of Obesity on the Cardiovascular System

Obesity and its management in primary care setting

Obesity is a worldwide epidemic affecting adults and children, regardless of their socioeconomic status. Significant progress has been made in understanding the genetic causes contributing to obesity, shedding light on a portion of cases worldwide. In young children with severe obesity however, recessive mutations, i.e., leptin or leptin receptor deficiency should be sought. Much more has been learned about the far-reaching impact of obesity on complications, including cardiovascular disease, liver and kidney dysfunction, diabetes, inflammation, hypertension, sleep, cancer, and the eye. Preventive strategies, particularly in children, are crucial for reducing obesity rates and mitigating its long-term complications. While dietary modifications and lifestyle changes remain the cornerstone of obesity prevention or treatment, recent advancements have introduced highly effective pharmacological options complementing weight-reduction surgery. Newer medications, like incretin-based therapies including glucagon-like peptide-1 agonists (GLP-1RA), have demonstrated remarkable efficacy in promoting weight loss, offering new insights into margining obesity-related conditions. Primary care providers, whether treating adults or children, play a pivotal role in preventing obesity, initiating treatment, and making onward referrals to specialists to assist in managing obesity and obesity-related complications.

The Contributions of Risk Factor Modifications to the Reduction of Cardiovascular Risk in Patients With Antidiabetic Treatment: A Meta-Regression Analysis and Model-Based Analysis

AIMS

This meta-regression analysis and model-based analysis aimed to assess the contributions of the risk factors and identify the predominant ones.

METHODS

PubMed/MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials with reports of cardiovascular events in patients receiving antidiabetic treatments. Five treatment-response factors such as changes in haemoglobin A1c (HbA1c), systolic blood pressure (SBP), body weight, low-density lipoprotein cholesterol (LDL-C) and estimated glomerular filtration rate (eGFR), and six baseline factors such as HbA1c, SBP, body weight, LDL-C, eGFR and age were included in the analyses. Eligible data were first analysed by a meta-regression analysis and then by a mathematical model-based analysis.

RESULTS

In all 41 studies were included. Among all treatment response factors, reduction in body weight and SBP were key factors in lowering cardiovascular risk. A 5-kg body weight reduction accounted for 5%, 33%, 11.6%, 13% and 31.2% risk reduction in MACE, CV death, MI, stroke, and HHF, respectively. A 5-mmHg SBP reduction contributed 42.3%, 34.9%, 38.5%, 11% and 21.4% to the risk reduction in MACE, CV death, MI, stroke and HHF, respectively. Among all baseline factors, an increase in the baseline body weight was the main contributor to cardiovascular risk reduction. A 5-kg increase in baseline body weight was associated with 12.5%, 3.5%, 6.5% and 8.4% risk reduction in MACE, CV death, MI, and stroke, respectively.

CONCLUSION

The reduction in body weight and SBP level were the dominant contributors to cardiovascular risk reduction among all 11 included potential factors. The treatment response factors might be more crucial to reduce cardiovascular risk when compared with baseline factors.

Impact of obesity on clinical outcomes in patients with high-risk pulmonary embolism: A comparative analysis

Background

Pulmonary embolism (PE) is a life-threatening cardiovascular condition with increasing global incidence. Obesity is a significant risk factor for PE, although its reported relationship with outcomes is inconsistent. This study aimed to investigate the impact of obesity on clinical outcomes in patients with high-risk PE.

Methods

We conducted a retrospective analysis of US adult patients hospitalized with high-risk PE from 2016 to 2019 using the National Inpatient Sample database. Patients were categorized into three groups based on BMI: non-obese, obese (30 to < 40 kg/m2), and severely obese (≥40 kg/m2). We compared baseline characteristics, in-hospital procedures, and outcomes among these groups. Multivariable logistic regression models assessed the relationship between obesity levels and in-hospital outcomes.

Results

Of 752,660 patients with PE, 29,610 (3.9 %) were classified as high-risk. The distribution among BMI categories was: non-obese (77.1 %), obese (8.8 %), and severely obese (14.1 %). Severely obese patients were younger (mean age 55.7 vs. 66.1 years for non-obese, p < 0.001) and more likely to be female (63.2 % vs. 51.4 % for non-obese, p < 0.001). After adjustment, obese and severely obese patients had lower odds of in-hospital mortality (obese: aOR 0.50, p < 0.001; severely obese: aOR 0.69, p < 0.001) and major adverse cardiovascular and cerebrovascular events (obese: aOR 0.50, p < 0.001; severely obese: aOR 0.72, p < 0.001).

Conclusion

Our study revealed an "obesity paradox" in high-risk PE patients, with obese and severely obese individuals showing lower mortality and fewer complications despite higher comorbidity rates. These findings emphasize the need for tailored risk assessment and treatment strategies in obese patients with high-risk PE.

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.

The flowers extracts of Citrus aurantium regulates fat metabolism in obese C57BL/6J mice by improving intestinal microbiota disorders

BACKGROUND

Obesity can lead to many diseases such as diabetes, hypertension, cancer and cardiovascular diseases, which seriously affect people's quality of life and health.

AIMS OF THE STUDY

To investigate the main components and potential of n-butanol extract from Citrus aurantium L. var. amara Engl to reduce lipid accumulation and to explore its modulatory effects on the gut microbiota.

METHODS

The main components of n-butanol extract were analyzed using liquid chromatography quadrupole trap mass spectrometry (LC-QTRAP-MS) and a high-fat diet-induced obese mouse model was established to analyze its effects on the determination of gene expression levels and intestinal microbiota using reverse transcription quantitative polymerase chain reaction (RT-qPCR) and 16S rRNA gene sequence method.

RESULTS

The n-butanol extract mainly consists of 15 components, and it could significantly inhibit weight gain, reduce liver coefficient and improve oxidative damage. By regulating the expression of related genes, it inhibited hepatic steatosis and hypertrophy of epididymal tissue. The n-butanol extract increased the diversity of intestinal microbiota, improved the composition and structure of the flora, and reversed the high-fat diet-induced disturbance of intestinal microbiota in mice.

CONCLUSION

These results indicated that the n-butanol extract of C. aurantium could inhibit lipid accumulation and provide a more comprehensive basis for the development and utilization of C. aurantium in anti-obesity activity. © 2025 Society of Chemical Industry.

Autoimmune mechanisms and inflammation in obesity-associated type 2 diabetes, atherosclerosis, and non-alcoholic fatty liver disease

Obesity, characterized by the excessive accumulation of white adipose tissue, is a significant global health burden and a major risk factor for a range of diseases, including malignancies and metabolic disorders. Individuals with high visceral fat content are particularly susceptible to severe complications such as type 2 diabetes, cardiovascular diseases, and liver disorders. However, the pathogenesis of obesity-related metabolic diseases extends beyond simple adiposity. Chronic obesity triggers a prolonged inflammatory response, which leads to tissue fibrosis and sustained organ damage, contributing to multi-organ dysfunction. This review explores the autoimmune mechanisms and inflammatory pathways underlying obesity-induced type 2 diabetes, atherosclerosis, and non-alcoholic fatty liver disease, with an emphasis on their interrelated pathophysiology and the potential for therapeutic interventions.

Long-term body mass index trajectories and the risk of type 2 diabetes mellitus and atherosclerotic cardiovascular disease using healthcare data from UK Biobank participants

BACKGROUND AND AIMS

Most epidemiological studies ignore long-term burden, gain and variability in body weight in assessing cardiometabolic disease risk. We investigated the associations of body mass index (BMI) trajectories measured by general practitioners with incident type 2 diabetes (T2D) and coronary artery disease (CAD).

METHODS

We used electronic healthcare data from 111,615 European-ancestry participants from UK Biobank (57.1 (SD 7.8) years, 59.6 % women) with at least three BMI measurements (median trajectory period: 14.9 [interquartile range 9.5, 20.1] years). We calculated six variables capturing different long-term aspects, including i.e. burden (long-term average, area under the curve), gain (slope) and variability (standard deviation, average of the [absolute] consecutive BMI differences). The variables were used in principal component (PC) analyses and k-means clustering. Newly-derived dimensions and subgroups were used as exposures in cox-proportional hazard models.

RESULTS

The BMI-trajectory indices were captured in two PCs reflecting BMI burden and BMI gain. The BMI-burden PC associated with higher T2D (hazard ratio [95 % confidence interval] per SD higher PC: 1.57 [1.55,1.60]) and CAD (1.17 [1.15,1.19]) risks, while weak or no associations were observed with the BMI-gain PC (T2D: 1.03 [1.01,1.05]; CAD: 1.01 [0.98,1.03]). Participants with the highest BMI burden, compared to those with lowest BMI burden without significant gain, had highest T2D (6.96 [6.41,7.55]) and CAD (1.57 [1.45,1.69]) risks. Both methods to capture BMI burden, gain and variability showed superior model fit compared to a single baseline BMI assessment.

CONCLUSIONS

Long-term high BMI burden, irrespective of BMI gain, was a risk factor for cardiometabolic disease.

Risk factors for substantial weight retention at 1 year postpartum: evidence from a German birth cohort study (KUNO-Kids)

PURPOSE

Postpartum weight retention (PPWR) increases the risk of overweight and obesity. This study aims to identify risk factors for substantial weight retention (≥ 5 kg) at 1 year postpartum.

METHODS

Data were obtained from N = 747 mothers participating in the KUNO-Kids birth cohort study. The following variables were analyzed: sociodemographic variables, pre-pregnancy body mass index, postpartum weight retention at 6 months, gestational weight gain, parity, breastfeeding, mode of delivery, gestational diabetes mellitus, physical activity, diet, alcohol consumption, smoking, sleep, and depression. Variables that showed an association of p < 0.2 with substantial postpartum weight retention (SPPWR) in univariable logistic regression analyses were included in the multivariable logistic regression analysis. Statistical analyses were performed using IBM SPSS.28.

RESULTS

One year after delivery, mean PPWR was 1.5 kg (SD 5.2 kg), and 21.6% of the women had SPPWR. The multivariable logistic regression model showed a significant negative association of SPPWR with an intermediate educational status compared to a low educational status (OR = 0.27 [95% CI 0.11-0.69]). In addition, PPWR at 6 months was positively associated with SPPWR (OR = 1.55 [95% CI 1.43-1.69]) at 1 year. None of the other associations reached statistical significance.

CONCLUSION

Postpartum weight retention may lead to weight gain. Losing weight in the first few months after delivery may prevent substantial postpartum weight retention. Women of low education may particularly benefit from weight loss support.

Association between cardiometabolic index and myocardial Infarction: based on NHANES database

BACKGROUND

The cardiometabolic index (CMI) combines abdominal obesity and abnormal blood lipid indices, representing a good predictive indicator of risk in cardiovascular diseases (CVDs). However, the association between CMI and myocardial infarction (MI) is not clear.

OBJECTIVE

The present project was designed to explore the linkage between CMI and MI.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were employed in this project, with CMI as the independent variable and MI as the dependent variable. Weighted logistic regression was applied in the association analysis between CMI and MI. Restricted cubic spline (RCS), subgroup analysis, and interaction tests were employed to elucidate the non-linear relationship and stability of CMI and MI's link. Moreover, to verify the robustness of the results, sensitivity analysis was conducted, with the MI status of subjects taking lipid-lowering drugs as the outcome variable.

RESULTS

A total of 13,923 participants were gathered in this project, with 605 cases of MI, accounting for 3.5%. In the weighted logistic regression model, a positive linkage was observed between CMI and the risk of MI (OR: 1.41, 95% CI: 1.18-1.68, p < 0.001). The RCS curves indicated a linear relationship between CMI and MI (P-non-linear = 0.146). Subgroup analysis manifested that CMI was positively linked with MI risk in males, individuals with BMI > 30kg/m2, and alcohol drinkers (p < 0.05). In addition, the interaction results demonstrated that there was no heterogeneity in the association between CMI and MI risk in the subgroups (p > 0.05). The sensitivity analysis showed that after adjusting for all confounding factors in the model, there was still a significant positive correlation (p < 0.01) between CMI and MI in the population taking lipid-lowering drugs.

CONCLUSION

There is a significant positive linkage of CMI with MI risk, which is particularly significant in males, those with a BMI greater than 30 kg/m2, and those who have drinking habits. Even after considering the impact of lipid-lowering drug therapy, the positive correlation between CMI and MI remains robust, supporting CMI as a promising tool for assessing MI risk and guiding clinical prevention. Further research is required to probe into the application of CMI in different populations and its role in the prevention of CVDs.

The trend of atherogenic indices in patients with type 2 diabetes after bariatric surgery: a national cohort study

BACKGROUND

Bariatric surgery has profound effects on weight loss, metabolic regulation, and gut hormone modulation, which make it an efficient tool for managing obesity and improving diabetes outcomes.

OBJECTIVES

The objective of this study is to evaluate the atherogenic indices, including atherogenic index of plasma (AIP), atherogenic coefficient (AC), Castelli's risk index II (CRI-II), and lipoprotein combine index (LCI) in individuals with type 2 diabetes (T2D) living with excess weight, who have undergone bariatric surgery.

SETTING

Three types of surgery including one-anastomosis gastric bypass/mini gastric bypass (OAGB/MGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) were performed on patients with obesity and T2D in the period of August 2009 to February 2021 at the Surgical Department of Hazrat-e Rasool Hospital (University Hospital), Tehran, Iran.

METHODS

In this retrospective cohort, 1246 individuals with obesity and T2D who underwent 3 types of bariatric surgery including RYGB, SG, and OAGB/MGB were studied for 2years after the surgery; the data were derived from the National Iranian Obesity Surgery Database. Afterward, the trend of biochemical parameters, total weight loss (TWL%), and atherogenesis-related indices were evaluated from baseline up to 2years in 5 follow-up visits.

RESULTS

A total of 1246 patients with T2D and obesity who underwent bariatric surgery were included in this study. The trend of all atherogenesis-related indices, including AIP, LCI, CRI-II, and AC, showed a significant reduction (49.2%, 53.4%, 20.8%, 22%, respectively) 2years after the bariatric surgery (P < .05). In the 6-month follow-up, 1-year follow-up, and 2-year follow-up, 1023 (83.10%), 719 (57.70%), and 341 (27.36%) individuals participated, respectively. In addition, a significant increase in high-density lipoprotein cholesterol levels was observed 2years after the surgery in both sexes (P < .05).

CONCLUSIONS

The bariatric surgery significantly reduced the levels of atherogenic indices including AIP, CRI-II, LCI, and AC.

Effects of high-calorie diet-induced obesity on molecular structures of lipids and proteins - A multi-organ study using FTIR spectroscopy

In the presented study, we evaluated changes in the molecular structures of lipids and proteins in organs/tissues at the early stage of obesity induced by a high-calorie diet (HCD), using animal models. We examined several different molecular parameters and the organs most affected by obesity. Fourier transform infrared (FTIR) spectroscopy combined with Principal Component Analysis (PCA) and Receiver Operating Characteristic (ROC) analysis were used to evaluate molecular changes in tissues taken from HCD-induced obese Wistar rats and their lean counterparts. We observed that at the early stage of obesity, changes occurred mainly in lipid structures, primarily affecting white epididymal adipose tissue (WAT) and the liver (Lr). No changes in protein molecular structures were observed in any of the examined organs. PCA showed distinctly different organ/tissue compositions, in terms of molecular parameters, for both groups. In turn, ROC analysis indicated that fatty acid chain length (FACL), lipid unsaturation (L_Unsat), and carbonyl/lipid ratio (Carb/L) for WAT, and FACL and lipid/protein ratio (L/P) for Lr, were the molecular parameters, whose levels differentiated the most between both groups. We demonstrated that studies using FTIR spectroscopy combined with advanced data mining methods could deepen the current knowledge about obesity and the biochemical changes occurring in the organs affected by this disease. Thus, they can help in the future with better and faster diagnosis and prevention of obesity and its complications.

The interplay of heart rate variability and ventricular repolarization parameters in the obese state: a review

The impact of obesity on heart rate variability (HRV) and ventricular repolarization, both vital indicators of cardiovascular health, is the focus of this review. Obesity, measured by BMI, waist circumference, and waist-to-hip ratio, significantly increases cardiovascular disease (CVD) risk due to structural and autonomic heart changes. Findings show that obese individuals exhibit prolonged QT and Tpeak-to-Tend (Tpe) intervals, suggesting delayed ventricular recovery and greater arrhythmia risk. Additionally, obesity-induced autonomic imbalance favors sympathetic activity over parasympathetic, reducing HRV and raising arrhythmogenic potential. Elevated QT and Tpe intervals reflect extended cardiac recovery phases, which contribute to poor cardiac outcomes. The Tpe interval could serve as an early marker of cardiac dysfunction in obese populations, highlighting the importance of early intervention to reduce CVD risk and enhance treatment strategies for obesity-related cardiovascular changes.

Predictive Value of Complete Blood Count (CBC)-Derived Indices-C-Reactive-Protein-Albumin-Lymphocyte index (CALLY), Glucose-to-Lymphocyte Ratio (GLR), Prognostic Nutritional Index (PNI), Hemoglobin, Albumin, Lymphocyte, Platelet (HALP), and Controlling Nutritional Status (COUNT)-on Body Composition Changes After Bariatric Surgery

BACKGROUND/OBJECTIVE

Obesity is linked to increased risks of cardiovascular disease, diabetes, and certain cancers. Bariatric surgery (BS) aids in weight management, significantly altering body composition. This study evaluates the predictive value of five complete blood count (CBC)-derived indices [C-reactive-protein-albumin-lymphocyte (CALLY), glucose-to-lymphocyte ratio (GLR), prognostic nutritional index (PNI), hemoglobin, albumin, lymphocyte, platelet (HALP), and controlling nutritional status (COUNT)] on body composition changes post-BS.

METHOD

A retrospective study was conducted on 240 patients undergoing BS at Sina Hospital, Tehran, Iran. Indices were calculated using routine laboratory tests, and body composition changes were measured using bioelectrical impedance analysis at 3 and 6 months post-surgery.  RESULTS: Higher pre-surgical GLR values positively correlated with increased fat-free mass (FFM) (p = 0.005 1, p = 0.003 2), muscle mass (MM) (p = 0.011 1, p = 0.008 2), and total body water (TBW) (p = 0.005 1, p = 0.005 2) post-surgery. In contrast, higher PNI was negatively associated with changes in FM (p = 0.029 1, p = 0.015 2), FFM (p = 0.002 1, p = 0.018 2), TBW (p = 0.002 1, p = 0.015 2) and MM (p = 0.003 2), particularly after laparoscopic sleeve gastrectomy (LSG). Furthermore, there was a significant correlation between pre-surgical HALP score and changes in FFM (p = 0.002 1, p = 0.042 2), TBW (p = 0.002 1) and MM (p = 0.011 1, p = 0.041 2). In addition, the modified HALP score showed a more significant correlation compared to the HALP score to predict the changes FM (p = 0.002 1, p = 0.002 2), FFM (p = 0.001 1, p = 0.006 2), TBW (p = 0.001 1, p = 0.003 2) and MM (p = 0.001 1, p = 0.023 2) particularly, after 6 months.

CONCLUSION

Our findings suggest that pre-surgical assessment of GLR, PNI, and HALP indices may provide valuable insights into predicting changes in body composition after bariatric surgery. Specifically, these indices could serve as tools for tailoring preoperative nutritional strategies and post-surgical interventions. However, as this study is retrospective, further prospective research with longer follow-ups is required to validate these findings and evaluate their utility in clinical practice. 1 3 months after metabolic bariatric surgery. 2 6 months after metabolic bariatric surgery.

Sex based disparities in hospitalization and readmission outcomes for complete atrioventricular block: Insights from United States readmission data

Background

Sex disparities in cardiovascular disorders are well-documented, but data on hospitalization and readmission outcomes in the context of sex for Complete Heart Block (CHB) remains limited.

Methods

We analyzed the 2016-2020 Nationwide Readmission Database to identify patients with a principal diagnosis of CHB. Men served as the control group, while women comprised the study cohort. The primary outcome was mortality. Secondary outcomes included odds of cardiac arrest, ventricular tachycardia, heart failure, mechanical ventilation use, all-cause 30-day readmission, total and early pacemaker use, length of stay (LOS), and total hospitalization charges (THC). Multivariate regression models adjusted for confounders.

Results

Among 175,257 patients with CHB, 45% were female. Female sex was associated with higher odds of mortality (adjusted OR [aOR] 1.42, 95% CI 1.3-1.55) compared to males. Additionally, females had higher odds of cardiac arrest (aOR 1.13, 95% CI 1.06-1.2), ventricular tachycardia (aOR 1.1, 95% CI 1.05-1.17), heart failure (aOR 1.18, 95% CI 1.14-1.22), mechanical ventilation use (aOR 1.1, 95% CI 1.03-1.17), and all-cause 30-day readmission (aOR 1.1, 95% CI 1.03-1.14). Women also had lower odds of total pacemaker use (aOR 0.92, 95% CI 0.88-0.96) and early pacemaker use (aOR 0.89, 95% CI 0.86-0.82). Female patients exhibited longer LOS (4.13 days vs. 3.86 days, p < 0.001) but incurred lower THC ($89,908 vs. $94,590, p = 0.002).

Conclusion

Female sex in CHB patients was associated with higher mortality and adverse events but lower pacemaker use compared to male patients.

Women With Polycystic Ovary Syndrome and Excess Body Fat Exhibit Atypical Sympathetic Autonomic Modulation That is Partially Reversed by Aerobic Physical Training

OBJECTIVE

The aetiology of impairments in autonomic modulation of heart rate variability (HRV) in polycystic ovary syndrome (PCOS) remains unclear, as does the impact of aerobic physical training (APT) on controlling endocrine-metabolic disorders and HRV. This is because these women often present excess body fat. Therefore, we assessed whether the dysregulation in autonomic modulation of HRV in women with PCOS is due to endocrine-metabolic disorders and whether the combination of excess body fat with endocrine-metabolic disorders amplifies cardiovascular autonomic deficits. We also investigated whether APT positively influences autonomic modulation of HRV in PCOS.

DESIGN

Non-randomised clinical trial.

PARTICIPANTS

Women with and without PCOS with different percentages of body fat.

MEASUREMENTS

Participants were divided into four groups: women without PCOS with a body fat percentage between 22% and 29% (CONTROL group; 22%-29%); CONTROL (30%-37%) group; PCOS (22%-29%) group; and PCOS (30%-37%) group. Hemodynamic, metabolic, and hormonal characteristics and HRV parameters were obtained before and after 16 weeks of APT.

RESULTS

The PCOS (22%-29%) group exhibited lower vagal modulation than the CONTROL (22%-29%) group. In contrast, no significant differences were observed between the CONTROL (30%-37%) and PCOS (30%-37%) groups. Furthermore, the PCOS (30%-37%) group demonstrated lower sympathetic modulation than the PCOS (22%-29%) group. After APT, the PCOS (22%-29%) group increased in vagal modulation, while the PCOS (30%-37%) group increased in sympathetic modulation.

CONCLUSION

PCOS affects vagal modulation; however, this effect may be masked at elevated levels of body fat. Additionally, the combination of excess body fat with endocrine-metabolic dysregulation appears to reduce sympathetic modulation, possibly due to sympathetic drive hyperactivity. APT positively affected HRV in both PCOS groups.

Exploration of the shared diagnostic genes and molecular mechanism between obesity and atherosclerosis via bioinformatic analysis

Obesity (OB) and atherosclerosis (AS) represent two highly prevalent and detrimental chronic diseases that are intricately linked. However, the shared genetic signatures and molecular pathways underlying these two conditions remain elusive. This study aimed to identify the shared diagnostic genes and the associated molecular mechanism between OB and AS. The microarray datasets of OB and AS were obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) analysis and the weighted gene co-expression network analysis (WGCNA) were conducted to identify the shared genes. Then least absolute shrinkage selection (LASSO) algorithm was used for diagnostic genes discovery. The diagnostic genes were validated using expression analysis and receiver operating characteristic (ROC) curves. Furthermore, Gene set enrichment analysis (GSEA) was used to investigate molecular pathways and immune infiltration related to the diagnostic genes. TF-gene and miRNA-gene networks were also constructed by utilizing the NetworkAnalyst tool. By intersecting the key module genes of WGCNA with DEGs in OB and AS, 56 shared genes with the same expression trend were identified. Using LASSO algorithm, we obtained two shared diagnostic genes, namely SAMSN1 and PHGDH. Validation confirmed their expression patterns and robust predictive abilities. GSEA revealed the crucial roles of SAMSN1 and PHGDH in disease-associated pathways. Additionally, higher immune cell infiltration expression was found in both diseases and strongly linked to the diagnostic genes. Finally, we constructed the TF-gene and miRNA-gene networks. We identified SAMSN1 and PHGDH as potential diagnostic genes for OB and AS. Our findings provide novel insights into the molecular underpinnings of the OB-AS link.

Association between body size and atrial myopathy: Investigation using the prevalence of left atrial low-voltage areas

Background

Left atrial low-voltage areas (LVAs) are known to be associated with atrial myopathy and atrial fibrillation (AF) recurrence after catheter ablation. However, the association between body size and prevalence of LVAs has not been fully elucidated. The purpose of this study was to clarify the association between body size and the prevalence of LVAs in patients with AF ablation.

Methods

In total, 1,479 (age, 68 ± 10 years; female, 500 [34 %]) consecutive patients who underwent initial AF ablation were enrolled. Body mass index (BMI), height and body weight were used as indicators of body size. BMI was divided into four groups, namely <18.5 kg/m2, 18.5-25.0 kg/m2, 25.0-30.0 kg/m2, ≥30.0 kg/m2. LVAs were defined as areas with bipolar voltage of <0.5 mV covering ≥5 cm2 of left atrium. Rhythm outcome following the catheter ablation procedure was followed for 24 months.

Results

LVAs were found in 349 (24 %) patients. A J-curve phenomenon was found between BMI or body weight and the prevalence of LVAs. In particular, BMI <18.5 kg/m2 was an independent predictor of LVAs (odds ratio, 1.9; 95 % confidence interval: 1.01-3.5; p = 0.046). Conversely, the prevalence of LVAs increased with decreasing height. For rhythm outcome, there was a significant difference in freedom from AF recurrence among groups stratified by BMI (p = 0.001).

Conclusions

A J-curve phenomenon existed between BMI or body weight and the prevalence of LVAs, which reflects atrial myopathy, in patients with AF ablation. In contrast, the prevalence of LVAs increased with decreasing height.

Age-specific and sex-specific associations of visceral adipose tissue with metabolic health status and cardiovascular disease risk

BACKGROUND

Visceral adipose tissue (VAT) is known to play a role in the development of metabolic and cardiovascular disease (CVD). However, the age- and sex-specific associations between VAT and these diseases remain unclear.

METHODS

In this cross-sectional study, 1,150 participants (39.5% women; mean age 61.5 years) underwent VAT measurement using dual abdominal bioelectrical impedance analysis (BIA). The four age groups that the participants were divided into were 18-44, 45-59, 60-74, and ≥ 75 years. The relationships between VAT and cardiometabolic outcomes were analyzed by age and sex using multivariable logistic regression.

RESULTS

Significant associations between VAT and metabolic health status were observed in middle-aged (45-59 years; OR = 1.41, 95% CI: 1.04-1.92) and elderly adults (60-74 years; OR = 1.45, 95% CI: 1.10-1.92). VAT demonstrated age-dependent relationships with cardiovascular risk factors, with the strongest associations found in the 60-74 years group for hypertension (OR: 1.55, 95% CI: 1.22-1.98) and low high-density lipoprotein cholesterol (OR: 1.66, 95% CI: 1.33-2.08). Notably, the VAT-CVD association was most pronounced in elderly women (60-74 years; OR: 1.86, 95% CI: 1.14-3.11), while no significant associations were observed in men across all age groups.

CONCLUSIONS

The impact of VAT on metabolic and cardiovascular disease risk varies by age and sex, with particularly strong associations observed in elderly women. This highlights the need for tailored prevention and treatment strategies.

Cardiovascular Profile and Cardiovascular Imaging After Bariatric Surgery: A Narrative Review

Background and Objectives: Up until now, behavioral interventions and pharmacological therapies were the main approach available for the management of obesity. Diet and exercise, when used as a singular therapeutic method, are inadequate for a successful outcome. Research shows promising results for the surgical treatment of obesity, especially in the area of bariatric surgery (BaS). The relevance of this study is the valuable analysis of the evolution of obese patients with increased cardiovascular risk. Materials and Methods: The patients eligible for BaS commonly suffer from multiple chronic conditions, including type 2 diabetes, obstructive sleep apnea, cardiovascular diseases, and non-alcoholic fatty liver disease. Additionally, obesity contributes to an increased probability of developing certain types of cancer, osteoarthritis, urinary incontinence, and chronic kidney disease. In this review, we focused especially on the cardiovascular status of obese patients who underwent bariatric procedures. Results: BaS has been found to be strongly associated with a reduced incidence of severe complications in individuals with a history of myocardial infarction (MI) and severe obesity. Specifically, this procedure is linked to a lower occurrence of major adverse cardiovascular events and a decrease in overall mortality. Also, BaS is correlated with a reduced risk of recurrent MI and the development of new-onset heart failure. Conclusions: The results of BaS involve a significant amelioration of the BMI, contributing to a considerable decrease in cardiovascular risk factors and to a notable refinement in the cardiovascular structure and function.

The effects of carvacrol on the cardiac apoptosis gene expression levels in heart tissue of obese male rats induced by high-fat diet

Objective

Animal studies have revealed that lipid accumulation in obese mice fed with a high-fat diet (HFD) leads to alterations in the structural and functional properties of cardiovascular tissues. The current study aimed to investigate apoptosis/anti-apoptotic markers in the heart tissue of rats fed with a HFD.

Materials and Methods

Twenty-four male Wistar rats (weighing approximately 180 grams) were randomly divided into three groups (n=8 each group), including the control group (C), the high-fat diet group (HFD), and the high-fat diet + carvacrol group (HFD + Carva). Animals received a standard or HFD to induce obesity for three months. From day 61 to 90 in the HFD+Carva group, carvacrol was injected intraperitoneally (50 mg/kg) every other day. At the end of the study, the heart tissue was examined for pathological changes and the mRNA levels of TNF-α, Bcl2, Bax, and caspase3 in the heart tissue by Real Time-PCR.

Results

HFD-induced obesity led to increased TNF-α, caspase-3, and Bax and decreased Bcl-2 expression levels in heart tissue. Furthermore, histopathological changes in intracytoplasmic vacuole accumulation were evident in the HFD-obese animals. Carvacrol treatment significantly decreased the expression of Bax, TNF-α, and caspase-3 and increased the expression of Bcl-2 in heart tissue.

Conclusion

In the findings, carvacrol was found to decrease the histopathological changes caused by HFD in heart tissue by suppressing the expression of genes involved in the apoptosis pathway.

Postnatally overfed mice display cardiac function alteration following myocardial infarction

BACKGROUND

Cardiovascular (CV) pathologies remain a leading cause of death worldwide, often associated with common comorbidities such as overweight, obesity, type 2 diabetes or hypertension. An innovative mouse model of metabolic syndrome induced by postnatal overfeeding (PNOF) through litter size reduction after birth was developed experimentally. This study aimed to evaluate the impact of PNOF on cardiac remodelling and the development of heart failure following myocardial infarction.

METHODS

C57BL/6 male mice were raised in litter adjusted to 9 or 3 pups for normally-fed (NF) control and PNOF group respectively. After weaning, all mice had free access to standard diet and water. At 4 months, mice were subjected to myocardial infarction (MI). Echocardiographic follows-up were performed up to 6-months post-surgery and biomolecular analyses were carried-out after heart collection.

FINDINGS

At 4 months, PNOF mice exhibited a significant increase in body weight, along with a basal reduction in left ventricular ejection fraction (LVEF) and an increase in left ventricular end-systolic area (LVESA), compared to NF mice. Following MI, PNOF mice demonstrated a significant decrease in stroke volume and an increased heart rate compared to their respective initial values, as well as a notable reduction in cardiac output 4-months after MI. After 6-months, left ventricle and lung masses, fibrosis staining, and mRNA expression were all similar in the NF-MI and PNOF-MI groups.

INTERPRETATION

After MI, PNOF mice display signs of cardiac function worsening as evidenced by a decrease in cardiac output, which could indicate an early sign of heart failure decompensation.

Open-bore MRI Scanner Assessment of Epicardial Adipose Tissue after Bariatric Surgery: A Pilot Study

BACKGROUND

The recognition of epicardial adipose tissue (EAT) as a cardiac risk factor has increased the interest in strategies that target cardiac adipose tissue.

AIM

The effect of bariatric and metabolic surgery (BMS)-induced weight loss on EAT volume was evaluated in this study.

METHODS

Fifteen bariatric patients, with (MS) or without (wMS) Metabolic Syndrome, underwent magnetic resonance imaging (MRI) using an open-bore scanner to assess EAT volume, visceral adipose tissue (VAT) thickness, and other cardiac morpho-functional parameters at baseline and 12 months after BMS. Nine patients underwent laparoscopic sleeve gastrectomy (LSG), and 6 patients underwent Roux-en-Y Gastric Bypass (RYGBP).

RESULTS

EAT volume significantly decreased in all the patients 12 months post-BMS from 91.6 cm3 to 67.1 cm3; p = 0.0002 in diastole and from 89.4 cm3 to 68.2 cm3; p = 0.0002 in systole. No significant difference was found between the LSG and RYGBP group. Moreover, EAT volume was significantly reduced among wMS compared with MS. In particular, EAT volume in diastole was significantly reduced from 80.9 cm3 to 54.4 cm3; p = 0.0156 in wMS and from 98.3 cm3 to 79.5 cm3; p = 0.031 in MS. The reduction was also confirmed in systole from 81.2 cm3 to 54.1 cm3; p = 0.0156 in wMS and from 105.7 cm3 to 75.1 cm3; p = 0.031 in MS. Finally, a positive correlation was found between EAT loss, BMI (r = 0.52; p = 0.0443) and VAT (r = 0.66; p = 0.008) reduction after BMS.

CONCLUSION

These findings suggest that EAT reduction may be a fundamental element for improving the cardio-metabolic prognosis of bariatric patients. Moreover, this is the first study performed with an open-bore MRI scanner to measure EAT volume.

The Impact of BMI on Heart Rate During Suspension Laryngoscopy Operation in Patients With Laryngeal Lesions: A Prospective Cohort Study

OBJECTIVES

Suspension laryngoscopy can trigger vagal reflexes, leading to a decrease in heart rate, a phenomenon that is more common in patients with a high body mass index (BMI). This study aims to systematically evaluate the effect of BMI on heart rate during suspension laryngoscopy (SL-HR) in patients with laryngeal lesions.

METHODS

We employed univariate generalized linear regression and stratified analyses to assess the relationship between BMI and changes in SLHR, adjusting for confounders such as age, gender, intubation type, and depth. A generalized additive model with spline smoothing was utilized to evaluate the BMI-HR relationship, with piecewise linear regression to identify specific cutoff points.

RESULTS

We conducted a prospective study of 205 patients who underwent general anesthesia for suspension laryngoscopy. Multivariate linear regression analysis indicated that, after adjusting for covariates, each one-unit increase in BMI was associated with a decrease of 1.04 beats per minute in SL-HR (β = -1.04 [95% CI, -1.85 to -0.23]). Curve fitting revealed a gradual decline in SL-HR with increasing BMI, plateauing at around 60 beats per minute. The decrease in SL-HR became more pronounced as BMI approached 30 kg/m², with further analysis revealing an inflection point at a BMI of 28.8 kg/m², where each additional unit of BMI correlated with a 6.5 beats per minute decrease in heart rate (β = -6.5 [95% CI, -10.1 to -2.8], P < 0.001).

CONCLUSIONS

Patients with high BMI are more prone to vagal reflexes during suspension laryngoscopy, resulting in significant reductions in heart rate, especially when BMI exceeds 28.8 kg/m². Therefore, close monitoring of heart rate changes is crucial in this patient demographic, along with considering prophylactic anticholinergic agents to mitigate vagal reflex effects.

Alterations in Biomarkers Associated with Cardiovascular Health and Obesity with Short-Term Lifestyle Changes in Overweight Women: The Role of Exercise and Diet

Background and Objectives: In this study, the effects of an eight-week exercise and nutrition program on blood lipids, glucose, insulin, insulin resistance (HOMA-IR), leptin, ghrelin, irisin, malondialdehyde (MDA), and Growth Differentiation Factor 15 (GDF15) in overweight women were investigated. Materials and Methods: A total of 48 women volunteers participated in this study. The participants were randomly divided into four groups: control (C), exercise (E), nutrition (N), exercise + nutrition (E + N). While no intervention was applied to group C, the other groups participated in the predetermined programs for 8 weeks. At the beginning and end of this study, body composition was measured and blood samples were taken. Results: It was determined that the body composition components, lipid profile indicators, insulin, glucose, insulin resistance, leptin, ghrelin, irisin, and MDA parameters examined in this study showed positive changes in the intervention groups. Group E had a greater effect on body muscle percentage, MDA, and irisin levels, while group N had a greater effect on blood lipids and ghrelin levels. Conclusions: As a result, it is thought that lifestyle changes are important to improve cardiovascular health and combat obesity, and that maintaining a healthy diet together with exercise may be more effective.

Increased risk of major adverse cardiovascular events in young and middle-aged adults with obesity receiving Chinese herbal medicine: A nationwide cohort study

BACKGROUND

Many patients with obesity in Taiwan seek Chinese herbal medicines (CHM) from traditional Chinese medicine (TCM) clinics. This study aimed to estimate the risk of major adverse cardiovascular events (MACEs) in adults diagnosed with obesity, with or without CHM.

METHODS

Patients with obesity aged 18 to 50 years were identified using diagnostic codes from Taiwan's National Health Insurance Research Database between 2008 and 2018. We randomized 67 655 patients with or without CHM using propensity score matching. All patients were followed up from the start of the study until MACEs, death, or the end of 2018. A Cox proportional regression model was used to evaluate the hazard ratios of MACEs in the CHM and non-CHM cohorts.

RESULTS

During a median follow-up of 4.2 years, the CHM group had a higher incidence of MACEs than the non-CHM control cohort (9.35 vs 8.27 per 1000 person-years). The CHM group had a 1.13-fold higher risk of MACEs compared with the non-CHM control (adjusted hazard ratio [aHR] = 1.13; 95% CI], 1.07-1.19; p < 0.001), especially in ischemic stroke (aHR = 1.18; 95% CI, 1.07-1.31; p < 0.01), arrhythmia (aHR = 1.26; 95% CI, 1.14-1.38; p < 0.001), and young adults aged 18 to 29 years (aHR = 1.22; 95% CI, 1.05-1.43; p < 0.001).

CONCLUSION

Although certain CHMs offer cardiovascular benefits, young and middle-aged obese adults receiving CHM exhibit a higher risk of MACEs than those not receiving CHM. Therefore, TCM practitioners should be cautious when prescribing medications to young patients with obesity, considering their potential cardiovascular risks.

[Impact of obesity and diabetes on health and cardiovascular disease]

Obesity and type 2 diabetes mellitus (T2D) significantly increase the risk of cardiovascular diseases such as coronary artery disease, atrial fibrillation, heart failure, and sudden cardiac death. This risk is proportional to body mass index (BMI), is exacerbated by comorbidities such as hypertension and dyslipidemia, and includes emerging risk factors like insulin resistance, low-grade chronic inflammation, and thrombosis tendency. The distribution of adipose tissue, especially visceral fat and ectopic deposition in the heart, is another key factor in the development of cardiovascular diseases in these patients, along with atrial and ventricular remodeling. Bariatric surgery has been shown to be effective in reducing these risks. The prevention and treatment of cardiovascular diseases in obesity and T2D include lifestyle changes, specific pharmacological treatment and management of comorbidities, and attention to cardiovascular risk factors.

Prevalence Rates of Abdominal Obesity, High Waist-to-Height Ratio and Excess Adiposity, and Their Associated Cardio-Kidney-Metabolic Factors: SIMETAP-AO Study

BACKGROUND/OBJECTIVE

In addition to obesity, adiposity and abdominal obesity (AO) are parameters included in the cardiovascular-kidney-metabolic (CKM) syndrome. However, their prevalence and association with the other CKM factors have been less studied. Our study aimed to determine the prevalence rates of AO, high waist-to-height ratio (WtHR), and excess adiposity (EA), and to compare their associations with CKM factors.

METHODS

A cross-sectional observational study was conducted with a random population-based sample of 6,588 study subjects between 18 and 102 years of age. Crude and sex- and age-adjusted prevalence rates of AO, high-WtHR, and EA were calculated, and their associations with CKM variables were assessed by bivariate and multivariate analyses.

RESULTS

The adjusted prevalence rates for AO, high-WtHR, and EA were 39.6% (33.6% in men; 44.9% in women), 30.6% (31.1% in men; 30.6% in women), and 65.6% (65.6% in men; 65.3% in women), respectively, and they increased with age. The main independent factors associated with AO, high-WtHR, and EA were hypertension, diabetes, prediabetes, low HDL-C, hypercholesterolaemia, hypertriglyceridemia, physical inactivity, hyperuricemia, and chronic kidney disease.

CONCLUSIONS

Two-thirds of the adult population have EA, one-third have AO, and one-third have high-WtHR. These findings support that the other factors of CKM syndrome, in addition to hyperuricemia and physical inactivity, show an independent association with these adiposity-related variables.

The Correlation Between Body Mass Index and Health-Related Quality of Life: Data from Two Weight Loss Intervention Studies

INTRODUCTION

The correlation between body mass index (BMI) and utility in participants with obesity was assessed using health-related quality-of-life data collected in two weight loss intervention studies, SCALE and STEP 1.

METHODS

Short Form Health Survey 36-Item (SF-36) scores from SCALE and STEP 1 were mapped to EuroQoL-5 dimensions-3 levels (EQ-5D-3L) using an established algorithm to derive utilities for the UK. SF-36 scores from STEP 1 were converted into Short Form 6 dimension (SF-6D) utilities for Portugal using the tool developed by the University of Sheffield. The correlation between baseline BMI and utility was assessed by multiple linear regression analyses, controlling for demographic and clinical parameters.

RESULTS

A higher baseline BMI correlated with lower EQ-5D-3L and SF-6D utilities, although the trend was non-significant. Assuming linearity between BMI ranges 30-40 kg/m2, an additional unit of BMI correlated with 0.0041 and 0.0031 lower EQ-5D-3L scores in SCALE and 0.0039 and 0.0047 lower EQ-5D-3L and 0.0027 and 0.0020 lower SF-6D scores in STEP 1 for men and women, respectively.

CONCLUSION

In individuals with comparable demographic characteristics and weight-related comorbidities, a 1 unit change in BMI leads to a difference of up to 0.005 in utility indices.

TRIAL REGISTRATION

ClinicalTrials.gov identifiers: SCALE (NCT01272219) and STEP 1 (NCT03548935).

Impact of semaglutide on weight and functional outcomes among obese heart failure patients: a propensity scores matching analysis

BACKGROUND & OBJECTIVES

Obesity is a common comorbidity in heart failure, yet effective pharmacological options for weight loss in these patients are limited. Semaglutide, a glucagon-like peptide 1 receptor agonist, has shown promise for weight reduction in obese adults. This study aims to evaluate semaglutide's impact on weight loss, functional status, and clinical outcomes in obese patients with heart failure.

METHODS

A retrospective analysis was conducted on all consecutive obese (BMI > 30 kg/m²) patients with heart failure at the University Hospital Bonn outpatient clinic from July 2019 to July 2022. Propensity score matching paired patients receiving semaglutide as an add-on therapy (SEMA) with those on medical therapy alone (Control).

RESULTS

Among 1,942 patients with heart failure screened, 26 matched pairs were identified. At one year, the SEMA group exhibited significant weight loss, with a mean BMI reduction of -2.91 kg/m² (95% CI: -4.27 to -1.55; p < 0.001), while the control group showed a non-significant mean change of -0.41 kg/m² (95% CI: -1.08 to 0.26; p = 0.22). The difference in BMI between the two groups was statistically significant (mean difference: 3.42 kg/m², 95% CI: 1.43 to 5.42; p = 0.001). Improvements by at least one NYHA class were observed in 65% of the SEMA group (p < 0.001) compared to 15% of the control group (p = 0.18). The SEMA group also showed a significant increase in 6-minute walk distance (6MWD), with a mean difference of 75 m between the groups at one year (95% CI: 0.53 to 150.02; p = 0.049). NT-proBNP levels significantly decreased in the SEMA group (p < 0.001) compared to the control group (p = 0.78), with a statistically significant difference in NT-proBNP between the groups (p = 0.048). Both improvements in 6MWD and reductions in NT-proBNP were significantly correlated with BMI percentage reductions.

CONCLUSIONS

Semaglutide was associated with significant weight reduction in obese patients with heart failure, accompanied by improved NYHA classification and 6-minute walk distance. Larger, multi-center trials and prospective, randomized controlled trials are warranted. These studies should focus on assessing long-term outcomes, optimizing dosage, and exploring the potential cardiovascular benefits beyond weight reduction.

Plant-based diet and risk of all-cause mortality: a systematic review and meta-analysis

Objective

A systematic analysis was conducted to determine the relationship between a plant-based diet and all-cause mortality.

Methods

The PubMed, Embase and Web of Science databases were searched. Two authors selected English documents from the database. Then the other two authors extracted the data and evaluated the Newcastle-Ottawa Scale (NOS). This study adhered to the guidelines of the Preferred Reporting Project (PRISMA) and the PROSPERO Registry protocols. A mixed-effects model combined maximum adjusted estimates, with heterogeneity measured using the I2 statistic. The sensitivity analysis validated the analysis's robustness, while publication bias was assessed.

Results

The results of the meta-analysis of 14 articles revealed that a plant-based diet (PDI) can reduce cancer mortality (RR = 0.88, [95% CI 0.79-0.98], τ2: 0.02, I2: 84.71%), cardiovascular disease (CVD) mortality (RR = 0.81, [95% CI 0.76-0.86], τ2: 0.00, I2: 49.25%) and mortality (RR = 0.84, [95% CI 0.79-0.89], τ2: 0.01, I2: 81.99%) risk. Adherence to a healthy plant-based diet (hPDI) was negatively correlated with cancer mortality (RR = 0.91, [95% CI 0.83-0.99], τ2:0.01, I2:85.61%), CVD mortality (RR = 0.85, [95% CI 0.77-0.94], τ2: 0.02, I2: 85.13%) and mortality (RR = 0.85, [95% CI 0.80-0.90], τ2: 0.01, I2: 89.83%). An unhealthy plant-based diet (uPDI) was positively correlated with CVD mortality (RR = 1.19, [95% CI 1.07-1.32], τ2: 0.02, I2: 80.03%) and mortality (RR = 1.18, [95% CI 1.09-1.27], τ2: 0.01, I2: 89.97%) and had a certain correlation with cancer mortality (RR = 1.10, [95% CI 0.97-1.26], τ2: 0.03, I2: 93.11%). Sensitivity analysis showed no contradictory results.

Conclusion

The hPDI was negatively associated with all-cause mortality, and the uPDI was positively associated with all-cause mortality.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#loginpage.

A Saudi Heart Association Position Statement on Obesity and Cardiovascular Disease

OBJECTIVES

The obesity pandemic is a major public health concern in Saudi Arabia, with significant impact on cardiovascular disease (CVD). This position statement aims to provide an overview of available evidence as well as the recommendations of the Saudi Heart Association on the management of obesity associated with CVD.

METHODS

Under the auspices of the Saudi Heart Association, a multidisciplinary expert panel comprised of cardiologists and endocrinologists discussed available evidence and provided recommendations on the management of obesity in CVD. The expert panel discussions occurred between September of 2023 and May of 2024 and also took into consideration local expertise in addition to published data in the management of obesity and CVD in the Kingdom of Saudi Arabia.

RESULTS AND CONCLUSIONS

The expert panel explored studies on obesity and its implication on CVD assessment modalities, while also examining the efficacy and cardiovascular safety of available interventions for weight reduction. The association between obesity and CVD is undeniable. The treatment of obesity, be it through lifestyle changes, pharmacological therapy or surgery, is an effective strategy for both weight loss as well as the primary and secondary prevention of CVD. The Saudi Heart Association position statement thus provides guidance and recommendations for the management of obesity/overweight and CVD in Saudi Arabia. This position statement is expected to contribute towards obesity and CVD prevention efforts in Saudi Arabia by promoting adequate and time-appropriate treatment of these conditions.

Comprehensive Multiple Risk Factor Control in Type 2 Diabetes to Mitigate Heart Failure Risk: Insights From a Prospective Cohort Study

OBJECTIVE

The impact of comprehensive risk factor control on heart failure (HF) risk and HF-free survival time in individuals with type 2 diabetes (T2D) was evaluated in this study.

RESEARCH DESIGN AND METHODS

This prospective study included 11,949 individuals diagnosed with T2D, matched with 47,796 non-T2D control study participants from the UK Biobank cohort. The degree of comprehensive risk factor control was assessed on the basis of the major cardiovascular risk factors, including blood pressure, BMI, LDL cholesterol, hemoglobin A1c, renal function, smoking, diet, and physical activity. Cox proportional hazards models were used to measure the associations between the degree of risk factor control and HF risk. Irwin's restricted mean was used to evaluate HF-free survival time.

RESULTS

During a median follow-up of 12.3 years, 702 individuals (5.87%) with T2D and 1,402 matched control participants (2.93%) developed HF. Each additional risk factor controlled was associated with an average 19% lower risk of HF. Optimal control of at least six risk factors was associated with a 67% lower HF risk (hazard ratio [HR] 0.33; 95% CI 0.20, 0.54). BMI was the primary attributable risk factor for HF. Notably, the excess risk of HF associated with T2D could be attenuated to levels comparable to those of non-T2D control participants when individuals had a high degree of risk factor control (HR 0.66; 95% CI 0.40, 1.07), and they exhibited a longer HF-free survival time.

CONCLUSIONS

Comprehensive management of risk factors is inversely associated with HF risk, and optimal risk factor control may prolong HF-free survival time among individuals with T2D.

Relationship between coronary artery disease with dyslipidaemia and trace mineral intake: a cross-sectional analysis of the Shika study

Although the relationship between dyslipidaemia (DL) and coronary artery disease (CAD) or between trace minerals intake and CAD is well known separately, the exact nature of this relationship remains unknown. We hypothesize that the relationship between trace mineral intake and CAD may differ depending on whether or not the individual has DL. The present study analysed the relationships among trace mineral intake, DL, and CAD in middle-aged and older adults living in Shika town, Ishikawa prefecture, Japan. This study included 895 residents following the exclusion of those with genetic risk carriers for familial hypercholesterolemia. Trace mineral intake was evaluated using the brief-type self-administered diet history questionnaire. Interactions were observed between DL and CAD with zinc (p = 0.004), copper (p = 0.010), and manganese intake (p < 0.001) in a two-way analysis of covariance adjusted for covariates such as sex, age, body mass index, and current smokers and drinkers. Multiple logistic regression analysis showed that zinc (odds ratio (OR): 0.752; 95% confidence interval (CI): 0.606, 0.934; p = 0.010), copper (OR: 0.175; 95% CI: 0.042, 0.726; p = 0.016), and manganese (OR: 0.494; 95% CI: 0.291, 0.839; p = 0.009) were significant independent variables for CAD in the dyslipidaemic group. The present results suggest that DL with a low trace mineral intake is associated with CAD. Further longitudinal studies are required to confirm this relationship.

Oxidative Stress: The Hidden Catalyst Fueling Atherosclerosis and Cardiovascular Disease

Atherosclerosis is a pathological condition characterized by the inflammation of arterial vessels, leading to serious cardiovascular outcomes such as myocardial infarction, stroke, and death [...].

Cardiovascular disease and cancer: shared risk factors and mechanisms

Cardiovascular disease (CVD) and cancer are among the leading causes of morbidity and mortality globally, and these conditions are increasingly recognized to be fundamentally interconnected. In this Review, we present the current epidemiological data for each of the modifiable risk factors shared by the two diseases, including hypertension, hyperlipidaemia, diabetes mellitus, obesity, smoking, diet, physical activity and the social determinants of health. We then review the epidemiological data demonstrating the increased risk of CVD in patients with cancer, as well as the increased risk of cancer in patients with CVD. We also discuss the shared mechanisms implicated in the development of these conditions, highlighting their inherent bidirectional relationship. We conclude with a perspective on future research directions for the field of cardio-oncology to advance the care of patients with CVD and cancer.

Outcomes of myocardial revascularization in patients with obesity and multivessel coronary artery disease

BACKGROUND

There is uncertainty regarding the best revascularization approach-whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)-for obese patients suffering from multi-vessel coronary artery disease.

RESULTS

406 patients with low and intermediate SYNTAX scores (SS) underwent PCI with drug-eluting stents (n = 200, 100 with SS ≤ 22, and 100 with SS 23-32) and CABG (n = 206, 100 with SS ≤ 22, and 106 with SS 23-32). Patients were also categorized by body mass index (BMI): normal weight (12%, 48 patients), overweight (41.6%, 169 patients), and obese (46.6%, 189 patients). The follow-up period averaged 9 ± 1.9 years. The endpoints of the study were as follows: major adverse cardiac and cerebrovascular events, a repeat revascularization, diminished left ventricular ejection fraction (LVEF), and high SS (≥ 33) observed over time. When comparing PCI and CABG in overweight individuals, the risk of myocardial infarction (MI) following PCI was greater than after CABG (Hazard Ratio [HR] 2.7, 95% Confidence Interval [CI] 1.1-6.7, p = 0.03). In patients with overweight and Class I obesity, CABG was associated with the risk of coronary atherosclerosis progression (SS ≥ 33) (HR 4.4, 95% CI 1.5-13, p = 0.009 and HR 4.9, 95% CI 1.9-12, p = 0.001, respectively); whereas PCI was connected with the likelihood of repeat revascularization (HR 2.7, 95% CI 1.6-4.55, p < 0.0001 and HR 2, 95% CI 1.3-3.1, p = 0.002, respectively). At the same time, for stented patients, Class III obesity was associated with the risk of repeat revascularization (HR 2.5, 95% CI 1.02-6, p = 0.044).

CONCLUSION

There were no significant weight-related impacts on long-term outcomes among patients who underwent surgery. Whereas in stented patients, Class III obesity was associated with the risk of repeat revascularization. When comparing PCI and CABG, for overweight and Class I obesity patients, CABG was associated with a likelihood of coronary atherosclerosis progression (SS ≥ 33), while PCI was linked to the risk of repeat revascularization. For overweight patients, CABG outperformed PCI in terms of the risk of MI. For other adverse events in patients of different weight categories, PCI and CABG did not reveal any significant benefits.

Anti-obesity effects and underlying molecular mechanisms of the ethanolic extract of figs from Ficus hispida using high fat-fed wister rats

Obesity is a known risk factor for many chronic diseases and a substantial threat to public health. We investigated the effects of figs sourced from Ficus hispida on a high fat-fed experimental rat model. We found that a 500-mg dose of ethanolic extract of figs (EFH) reduced oxidative stress markers nitric oxide (NO), malondialdehyde (MDA), and advanced oxidation protein products (AOPP), which were increased in high fat-fed rats. Antioxidant enzymes superoxide dismutase (SOD), catalase, reduced glutathione (GSH), and myeloperoxidase (MPO), found elevated in high fat-fed rats, were also normalized to nearly regular levels by fig treatment. Administration of EFH further reduced fat deposition and expression of adipogenic genes leptin, fatty acid synthase (FAS), peroxisome proliferator-activated receptor gamma (PPARγ), and sterol regulatory element-binding protein-1c (SERBP-1c). Our results suggest that figs have significant effects on reducing oxidative stress and mitigating obesity-associated liver and adipose tissue abnormalities via suppressing adipogenesis. Thus, we propose that F. hispida has potential benefits in reducing obesity.

Impact of obesity on echocardiographic parameters in individuals free of CVD using anthropometric measurements

Obesity is a global pandemic and is a recognised risk factor for cardiovascular diseases. However, its impact on cardiac structure and function using echocardiography, as well as its association with anthropometric parameters in otherwise healthy individuals, requires further investigation. Therefore, we conducted an observational study with a cohort of 196 participants, comparing various echocardiographic parameters in normal weight individuals and those who were overweight or obese but had no other risk factors. Our findings revealed that obese participants had significant changes in echocardiographic measurements of the structure and functions of the left ventricle, left ventricular global longitudinal strain, left atrium, right ventricle and right ventricular global longitudinal strain compared with the control group. Body surface area and body mass index were important anthropometric features that correlated with the above echocardiographic changes, and should be routinely evaluated to assess cardiovascular risk in patients. Further larger studies are necessary to determine the clinical significance of the echocardiographic changes observed in obese individuals and their impact on health.

Lycium chinense Mill Induces Anti-Obesity and Anti-Diabetic Effects In Vitro and In Vivo

This study investigated the effects of Lycium chinense Mill (LCM) extract on obesity and diabetes, using both in vitro and high-fat diet (HFD)-induced obesity mouse models. We found that LCM notably enhanced glucagon-like peptide-1 (GLP-1) secretion in NCI-h716 cells from 411.4 ± 10.75 pg/mL to 411.4 ± 10.75 pg/mL compared to NT (78.0 ± 0.67 pg/mL) without causing cytotoxicity, implying the involvement of Protein Kinase A C (PKA C) and AMP-activated protein kinase (AMPK) in its action mechanism. LCM also decreased lipid droplets and lowered the expression of adipogenic and lipogenic indicators, such as Fatty Acid Synthase (FAS), Fatty Acid-Binding Protein 4 (FABP4), and Sterol Regulatory Element-Binding Protein 1c (SREBP1c), indicating the suppression of adipocyte differentiation and lipid accumulation. LCM administration to HFD mice resulted in significant weight loss (41.5 ± 3.3 g) compared to the HFD group (45.1 ± 1.8 g). In addition, improved glucose tolerance and serum lipid profiles demonstrated the ability to counteract obesity-related metabolic issues. Additionally, LCM exhibited hepatoprotective properties by reducing hepatic lipid accumulation and diminishing white adipose tissue mass and adipocyte size, thereby demonstrating its effectiveness against hepatic steatosis and adipocyte hypertrophy. These findings show that LCM can be efficiently used as a natural material to treat obesity and diabetes, providing a new approach for remedial and therapeutic purposes.

Salvia miltiorrhiza stem-leaf of total phenolic acid conversion products alleviate myocardial ischemia by regulating metabolic profiles, intestinal microbiota and metabolites

Myocardial ischemia (MI) is a significant contributor to ischemic heart diseases like angina pectoris and myocardial infarction. Reactive oxygen species produced during MI can trigger lipid peroxidation, damaging cell structure and function. Salvia miltiorrhiza (SM) has been widely used clinically in the treatment of cardiovascular diseases. However, in the process of rooting, the aboveground parts of this plant are usually discarded by tons. To make better use of these plant resources, the phenolic acids extracted and purified from the aerial part of SM were studied and chemically transformed, and the potential protective effect and possible mechanism of salvianolic acids containing a higher content of salvianolic acid A on MI were obtained. The transformed products of SM stem-leaves total phenolic acids with 8.16 % salvianolic acid A showed a better protective effect on the isoproterenol (ISO)-induced acute MI injury rat model. It can improve ST segment changes and has good antioxidant, anti-inflammatory and anticoagulant effects. In addition, the dysbiosis of gut microbiota and the related metabolic levels of short chain fatty acids (SCFAs), phenylalanine and glycerophospholipids were improved. This was achieved by reducing the abundance of Bacteroides, Faecalibaculum, and L-phenylalanine levels. In addition, the abundance of probiotics in Butyricoccus, Roseburia, and norank_f_Eubacterium_coprostanoligenes_group, as well as the contents of propionic acid and isobutyric acid, LPCs and PCs were increased. In conclusion, total phenolic acids of SM stem-leaves showed protective effects against ISO-induced rats, especially the strongest effect after conversion, which is a new option for the prevention and treatment of MI.

Perindopril and losartan affect ACE-2 and IL- 6 expression in obese rat model

Obesity has emerged as a worldwide health concern due to its increasing prevalence. Adipocytes have the ability to express angiotensin-converting enzyme 2 receptors (ACE2) and several adipocytokines. These expressions could lead to the activation of a cytokine storm, which in turn promotes the development of cardiovascular diseases. The aim of this study was to investigate the impact of perindopril and losartan exposure on the ACE2 and interleukin 6 (IL-6) levels in adipocyte cells. This study used an in vivo true experimental design utilizing a post-test-only control group. A total of 24 adult male albino rats were divided into four groups, one group served as the non-obese (negative control), while the other three groups were obese: (1) the positive control (untreated obese rats); (2) perindopril group (2 mg/kg BW/day orally for 4 weeks); and (3) losartan group (20 mg/kg BW/day for 4 weeks). Afterwards, the rats were euthanized, and the visceral fat tissue were obtained during dissection. The levels of ACE2 and IL-6 were measured using the enzyme-linked immunosorbent assay (ELISA). Losartan administration in obese rats resulted in a notable elevation in ACE2 levels compared to both the perindopril group (losartan vs perindopril, p=0.011) and the positive control (p=0.004). In addition, the treatment of perindopril and losartan in obese rats resulted in a significant reduction in IL-6 levels when compared to the positive control (perindopril vs positive control, p=0.020; losartan vs positive control, p=0.002, respectively). This study provides insight into the administration of perindopril and losartan, which could suppress the pro-inflammatory (IL-6) but increase the ACE2 levels in adipose tissue.

The Effect of Obesity on Short- and Long-Term Outcome after Surgical Treatment for Acute Type A Aortic Dissection

BACKGROUND

A paradox of lower morbidity and mortality in overweight or obese patients undergoing cardiac surgery has been described; however, knowledge about the influence of obesity in patients with acute Type A aortic dissection (AAD) is limited. This study aimed to evaluate the effect of obesity on short- and long-term outcomes after surgical treatment for AAD.

METHODS

Between 01/2004 and 12/2022, 912 patients with a BMI of 18.5 or greater were operated on for AAD. Patients were grouped according to their BMI (normal weight: BMI 18.5-24.9, n = 332; overweight: BMI 25-29.9, n = 367; obesity class I: BMI 30-34.9, n = 133; obesity class II+: BMI ≥ 35, n = 67), and the obtained clinical and surgical data were compared.

RESULTS

Obese patients were younger at the time of AAD (p = 0.001) and demonstrated higher rates of typical cardiovascular comorbidities (arterial hypertension, p = 0.005; diabetes mellitus, p < 0.001). The most important preoperative parameters, as well as the surgical approach, were similar between all four groups. The occurrence of renal failure requiring dialysis was higher in patients with BMI ≥ 35 (p = 0.010), but the in-hospital (p = 0.461) and long-term survival (p = 0.894) showed no significant differences.

CONCLUSIONS

There are no indications that the obesity paradox is applicable in the setting of AAD. Since obese patients are affected by AAD at a younger age, obesity might constitute a risk factor for AAD. However, obesity does not influence short- or long-term survival. Regardless of body weight, immediate surgical therapy remains the treatment of choice for AAD.

Usefulness of the ECORE-BF Scale to Determine Atherogenic Risk in 386,924 Spanish Workers

BACKGROUND

Cardiovascular diseases are the leading cause of death worldwide. Obesity and atherosclerosis are considered risk factors for this pathology. There are multiple methods to evaluate obesity, in the same way as there are different formulas to determine atherogenic risk. Since both pathologies are closely related, the objective of our work was to evaluate whether the ECORE-BF scale is capable of predicting atherogenic risk.

METHODS

Observational, descriptive, and cross-sectional study in which 386,924 workers from several autonomous communities in Spain participated. The association between the ECORE-BF scale and five atherogenic risk indices was evaluated. The relationship between variables was assessed using the chi-square test and Student's t test in independent samples. Multivariate analysis was performed with the multinomial logistic regression test, calculating the odds ratio and 95% confidence intervals, with the Hosmer-Lemeshow goodness-of-fit test. ROC curves established the cut-off points for moderate and high vascular age and determined the Youden index.

RESULTS

The mean values of the ECORE-BF scale were higher in individuals with atherogenic dyslipidemia and the lipid triad, as well as in those with elevated values of the three atherogenic indices studied, with p <0.001 in all cases. As atherogenic risk increased across the five evaluated scales, the prevalence of obesity also significantly increased, with p <0.001 in all cases. In the ROC curve analysis, the AUCs for atherogenic dyslipidemia and the lipid triad were above 0.75, indicating a good association between these scales and the ECORE-BF. Although the Youden indices were not exceedingly high, they were around 0.5.

CONCLUSIONS

There is a good association between atherogenic risk scales, atherogenic dyslipidemia, and lipid triad, and the ECORE-BF scale. The ECORE-BF scale can be a useful and quick tool to evaluate atherogenic risk in primary care and occupational medicine consultations without the need for blood tests.

Effects of combined morbid insomnia and sleep apnea on long-term cardiovascular risk and all-cause mortality in elderly patients: a prospective cohort study

PURPOSE

It is reported that insomnia and obstructive sleep apnea (OSA) increase the incidence of adverse cardiovascular events. The aim of this study was to analyze the risk of cardiovascular disease and mortality in elderly patients with comorbid insomnia and obstructive sleep apnea (COMISA).

METHODS

We included 868 elderly patients with OSA who underwent sleep monitoring at a multicenter sleep room from January 2015 to October 2017. We collected demographic data, clinical features, medical history, sleep parameters, and laboratory findings. Cox proportional hazards analysis was used to identify the relationship between COMISA and adverse cardiovascular events and all-cause mortality.

RESULTS

There were 181 elderly patients with COMISA. The median follow-up was 43 months, during which we observed major adverse cardiac events (MACE) in 90 patients. The Kaplan-Meier survival curve indicated a significant relationship between COMISA and MACE (Plog Rank < 0.001). Multivariate Cox regression analysis showed that COMISA increased the incidence of MACE (HR = 2.328, 95% CI: 1.349-4.018, P = 0.002), hospitalization for unstable angina (HR = 2.915, 95% CI: 1.397-6.081, P = 0.004), and the combination of all events (HR = 2.301, 95% CI: 1.393-3.803, P = 0.001). However, there were no significant differences in cardiovascular death, all-cause mortality, myocardial infarction, or hospitalized heart failure in patients with COMISA (P > 0.05). Subgroup analyses showed that among COMISA patients, male sex (HR = 2.800, 95% CI: 1.458-5.377, P = 0.002), age < 70 years (HR = 4.050, 95% CI: 2.022-8.115, P < 0.001), and overweight and obesity (HR = 2.482, 95% CI: 1.383-4.453, P = 0.002) were associated with a higher risk of MACE.

CONCLUSIONS

Our results showed that COMISA increased the risk of MACE, unstable angina, and the compound occurrence of all events. Male, overweight or obese COMISA patients under 70 years of age have an increased risk of MACE.

Medicinal Plant Extracts against Cardiometabolic Risk Factors Associated with Obesity: Molecular Mechanisms and Therapeutic Targets

Obesity has increasingly become a worldwide epidemic, as demonstrated by epidemiological and clinical studies. Obesity may lead to the development of a broad spectrum of cardiovascular diseases (CVDs), such as coronary heart disease, hypertension, heart failure, cerebrovascular disease, atrial fibrillation, ventricular arrhythmias, and sudden cardiac death. In addition to hypertension, there are other cardiometabolic risk factors (CRFs) such as visceral adiposity, dyslipidemia, insulin resistance, diabetes, elevated levels of fibrinogen and C-reactive protein, and others, all of which increase the risk of CVD events. The mechanisms involved between obesity and CVD mainly include insulin resistance, oxidative stress, inflammation, and adipokine dysregulation, which cause maladaptive structural and functional alterations of the heart, particularly left-ventricular remodeling and diastolic dysfunction. Natural products of plants provide a diversity of nutrients and different bioactive compounds, including phenolics, flavonoids, terpenoids, carotenoids, anthocyanins, vitamins, minerals, fibers, and others, which possess a wide range of biological activities including antihypertensive, antilipidemic, antidiabetic, and other activities, thus conferring cardiometabolic benefits. In this review, we discuss the main therapeutic interventions using extracts from herbs and plants in preclinical and clinical trials with protective properties targeting CRFs. Molecular mechanisms and therapeutic targets of herb and plant extracts for the prevention and treatment of CRFs are also reviewed.

The association between the visceral to subcutaneous abdominal fat ratio and the risk of cardiovascular diseases: a systematic review

BACKGROUND

Cardiovascular diseases (CVDs) are the primary cause of mortality globally. The prevalence of obesity is rising worldwide; there seems to be a significant positive association between obesity and CVDs. The distribution of fat in the abdominal area in the form of visceral (VAT) or subcutaneous adipose tissue (SAT) affects the risk of CVDs. The aim of the present study was to conduct a systematic review of the available literature regarding the association between the VAT-to-SAT ratio and CVDs.

METHODS

A comprehensive search strategy was used to retrieve all human observational studies indexed in PubMed, Scopus and Google Scholar databases/search engines (from Jan 2000 up to Oct 2023). The VAT-to-SAT or SAT-to-VAT ratio was an independent variable and various cardiovascular diseases, including hypertension, atherosclerosis, coronary heart disease, cerebrovascular disease and heart failure, were considered as outcomes of interest.

RESULTS

Out of 1173 initial studies, 910 papers were screened. Based on the inclusion criteria, 883 papers were excluded. Finally, 27 papers (18 cross-sectional and 9 cohort studies) published between 2010 and 2023 which met the inclusion criteria were reviewed.

CONCLUSIONS

The distribution of abdominal fat seems to be associated with the risk of CVDs; the majority of the evidence suggests that a higher abdominal VAT-to-SAT ratio is associated with the development of CVDs. Therefore, this ratio can be used as a prognostic indicator for CVDs.

TRIAL REGISTRATION

Not applicable.

Association between sequelae of COVID-19 with periodontal disease and obesity: A cross-sectional study

BACKGROUND

To assess the sequelae of coronavirus disease 2019 (COVID-19) and associated factors, such as obesity and periodontitis in adults.

METHODS

The study included 128 individuals aged ≥35 years with a history of a diagnosis of COVID-19 through real-time polymerase chain reaction (RT-PCR), from Pelotas, Brazil. Self-report sequelae from COVID-19 were defined as the primary outcome. A questionnaire containing sociodemographic, medical, behavioral and self-report of sequelae of COVID-19 was applied. A complete periodontal clinical examination was performed. Weight and height were assessed. Uni-, bi- and multivariate analyses were performed using Poisson regression with robust variance. Additional analyses were performed considering obesity as a subgroup.

RESULTS

When considering the whole sample, no statistically significant associations between sequelae of COVID-19 with periodontitis (prevalence ratio [PR]:1.14;95% confidence interval [95%CI]: 0.80-1.61) and obesity (0.93 [0.68-1.26]) were identified. In the subgroup analysis, considering only individuals with obesity, those diagnosed with generalized periodontitis had 86% higher probability to have sequelae of COVID-19 when compared to individuals with periodontal health or localized periodontitis. However, when only those without obesity were considered, no significant association with periodontal status was detected (0.82 [0.55-1.23). No significant association with periodontal status were observed when the severity of sequelae (no sequelae, 1 sequela, and >1 sequela) were considered (p > 0.05).

CONCLUSIONS

Individuals diagnosed with obesity and periodontitis have a higher PR of reporting sequelae from COVID-19 compared to individuals with only obesity.

The Prevalence of Bradycardia 12 Years After Roux-en-Y Gastric Bypass for Severe Obesity

PURPOSE

The aim was to describe the frequency of bradycardia 12 years after Roux-en-Y gastric bypass (RYGB), relations to weight loss, patient characteristics, and the clinical impact.

MATERIALS AND METHODS

The BAROPS study is a prospective observational study of patients who had follow-up > 10 years after RYGB. Patients with heart rate (HR) ≤ 50 bpm were compared to patients with HR > 50 bpm.

RESULTS

After a mean observation period of 12 years, 32 of 546 patients (6%) had a HR ≤ 50 with a mean HR of 47.0 (2.8) bpm. The comparator group (192 patients) had a mean HR of 66.4 (10.2) bpm (p < 0.001). A higher proportion of the bradycardic vs. non-bradycardic patients (18.8% vs. 7.8% at baseline (p = 0.05) and 18.8% vs. 5.2% at end of study (p = 0.006)) used beta-blockers. Both groups had a significant reduction in heart rate from pre-surgery to end of observation. Percent total weight loss from baseline was negatively related to heart rate (p < 0.001), and smoking was positively related to heart rate (p = 0.014). Change in BMI from pre-surgery (p < 0.001) and hypertension at pre-surgery (p = 0.006) were significant predictors of change in heart rate. The only predictor of HR ≤ 50 was the use of beta-blockers (p = 0.010). There were no difference in bradycardia-related symptoms.

CONCLUSION

Six percent of patients had HR ≤ 50 bpm 12 years after RYGB, but there was no increased bradycardia-related symptoms in these patients. RYGB induced a significant reduction in HR, and heart rate and changes in heart rate 12 years after RYGB were related to the amount of weight loss.

A latent profile analysis based on diet quality and eating behaviours in participants of the PREDISE study characterized by a higher BMI

The aim of this study was to identify eating-related latent profiles based on diet quality and eating behaviours within a population characterized by a body mass index (BMI) of at least 25 kg/m2, and to compare metabolic variables between profiles. This analysis was conducted in a sample of 614 adults (45.6% women; 44.8 ± 12.9 years) from the cross-sectional PREDISE study. Participants completed the Three-Factor Eating Questionnaire, the Intuitive Eating Scale-2, the Regulation of Eating Behavior Scale, and three self-administered 24 h food recalls. Waist circumference, blood lipids, blood pressure, and fasting glucose were measured to identify carriers of the metabolic syndrome. A latent profile analysis was performed, and cases of metabolic syndrome were compared between profiles. A three-profile solution was found. Profile 1 (22.8%) was characterized by lower diet quality, lower self-determined motivation for eating, lower restraint, and higher intuitive eating. Profile 2 (44.5%) was characterized by higher diet quality, higher self-determined motivation for eating, higher restraint, lower disinhibition, and higher intuitive eating. Profile 3 (32.7%) was characterized by intermediate diet quality, higher non-self-determined motivation for eating, higher restraint and disinhibition, and lower intuitive eating. We found fewer cases of metabolic syndrome among participants in profile 2 than in the other profiles (p = 0.0001). This study suggests that a profile characterized by a lower disinhibition and higher levels of restraint, intuitive eating, self-determined motivation, and diet quality is associated with a better metabolic health among individuals with a higher BMI.

Neck Circumference Cut-Off Points for Identifying Adiposity: Association with Chronic Metabolic Diseases in Older People

BACKGROUND

The leading cause of death in older people is cardiovascular diseases. Several studies have found that neck circumference (NC) is a simple anthropometric marker associated with adiposity. The aim of this study is to estimate and validate NC cut-off points as adiposity markers and analyze their association with cardiovascular and chronic metabolic diseases in older people.

METHODS

A cross-sectional study in 358 non-disabled, community-dwelling older people (71.7 ± 3.9 years) living in Santiago de Chile and participating in the HTSMayor study was conducted. Measurements of body composition and cardiovascular risks were evaluated. Receiver operating characteristic (ROC) curves and multiple logistic regression models were used to evaluate the association of NC with cardiovascular and chronic metabolic diseases. NC cut-off points were obtained to predict obesity, abdominal obesity, and adiposity.

RESULTS

The best performance values of neck circumference relative to obesity and adiposity were obtained with respect to abdominal obesity (40.6 cm in men and 34.2 cm in women). Higher NC values were associated with a higher area under the curve (AUC) for men and women (men: AUC = 0.84; women: AUC = 0.86). NC was significantly associated with a higher risk for diabetes mellitus (OR = 1.95), hypertension (OR = 2.42), acute myocardial infarction (OR = 4.36), and comorbidities (OR = 2.01), and a lower risk for sarcopenia (OR = 0.35).

CONCLUSIONS

This study shows that NC is a useful tool for detecting abdominal obesity, obesity, and adiposity in older people and that a higher NC increases the risk of chronic diseases.