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Al-Kayed J, Okoli CC. General Factors That Reduce Cardiovascular Risk in People With Schizophrenia: A Systematic Review. J Cardiovasc Nurs 2024; 39:E198-E211. [PMID: 37747326 DOI: 10.1097/jcn.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND The life expectancy of individuals with schizophrenia in the United States is 20% shorter than that of the general population owing to cardiovascular disease (CVD). It is crucial to identify the factors that reduce CVD risk in these individuals. OBJECTIVE In this systematic review, we examined the factors associated with CVD in people with schizophrenia. METHODS We searched 3 electronic databases for English articles published before April 2023. Investigators assessed the factors associated with 2 cardiovascular health outcomes among people with schizophrenia: the 10-year coronary heart disease (CHD)/CVD risk and peak oxygen uptake (VO 2Peak/max ). RESULTS We retrieved 17 studies from the search. Investigators examined factors affecting 10-year CHD/CVD risk in 11 studies and VO 2Peak/max in 6 studies among people with schizophrenia. We found that individuals who had low metabolic symptoms (ie, hypertension and hyperglycemia), did not smoke, engaged in continuous CVD risk assessments, had a shorter duration of the diagnosis and hospitalization, and were of normal weight had a lower 10-year CHD/CVD risk. Furthermore, individuals who engaged in specific physical activity had a higher VO 2Peak/max . Finally, those taking antipsychotic medications had a higher 10-year CHD/CVD risk and a lower VO 2Peak/max . CONCLUSIONS The CVD risk factors observed in the general population are common among people with schizophrenia. When these risk factors are controlled, the 10-year CHD/CVD risk and VO 2Peak/max of these individuals may be improved. Given the elevated CVD risk associated with antipsychotic medications, future researchers should examine modifying CVD risk factors to mitigate the additional risks associated with medication use in this population.
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Zhang Z, Du C, Zhong X, Wang R, Tang L, Liu X. The secondary prevention of coronary heart disease in US adults 75 Years and older in daily practice: Results from the National Health and Nutrition Examination Survey 1999-2018 survey. Heliyon 2024; 10:e28239. [PMID: 38571641 PMCID: PMC10987917 DOI: 10.1016/j.heliyon.2024.e28239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Background Pharmacologic therapies, risk factor control, and lifestyle alterations were independently proven to reduce long-term cardiovascular events. However, comprehensive research examining the extent to which individuals aged 75 and above in the United States adhere to national guidelines for the secondary prevention of coronary heart disease is limited. Therefore, the primary objective of this study was to examine the current state of secondary prevention of coronary heart disease in persons 75 years of age and older in the United States and to examine the factors that contribute to inadequate drug utilization and poor control of numerous risk factors. Methods We identified patients over 75 years of age with coronary heart disease based on the National Health and Nutrition Examination Survey from 1999 to 2018 and analyzed the adequacy of risk factor control and adherence to lifestyle and medication recommendations to assess the effectiveness of coronary heart disease management. Logistic regression analysis was used to identify factors associated with uncontrolled risk factors or noncompliance with recommended medications. Results We collected information from 1566 known coronary heart disease patients aged ≥75 years of age. The majority were at target goals for blood pressure (58.88%), low-density lipoprotein cholesterol (66.85%), and glycated hemoglobin (76.12%). Only 27.8% and 36.06% were at targets for body mass index and waist circumference, respectively. 91.95% reported smoking cessation, 85.98% followed recommended alcohol consumption, whereas only 10.34% reported sufficient physical activity. For β blockers, angiotensin -converting enzyme inhibitors/angiotensin receptor blockers, statins, and antiplatelet drugs, the utilization of indicated therapy was 54.41%, 49.36%, 54.79%, and 19.03%, respectively (6.26% for all 4 medications). The results of the logistic regression analysis demonstrated that diabetes mellitus and metabolic syndrome were critical markers of numerous uncontrolled risk variables as well as noncompliance with medication regimens. Conclusions A vast majority of coronary heart disease patients ≥75 years in the USA exhibited suboptimal overall control of critical coronary heart disease risk factors. For this patient population, more knowledge is necessary to enable patients to receive continuous support, guidance, and counseling.
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Affiliation(s)
- Zhi Zhang
- Department of Cardiology, First People's Hospital of Linping District, Hangzhou, Zhejiang 311199, PR China
| | - Changqing Du
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
| | - Xin Zhong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Ruilin Wang
- Department of Radiology, Zhejiang Hospital, Hangzhou, Zhejiang, 310013, PR China
| | - Lijiang Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
| | - Xiaowei Liu
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
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Ramezankhani A, Azizi F, Hadaegh F. Sex differences in risk factors for coronary heart disease events: a prospective cohort study in Iran. Sci Rep 2023; 13:22398. [PMID: 38104178 PMCID: PMC10725458 DOI: 10.1038/s41598-023-50028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/14/2023] [Indexed: 12/19/2023] Open
Abstract
We investigated sex-specific associations and their differences between major cardiovascular risk factors and the risk of incident coronary heart disease (CHD) and hard CHD (defined as nonfatal myocardial infarction and CHD death). A total of 7518 (3377 men) participants from the Tehran Lipid and Glucose Study were included. Cox models were used to estimate the hazard ratios (HRs) and women-to-men ratios of HRs for CHD events associated with each risk factor. During 20 years of follow-up (1999-2018), 1068 (631 men) and 345 (238 men) new cases of CHD and hard CHD, respectively, were documented. In total population, the incidence rates per 1000 person-years were 9.5 (9.0-10.1) and 2.9 (2.6-3.2) for CHD and hard CHD, respectively. Hypertension, diabetes, pre-diabetes, and a high waist-to-hip ratio (WHR) were associated with a greater HR of hard CHD in women than men; the women-to-men HRs were 2.85 [1.36-5.98], 1.92 [1.11-3.31], 2.04 [1.09-3.80] and 1.42 [1.10-1.82], respectively. Diabetes was associated with a higher HR of CHD in women than men (ratio of HRs 1.49 (1.10-2.01). In conclusion, we found that hypertension, diabetes, pre-diabetes, and high WHR conferred a greater excess risk of CHD events in women than in men, suggesting that Iranian women may require greater attention for the prevention of CHD events.
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Affiliation(s)
- Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Wei YM, Wang XJ, Yang XD, Wang CS, Wang LL, Xu XY, Zhao GJ, Li B, Zhu DM, Wu Q, Shen YF. Safety and effectiveness of lurasidone in the treatment of Chinese schizophrenia patients: An interim analysis of post-marketing surveillance. World J Psychiatry 2023; 13:937-948. [DOI: 10.5498/wjp.v13.i11.937] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Schizophrenia is a psychiatric disorder characterized by chronic or recurrent symptoms. Lurasidone was licensed in China in 2019 for the treatment of adult schizophrenia in adults with a maximum dose of 80 mg/d. However, post-market surveillance (PMS) with an adequate sample size is required for further validation of the drug’s safety profile and effectiveness.
AIM To conduct PMS in real-world clinical settings and evaluate the safety and effectiveness of lurasidone in the Chinese population.
METHODS A prospective, multicenter, open-label, 12-wk surveillance was conducted in mainland China. All patients with schizophrenia from 10 sites who had begun medication with lurasidone between September 2019 and August 2022 were eligible for enrollment. Safety assessments included adverse events (AEs), adverse drug reactions (ADRs), extrapyramidal symptoms (EPS), akathisia, use of EPS drugs, weight gain, and laboratory values as metabolic parameters and the QTc interval. The effectiveness was assessed using the brief psychiatric rating scale (BPRS) from baseline to the end of treatment.
RESULTS A total of 965 patients were enrolled in the full analysis set and 894 in the safety set in this interim analysis. The average daily dose was 61.7 ± 19.08 mg (mean ± SD) during the treatment. AEs and ADRs were experienced by 101 patients (11.3%) and 78 patients (8.7%), respectively, which were mostly mild. EPS occurred in 25 individuals with a 2.8% incidence, including akathisia in 20 individuals (2.2%). Moreover, 59 patients received drugs for treating EPS during the treatment, with an incidence of 6.6% which dropped to 5.4% at the end of the treatment. The average weight change was 0.20 ± 2.36 kg (P = 0.01687) with 0.8% of patients showing a weight gain of ≥ 7% at week 12 compared with that at the baseline. The mean values of metabolic parameters and the QTc interval at baseline and week 12 were within normal ranges. The mean changes in total BPRS scores were -8.9 ± 9.76 (n = 959), -13.5 ± 12.29 (n = 959), and -16.8 ± 13.97 (n = 959) after 2/4, 6/8, and 12 wk, respectively (P < 0.001 for each visit compared with the baseline) using the last-observation-carried-forward method.
CONCLUSION The interim analysis of the PMS of adult patients with schizophrenia demonstrate the safety and effectiveness of lurasidone in the Chinese population. No new safety or efficacy concerns were identified.
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Affiliation(s)
- Yu-Mei Wei
- Shanghai Clinical Research Center for Mental Health, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xi-Jin Wang
- Department of Psychiatry, The First Psychiatric Hospital of Harbin, Harbin 150056, Heilongjiang Province, China
| | - Xiao-Dong Yang
- Department of Psychiatry, Shandong Provincial Mental Health Center, Jinan 250014, Shandong Province, China
| | - Chuan-Sheng Wang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
| | - Li-Li Wang
- Department of Psychiatry, Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin 300222, China
| | - Xiao-Ying Xu
- Department of Psychiatry, The Fifth People’s Hospital of Zigong, Zigong 643020, Sichuan Province, China
| | - Gui-Jun Zhao
- Department of Psychiatry, Guangyuan Mental Health Center, Guangyuan 628001, Guizhou Province, China
| | - Bin Li
- Department of Psychology, Fujian Energy General Hospital, Fuzhou 350001, Fujian Province, China
| | - Dao-Min Zhu
- Department of Sleep Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People’s Hospital, Anhui Mental Health Center, Hefei 230022, Anhui Province, China
| | - Qi Wu
- Sumitomo Pharma (China), Co., Ltd., Shanghai 200025, China
| | - Yi-Feng Shen
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Clinical Research Center for Mental Health, Shanghai Jiao Tong University, Shanghai 200030, China
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TOPUZ AN, BOZDEMİR N. Sağlıklı bir popülasyonda kardiyovasküler hastalık risk faktörleri bilgi düzeyi, Framingham skoru ve kardiyak belirteçlerin değerlendirilmesi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1103219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Bu çalışmanın amacı eğitimli ve sağlıklı bir popülasyonun kardiyovasküler hastalık (KVH) bilgi düzeylerini değerlendirmek ve bunu günlük yaşama ne kadar aktardıklarını belirlemektir. Bu çalışmada üniversitemiz bünyesinde çalışan ve sağlıklı görünen katılımcılarda KVH farkındalığı değerlendirilmiş ve 10 yıllık kardiyovasküler hastalık gelişme riski (Framingham Skoru) hesaplanıp Nabız Dalga Hızı (NDH) ve labaratuvar parametreleri arasındaki ilişkilerin incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışma, Çukurova Üniversitesi bünyesinde çalışan sağlıklı 192 gönüllü katılımcı ile yapıldı. Katılımcıların farkındalığı kardiyovasküler hastalık risk faktörleri bilgi düzeyi ölçeği (KARRİF-BD) ile 10 yıllık KVH gelişim riski ise Framingham risk skoru ile değerlendirildi. NDH değerleri invaziv olmayan arteriografi cihazı kullanıldı. Tüm katılımcılardan kan örnekleri alındı.
Bulgular: Tüm katılımcıların yaş ortalaması 45,3 ± 8,0 yıl (% 53,6 kadın) idi. Katılımcıların ortalama KARRİF-BD skoru 20,4 ± 4,0 ve Framingham skoru ortalaması 6,9±5,6 olarak bulundu. NDH ortalaması 7,9±1,5m/sn bulundu. Korelasyon analizlerinde NDH, hem ortalama KARRİF-BD skoru hem de Framingham skoru ile belirgin ilişkili bulundu. En yüksek KARRİF-BD puanına sahip olan katılımcılar aynı zamanda en yüksek Framingham puanına ve NDH' na sahipti.
Sonuç: Eğitim ve bilgi düzeyi yüksek olmasına rağmen bu bilginin KVH risk faktörleri açısından günlük yaşama yansımadığı görülmektedir. Bilginin davranış ve risk faktörü düzeylerini etkilemesi için ulaşılması gereken KVH farkındalığı eşik düzeyi olup olmadığı konusunda daha ileri çalışmalara ihtiyaç vardır. Etkili koruma için, bilgi davranışsal danışmanlık müdahaleleri ile desteklenmelidir.
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Topal DG, Aleksov Ahtarovski K, Lønborg J, Høfsten D, Nepper-Christensen L, Kyhl K, Schoos M, Ghotbi AA, Göransson C, Bertelsen L, Holmvang L, Helqvist S, Pedersen F, Schnabel R, Køber L, Kelbæk H, Vejlstrup N, Engstrøm T, Clemmensen P. Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction - A cardiac magnetic resonance imaging study. IJC HEART & VASCULATURE 2021; 33:100731. [PMID: 33732867 PMCID: PMC7937772 DOI: 10.1016/j.ijcha.2021.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 11/05/2022]
Abstract
Background Coronary collateral circulation and conditioning from
remote ischemic coronary territories may protect culprit myocardium in the
elderly, and younger STEMI patients could suffer from larger infarcts. We
evaluated the impact of age on myocardial salvage and long-term prognosis in a
contemporary STEMI cohort. Methods Of 1603 included STEMI patients 807 underwent cardiac
magnetic resonance. To assess the impact of age on infarct size and left
ventricular ejection fraction (LVEF) as well as the composite endpoint of death
and re-hospitalization for heart failure we stratified the patients by an age
cut-off of 60 years. Results Younger STEMI patients had smaller final infarcts (10%
vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After
adjusting for multiple potential confounders age did not remain significantly
associated with infarct size and LVEF. During 4-year follow-up, the composite
endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a
univariate hazard ratio of 5.77 (95% CI, 3.75–8.89; p < 0.001). Event
estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below
median) showed a gradual increase in the occurrence of the composite endpoint
depending on both age and acute infarct size (log-rank
p < 0.001). Conclusion Having a STEMI after entering the seventh decade of life
more than quadrupled the risk of future death or re-hospitalization for heart
failure. Risk of death and re-hospitalization depended on both advanced age and
infarct size, albeit no substantial difference was found in infarct size, LVEF
and salvage potential between younger and elderly patients with
STEMI.
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Affiliation(s)
- Divan Gabriel Topal
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Mikkel Schoos
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Adam Ali Ghotbi
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Litten Bertelsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Renate Schnabel
- Department of Cardiology, University Heart Center Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.,Department of Cardiology, Lund University Hospital, Lund, Sweden
| | - Peter Clemmensen
- Department of Cardiology, University Heart Center Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Department of Medicine, Nykøbing F Hospital, Nykøbing F, Institute for Regional Research, University of Southern Denmark, Odense, Denmark
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Wasim M, Singh C, Solanki RK. A study of cardiovascular risk among depressed obese patients. JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2020. [DOI: 10.4103/jmhhb.jmhhb_19_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Perceptions of the Built Environment and Support for Policies That Promote Physical Activity. J Phys Act Health 2019; 16:976-984. [PMID: 31521055 DOI: 10.1123/jpah.2018-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/03/2019] [Accepted: 07/18/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND To assess how perceptions of the community built environment influence support for community policies that promote physical activity (PA). METHODS A national cross-sectional survey assessed perceptions of the local built environment and support of community policies, including school and workplace policies, promoting PA. A random digit-dialed telephone survey was conducted in US counties selected on Behavioral Risk Factor Surveillance System data for high or low prevalence of obesity and inactivity. A total of 1208 subjects were interviewed, 642 from high-prevalence counties and 566 from low-prevalence counties. Analyses were stratified by county prevalence of obesity and inactivity (high or low). Linear models adjusted for covariates were constructed to assess the influence of built environment perceptions on policy support. RESULTS Perception of more destinations near the residence was associated with increased support for community policies that promote PA, including tax increases in low-prevalence (obesity and inactivity) counties (P < .01). Positive perception of the workplace environment was associated (P < .001) with increased support for workplace policies among those in high-, but not low-, prevalence counties. CONCLUSIONS Support for community policies promoting PA varies by perception of the built environment, which has implications for policy change.
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Bagheri MJ, Talebpour M, Sharifi A, Talebpour A, Mohseni A. Lipid profile change after bariatric surgeries: laparoscopic gastric plication versus mini gastric bypass. Acta Chir Belg 2019; 119:146-151. [PMID: 30451582 DOI: 10.1080/00015458.2018.1479022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Bariatric surgeries are known to have profound effects on lipid profile. Laparoscopic gastric plication (LGP) has been shown to have a comparable effect on weight loss rather than Roux-en-Y gastric bypass (RYGB) and mini gastric bypass (MGB). But the post-operative effect on lipid profile is not well-compared. We aimed to compare post-operative lipid profile change after LGP and MGB. METHODS In a retrospective analysis, we reviewed 91 patients for at least 12 months. Patients were assigned to undergo either LGP (71 patients) or MGB (20 patients). Preoperative and postoperative visits were accomplished and weight, BMI, fasting blood glucose (FBG) and lipid profile including triglyceride (TG), and total cholesterol (TC) levels were repeatedly measured. Follow up rate for the first year was 100%. RESULTS LGP significantly decreased both TG and TC levels in each follow up (all p values < .05). The same trends were observed in BMI reduction, total body weight loss percentage, and FBG. When comparing either TC or TG level between LGP and MGB, there was just one statistically significant result in TG reduction at 6 months (p value = .042) while MGB showed more reduction. All other variables in different follow up visits were not significantly different between two techniques. CONCLUSIONS LGP would result in lipid profile improvement lasting at least for one year. Lipid-lowering effect seems to be similar between LGP and MGB. This lipid-lowering property and weight reduction might be indicative that LGP is an alternative for RYGB and MGB in selective patients.
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Affiliation(s)
- Mohammad Javad Bagheri
- Department of Surgery, Hazrat-e-Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Talebpour
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirsina Sharifi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Atieh Talebpour
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mohseni
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Past, present and future of pharmacotherapy for obesity. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:256-264. [PMID: 28935287 DOI: 10.1016/j.arteri.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 01/04/2023]
Abstract
Conventional treatment for obesity with diet, exercise and bariatric surgery has limitations; thus, it is necessary to have pharmacological tools. In the past, different drugs were marketed that were withdrawn due to safety problems. There are currently 3 drugs approved by the European Medicines Agency (EMA) and the Food and Drug Administration (FDA) for obesity therapy (orlistat, combination of bupropion and delayed-release naltrexone and liraglutide) and two more only authorized by FDA (lorcaserin and the combination of phentermine and extended release topiramate). It is recommended to use as a second therapeutic line and its choice should be individualized taking into account multiple aspects such as expected weight loss, route of administration, safety profile and cost. Currently there are several drugs under development that act on different therapeutic targets.
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The Effect of Bariatric Surgery Type on Lipid Profile: An Age, Sex, Body Mass Index and Excess Weight Loss Matched Study. Obes Surg 2016. [PMID: 26220239 DOI: 10.1007/s11695-015-1825-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bariatric surgery improves lipid profile. A still unanswered question is whether this improvement is merely weight-dependent or also results from factors inherent to specificities of the bariatric procedure. We aimed to study lipid profile 1 year after bariatric surgery and compare its changes between the different procedures in patients matched for initial weight and weight loss. METHODS We retrospectively analysed patients submitted to Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB) or sleeve gastrectomy (SG) between 2010 and 2013. Patients were matched for age (±5 years), sex, pre-surgery body mass index (BMI) (±2 Kg/m(2)) and excess weight loss (EWL) (±5%). Baseline and 1-year lipid profile, its variation and percentage of variation was compared between surgeries. RESULTS We analysed 229 patients: 72 pairs RYGB-AGB, 47 pairs RYGB-SG and 33 pairs AGB-SG. The median age was 41 (35-52) years and 11.8% were male. Pre-operative BMI was 44.0 ± 4.6 and 32.1 ± 4.4 Kg/m(2) at 1 year. EWL at 1 year was 64.2 ± 18.9%. There were no differences in baseline lipid profile between patients submitted to different types of bariatric surgery. At 1 year, high-density lipoprotein cholesterol (HDL) and triglycerides (TG) improved similarly with all surgeries. Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL) at 1 year decreased significantly more in patients submitted to RYGB than in weight-matched patients undergoing AGB or SG. CONCLUSIONS RYGB is the only bariatric surgery that reduces TC and LDL in age-, sex-, BMI- and EWL-matched patients. All three procedures improved TG and HDL similarly when the confounding effect of weight loss is eliminated.
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Shah N, Kelly AM, Cox N, Wong C, Soon K. Myocardial Infarction in the "Young": Risk Factors, Presentation, Management and Prognosis. Heart Lung Circ 2016; 25:955-60. [PMID: 27265644 DOI: 10.1016/j.hlc.2016.04.015] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/31/2015] [Accepted: 04/10/2016] [Indexed: 12/15/2022]
Abstract
Myocardial infarction (MI) in the "young" is a significant problem, however there is scarcity of data on premature coronary heart disease (CHD) and MI in the "young". This may lead to under-appreciation of important differences that exist between "young" MI patients versus an older cohort. Traditional differences described in the risk factor profile of younger MI compared to older patients include a higher prevalence of smoking, family history of premature CHD and male gender. Recently, other potentially important differences have been described. Most "young" MI patients will present with non-ST elevation MI but the proportion presenting with ST-elevation MI is increasing. Coronary angiography usually reveals less extensive disease in "young" MI patients, which has implications for management. Short-term prognosis of "young" MI patients is better than for older patients, however contemporary data raises concerns regarding longer-term outcomes, particularly in those with reduced left ventricular systolic function. Here we review the differences in rate, risk factor profile, presentation, management and prognosis between "young" and older MI patients.
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Affiliation(s)
- Nadim Shah
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia.
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Vic, Australia
| | - Nicholas Cox
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
| | - Chiew Wong
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
| | - Kean Soon
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
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Castaldo G, Palmieri V, Galdo G, Castaldo L, Molettieri P, Vitale A, Monaco L. Aggressive nutritional strategy in morbid obesity in clinical practice: Safety, feasibility, and effects on metabolic and haemodynamic risk factors. Obes Res Clin Pract 2016; 10:169-77. [DOI: 10.1016/j.orcp.2015.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 04/12/2015] [Accepted: 05/01/2015] [Indexed: 01/12/2023]
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Abstract
The objective of this analysis was to evaluate the effect of 12 months of treatment with lurasidone on weight in patients with schizophrenia. Post-hoc, observed-case analysis included pooled data from six studies on 40-160 mg/day lurasidone; two studies included active comparators (2-6 mg/day risperidone or 200-800 mg/day quetiapine XR). Overall, 593 patients completed 12 months of treatment (N=471 lurasidone, N = 89 risperidone, N = 33 quetiapine XR). The mean baseline weight was 72.8, 80.8, and 72.4 kg in the lurasidone, risperidone, and quetiapine XR groups, respectively. The mean weight change at month 12 was -0.4 kg with lurasidone, +2.6 kg with risperidone, and +1.2 kg with quetiapine XR. Weight gain of at least 7% from study baseline was observed in 16.0, 25.8, and 15.2% of patients, and weight loss of at least 7% was seen in 18.5, 6.7, and 9.1% of patients treated with lurasidone, risperidone, and quetiapine XR, respectively. A shift from normal/underweight baseline BMI status to overweight/obese at month 12 occurred in 10.2, 27.6, and 15.0% of patients in the lurasidone, risperidone, and quetiapine XR groups, respectively. Conversely, 14.3, 1.7, and 7.7% of patients, respectively, shifted from overweight/obese to normal/underweight. In summary, a low potential for clinically significant weight gain was observed in patients with schizophrenia treated continuously with lurasidone for 12 months.
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15
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Cardiovascular risk in obese diabetic patients is significantly reduced one year after gastric bypass compared to one year of diabetes support and education. Surg Endosc 2014; 28:2815-20. [DOI: 10.1007/s00464-014-3550-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/11/2014] [Indexed: 11/26/2022]
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Sorkin JD, Vasaitis TS, Streeten E, Ryan AS, Goldberg AP. Evidence for threshold effects of 25-hydroxyvitamin D on glucose tolerance and insulin resistance in black and white obese postmenopausal women. J Nutr 2014; 144:734-42. [PMID: 24717362 PMCID: PMC3985830 DOI: 10.3945/jn.114.190660] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We identified normal vs. abnormal 25-hydroxyvitamin D [25(OH)D] concentrations by examining the relation of 25(OH)D to non-bone-related measures (plasma glucose, insulin resistance, lipids, blood pressure, fitness, obesity, and regional adiposity) and asking whether there is a 25(OH)D concentration above and below which the relation between 25(OH)D and outcome changes. We examined the relation between 25(OH)D and outcome by race to see whether race-specific normal ranges are needed, and we examined the role of insulin-like growth factor-1 (IGF-1) in modulating the relation between 25(OH)D and outcome. In a cross-sectional study of 239 overweight and obese, sedentary postmenopausal women without diabetes (83 black, 156 white), outcome measures included plasma lipids, glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), IGF-1, parathyroid hormone (PTH), aerobic fitness, body composition, subcutaneous abdominal and visceral fat, and blood pressure. We identified threshold effects in the association between 25(OH)D and these variables using piecewise linear regressions. We found that 25(OH)D was inversely related to fasting glucose, fasting and 2-h insulin, HOMA-IR, visceral abdominal fat, percentage fat, PTH, and triglycerides. Evidence for a threshold effect of 25(OH)D was found for 2-h glucose, 2-h insulin, fasting insulin, and HOMA-IR. There was no evidence suggesting the need for race-specific normal 25(OH)D concentrations. IGF-1 modulated the relation between 25(OH)D and outcome but only below, and not above, a threshold 25(OH)D concentration. Our findings suggest a threshold effect of 25(OH)D on glucose-insulin metabolism such that 25(OH)D ≥ ∼26 μg/L (65.0 pmol/L) supports normal glucose homeostasis and that the same cut point defining normal 25(OH)D concentration can be used in black and white women. This study was registered at clinicaltrials.gov as NCT01798030.
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Affiliation(s)
- John D. Sorkin
- Divisions of Gerontology and Geriatric Medicine and,Department of Veterans Affairs, Baltimore Veterans Affairs Medical Center, Baltimore, MD; and,To whom correspondence should be addressed. E-mail:
| | - Tadas Sean Vasaitis
- Divisions of Gerontology and Geriatric Medicine and,University of Maryland Eastern Shore School of Pharmacy, Princess Anne, MD
| | - Elizabeth Streeten
- Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD,Department of Veterans Affairs, Baltimore Veterans Affairs Medical Center, Baltimore, MD; and
| | - Alice S. Ryan
- Divisions of Gerontology and Geriatric Medicine and,Department of Veterans Affairs, Baltimore Veterans Affairs Medical Center, Baltimore, MD; and
| | - Andrew P. Goldberg
- Divisions of Gerontology and Geriatric Medicine and,Department of Veterans Affairs, Baltimore Veterans Affairs Medical Center, Baltimore, MD; and
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17
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Lee JJ, Freeland-Graves JH, Pepper MR, Yao M, Xu B. Predictive equations for central obesity via anthropometrics, stereovision imaging and MRI in adults. Obesity (Silver Spring) 2014; 22:852-62. [PMID: 23613161 PMCID: PMC3855593 DOI: 10.1002/oby.20489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/25/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Abdominal visceral adiposity is related to risks for insulin resistance and metabolic perturbations. Magnetic resonance imaging (MRI) and computed tomography are advanced instruments that quantify abdominal adiposity; yet field use is constrained by their bulkiness and costliness. The purpose of this study is to develop prediction equations for total abdominal, subcutaneous, and visceral adiposity via anthropometrics, stereovision body imaging (SBI), and MRI. METHODS Participants (67 men and 55 women) were measured for anthropometrics and abdominal adiposity volumes evaluated by MRI umbilicus scans. Body circumferences and central obesity were obtained via SBI. Prediction models were developed via multiple linear regression analysis, utilizing body measurements and demographics as independent predictors, and abdominal adiposity as a dependent variable. Cross-validation was performed by the data-splitting method. RESULTS The final total abdominal adiposity prediction equation was -470.28 + 7.10 waist circumference - 91.01 gender + 5.74 sagittal diameter (R2 = 89.9%), subcutaneous adiposity was -172.37 + 8.57 waist circumference - 62.65 gender - 450.16 stereovision waist-to-hip ratio (R2 =90.4%), and visceral adiposity was -96.76 + 11.48 central obesity depth - 5.09 central obesity width + 204.74 stereovision waist-to-hip ratio - 18.59 gender (R2 = 71.7%). R2 significantly improved for predicting visceral fat when SBI variables were included, but not for total abdominal or subcutaneous adiposity. CONCLUSIONS SBI is effective for predicting visceral adiposity and the prediction equations derived from SBI measurements can assess obesity.
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Affiliation(s)
- Jane J Lee
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas, USA
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Sulistyoningrum DC, Gasevic D, Green TJ, Lear SA, Devlin AM. Adiposity and the relationship between vitamin D and blood pressure. Metabolism 2013; 62:1795-802. [PMID: 23987237 DOI: 10.1016/j.metabol.2013.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/06/2013] [Accepted: 07/17/2013] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Circulating vitamin D (25OHD) concentrations are negatively associated with blood pressure (BP) but little is known about the mechanisms for this relationship. Adiposity is positively associated with BP and inversely with circulating 25OHD concentrations but no studies have assessed the relationship between plasma 25OHD and adiposity on BP. The goal of this study is to investigate if the association between plasma 25OHD and BP is mediated by adiposity. MATERIALS/METHODS The relationship between plasma 25OHD, systolic and diastolic BP, and adiposity [BMI, waist circumference, visceral adipose tissue (VAT)] was assessed in a multi-ethnic cross-sectional study of Aboriginal (n=151), Chinese (n=190), European (n=170), and South Asian (n=176) participants by linear regression models. RESULTS Plasma 25OHD concentrations were negatively associated with systolic (standardized B=-0.191, P<0.001) and diastolic BP (standardized B=-0.196, P<0.001) in models adjusted for age, sex, ethnicity, family history of CVD, smoking status, alcohol consumption, and physical activity. The negative relationship between plasma 25OHD concentrations and systolic and diastolic BP was attenuated after the addition of BMI, waist circumference, and VAT to the models, but the relationship remained significant. Plasma 25OHD concentrations accounted for 0.7% and 0.8% of the variance in systolic and diastolic BP, respectively. CONCLUSION These findings suggest that the relationship between vitamin D and BP is independent of adiposity. Further studies are required to determine the mechanisms by which vitamin D affects BP.
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Affiliation(s)
- Dian C Sulistyoningrum
- Department of Pathology and Laboratory Medicine, University of British Columbia, Child and Family Research Institute, Vancouver, Canada
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Wang Z, Hoy WE. Age-dependent decline of association between obesity and coronary heart disease: a cohort study in a remote Australian Aboriginal community. BMJ Open 2013; 3:e004042. [PMID: 24282250 PMCID: PMC3845075 DOI: 10.1136/bmjopen-2013-004042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To determine whether the association between obesity and coronary heart disease (CHD) in Aboriginal adults depends on age. DESIGN, SETTING AND PARTICIPANTS A cohort study with up to 20 years of follow-up of 849 participants aged 18-76 years in a remote Aboriginal community in the Northern Territory of Australia. MAIN OUTCOME MEASURES Newly diagnosed CHD cases were identified through hospital records according to ICD codes during the follow-up period. Cox proportional hazard model was used to assess whether the association between obesity and CHD depends on age. RESULTS During the follow-up period, 171 participants were diagnosed with CHD. On an average, the incidence rate of CHD increased with the increasing baseline BMI, 11.3%, 16.3% and 20.2% for normal weight, overweight and obese groups, respectively. HR of CHD for obesity were 2.6 (95% CI 1.1to 6.3), 1.2 (0.7 to 2.0) and 0.5 (0.1 to 2.1) for those <40, 40-59 and 60+ years, respectively. HRs corresponding to 1 SD increase in BMI were 1.4 (1.0 to 2.0), 1.2 (1.0 to 1.5) and 0.8 (0.5 to 1.2) for those <40, 40-59 and 60+ years, respectively. The interaction terms between age and BMI as category variables or as a continuous variable were statistically significant. CONCLUSIONS The association between obesity and CHD is stronger for younger adults than for older adults in Aboriginal Australians in the remote community. Our findings suggest that weight control efforts may produce more beneficial effects in CHD prevention in young adults than in older adults.
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Affiliation(s)
- Zhiqiang Wang
- Centre for Chronic Disease, School of Medicine, University of Queensland, Herston, Queensland, Australia
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20
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Wang B, Yang H, Wu S, Cao G, Yang H. Obesity and the risk of late mortality after aortic valve replacement with small prosthesis. J Cardiothorac Surg 2013; 8:174. [PMID: 23856275 PMCID: PMC3765481 DOI: 10.1186/1749-8090-8-174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 06/25/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Whether obesity is related to late mortality with implantation of small aortic prosthesis remains to be clarified. This study was aimed to evaluate the effect of obesity on late survival of patients after aortic valve replacement (AVR) with implantation of small aortic prosthesis (size ≤ 21 mm). METHODS From January 1998 to December 2008, 307 patients in our institution who underwent primary AVR with smaller prostheses survived the 30 days after surgery. Patients were defined as normal if body mass index (BMI) was < 24 kg/m2, as overweight if BMI 24-27.9 kg/m2, and as obese if BMI ≥ 28 kg/m2. Data of New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF), effective orifice area index (EOAI), and left ventricular mass index (LVMI) of the patients collected at the 3rd month (M), 6th M, 1st year (Y), 3rd Y, 5th Y, 8th Y after operation respectively. RESULTS By multivariable analysis, obesity was an independent factor of late mortality (hazard ratio [HR]: 1.62; P = 0.01). The obesity and overweight group had more poor survival (p < 0.001) and higher proportion of NYHA class III/IV (p < 0.01) compared with the normal group. Lower EOAI and higher LVMI were found in obesity and overweight group, but we saw no significant difference about LVEF among the three groups. CONCLUSIONS Obesity was associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Being obese or and overweight may also affect the NYHA classification, even in the longer term. EOAI should be improved where possible, as it may reduce late mortality and improve quality of life in obese or overweight patients.
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Affiliation(s)
- Biao Wang
- Department of Cardiovascular Surgery Qilu Hospital, Shandong University, Jinan, China
| | - Hongyang Yang
- Department of Cardiovascular Surgery Qilu Hospital, Shandong University, Jinan, China
| | - Shuming Wu
- Department of Cardiovascular Surgery Qilu Hospital, Shandong University, Jinan, China
| | - Guangqing Cao
- Department of Cardiovascular Surgery Qilu Hospital, Shandong University, Jinan, China
| | - Hongling Yang
- Department of Cardiovascular Surgery Qilu Hospital, Shandong University, Jinan, China
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Largent JA, Vasey J, Bessonova L, Okerson T, Wong ND. Reduction in Framingham risk of cardiovascular disease in obese patients undergoing laparoscopic adjustable gastric banding. Adv Ther 2013; 30:684-96. [PMID: 23897217 PMCID: PMC3747322 DOI: 10.1007/s12325-013-0045-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Indexed: 12/17/2022]
Abstract
Background Obesity is a major risk factor for cardiovascular disease (CVD), with weight loss offering improvement in CVD risk factors. Aims To examine whether weight loss in laparoscopic adjustable gastric band (LAGB)-treated obese patients is associated with meaningful reductions in estimated 10- and 30- year Framingham CVD risk 12–15 months post-LAGB. Methods Obese adult patients [body mass index (BMI) ≥30 kg/m2] treated with LAGB were identified in a large US healthcare database. Patients without CVD at baseline and with measures of BMI, systolic blood pressure, diabetes, and smoking status at baseline and follow-up were eligible. Non-LAGB patients were propensity score matched to LAGB patients on baseline BMI, age, and gender. Estimated 10- and 30-year risk of developing CVD using office-based data, including BMI, was calculated at baseline and 12–15 months follow-up. Results Mean BMI in LAGB patients (n = 647, average age 45.66 years, 81.1% female) decreased from 42.7 to 33.4 kg/m2 (P < 0.0001), with 35.4% no longer obese; 10- and 30-year estimated CVD risk decreased from 10.8 to 7.6% (P < 0.0001) and 44.34 to 32.30% (P < 0.0001), respectively, 12–15 months post-LAGB. Improvements were significantly greater than in non-LAGB patients (N = 4,295) (P < 0.0001). In the subset with lipid data (n = 74), improvements in total (−20.6 mg/dL; P < 0.05) and high-density lipoprotein (+10.6 mg/dL, P < 0.0001) cholesterol 1 year post-LAGB were also observed. Conclusions Data from a US healthcare database show that individuals undergoing LAGB have significant weight loss and reductions in estimated 10- to 30-year CVD risk within 1 year post-LAGB.
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Brixner DI, Bron M, Bellows BK, Ye X, Yu J, Raparla S, Oderda GM. Evaluation of cardiovascular risk factors, events, and costs across four BMI categories. Obesity (Silver Spring) 2013; 21:1284-92. [PMID: 23913737 DOI: 10.1002/oby.20215] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the 1-year cost of cardiovascular (CV) events by body mass index (BMI) subgroups from a US employer health plan perspective. DESIGN AND METHODS Patients aged 20-64 years from the GE Centricity Electronic Medical Record, National Health and Nutrition Examination Survey, and MarketScan databases were used to determine prevalence of risk factors (RFs) and CV events and 1-year costs. Risk factors included hypertension (HTN), diabetes, and hyperlipidemia (HLD) and CV events included myocardial infarction, angina, heart failure, and stroke. CV event costs were determined from claims by ICD-9 code in patients with overweight/obesity. RESULTS Of 220,136 patients identified in GE, BMI was 25-26.9 in 19.4%, 27-29.9 in 30.4%, 30-34.9 in 27.9%, and ≥35 in 22.3%. Patients with diabetes, HTN, and HLD increased with BMI from 1.8% (25-26.9) to 11.4% (≥35) in males and 1.1% to 6.8% in females. Prevalence of CV events increased from 0.1% with no RFs up to 10.2% with multiple RFs. The average 1-year cost per patient increased from $1122 to $2383 as BMI increased. CONCLUSIONS Patients with higher BMI values had an increased prevalence of RFs and CV events, which lead to higher average 1-year costs.
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Affiliation(s)
- D I Brixner
- Department of Pharmacotherapy, University of Utah, 30 South 2000 East, Room 4781, Salt Lake City, UT 84112, USA.
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Wang B, Yang H, Zhu W, Zhang X, Cao G, Wu S. Obesity is associated with higher long-term mortality after aortic valve replacement with small prosthesis. Heart Lung Circ 2013; 22:731-7. [PMID: 23680088 DOI: 10.1016/j.hlc.2013.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/16/2013] [Accepted: 03/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Although many studies have evaluated the impacts of obesity on various medical treatments, it is not known whether obesity is related to late mortality with implantation of small aortic prosthesis. This study evaluated the effect of obesity on late survival of patients after aortic valve replacement (AVR) with implantation of small aortic prosthesis (size ≤ 21 mm). METHODS From January 1998 to December 2008, 536 patients in our institution who underwent primary AVR (307 patients with smaller prostheses) survived the 30 days after surgery. Patients were categorised as normal weight if body mass index (BMI) was ≤ 25 kg/m(2), as overweight if BMI 25-30 kg/m(2), and as obese if BMI ≥ 30 kg/m(2). Data were collected at the third-month (M), sixth-M, first-year (Y), third-Y, fifth-Y, and eighth-Y after operation. RESULTS By multivariable analysis, obesity was a significant independent factor of late mortality (hazard ratio [HR]: 1.59; p=0.006). The obese and overweight groups of patients exhibited lower survival (p<0.001) and a higher proportion in NYHA class III/IV (p<0.01) compared with the normal group. Lower EOAI and higher left ventricular mass index were found in the obese and overweight groups, but we saw no significant variance in LVEF among the three groups. CONCLUSIONS Obesity was associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Being obese or and overweight may also affect the NYHA classification, even in the longer term.
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Affiliation(s)
- Biao Wang
- Department of Cardiovascular Surgery, Qilu Hospital, Shandong University, Jinan, China.
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Wang B, Yang H, Wang T, Zhang X, Zhu W, Cao G, Wu S. Impact of obesity on long-term survival after aortic valve replacement with a small prosthesis. Interact Cardiovasc Thorac Surg 2013; 17:66-72. [PMID: 23529754 DOI: 10.1093/icvts/ivt058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Although many studies have evaluated the impact of obesity on various medical treatments, it is not known whether obesity is related to late mortality with implantation of small aortic prostheses. This study evaluated the effect of obesity on the late survival of patients after aortic valve replacement (AVR) with implantation of a small aortic prosthesis (size ≤ 21 mm). METHODS From January 1998 to December 2008, 307 patients in our institution who underwent primary AVR with smaller prostheses survived 30 days after surgery. Patients were categorized as normal weight if body mass index (BMI) was <24 kg/m(2), overweight if BMI 24-27.9 kg/m(2) and obese if BMI ≥ 28 kg/m(2). Data of the New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF), effective orifice area index (EOAI) and left ventricular mass index of the patients were collected at the third month, sixth month, first year, third year, fifth year and eighth year after operation. RESULTS By multivariable analysis, obesity was a significant independent factor of late mortality (hazard ratio: 1.62; P = 0.01). The obese and overweight groups of patients exhibited lower survival (P < 0.001) and a higher proportion in NYHA Class III/IV (P < 0.01) compared with the normal group. A lower EOAI and higher left ventricular mass index were found in the obese and overweight groups, but we saw no significant variance in LVEF among the three groups. CONCLUSIONS Obesity is associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Obesity or/and overweight may also affect the NYHA classification, even in the longer term. EOAI should be improved where possible, as it may reduce late mortality and improve quality of life in obese or overweight patients.
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Affiliation(s)
- Biao Wang
- Department of Cardiovascular Surgery, Qilu Hospital, Shandong University, Jinan, China
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Dong Q, Liu JJ, Zheng RZ, Dong YH, Feng XM, Li J, Huang F. Obesity and depressive symptoms in the elderly: a survey in the rural area of Chizhou, Anhui province. Int J Geriatr Psychiatry 2013; 28:227-32. [PMID: 22492613 DOI: 10.1002/gps.3815] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 03/14/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of the present study is to examine the relationship between obesity and depressive symptoms and to test the "Jolly Fat" hypothesis among older Chinese. METHODS A total of 736 rural Chinese aged 60 years and older participated in this cross-sectional study. Body mass index (BMI = kg/m(2) ) was calculated from the subjects' measured weight (kg) and height (meter). Depressive symptoms were assessed using the 30-item Geriatric Depression Scale (GDS-30), with a cut-off point of 11. RESULTS Among 736 total participants, the prevalence of depressive symptoms was 24.1% in men and 27.9% in women. A trend about depressive symptoms decreased with increasing BMI was found in men (χ(2) trend = 5.74, df = 1, p = 0.01). A weak inverse linear trend between obesity and depressive symptoms was observed among subjects. In men, obese group was less likely to suffer from depressive symptoms compared with normal weight group before or after adjustment for confounders, with odds ratios of 0.32 (95% confidence interval (CI): 0.12-0.85) and 0.28 (95% CI: 0.09-0.85), respectively. However, the association between BMI and depressive symptoms in women showed no significant differences. CONCLUSIONS Our results supported the "Jolly Fat" hypothesis only in rural older Chinese men, but not in women. Gender differences existed in the relationship between obesity and depressive symptoms.
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Affiliation(s)
- Qing Dong
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China
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Johnson BL, Blackhurst DW, Latham BB, Cull DL, Bour ES, Oliver TL, Williams B, Taylor SM, Scott JD. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg 2013; 216:545-56; discussion 556-8. [PMID: 23391591 DOI: 10.1016/j.jamcollsurg.2012.12.019] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 12/12/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery (BAR) has been established as an effective treatment for type 2 diabetes mellitus (T2DM) in obese patients. However, few studies have examined the mid- to long-term outcomes of bariatric surgery in diabetic populations. Specifically, no comparative studies have broadly examined major macrovascular and microvascular complications in bariatric surgical patients vs similar, nonbariatric surgery controls. STUDY DESIGN We conducted a large, population-based, retrospective cohort study of adult obese patients with T2DM, from 1996 to 2009, using UB-04 administrative data and vital records. Eligible patients undergoing bariatric surgery (BAR [n = 2,580]) were compared with nonbariatric surgery controls (CON [n = 13,371]) for the outcomes of any first major macrovascular event (myocardial infarction, stroke, or all-cause death) or microvascular event (new diagnosis of blindness, laser eye or retinal surgery, nontraumatic amputation, or creation of permanent arteriovenous access for hemodialysis), assessed in combination and separately, as well as other vascular events (carotid, coronary or lower extremity revascularization or new diagnosis of congestive heart failure or angina pectoris). RESULTS Bariatric surgery was associated with favorable unadjusted 5-year event-free survival estimates for the combined primary outcome (95% ± 1% vs 81% ± 1%, log-rank p < 0.01) and each secondary outcome (log-rank p < 0.01). Multivariate-adjusted and propensity-based relative risk estimates showed BAR to be associated with a 60% to 70% reduction (adjusted hazard ratio [HR] 0.36, 95% CI 0.27 to 0.47) in the combined primary outcome and 60% to 80% risk reductions for each secondary outcome (macrovascular events [adjusted HR 0.39, 95% CI 0.29 to 0.51]; microvascular events [adjusted HR 0.22, 95% CI 0.09 to 0.49]; and other vascular events [adjusted HR 0.25, 95% CI 0.19 to 0.32]). CONCLUSIONS Bariatric surgery is associated with a 65% reduction in major macrovascular and microvascular events in moderately and severely obese patients with T2DM.
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Affiliation(s)
- Brent L Johnson
- Greenville Hospital System University Medical Center, University of South Carolina School of Medicine, Greenville, SC 29605, USA
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Pillai VB, Sundaresan NR, Kim G, Samant S, Moreno-Vinasco L, Garcia JGN, Gupta MP. Nampt secreted from cardiomyocytes promotes development of cardiac hypertrophy and adverse ventricular remodeling. Am J Physiol Heart Circ Physiol 2012. [PMID: 23203961 DOI: 10.1152/ajpheart.00468.2012] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Nicotinamide phosphoribosyltransferase (Nampt) is an important coenzyme involved in cellular redox reactions. Inside the cell, Nampt (iNampt) functions as a rate-limiting enzyme in the NAD salvage pathway, and outside the cell (eNampt), it acts as a proinflammatory cytokine. High-circulating levels of Nampt are reported in different pathological conditions. This study was designed to examine the role of Nampt in the development of cardiac hypertrophy and ventricular remodeling. We studied the hypertrophic response in Nampt heterozygous (+/-) knockout and cardiac-specific overexpressing Nampt transgenic mice. Whereas Nampt(+/-) mice were protected against agonist (isoproterenol and angiotensin II)-induced hypertrophy, Nampt transgenic mice spontaneously developed cardiac hypertrophy at 6 mo of age. Experiments conducted to gain insight into the mechanism revealed that treatment of cardiomyocytes with recombinant (eNampt) or overexpression with Nampt-synthesizing adenovirus vector (Ad.Nampt) induced cardiomyocyte hypertrophy. The prohypertrophic effects of eNampt and Ad.Nampt were blocked by the addition of a Nampt-blocking antibody into cultures, thus suggesting that Nampt was in fact invoking hypertrophic response of cardiomyocytes by acting on the cell surface receptors. We also found increased Nampt levels in the supernatant of cardiomyocyte cultures subjected to stress by either serum starvation or H(2)O(2) treatment. Exploration of signaling pathways in Nampt-induced cardiac hypertrophy and fibrosis revealed increased activation of mitogen-activated protein kinases, namely, JNK1, p38, and ERK. This was also associated with increased calcineurin levels and nuclear factor of activated T-cell localization into the nucleus. From these studies we conclude that cardiomyocytes are capable of secreting Nampt during stress, and exogenous Nampt is a positive regulator of cardiac hypertrophy and adverse ventricular remodeling.
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Affiliation(s)
- Vinodkumar B Pillai
- Department of Surgery, Section of Cardiothoracic Surgery, University of Chicago, Chicago, Illinois 60637, USA
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Tate T, Willig AL, Willig JH, Raper JL, Moneyham L, Kempf MC, Saag MS, Mugavero MJ. HIV infection and obesity: where did all the wasting go? Antivir Ther 2012; 17:1281-9. [PMID: 22951353 PMCID: PMC3779137 DOI: 10.3851/imp2348] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The success of antiretroviral therapy (ART) has led to dramatic changes in causes of morbidity and mortality in HIV-infected individuals. As chronic diseases rates have increased in HIV+ populations, modifiable risk factors such as obesity have increased in importance. Our objective was to evaluate factors associated with weight change among patients receiving ART. METHODS ART-naïve patients initiating therapy at the University of Alabama - Birmingham 1917 HIV/AIDS Clinic from 2000- 2008 were included. Body Mass Index (BMI) was categorized as: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9) and obese (≥30). Linear regression models were used to evaluate overall change in BMI and factors associated with increased BMI category 24 months following ART initiation. RESULTS Among 681 patients, the mean baseline BMI was 25.4 ± 6.1; 44% of patients were overweight/obese. At 24 months, 20% of patients moved from normal to overweight/obese or overweight to obese BMI categories. Greater increases in BMI were observed in patients with baseline CD4 count < 50 cells/µl (3.4 ± 4.1, P<0.01) and boosted protease inhibitor use (2.5±4.1 P=0.01), but did not account for all of the variation observed in weight change. CONCLUSIONS The findings that almost half of patients were overweight or obese at ART initiation, and 1 in 5 patients moved to a deleterious BMI category within 2 years of ART initiation are alarming. ART therapy provides only a modest contribution to weight gain in patients. Obesity represents a highly prevalent condition in patients with HIV infection and an important target for intervention.
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Affiliation(s)
- Tyler Tate
- University of Alabama School of Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Amanda L. Willig
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - James H. Willig
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - James L. Raper
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Linda Moneyham
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Michael S. Saag
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Michael J. Mugavero
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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Wang H, Steffen LM, Zhou X, Harnack L, Luepker RV. Consistency between increasing trends in added-sugar intake and body mass index among adults: the Minnesota Heart Survey, 1980-1982 to 2007-2009. Am J Public Health 2012; 103:501-7. [PMID: 22698050 DOI: 10.2105/ajph.2011.300562] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We described 27-year secular trends in added-sugar intake and body mass index (BMI) among Americans aged 25 to 74 years. METHODS The Minnesota Heart Survey (1980-1982 to 2007-2009) is a surveillance study of cardiovascular risk factors among residents of the Minneapolis-St Paul area. We used generalized linear mixed regressions to describe trends in added-sugar intake and BMI by gender and age groups and intake trends by weight status. RESULTS BMI increased concurrently with added-sugar intake in both genders and all age and weight groups. Percentage of energy intake from added sugar increased by 54% in women between 1980 to 1982 and 2000 to 2002, but declined somewhat in 2007 to 2009; men followed the same pattern (all P < .001). Added-sugar intake was lower among women than men and higher among younger than older adults. BMI in women paralleled added-sugar intake, but men's BMI increased through 2009. Percentage of energy intake from added sugar was similar among weight groups. CONCLUSIONS Limiting added-sugar intake should be part of energy balance strategies in response to the obesity epidemic.
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Affiliation(s)
- Huifen Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
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Berwick ZC, Dick GM, Tune JD. Heart of the matter: coronary dysfunction in metabolic syndrome. J Mol Cell Cardiol 2012; 52:848-56. [PMID: 21767548 PMCID: PMC3206994 DOI: 10.1016/j.yjmcc.2011.06.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 06/16/2011] [Accepted: 06/30/2011] [Indexed: 12/14/2022]
Abstract
Metabolic syndrome (MetS) is a collection of risk factors including obesity, dyslipidemia, insulin resistance/impaired glucose tolerance, and/or hypertension. The incidence of obesity has reached pandemic levels, as ~20-30% of adults in most developed countries can be classified as having MetS. This increased prevalence of MetS is critical as it is associated with a two-fold elevated risk for cardiovascular disease. Although the pathophysiology underlying this increase in disease has not been clearly defined, recent evidence indicates that alterations in the control of coronary blood flow could play an important role. The purpose of this review is to highlight current understanding of the effects of MetS on regulation of coronary blood flow and to outline the potential mechanisms involved. In particular, the role of neurohumoral modulation via sympathetic α-adrenoceptors and the renin-angiotensin-aldosterone system (RAAS) are explored. Alterations in the contribution of end-effector K(+), Ca(2+), and transient receptor potential (TRP) channels are also addressed. Finally, future perspectives and potential therapeutic targeting of the microcirculation in MetS are discussed. This article is part of a Special Issue entitled "Coronary Blood Flow".
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Affiliation(s)
- Zachary C. Berwick
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Gregory M. Dick
- Department of Exercise Physiology Center for Cardiovascular and Respiratory Sciences West Virginia University School of Medicine
| | - Johnathan D. Tune
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN 46202
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Kishinevsky FI, Cox JE, Murdaugh DL, Stoeckel LE, Cook EW, Weller RE. fMRI reactivity on a delay discounting task predicts weight gain in obese women. Appetite 2012; 58:582-92. [DOI: 10.1016/j.appet.2011.11.029] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/28/2011] [Accepted: 11/29/2011] [Indexed: 01/03/2023]
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Iversen LB, Strandberg-Larsen K, Prescott E, Schnohr P, Rod NH. Psychosocial risk factors, weight changes and risk of obesity: the Copenhagen City Heart Study. Eur J Epidemiol 2012; 27:119-30. [DOI: 10.1007/s10654-012-9659-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 02/07/2012] [Indexed: 02/07/2023]
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Byrne S, Barry D, Petry NM. Predictors of weight loss success. Exercise vs. dietary self-efficacy and treatment attendance. Appetite 2012; 58:695-8. [PMID: 22248709 DOI: 10.1016/j.appet.2012.01.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/27/2011] [Accepted: 01/02/2012] [Indexed: 11/18/2022]
Abstract
Pre-treatment diet and exercise self-efficacies can predict weight loss success. Changes in diet self-efficacy across treatment appear to be even stronger predictors than baseline levels, but research on changes in exercise self-efficacy is lacking. Using data from a pilot study evaluating tangible reinforcement for weight loss (N=30), we examined the impact of changes in diet and exercise self-efficacy on outcomes. Multiple regression analyses indicated that treatment attendance and changes in exercise self-efficacy during treatment were the strongest predictors of weight loss. Developing weight loss programs that foster the development of exercise self-efficacy may enhance participants' success.
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Affiliation(s)
- Shannon Byrne
- Calhoun Cardiology Center, University of Connecticut Health Center, 263 Farmington Avenue (MC3944), Farmington, CT 06030-3944, USA
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Pecori Giraldi F, Manzoni G, Michailidis J, Scacchi M, Stramba-Badiale M, Cavagnini F. High prevalence of prolonged QT interval in obese hypogonadal males. Obesity (Silver Spring) 2011; 19:2015-8. [PMID: 21350439 DOI: 10.1038/oby.2011.33] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Obese subjects show several electrocardiographic alterations, including prolonged QT interval, a marker for fatal cardiac arrhythmias. Prolonged QT interval has recently been linked to low testosterone levels, a frequent occurrence in male obese patients but no study has yet assessed whether hypoandrogenism contributes to QT interval prolongation in this population. Aim of this study was to evaluate whether prolonged QT interval is linked to hypogonadism in male obese subjects. QT interval corrected for heart rate (QTc) was measured from standard electrocardiogram recordings in 136 obese men (BMI 30 >kg/m(2), range 30.1-75.4 kg/m(2)). Obese men were classified as eugonadal or hypogonadal according to serum total testosterone levels (i.e., greater or less than 9.9 nmol/l). Our study showed that QTc measurements corrected by either Bazett (419 ± 3.2 vs. 408 ± 3.4 ms, P < 0.05), Fridericia (406.3 ± 3.39 vs. 396.4 ± 3.03 ms, P < 0.05) or Hodges (407.0 ± 3.12 vs. 397.3 ± 2.84 ms, P < 0.05) were longer in hypogonadal compared with eugonadal obese men; further, prolonged QTc interval (i.e., >440 ms) was more frequent among hypogonadal compared with eugonadal obese men (23% vs. 10%, P < 0.05). The degree of weight excess, diabetes, sleep apnoea and potassium levels were not associated with prolonged QTc. In conclusion, obese hypogonadal men show a greater prevalence of prolonged QT interval compared with their eugonadal counterparts. It appears therefore that low levels of testosterone in obese men may contribute to the arrhythmogenic profile of these patients, a heretofore unknown link which warrants further clinical attention.
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Distribution of 10-year risk for coronary heart disease and eligibility for therapeutic approaches among Tehranian adults. Public Health 2011; 125:338-44. [DOI: 10.1016/j.puhe.2011.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 12/22/2010] [Accepted: 02/03/2011] [Indexed: 11/19/2022]
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Benaiges D, Goday A, Ramon JM, Hernandez E, Pera M, Cano JF. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis 2011; 7:575-80. [PMID: 21546321 DOI: 10.1016/j.soard.2011.03.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 03/02/2011] [Accepted: 03/03/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Very few studies have compared laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) outcomes or analyzed improvement in cardiovascular risk (CVR) after bariatric surgery. None of the studies considered the Mediterranean population. Our primary objective was to compare the 10-year estimated CVR reduction achieved by LRYGB and LSG in Spanish subjects with severe obesity. The secondary objectives were to compare the techniques in terms of weight loss and co-morbidity improvement. The study was performed at a university hospital in Barcelona, Spain. METHODS A 12-month prospective cohort study of 140 consecutive patients (95 LRYGB and 45 LSG) compared the 2 surgical intervention groups to study the percentage of excess weight loss, resolution and improvement/resolution of co-morbidities, and effect on CVR using both the Framingham risk score (FRS) and the Registre Gironí del Cor (REGICOR) model. RESULTS At 12 months, the overall CVR decreased from 6.6% to 3.4% using the FRS and from 3.7% to 1.9% using the REGICOR score. Neither model found a difference between the 2 surgical intervention groups in decreased postoperative CVR risk, with a FRS of 3.4% ± 2.2% for LRYGB versus 3.3% ± 2.1% for LSG (P = .872) and a REGICOR score of 1.9% ± 1.5% versus 1.8% ± 1.6%, respectively (P = .813). No differences were observed in the percentage of excess weight loss or the resolution of type 2 diabetes mellitus and hypertension. The hypercholesterolemia improvement/resolution rate was lower in the LSG group than in the LRYGB group. CONCLUSION Bariatric surgery reduces the estimated CVR by one half at 1 year after surgery. Except for the less-improved cholesterol metabolism, LSG, a restrictive technique, proved to be equally as effective at 1 year of follow-up as LRYGB.
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Affiliation(s)
- David Benaiges
- Department of Endocrinology and Nutrition, Hospital Universitari del Mar, Barcelona, Spain.
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Practice Paper of the American Dietetic Association: Addressing Racial and Ethnic Health Disparities. ACTA ACUST UNITED AC 2011; 111:446-56. [DOI: 10.1016/j.jada.2011.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Faulconbridge LF, Wadden TA, Berkowitz RI, Pulcini ME, Treadwell T. Treatment of Comorbid Obesity and Major Depressive Disorder: A Prospective Pilot Study for their Combined Treatment. J Obes 2011; 2011:870385. [PMID: 21773011 PMCID: PMC3136248 DOI: 10.1155/2011/870385] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 03/04/2011] [Accepted: 03/21/2011] [Indexed: 11/18/2022] Open
Abstract
Background. Obese individuals who suffer from major depressive disorder are routinely screened out of weight loss trials. Treatments targeting obesity and depression concurrently have not been tested. Purpose. To test the short-term efficacy of a treatment that combined behavioral weight management and cognitive behavioral therapy (CBT) for obese adults with depression. Methods. Twelve obese females diagnosed with major depressive disorder received weekly group behavioral weight management, combined with CBT for depression, for 16 weeks. Weight, symptoms of depression, and cardiovascular disease (CVD) risk factors were measured at baseline and week 16. Results. Participants lost 11.4% of initial weight and achieved significant improvements in symptoms of depression and CVD risk factors. Conclusions. Obese individuals suffering from major depressive disorder can lose weight and achieve improvements in symptoms of depression and CVD risk factors with 16 weeks of combined treatment. A larger randomized controlled trial is needed to establish the efficacy of this treatment.
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Affiliation(s)
- Lucy F. Faulconbridge
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA
- *Lucy F. Faulconbridge:
| | - Thomas A. Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA
| | - Robert I. Berkowitz
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Melissa E. Pulcini
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA
| | - Thomas Treadwell
- Center for Cognitive Therapy, Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA
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