The prevalence of obesity has reached pandemic proportions worldwide and certainly in the United States. Obesity is a well-established independent risk factor for development of many cardiovascular ...diseases (CVD), including heart failure, coronary heart disease, atrial fibrillation, and hypertension. Therefore, it is logical to expect obesity would have a strong correlation with CVD mortality. However, a substantial body of literature demonstrates a paradox with improved prognosis of overweight and obese patients with established CVD compared to lean patients with the identical CVD. Surprisingly, similar data has also shown that cardiovascular fitness, rather than weight loss alone, influences the relationship between obesity and mortality in those with established CVD. The impact of fitness, exercise, physical activity (PA), and weight loss and their relationship to the obesity paradox are all reviewed here.
Abstract Purpose Because obesity is a cardiovascular risk factor but is associated with a more favorable prognosis among cohorts of cardiac patients, we assessed this “obesity paradox” in overweight ...and obese patients with coronary heart disease enrolled in a cardiac rehabilitation and exercise training (CRET) program, making this assessment in patients classified as overweight/obese using both traditional body mass index (BMI) and percent body fat assessments. Additionally, we assessed the efficacy and safety of purposeful weight loss in overweight and obese coronary patients. Patients and Methods We retrospectively studied 529 consecutive CRET patients following major coronary events before and after CRET, and compared baseline and post program data in 393 overweight and obese patients (body mass index BMI ≥25 kg/m2 ) divided by median weight change (median = −1.5%; mean +2% vs −5%, respectively). In addition, we assessed 3-year total mortality in various baseline BMI categories as well as compared mortality in those with high baseline percent fat (>25% in men and >35% in women) versus those with low baseline fat. Results Following CRET, the overweight and obese with greater weight loss had improvements in BMI (−5%; P <.0001), percent fat (−8%; P <.0001), peak oxygen consumption (+16%; P <.0001), low-density lipoprotein cholesterol (−5%; P <.02), high-density lipoprotein cholesterol (+10%; P <.0001), triglycerides (−17%; P <.0001), C-reactive protein (−40%; P <.0001), and fasting glucose (−4%; P = .02), as well as marked improvements in behavioral factors and quality-of-life scores. Those with lower weight loss had no significant improvements in percent fat, low-density lipoprotein cholesterol, triglycerides, C-reactive protein, and fasting glucose. During 3-year follow-up, overall mortality trended only slightly lower in those with baseline overweightness/obesity who had more weight loss (3.1% vs 5.1%; P = .30). However, total mortality was considerably lower in the baseline overweight/obese (BMI ≥25 kg/m2 ) than in 136 CRET patients with baseline BMI <25 kg/m2 (4.1% vs 13.2%; P <.001), as well as in those with high baseline fat compared with those with low fat (3.8% vs 10.6%; P <.01). Conclusions Purposeful weight loss with CRET in overweight/obese coronary patients is associated with only a nonsignificant trend for lower mortality but is characterized by marked improvements in obesity indices, exercise capacity, plasma lipids, and inflammation, as well as behavioral factors and quality of life. Although an “obesity paradox” exists using either baseline BMI or baseline percent fat criteria, these results support the safety and potential long-term benefits of purposeful weight loss in overweight and obese patients with coronary heart disease.
Psychopharmacology and Cardiovascular Disease Piña, Ileana L.; Di Palo, Katherine E.; Ventura, Hector O.
Journal of the American College of Cardiology,
05/2018, Letnik:
71, Številka:
20
Journal Article
Recenzirano
Odprti dostop
This review discusses common mental health disorders and their associations with cardiovascular disease risks. Commonly found mental health disorders include depression, anxiety, and personality ...types. The link between depression and cardiovascular disease mortality has been established. Depression is also common in patients with heart failure. In addition to discussing psychological disorders, a review of psychotropic drugs is also included. Drugs are described for therapy for depression and anxiety, as well as associations with cardiovascular drug-drug interactions. Drug-drug interactions are more common and potentially dangerous in elderly patients, in whom the conditions often coexist. The most common drug-drug interactions involve the P450 system of enzymes.
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Abstract Background Hypertension is present in 30% of the adult U.S. population and is a major contributor to cardiovascular disease. The established office-based approach yields only 50% blood ...pressure control rates and low levels of patient engagement. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. Methods We evaluated blood pressure control in 156 patients with uncontrolled hypertension enrolled into a home-based digital medicine blood pressure program and compared them to 400 patients (matched to age, gender, body mass index and blood pressure) in a usual care group after 90 days. Digital medicine patients completed questionnaires on-line, were asked to submit ≥1 blood pressure reading/week, and received medication management and lifestyle recommendations via a clinical pharmacist and a health coach. Blood pressure units were commercially available, that transmitted data directly to the electronic medical record. Results Digital Medicine patients averaged 4.2 blood pressure readings per week. At 90-days 71% of digital medicine versus 31% of usual care patients had achieved target blood pressure control. Mean drop in systolic/diastolic blood pressure was 14/5 mmHg in digital medicine versus 4/2 mmHg in usual care (p<0.001). Excess sodium consumption decreased from 32% to 8% in the digital medicine group (p=0.004). Mean patient activation increased from 41.9 to 44.1 (p=0.008) and the percentage of patients with low patient activation decreased from 15% to 6% (p=0.03) in the digital medicine group. Conclusion A digital hypertension program is feasible and associated with significant improvement in blood pressure control rates and lifestyle change. Utilization of a virtual health intervention using connected devices improves patient activation and is well accepted by patients.
Muscling up to improve heart failure prognosis Ventura, Hector O.; Carbone, Salvatore; Lavie, Carl J.
European journal of heart failure,
November 2018, 2018-11-00, 20181101, Letnik:
20, Številka:
11
Journal Article
Obesity and cardiovascular diseases Kachur, Sergey; Lavie, Carl J; de Schutter, Alban ...
Minerva medica,
06/2017, Letnik:
108, Številka:
3
Journal Article
Recenzirano
Obesity is increasingly more common in postindustrial societies, and the burden of childhood obesity is increasing. The major effects of obesity on cardiovascular (CV) health are mediated through the ...risk of metabolic syndrome (insulin-resistance, dyslipidemia, and hypertension), such that an absence of these risk factors in obese individuals may not be associated with increased mortality risk. In individuals already diagnosed with chronic CV disease (CVD), the overweight and class I obese have significant associations with improved survival. However, this effect is attenuated by increases in cardiorespiratory fitness. The negative effects of obesity on CV health manifest as accelerated progression of atherosclerosis, higher rates of ventricular remodeling and a higher risk of associated diseases, including stroke, myocardial infarction, and heart failure. The most effective therapies at reversing CVD risk factors associated with obesity have been dietary changes with exercise, especially through structured exercise programs, such as cardiac rehabilitation.
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