BACKGROUND: The impact of overweight and obesity on outcomes in "real world" patients with atrial fibrillation (AF) is not fully defined. Second, sex differences in AF outcomes may also exist. METHODS AND RESULTS: The aim was to investigate outcomes at 1 year follow-up for AF patients enrolled in the EORP-AF Registry, according to BMI (kg/m2 ), comparing patients with normal BMI (18.5 to < 25 kg/m2 ), overweight (25 to < 30 kg/m2 ) and obesity (≥ 30 kg/m2 ), in relation to sex differences. Among 2,540 EORP AF patients (38.9% female; median age 69) with 1 year follow-up data available, 720 (28.3%) had a normal BMI, 1,084 (42.7%) were overweight, and 736 (29.0%) were obese. Obese patients were younger and with more prevalent diabetes mellitus and hypertension (P < 0. 001). One-year outcomes showed that all-cause mortality was significantly different according to BMI among female patients (9.3% normal BMI, 5.3% overweight, and 4.3 % obese, P = 0.023), but not among male patients (P = 0.748). The composite outcome of thromboembolic events and death was also significantly different, being lower in obese females (P = 0.035). Among male patients, bleeding events were significantly more frequent in obese subjects (P = 0.035). On multivariable Cox analysis, BMI was not independently associated with all-cause mortality. CONCLUSIONS: Among AF patients, overweight and obesity are common and associated with better outcomes in females (a finding previously reported as "obesity paradox"), while no significant differences in outcomes are detected among male patients. Final multivariable model found that increasing BMI was not associated with increased risk of all-cause death; conversely, age and comorbidities persisted as major determinants.
Atrial Fibrillation/epidemiology , Obesity/epidemiology , Overweight/epidemiology , Age Factors , Aged , Atrial Fibrillation/diagnosis , Atrial Fibrillation/mortality , Atrial Fibrillation/therapy , Body Mass Index , Comorbidity , Female , Humans , Male , Obesity/diagnosis , Obesity/mortality , Overweight/diagnosis , Overweight/mortality , Pilot Projects , Prevalence , Prognosis , Registries , Risk Assessment , Risk Factors , Sex Factors , Time Factors
Current research suggest that plasminogen activator inhibitor type 1 (PAI-1) is an important contributor to a number of disease processes. The aim of the current paper is to emphasize the deleterious effects of PAI-1 on cardiovascular diseases development and progression. The plasminogen system is known by its role in hemostasis and thrombosis regulation. Lifestyle changes and pharmacological treatment can regulate PAI-1 levels and functions. Some pharmacologic agents currently used in the management of atherosclerosis and its complications can counteract the deleterious effects of PAI-1.
Endocarditis still carries a poor prognosis despite improvement in preventive strategies and advances in diagnosis and also in treatment. Epidemiology of infective endocarditis (IE) has changed in late years. Contemporary antibiotic overuse determines antibiotic resistance against microorganisms involved in IE. Prophylaxis principles have been changed and restricted in order to avoid excessive antibiotic use and unfounded costs. Current guidelines are often based on expert opinion because of the low incidence of the disease, the absence of randomized trials, and the limited number of meta-analyses. The present review will focus on current changes in epidemiology, prophylaxis, diagnosis and treatment options.
