Obesity Paradox in the Intrahospital and Follow-Up Phases of the Acute Coronary Syndrome: A Meta-Analysis and Systematic Review.

BACKGROUND: Obesity is an important risk factor for the development of dyslipidemia, diabetes mellitus, hypertension, coronary artery disease, ventricular dysfunction, congestive heart failure (HF), stroke, and cardiac arrhythmias. OBJECTIVES: This meta-analysis brings comprehensive evaluation about still controversial association between the body mass index (BMI) and the outcomes of acute coronary syndrome. METHOD: PubMed/ScienceDirect databases were systematically searched for studies with baseline parameters, primary (HF, cardiogenic shock, cardiac arrest, reinfarction, stroke, death, total in-hospital complications) and secondary outcomes (reinfarction, stroke, death, total major adverse cardiovascular events [MACE]) in relation to BMI strictly classified into four groups (underweight [<18.5 kg/m2], normal weight [18.5-24.9 kg/m2], overweight [25.0-29.9 kg/m2], and obese [≥30.0 kg/m2], grouped into mildly obese [30.0-34.9 kg/m2] and severely obese [≥35.0 kg/m2]). RESULTS: We included 24 studies, with 585,919 participants (55.5% males), aged 66.8 years. Underweight was negatively associated with hypertension, hyperlipidemia and diabetes, and positively with primary outcomes {HF (odds ratio [OR] = 1.37, confidence interval [CI] [1.15-1.63]), cardiogenic shock (OR = 1.43, CI [1.04-1.98]), stroke (OR = 1.21, CI [1.05-1.40]), overall death (OR = 1.64, CI [1.20-2.26]), total in-hospital complications (OR = 1.39, CI [1.24-1.56])} and secondary outcomes during 34-month follow-up {cardiovascular/overall death (OR = 3.78, CI [1.69-8.49]/OR = 2.82, CI [2.29-3.49]), respectively, total MACE (OR = 2.77, CI [2.30-3.34])} (for all p < 0.05). Obesity had positive association with hypertension, hyperlipidemia, diabetes and smoking, and negative with primary outcomes {reinfarction (OR = 0.83, CI [0.76-0.91]), stroke (OR = 0.67, CI [0.54-0.85]), overall death (OR = 0.55, CI [0.49-0.63]), total in-hospital complications (OR = 0.81, CI [0.70-0.93])} and secondary outcomes {cardiovascular/overall death (OR = 0.77, CI [0.66-0.88]/OR = 0.62, CI [0.53-0.72]), respectively, total MACE (OR = 0.63, CI [0.60-0.77])} (for all p < 0.05). This negative association with several primary outcomes (cardiogenic shock, overall death, total in-hospital complications) and secondary outcomes (cardiovascular/overall death, total MACE) was more pronounced in mild obesity (p < 0.05). These results give an "obesity paradox" with a bimodal pattern (slightly U-shaped). CONCLUSIONS: Obesity is positively associated with traditional cardiovascular risk factors and negatively with primary and secondary outcomes, which confirms the persistence of overall "obesity paradox."

CHANGES IN PHYSICAL ACTIVITY LEVELS IN PATIENTS WITH ACUTE CORONARY SYNDROME BETWEEN THE FIRST AND THIRD DECADES OF THE 21st CENTURY.

Sedentary lifestyle and obesity increase the risk of coronary disease (CAD). The aims of this prospective study were to estimate the trends in physical activity (PA) level, accuracy of the Baecke's/LRC-PA questionnaires, and trends in obesity parameters (body mass index-BMI/waist-to-hip ratio-WHR) in patients with acute coronary syndrome (ACS) in the last two decades. We grouped 209 patients with ACS (UAP-unstable angina, STEMI-ST-elevation myocardial infarction, NSTEMI-non STEMI) by year of admission (Group 2002-05/Group 2017) and compared them by the levels of PA (Baecke's/LRC-PA questionnaires) and obesity parameters (BMI, WHR). Group 2017 had higher WHR (1.02 vs. 0.97) and leisure PA index (LI) (3.00 vs. 2.50), as well as less high and very low activity patients (P<0.05). Patients with UAP/STEMI had higher WHR in 2017 (1.02 vs. 0.96, 1.02 vs. 0.99, respectively) (P<0.05) and had lower LI in 2002-05 (2.50 vs. 3.25, 2.75 vs. 3.50, respectively) (P<0.05). In conclusion, leisure PA and WHR was increased in the study period both in patients with ACS and in the general population. We emphasize the usage of more precise methods for evaluation of PA and obesity (Baecke's/Four-point LRC-PA questionnaires, WHR), and that only increased PA with dietary changes leads to reduction of central obesity and risk of ACS.

The Role of Ambulatory Cardiac Rehabilitation in Improvement of Quality of Life, Anxiety and Depression.

BACKGROUND: Psychological reactions may adversely affect recovery after major cardiac events. This study investigates the role and frequently negligible importance of ambulatory cardiac rehabilitation (ACR) in improvement of quality of life (QoL), anxiety and depression at patients with various cardiac pathology. SUBJECTS AND METHODS: This prospective study included subjects treated for acute coronary syndrome (ACS), those with performed elective revascularization, and OTHERS (after valve replacement, implanted pacemaker or other device, with stable heart failure and coronary artery disease). Their anxiety (State Trait Anxiety Inventory (STAI) questionnaire), depression (Beck Depression Inventory (BDI-II) questionnaire) and QoL data (Short Form Health Survey-36 (SF-36) questionnaire, for physical and mental QoL components) were collected initially and after 3-month of ACR. RESULTS: ACR underwent 170 patients, aged 59 (53-66 years), predominately males (74.7%). At both genders, median duration of ACR was 12 weeks, with reduction of anxiety and depression scores and improvement in almost all components of QoL (P<0.05), except in mental health and bodily pain in males and females, respectively. After ACS (63.5%), ACR lasted 12 weeks, with reduction of anxiety and depression scores and improvement in all components of QoL (P<0.05). After elective revascularization (14.1%), ACR lasted 12 weeks, with reduction of anxiety score and improvement in almost all components of QoL (P<0.05), except mental health. At OTHERS (22.4%), ACR lasted 4 weeks, with improvement in almost all components of QoL (P<0.05), except mental health; ACR duration negatively correlated with anxiety and depressive scores (P<0.05). CONCLUSION: ACR during 3-month results with improvement of anxiety, depression and QoL at patients with various cardiac pathology.

Sexual Activity in Patients with Cardiac Diseases.

In this article, we outline the latest guidelines published by the American Heart Association on sexual activity in patients with coronary artery disease, heart failure, structural heart diseases, arrhythmias, implanted pacemakers or cardioverter defibrillators, as well as on treatment options of sexual dysfunction. Sexual activities are similar to mild/moderate physical activity during a short period. Most patients are recommended to involve in sexual activity after prior comprehensive evaluation of physical condition. Those with stable cardiac symptoms and good functional capacity are at a low risk of adverse cardiovascular events, and others require treatment or stabilization before involving in sexual activity. Stress testing is useful in evaluating safety of sexual activity in patients with questionable or undetermined risk. Treatment of sexual dysfunction includes counseling of patients and their sexual partners, and drug treatment with phosphodiesterase inhibitors (sildenafil, tadalafil, vardenafil) which have been demonstrated to be safe and effective, in men, and with serotonin reuptake inhibitors (flibanserin) and local vaginal estrogen administration in women. In conclusion, in routine clinical practice, patients should be approached individually and multidisciplinarily in order to detect and eliminate the factors that interfere with normal sexual activities and disturb the quality of life.

Correlation Between Concentration of Air Pollutants and Occurrence of Cardiac Arrhythmias in a Region with Humid Continental Climate

In this study, we investigated the correlation of air temperature, pressure and concentration of air pollutants with the rate of admissions for cardiac arrhythmias at two clinical centers in the area with a humid continental climate. This retrospective study included 3749 patients with arrhythmias admitted to emergency department (ED). They were classified into four groups: supraventricular tachycardia (SVT), ventricular tachycardia (VT), atrial fibrillation/undulation (Afib/Aund), and palpitations (with no ECG changes, or with sinus tachycardia and extrasystoles). The number of patients, values of meteorological parameters (average daily values of air temperature, pressure and relative humidity) and concentrations of air pollutants (particles of dimensions ~10 micrometers or less (PM(10)), ozone (O(3)) and nitrogen dioxide (NO(2))) were collected during a two-year period ( July 2008-June 2010). There were 1650 (44.0%), 1525 (40.7%), 451 (12.0%) and 123 (3.3%) patients with palpitations, Afib/Aund, SVT and VT, respectively. Spearman's correlation yielded positive correlation between the occurrence of arrhythmias and air humidity on the day (r=0.07), and 1 (r=0.08), 2 (r=0.09) and 3 days before (r=0.09), and NO(2) particles on the day (r=0.08) of ED admission; palpitations and air humidity on the day (r=0.11), and 1 (r=0.09), 2 (r=0.07) and 3 days before (r=0.10), and PM(10) (r=0.11) and NO(2) (r=0.08) particles on the day of ED admission; and Afi b/Aund and air humidity 2 days before (r=0.08) ED admission (p<0.05 all). In conclusion, there was a very weak positive correlation of the occurrence of cardiac arrhythmias with air humidity and concentration of air pollutants in the region with a humid continental climate.

Correlation Between Occurrence and Deterioration of Respiratory Diseases and Air Pollution Within the Legally Permissible Limits.

The aim of the study was to investigate the unknown effect of air pollutants on the occurrence or deterioration of respiratory diseases in the area with a humid continental climate. This retrospective study included 5868 patients with respiratory symptomatology (upper respiratory tract infection (URTI), pneumonia, acute bronchitis, chronic obstructive pulmonary disease (COPD), and asthma) admitted to emergency department (ED). The number of patients, values of meteorological parameters (mean daily values of air temperature pressure and relative humidity) and concentrations of air pollution particles (≤10 µm (PM10), ozone (O3) and nitrogen dioxide (NO2)) were collected during a two-year ( July 2008 - June 2010) period. There were 1839 (31.3%), 1712 (29.2%), 1313 (22.4%), 614 (10.5%) and 390 (6.6%) patients with pneumonia, COPD, URTI, acute bronchitis and asthma, respectively. The mean daily concentrations of NO2 (25.9 (1.7-89.7) µg/m3), O3 (47.1 (4.7-135.4) µg/m3) and PM10 particles (25.7 (4.6-146.6) µg/m3) were below the legally defined thresholds. Among other results, the occurrence of respiratory diseases showed positive Spearman's correlation with the values of air humidity (days 0-3, r=0.15 to 0.19), PM10(days 0-3, r=0.10 to 0.13) and NO2 concentrations (day 0, r=0.11), and negative correlation with the values of air temperature (days 0-3, r=-0.36 to -0.34), pressure (day 0, r=-0.10) and O3 concentrations (days 0-3, r=-0.21 to -0.22) (p<0.05 all). In conclusion, the occurrence of respiratory diseases showed correlation with weather conditions and air pollutants despite the legally permitted values in the region with a humid continental climate.

The Role of Anthropometry in Acute St-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention.

The aim of this study was to investigate the controversial influence of anthropometry on clinical severity and prognosis of acute ST-elevation myocardial infarction (STEMI). We prospectively analyzed 250 patients with acute STEMI treated with primary percutaneous coronary intervention (September 2011 ­ September 2012). They were grouped according to the following anthropometric parameters: body mass index (BMI) (<25.0, 25.0-29.9, ≥30.0 kg/m²), waist circumference (WC) (<102/88, ≥102/88 cm), waist-to-hip ratio (WHR) (<0.90/0.85, ≥0.90/0.85) and waist-to-height ratio (WHtR) (<53/49, 53/49-62/57, ≥63/58). The groups were analyzed by baseline, as well as severity (clinical, laboratory, echocardiography, coronary angiography, in-hospital complications) and prognostic parameters (major adverse cardiovascular events and sick leave duration during 12-month follow up). Patients with BMI <25.0 kg/m2 had the highest rates of dyspnea and those with BMI ≥30.0 kg/m² had the longest hospitalization and widest stents; patients with WHR ≥0.90/0.85 had higher rates of significantly stenosed proximal/middle coronary segments, while those with WHtR ≥63/58 had the highest rates of heart failure and total in-hospital complications (p<0.05). BMI <25.0 kg/m2 increased (odds ratio (OR) 2.00, confidence interval (CI) [1.09-3.68], p=0.026) and BMI 25.0-29.9 kg/m2 reduced (OR 0.52, CI [0.30-0.91], p=0.022) the risk of dyspnea; WHR≥0.90/0.85 increased the risk of significant proximal/middle coronary segment stenosis (OR 3.34, CI [1.13-9.86], p=0.029) and WHtR ≥63/58 the risk of heart failure (OR 2.05, CI [1.13-3.71], p=0.017) and total in-hospital complications (OR 1.94, CI [1.13-3.33], p=0.017) (p<0.05). In conclusion, WHR and WHtR are better anthropometric parameters than BMI in predicting acute STEMI severity, while WC has no influence on it. Anthropometry has no influence on prognosis.

Metabolic syndrome: influence on clinical severity and prognosis in patients with acute ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.

OBJECTIVE: The aim of this study was to investigate the metabolic syndrome (MS) influence on clinical severity and prognosis in patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). METHODS: We prospectively analysed 250 patients with acute STEMI treated with primary PCI, between September 2011-2012. MS was diagnosed by the revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Patients were divided into two groups (with/without MS) and compared by their baseline data (medical history, demographic and anthropometric data) and parameters of severity (clinical, laboratory, echocardiography, coronary angiography and in-hospital complications data) and prognosis (major adverse cardiovascular events and sick leave duration (SLD) during 12 months offollow-up). Results Our study included 136 (54.4%) and 114 (45.6%) patients with and without MS, respectively. MS patients had longer hospitalization (9.0 vs 8.0 days), higher rates of total in-hospital complications (25.0% vs 14.9%), higher number of significantly stenosed coronary arteries (CAs) (2 vs 1), higher stent diameters (3.5 vs 3.0 mm), higher rate of significantly stenosed proximal and middle CAs segments (94.1% vs 86.7%), and longer SLD (16 vs 10 weeks) (P < 0.05). MS was independently associated with higher risk of total in-hospital complications (odds ratio (OR) 1.90, confidence interval (CI) [1.06-3.64], P = 0.047) and with higher risk of > or =2 significant stenosed CAs (OR 1.72, Cl [1.04-2.84], P= 0.034). CONCLUSION: MS in acute STEMI is an important predictor of total in-hospital complications and severity of CAs disease, but not for other parameters of severity and prognosis. MS patients have longer SLD.