bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obesity in young sudden cardiac death: rates, clinical features, and insights into people with body mass index &gt;50kg/m2
Authors: Ashokkumar S , Paratz E , Van Heusden A , Smith K , Zentner D , Morgan N , Parsons S , Thompson T , James P , Connell V , Pflaumer A , Semsarian C , Ingles J , Stub D , La Gerche A 
Published: October 2022

Abstract

Background
Obesity is common in young sudden cardiac death (SCD) victims but it is unclear whether it is more common than in the general population. This study aimed to contextualize young SCD obesity rates, identifying clinical and pathologic features in WHO class II and III obesity.

Methods
A prospective state-wide out-of-hospital cardiac arrest registry included all SCDs in Victoria, Australia from 2019–2021. Body mass indices (BMIs) of patients 18–50 years were compared to age-referenced general population. Characteristics of SCD patients with WHO Class II obesity (BMI ≥30kg/m2) and non-obesity (BMI &lt;30kg/m2) were compared. Clinical characteristics of people with BMI &gt;50kg/m2 were assessed.

Results
504 patients were included. Obesity was strongly over-represented in young SCD compared to the age-matched general population (55.0% vs 28.7%, p&lt;0.0001). Obese SCD patients more frequently had hypertension, diabetes and obstructive sleep apnoea (p&lt;0.0001, p=0.009 and p=0.001 respectively), ventricular fibrillation as their arrest rhythm (p=0.008) and left ventricular hypertrophy (LVH) (p&lt;0.0001). Obese patients were less likely to have toxicology positive for illicit substances (22.0% vs 32.6%, p=0.008) or significant alcohol history (18.8% vs 26.9%, p=0.030). Patients with BMI &gt;50 kg/m2 represented 8.5% of young SCD. LVH (n=26, 60.5%) was their predominant cause of death and only 10 (9.3%) patients died from coronary disease.

Conclusion
Over half of young Australian SCD patients are obese, with all obesity classes over-represented compared to the general population. Obese patients had more cardiac risk factors. Almost two thirds of patients with BMI&gt;50 kg/m2 died with LVH, with fewer than 10% dying from coronary disease.

Funding Acknowledgement
Type of funding sources: None.
Incidence of type 2 diabetes after gastric by-pass surgery in a Swedish controlled cohort study
Authors: Jamaly S , Lundberg C , Adiels A , Lagergren J , Bjorck L , Rosengren A 
Published: October 2022

Abstract

Aims
To assess the long-term risk of developing type 2 diabetes in patients with obesity who have undergone gastric bypass surgery compared to non-operated patients with obesity and the general population.

Methods and results
This study included 55,534 patients aged 20–65 years with a principal diagnosis of obesity in the Swedish Patient Register in 2001–2013. Of these, 23,099 had undergone gastric bypass and 32,435 had not. Each patient was matched by age, sex and geographic region with two population controls from the general population without an obesity diagnosis, i.e., 44,735 controls for the gastric bypass patients and 62,522 controls for the non-operated cohort with obesity. During a median follow-up of 4.2 years (interquartile range [IQR] 2.4, 7.1 years), 3,761 (11.6%) non-operated patients with obesity developed type 2 diabetes (incidence rate 226.0 per 1,000 person-years, confidence interval [CI] 218.8–233.4) compared to 381 (1.6%) among gastric bypass patients (incidence rate 38.7 per 1,000 person-years CI 34.7–43.5). The latter incidence was comparable to population controls incidence rate (34.7 per 1,000 person-years CI 31.7–38.2). Operated and non-operated patients with obesity were also directly compared using Cox regression analysis with adjustment for age, education, and sex, and showed gastric bypass patients had an 85% lower risk of developing diabetes compared to non-operated patients with obesity during the first six years of follow-up (hazard ratio 0.14; 95% CI 0.12–0.17).

Conclusion
Gastric bypass surgery for obesity seems to reduce the risk of developing type 2 diabetes to levels similar to that of the general population during the first six years of follow-up, but not thereafter.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish government and the county councils concerning economic support of research and education of doctorsSwedish Heart and Lung FoundationSwedish Research Council
Low muscle mass is linked with presence of non-alcoholic fatty liver disease irrespective to central obesity: highlights from a prospective epidemiological study in Greece
Authors: Kouvari M , Polyzos S A , Chrysohoou C , Skoumas J , Pitsavos C , Mantzoros C , Panagiotakos D B 
Published: October 2022

Abstract

Background/Introduction
The association between sarcopenia and nonalcoholic fatty liver (NAFL) is highlighted in recent epidemiological studies, although results remain inconsistent.

Purpose
This study aimed to examine the association of low skeletal muscle mass with NAFL as well as the potential mediating effect of waist circumference on the examined association.

Methods
At baseline, 3,042 participants from the Attica region of Greece were recruited. NAFL was assessed through hepatic steatosis index (HSI). Skeletal muscle mass index (SMI) was indirectly calculated using a standard validated procedure.

Results
Ranking from 1st to 3rd SMI tertiles NAFL rate was 45%, 33% and 22%, respectively (p&lt;0.001). Multi-adjusted logistic regression analysis revealed that participants assigned in the 2nd (Odds Ratio (OR): 0.50, 95% Confidence Interval (95% CI): 0.41–0.61)) and 3rd SMI tertile had 50% and 76% (OR: 0.24, 95% CI: 0.19–0.29) lower likelihood to have NAFL compared with their 1st tertile counterparts. This association remained robust after multiple adjustments; however, significance was marginally lost, when waist circumference was added to the model. Subsequently, a multi-adjusted dose-response analysis between SMI and NAFL was performed in the total sample, as well as in the subcategories of normal and abnormal waist circumference. In the total sample, a significant inverse association between SMI and NAFL was observed [OR (per 2 points increase in SMI) = 0.94 (95% CI: 0.92–0.95); p=0.001]. When categorized by waist circumference, participants with moderate/high SMI and normal waist circumference had the lowest NAFL rates (24.3%). Those with low SMI and normal waist circumference and those with moderate/high SMI and abnormal waist circumference had similar rates of NAFL (47.4% and 50.3%, respectively; p=0.25). Participants with both low SMI and abnormal waist circumference presented the highest NAFL rate (60.5%), which was significantly higher compared with the rest subgroups (p&lt;0.001). These findings were confirmed in multi-adjusted analysis to assess NAFL odds per case: participants with adnormal waist, [OR (per 2 points increase in SMI) = 0.97 (95% CI: 0.94–1.00)] vs. participants with normal waist [OR (per 2 points increase in SMI) = 0.89 (95% CI: 0.84–0.95)].

Conclusions
Increasing SMI was associated with lower rates of NAFL independently to abdominal obesity, whereas the two interact as key determinants of NAFL.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Hellenic Society of Cardiology
Metabolically healthy obesity in a young population assisted by the family health strategy LapARC study
Authors: De Souza Mello T , Parente Macedo Moura C , Avelar Mendes De Vasconcellos C , Camara Garcia J , Rossilho Moyses Ushijima N , Rey Costa Tostes F , Brandao Catharina L , Maria Da Costa Muguet C , Do Valle Kangussu F , Dos Santos Ferreira D , Henrique Dos Santos Lemos P , Lopes Monteiro De Barros Junqueira L , Da Silva Guimaraes K , Silaid Muxfeldt E , Tenorio Da Costa Fernandes A C 
Published: October 2022

Abstract

Introduction
Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease.

Objective
To evaluate the prevalence and cardiovascular (CV) risk factors associated with metabolically healthy obesity (MHO) in a young population assisted by a Family Health Care unit in a large urban center.

Design and method
A cross-sectional population study for CV risk assessment in adults aged 20–50 years old from a Family Health Care unit. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (BP) measurements, laboratory evaluation (lipid and glycidic profile). Obesity was defined as a body mass index (BMI) &gt;30 kg/m2 and MHO are those who have less than 3 of the following criteria for metabolic syndrome: office BP higher or equal to 130 x 85 mmHg, hypertension, fasting blood sugar higher or equal to 100 mg/dL, HDL &lt;40 mg/dL (men) and 50 mg/dL (women), triglycerides &gt;150 mg/dL and waist circumference &gt;102 cm (men) and &gt;88 cm (women).

Results
A total of 632 individuals were evaluated (60% female; mean age 37±9 years). The prevalence of obesity was 26%, of which 73% were classified as MHO. Obeses are older, with a higher prevalence of physical inactivity (51% vs 41%, p=0.03), hypertension (44% vs 19%, p&lt;0.001), dyslipidemia (50% vs 36%, p=0.002), and diabetes (7% vs 2%, p=0.001) with higher systolic OBP. MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p=0.02) and abdominal circumference (102 vs 110 cm, p=0.03), with lower diastolic BP.

Conclusion
MHO was more prevalent in this young population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): CNPQFAPERJ
Effect of diet and lifestyle on the relationship between body mass index and waist circumference and cardiovascular mortality in myocardial infarction patients from the Alpha Omega Cohort
Authors: Cruijsen E , Bonekamp N E , Koopal C , Winkels R M , Visseren F L J , Geleijnse J M 
Published: October 2022

Abstract

Introduction
The associations between measures of body adiposity body mass index (BMI) and waist circumference (WC) and cardiovascular disease (CVD) mortality have been frequently studied and usually follow a J-shaped curve or show a positive relationship. However, less is known about the influence of diet and physical activity on these associations.

Purpose
We aimed to gain insight in potential lifestyle-related effect modifiers of the association of BMI and WC with CVD mortality in myocardial infarction (MI) patients.

Methods
We included 4,837 Dutch patients from the Alpha Omega Cohort with a MI &lt;10 y prior enrolment. BMI and WC were assessed at baseline (2002–2006). Patients were followed through December 2018 for vital status and cause-specific mortality. Continuous associations of BMI and WC with CVD mortality were estimated using Cox proportional hazards models with restricted cubic splines. A BMI of 25 kg/m2 and a WC of 100 cm were used as the references. Age and sex adjusted associations were stratified for diet quality and physical activity level and interaction terms were calculated.

Results
Of the study population (69.0±5.6 y), 17% smoked, 21% had diabetes, 22% were female and &gt;85% used any type of cardiovascular medication. During a median follow-up of 12.4 years [8.5–13.8], 1,010 deaths occurred due to CVD. A J-shaped continuous association was observed between BMI and CVD mortality with inverse associations for a BMI between 25–30 kg/m2, compared to 25 kg/m2. The nadir (HR, 95% CI) was 27.4 kg/m2 (HR: 0.94, 95% CI: 0.88, 1.00) (A). For WC, a non-linear association was observed with CVD mortality with higher mortality risks for a WC above 100 cm (A). Results were similar in patients with low versus high diet quality and in patients with low versus high physical activity (B), interaction terms were not significant (all p&gt;0.55).

Conclusion
In MI patients, a BMI between 25–30 kg/m2 was associated with the lowest risk of CVD mortality. A WC above 100 cm was associated with a higher CVD mortality risk. The observed associations manifested independently of diet quality and physical activity level. Therefore, body adiposity seems to determine CVD mortality risk independently of underlying lifestyle factors.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Regio Deal Foodvalley
Evaluation of cardiac involvement in patients with clinical post-COVID-19 syndrome
Authors: Gorecka M , Jex N , Thirunavukarasu S , Chowdhary A , Poenar A M , Sharrack N , Swoboda P P , Xue H , Vassiliou V , Kellman P , Plein S , Simms A , Greenwood J P , Levelt E 
Published: October 2022

Abstract

Introduction
The underlying pathophysiology of Post-COVID-19 syndrome remains unknown, but increased cardiometabolic demand and state of mitochondrial dysfunction have emerged as candidate mechanisms. Cardiovascular magnetic resonance (CMR) provides insight into pathophysiological mechanisms underlying cardiovascular disease and 31-phosphorus magnetic resonance spectroscopy (31P-MRS) allows non-invasive assessment of the myocardial energetic state.

Purpose
We sought to assess whether Post-COVID-19 syndrome is associated with abnormalities of myocardial structure, function, perfusion and tissue characteristics or energetic derangement.

Methods
Prospective case-control study. A total of 20 patients with a clinical diagnosis of Post-COVID-19 syndrome (seropositive) and no prior underlying cardiovascular disease (CVD) and ten matching controls underwent 31P-MRS and CMR at 3T at a single time point. (Figure 1) All patients had been symptomatic with acute COVID-19, but none required hospital admission.

Results
Between the Post-COVID-19 syndrome patients and matched contemporary controls there were no differences in myocardial energetics (phosphocreatine to ATP ratio), in cardiac structure (biventricular volumes, left ventricular mass), function (biventricular ejection fractions, global longitudinal strain), tissue characterization (T1 and extracellular volume [ECV] fraction mapping, late gadolinium enhancement) or perfusion (myocardial rest and stress blood flow, myocardial perfusion reserve). One patient with Post-COVID-19 syndrome showed subepicardial hyperenhancement on the late gadolinium enhancement imaging compatible with prior myocarditis, but no accompanying abnormality in cardiac size, function, perfusion, ECV, T1, T2 mapping or energetics. This patient was excluded from statistical analyses. (Table 1)

Conclusion
In this study, the overwhelming majority of patients with a clinical Post-COVID-19 syndrome with no prior CVD did not exhibit any abnormalities in myocardial energetics, structure, function, blood flow or tissue characteristics.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Welcome Trust Clinical Career Development Fellowship (221690/Z/20/Z);NIHR-UKRI COVID-19 Rapid Response Rolling Call (COV0254)ESC Training Grant
Diabetes and coronary risk equivalency – a population-based cohort study from Western Denmark
Authors: Olesen K , Gyldenkerne C G , Thrane P G , Maeng M M 
Published: October 2022

Abstract

Background
Diabetes is associated with an increased risk of cardiovascular disease. Accordingly, guidelines recommend extensive management of cardiovascular risk factors in patients with diabetes. Diabetes has previously thought to carry the same high cardiovascular risk as already having coronary heart disease. It is, however, unknown if the intensified focus on prophylactic treatment has changed the risk of myocardial infarction and ischemic stroke in contemporary practice.

Aims
We aimed to examine whether diabetes remains a cardiovascular risk equivalent to coronary heart disease under the contemporary treatment regimen.

Methods
We included every person residing in Western Denmark on January 1, 2012, aged 50–89 years. The cohort was stratified by diabetes and coronary heart disease (defined as previous myocardial infarction, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or coronary artery disease documented by coronary angiography). The four groups were followed for up to seven years after inclusion. Outcomes were myocardial infarction, ischemic stroke, cardiac death, and all-cause death. Patients with coronary heart disease only were compared to patients with diabetes only using a multivariable Cox regression model.

Results
We included 1,111,456 persons residing in Western Denmark on January 1, 2012, of whom 86.1% had neither diabetes nor coronary heart disease, 7.5% had diabetes only, 5.0% only had history of coronary heart disease, 1.4% had both diabetes and coronary heart disease. Patients with diabetes only less likely to be in antithrombotic treatment, lipid-lowering treatment, and antihypertensive treatment compared to patients with coronary heart disease only. Compared to patients with diabetes only (Figure 1), coronary heart disease was associated with an increased risk of myocardial infarction (adjusted HR 1.73, 95% CI 1.65–1.82) and cardiac death (adjusted HR 1.40, 95% 1.32–1.48). However, coronary heart disease only was associated with a reduced risk of ischemic stroke (adjusted HR 0.83, 95% CI 0.79–0.87) and all-cause mortality (adjusted HR 0.76, 95% CI 0.74–0.77) compared to diabetes only (Figure 1).

Conclusions
In contemporary practice in Denmark, patients with diabetes only have a lower risk of myocardial infarction or cardiac death than observed in non-diabetic patients with verified coronary heart disease. On the contrary, patients with diabetes only have a greater risk ischemic stroke and al–cause mortality than coronary heart disease only. Thus, diabetes is not a uniform cardiovascular risk equivalent to coronary heart disease, but depends on the given outcome.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
Association of hepatic steatosis with subclinical cardiac dysfunction in asymptomatic people with type 2 diabetes
Authors: Yeo J L , Gulsin G S , Dattani A , Brady E M , Bilak J M , Ayton S L , Moss A J , Pang W , Boulos S , House M J , St Pierre T G , McCann G P 
Published: October 2022

Abstract

Introduction
Non-alcoholic fatty liver disease is highly prevalent among people with type 2 diabetes (T2D) and is an emerging risk factor for heart failure with preserved ejection fraction (HFpEF). Whether excess liver adiposity is simply a marker of the coexisting adverse cardiometabolic risk profile or independently contributes to the development of HFpEF is unclear.

Purpose
To assess the association between liver fat fraction and subclinical cardiac dysfunction in adults with T2D.

Methods
Prospective cross-sectional study. Two-hundred and thirty-eight adults with T2D (mean age 63±7 years, 62% males, HbA1c 7.2±1.5%, diabetes duration 10±8 years) with no signs, symptoms, or evidence of cardiovascular disease and 40 age-, sex-, and ethnicity-matched non-diabetic controls (mean age 61±8 years, 63% males, HbA1c 5.2±1.2%) underwent comprehensive phenotyping with echocardiography and multiparametric cardiac MRI including adenosine stress and rest perfusion. Volumetric liver fat fraction (VLFF) was measured using a histologically validated, proprietary MRI technique blinded to all participant details. Inter-study reproducibility was assessed in participants (n=28) who underwent a repeat MRI within two weeks. Linear regression analysis was performed to assess any independent associations between VLFF and identified markers of subclinical cardiac dysfunction in subjects with T2D.

Results
People with T2D had evidence of concentric left ventricular (LV) remodelling (higher LV mass/volume), extracellular matrix expansion (higher ECV fraction), both systolic and diastolic dysfunction (lower global longitudinal systolic strain and E/A ratio, respectively), and coronary microvascular dysfunction (lower myocardial perfusion reserve) (Table 1). VLFF demonstrated excellent inter-study reproducibility with an intra-class correlation coefficient (ICC) of 0.988 (0.974–0.994). T2Ds had higher VLFF compared to controls [7.5 (3.8–13.7)% vs 2.9 (1.7–4.7)%, p&lt;0.001]. In multivariable regression analysis adjusting for age, sex, ethnicity, body mass index, ambulatory systolic blood pressure, HbA1c, and low-density lipoprotein, VLFF (β=−0.161, p=0.027) was independently associated with E/A, but not other imaging measures of subclinical cardiac dysfunction.

Conclusion
Liver fat fraction is elevated in people with T2D and is independently associated with early LV diastolic dysfunction. These results add to the growing evidence that ectopic fat plays an important role in the pathogenesis of HFpEF and may be a potential target for intervention.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) United Kingdom through a Research Professorship award (RP-2017-08-ST2-007).British Heart Foundation through a Clinical Research Training Fellowship (FS/16/47/32190).