Obesity as a risk factor in atrial fibrillation and heart failure
Authors:
Jakub Jurica; Martin Jozef Péč; Jakub Benko; Tomáš Bolek; Matej Samoš; Peter Galajda; Marián Mokáň
Authors‘ workplace:
I. interná klinika JLF UK a UNM, Martin
Published in:
Forum Diab 2021; 10(3): 180-186
Category:
Overview
The prevalence of obesity in the world population is rising at an alarming rate and it is evident now that obesity is a worldwide pandemic with a significant impact on the morbidity and mortality of the world population. It is a wellknown fact that obesity is closely associated with cardiovascular disease. It is also considered as a risk factor of various diseases including atrial fibrillation (AF) and chronic heart failure (HF). Multiple recent studies point to obesity being a potential causal factor in the development of AF and HF. The discussion about obesity in relation to cardiovascular disease cannot omit the so-called obesity paradox, which represents a dilemma for clinicians around the world and is still a source of irregularities regarding the strategy of weight reduction in obese patients with HF. Most recently, the obesity paradox is also assumed to play a role in the association between obesity and the thromboembolic complications of AF. The aim of this article is to provide an insight into the role of obesity not only as a risk factor, but also as a possible etiologic agent of AF and HF, to elucidate the pathological mechanisms of the AF and HF development on the basis of obesity and to describe treatment options in the light of novel evidence.
Keywords:
obesity – atrial fibrillation – chronic heart failure
Sources
1. Wang W, Wei PL, Lee YC et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg 2005; 15(5): 648–654. Dostupné z DOI: <http://dx.doi.org/10.1381/0960892053923752>.
2. Abdelaal M, Le Roux CW, Docherty NG. Morbidity and mortality associated with obesity. Ann Transl Med 2017; 5(7): 161. Dostupné z DOI: <http://dx.doi.org/10.21037/atm.2017.03.107>.
3. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894:i-xii, 1–253.
4. Bowman K, Atkins JL, Delgado J et al. Central adiposity and the overweight risk paradox in aging: follow-up of 130,473 UK Biobank participants. Am J Clin Nutr 2017; 106: 130–135. Dostupné z DOI: <http://dx.doi.org/10.3945/ajcn.116.147157>.
5. Vyas V, Lambiase P. Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic Opportunities. Arrhythm Electrophysiol Rev 2019; 8(1): 28–36. Dostupné z DOI: <http://dx.doi.org/10.15420/aer.2018.76.2>.
6. Huxley RR, Lopez FL, Folsom AR et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the atherosclerosis risk in communities (ARIC) study. Circulation 2011; 123: 1501–1508. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.110.009035>.
7. Foy AJ, Mandrola J, Liu G et al. Relation of Obesity to New-Onset Atrial Fibrillation and Atrial Flutter in Adults. Am J Cardiol 2018; 121(9): 1072–1075. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjcard. 2018.01.019>.
8. Wang TJ, Parise H, Levy D et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 2004; 292(20): 2471–2477. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.292.20.2471>.
9. Wong CX, Sullivan T, Sun MT et al. Obesity and the risk of incident, post-operative, and post-ablation atrial fibrillation: a metaanalysis of 626,603 individuals in 51 studies. JACC Clin Electrophysiol 2015; 1(3): 139–152. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacep.2015.04.004>.
10. Krijthe BP, Kunst A, Benjamin EJ et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 2013; 34(35): 2746–2751. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/eht280>.
11. Lee H, Choi EK, Lee SH et al. Atrial fibrillation risk in metabolically healthy obesity: a nationwide population-based study. Int J Cardiol 2017; 240: 221–227. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ijcard.2017.03.103>.
12. ChoB-H, Cheon K, Lee KY et al. Association between body mass index and stroke severity in acute ischaemic stroke with non-valvular atrial fibrillation. Eur J Neurol 2020; 27(8): 1672–1679. Dostupné z DOI:<http://doi/10.1111/ene.14304>.
13. Wanahita N, Messerli FH, Bangalore S et al. Atrial fibrillation and obesity-- results of a meta-analysis. Am Heart J 2008; 155(2): 310–315. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ahj.2007.10.004>.
14. Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg 2003; 13(5): 676–683. Dostupné z DOI: <http://dx.doi.org/10.1381/096089203322509228>.
15. Qu YC, Du YM, Wu SL et al. Activated nuclear factor-kappaB and increased tumor necrosis factor-alpha in atrial tissue of atrial fibrillation. Scand Cardiovasc J 2009; 43(5): 292–297. Dostupné z DOI: <http://dx.doi.org/10.1080/14017430802651803>.
16. Venteclef N, Guglielmi V, Balse E et al. Human epicardial adipose tissue induces fibrosis of the atrial myocardium through the secretion of adipo-fibrokines. Eur Heart J 2015; 36(13): 795–805a. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/eht099>.
17. Balcioğlu AS, Çiçek D, Akinci S et al. Arrhythmogenic evidence for epicardial adipose tissue: heart rate variability and turbulence are influenced by epicardial fat thickness. Pacing Clin Electrophysiol 2015; 38(1): 99–106. Dostupné z DOI: <http://dx.doi.org/10.1111/pace.12512>.
18. Al Chekakie MO, Welles CC, Metoyer R et al. Pericardial fat is independently associated with human atrial fibrillation. J Am Coll Cardiol. 2010; 56(10): 784–788. Dostupné z DOI: <http://dx.doi.org/10.1016/j. jacc.2010.03.071>.
19. Martin K, Beyer-Westendorf J, Davidson BL et al. Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the ISTH. J Thromb Haemost. 2016; 14(6): 1308–1313. Dostupné z DOI:<http://dx.doi.org/10.1111/jth.13323>.
20. Yu L, Scherlag BJ, Sha Y et al. Interactions between atrial electrical remodelling and autonomic remodelling: How to break the vicious cycle. Heart Rhythm 2012; 9(5): 804–809. Dostupné z DOI: <http://dx.doi.org/10.1016/j.hrthm.2011.12.023>.
21. Kaplan RM, Diaz CL, Strzelczyk T et al. Outcomes with novel oral anticoagulants in obese patients who underwent electrical cardioversion for atrial arrhythmias. Am J Cardiol 2018; 122(7): 1175–1178. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjcard.2018.06.022>.
22. Thangjui S, Kewcharoen J, Yodsuwan R et al. Efficacy and safety of direct oral anticoagulant in morbidly obese patients with atrial fibrillation: systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother 2021; pvab026. Dostupné z DOI: <http://dx.doi.org/10.1093/ehjcvp/pvab026>.
23. Xue Y, Xu X, Zhang XQ et al. Preventing diet-induced obesity in mice by adipose tissue transformation and angiogenesis using targeted nanoparticles. Proc Natl Acad Sci USA 2016; 113(20): 5552–5557. Dostupné z DOI: <http://dx.doi.org/10.1073/pnas.1603840113>.
24. Iacobellis G, Mohseni M, Bianco SD et al. Liraglutide causes large and rapid epicardial fat reduction. Obesity 2017; 25(2): 311–316. Dostupné z DOI: <http://dx.doi.org/10.1002/oby.21718>.
25. Sato T, Aizawa Y, Yuasa S et al. The effect of dapagliflozin treatment on epicardial adipose tissue volume. Cardiovasc Diabetol 2018; 17(1): 6. Dostupné z DOI: <http://dx.doi.org/10.1186/s12933–017–0658–8>.
26. Chung MK, Eckhardt LL, Chen LY et al. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation 2020; 141(16): e750–e772. Dostupné z DOI: <http://dx.doi.org/10.1161/CIR.0000000000000748>.
27. Pathak RK, Elliott A, Middeldorp ME et al. Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation: the CARDIO-FIT study. J Am Coll Cardiol 2015; 66(9): 985–996. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2015.06.488>.
28. Qureshi WT, Alirhayim Z, Blaha MJ et al. Cardiorespiratory fitness and risk of incident atrial fibrillation: results from the Henry ford exercise testing (FIT) project. Circulation 2015; 131(21): 1827–1834. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.114.014833>.
29. Jamaly S, Carlsson L, Peltonen M et al. Bariatric surgery and the risk of new-onset atrial fibrillation in Swedish obese subjects. J Am Coll Cardiol 2016; 68(23): 2497–2504. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2016.09.940>.
30. Donnellan E, Wazni OM, Kanj M et al. Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation. Europace 2019; 21(10): 1476–1483. Dostupné z DOI: <http://dx.doi.org/10.1093/europace/euz183>.
31. Lévy S, Lauribe P, Dolla E et al. A randomized comparison of external and internal cardioversion of chronic atrial fibrillation. Circulation 1992; 86(5): 1415–1420. Dostupné z DOI: <http://dx.doi.org/10.1161/01.CIR.86.5.1415>.
32. Voskoboinik A, Moskovitch J, Plunkett G et al. Cardioversion of atrial fibrillation in obese patients: Results from the Cardioversion-BMI randomized controlled trial. J Cardiovasc Electrophysiol 2019; 30(2): 155–161. Dostupné z DOI: <http://dx.doi.org/10.1111/jce.13786>
33. Braunschweig F, Cowie MR, Auricchio A. What are the costs of heart failure? Europace 2011; 13(Suppl 2): ii13–ii17. Dostupné z DOI:<http://dx.doi.org/10.1093/europace/eur081>.
34. Roger VL, Go AS, Lloyd-Jones DM et al. [American Heart Association Statistics Committee and Stroke Statistics Subcommittee]. Heart Disease and Stroke Statistics-2011 Update: A Report From the American Heart Association. Circulation 2011; 123(4): e18–e209. Dostupné z DOI: <http://dx.doi.org/10.1161/CIR.0b013e3182009701>.
35. Zamora E,Lupon J, De Antonio M et al. Obesity paradox in heart failure with mid-range ejection fraction. P6330. Eur Heart J 2019; 40(Suppl 1): ehz746.0927. Dostupné z DOI: <https://doi.org/10.1093/eurheartj/ehz746.0927>.
36. Gupta PP, Fonarow GC, Horwich TB. Obesity and the obesity paradox in heart failure. Can J Cardiol 2015; 31(2): 195–202. Dostupné z DOI:<http://dx.doi.org/10.1016/j.cjca.2014.08.004>.
37. Kenchaiah S, Evans JC, Levy D et al. Obesity and the risk of heart failure. N Engl J Med 2002; 347(5): 305–313. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa020245>.
38. Ashrafian H, le Roux CW, Darzi A et al. Effects of Bariatric Surgery on Cardiovascular Function. Circulation 2008; 118(20): 2091–2102. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.107.721027>.
39. Glenn DJ, Wang F, Nishimoto M et al. A Murine Model of Isolated Cardiac Steatosis Leads to Cardiomyopathy. Hypertension 2011; 57(2): 216–222. Dostupné z DOI: <http://dx.doi.org/10.1161/hypertensionaha.110.160655>.
40. Gosman GG, Katcher HI, Legro RS. Obesity and the role of gut and adipose hormones in female reproduction. Hum Reprod Update 2006; 12(5): 585–601. Dostupné z DOI: <http://dx.doi.org/10.1093/humupd/dml024>.
41. Sarzani R, Salvi F, Dessi-Fulgheri P et al. Renin-angiotensin system, natriuretic peptides, obesity, metabolic syndrome, and hypertension: an integrated view in humans. J Hypertens 2008; 26(5): 831–843. Dostupné z DOI: <http://dx.doi.org/10.1097/HJH.0b013e3282f624a0>.
42. Piot O. Atrial fibrillation and heart failure: a dangerous criminal conspiracy. Ann Cardiol Angeiol (Paris) 2009; 58(Suppl 1): S14–16. Dostupné z DOI: <http://dx.doi.org/10.1016/S0003–3928(09)73391–8>.
43. Poirier P, Giles TD, Bray GA et al. [American Heart Association]. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006; 113(6): 898–918. Dostupné z DOI: <http:// dx.doi.org/10.1161/CIRCULATIONAHA.106.171016>.
44. Grundy SM, Brewer Jr HB, Cleeman JI et al. [National Heart, Lung, and Blood Institute; American Heart Association]. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/ American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol 2004; 24(2): e13-e18. Dostupné z DOI:<http://dx.doi.org/10.1161/01.ATV.0000111245.75752.C6>.
45. Brassard P, Legault S, Garneau C et al. Normalization of diastolic dysfunction in type 2 diabetics after exercise training. Med Sci Sports Exerc 2007; 39(11): 1896–1901. Dostupné z DOI: <http://dx.doi.org/10.1249/mss.0b013e318145b642>.
46. Ponikowski P, Voors AA, Anker SD et al. [ESC Scientific Document Group]. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Practice Guideline Eur Heart J 2016; 37(27): 2129–2200. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehw128>.
47. McDonald M, Virani S, Chan M et al. CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction Can J Cardiol 2021; 37(4): 531–546. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cjca.2021.01.017>.
48. MacMahon S, Collins G, Rautaharju P et al. Electrocardiographic left ventricular hypertrophy and effects of antihypertensive drug therapy in hypertensive participants in the Multiple Risk Factor Intervention Trial. Am J Cardiol 1989; 63(3): 202–210. Dostupné z DOI: <http://dx.doi.org/10.1016/0002–9149(89)90286–5>.
49. Pandey A, LaMonte M, Klein L et al. Relationship between physical activity, body mass index, and risk of heart failure. J Am Coll Cardiol 2017; 69(9): 1129–1142. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2016.11.081>.
50. Kitzman DW, Brubaker P, Morgan T et al. Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved ,Ejection Fraction: A Randomized Clinical Trial. JAMA 2016; 315(1): 36–46. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2015.17346>.
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