scholarly journals Effects of body mass index on relationship status, social contact, and socioeconomic position: Mendelian Randomization study in UK Biobank

2019 ◽  
Author(s):  
Laura D Howe ◽  
Roshni Kanayalal ◽  
Robin N Beaumont ◽  
Alisha R Davies ◽  
Timothy M Frayling ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Mendelian Randomization ◽  
Relationship Status ◽  
Social Activities ◽  
Uk Biobank ◽  
Non Linear ◽  
Low Bmi ◽  
Degree Level ◽  
High Bmi

AbstractObjectiveTo assess whether body mass index (BMI) has a causal effect on social and socioeconomic factors, including whether both high and low BMI can be detrimental.DesignMendelian Randomization, using genetic variants for BMI to obtain unconfounded estimates, and non-linear Mendelian Randomization.SettingUK Biobank.Participants378,244 men and women of European ancestry, mean age 57 (SD 8 years).Main outcome measuresTownsend deprivation index, income, age completed full time education, degree level education, job class, employment status, cohabiting relationship status, participation in leisure and social activities, visits from friends and family, and having someone to confide in.ResultsHigher BMI was causally associated with higher deprivation, lower income, fewer years of education, lower odds of degree-level education and skilled employment. For example, a 1 SD higher genetically-determined BMI (4.8kg/m2 in UK Biobank) was associated with £1,660 less income per annum [95%CI: £950, £2,380]. Non-linear Mendelian Randomization provided evidence that both low BMI (bottom decile, <22kg/m2) and high BMI (top seven deciles, >24.6kg/m2) can increase deprivation and reduce income. In men only, higher BMI was related to lower participation in leisure and social activities. There was no evidence of causal effects of BMI on visits from friends and family or in having someone to confide in. Non-linear Mendelian Randomization analysis showed that low BMI (bottom three deciles, <23.5kg/m2) reduces the odds of cohabiting with a partner or spouse for men, whereas high BMI (top two deciles, >30.7kg/m2) reduces the odds of cohabitation with a partner or spouse for women.ConclusionsBMI affects social and socioeconomic outcomes, with both high and low BMI being detrimental for some measures of SEP. This suggests that in addition to health benefits, maintaining healthy ranges of BMI across the population could have benefits both for individuals and society.

scholarly journals Effects of body mass index on relationship status, social contact and socio-economic position: Mendelian randomization and within-sibling study in UK Biobank

2019 ◽  
Vol 49 (4) ◽  
pp. 1173-1184 ◽  
Author(s):  
Laura D Howe ◽  
Roshni Kanayalal ◽  
Sean Harrison ◽  
Robin N Beaumont ◽  
Alisha R Davies ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Mendelian Randomization ◽  
Specific Effect ◽  
Economic Outcomes ◽  
European Ancestry ◽  
Uk Biobank ◽  
Non Linear ◽  
Low Bmi ◽  
Economic Position

Abstract Background We assessed whether body mass index (BMI) affects social and socio-economic outcomes. Methods We used Mendelian randomization (MR), non-linear MR and non-genetic and MR within-sibling analyses, to estimate relationships of BMI with six socio-economic and four social outcomes in 378 244 people of European ancestry in UK Biobank. Results In MR of minimally related individuals, higher BMI was related to higher deprivation, lower income, fewer years of education, lower odds of degree-level education and skilled employment. Non-linear MR suggested both low (bottom decile, &lt;22 kg/m2) and high (top seven deciles, &gt;24.6 kg/m2) BMI, increased deprivation and reduced income. Non-genetic within-sibling analysis supported an effect of BMI on socio-economic position (SEP); precision in within-sibling MR was too low to draw inference about effects of BMI on SEP. There was some evidence of pleiotropy, with MR Egger suggesting limited effects of BMI on deprivation, although precision of these estimates is also low. Non-linear MR suggested that low BMI (bottom three deciles, &lt;23.5 kg/m2) reduces the odds of cohabiting with a partner or spouse in men, whereas high BMI (top two deciles, &gt;30.7 kg/m2) reduces the odds of cohabitation in women. Both non-genetic and MR within-sibling analyses supported this sex-specific effect of BMI on cohabitation. In men only, higher BMI was related to lower participation in leisure and social activities. There was little evidence that BMI affects visits from friends and family or having someone to confide in. Conclusions BMI may affect social and socio-economic outcomes, with both high and low BMI being detrimental for SEP, although larger within-family MR studies may help to test the robustness of MR results in unrelated individuals. Triangulation of evidence across MR and within-family analyses supports evidence of a sex-specific effect of BMI on cohabitation.

Abstract 14966: Non-biased Fat Scoring System for Human Cardiac Variability and Body Mass Index Correlation Analyses

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kyra Peczkowski ◽  
Farbod Fazlollahi ◽  
Mohammed Mashali ◽  
Nancy Saad ◽  
Salome Kiduko ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Adipose Tissue ◽  
Body Mass ◽  
Scoring System ◽  
Wide Distribution ◽  
Epicardial Fat ◽  
Equal Distribution ◽  
Correlation Analyses ◽  
Low Bmi ◽  
High Bmi

Introduction: It remains unclear if body mass index (BMI) is correlated to the amount of cardiac adipose tissue in humans. Echocardiography is typically utilized to measure epicardial fat in live patients, but has yielded inconclusive results, as it is difficult to measure cardiac adipose tissue levels from a single location on a 1-dimensional image, as fat is not always distributed equally across the heart. Methods: Through the Ohio State Cardiac Research Tissue program, we have collected over 200 human hearts of various conditions. Multi-angle photographs are available for every heart. We developed an adipose tissue scoring system, so correlations can be drawn between the adipose tissue score (ATS), and BMI in failing and non-failing human hearts. Hearts were scored based on the multi-angle photographs. Each heart was given an atrial (AATS) and a ventricular score (VATS) ranging from 0-7, based on fat distribution and epicardial fat thickness. Nine sets of scores by individuals blinded to any patient information were averaged for each heart and the average ATS was plotted for correlation analyses against BMI and etiology. Results: A strong correlation was not apparent by plotting BMI versus VATS for all failing and non-failing hearts (R 2 = 0.011915 failing, 0.017262 non-failing). It is of interest to note that the lower right quadrant of the correlation plot is empty, indication that in patients with high BMI, the ATS was also high. However, in individuals with low BMI, there was a wide distribution of ATS. VATS and AATS are closely correlated in both failing (R 2 = 0.67082) and non-failing (R 2 = 0.84446) hearts. Conclusions: Our analysis shows that in humans, a high BMI is typically correlated with a high ATS score, but a low BMI does not necessarily correlate with a low ATS. The non-failing hearts have a stronger correlation between VATS and AATS compared to the failing hearts, suggesting that failing hearts do not always have an equal distribution of adipose tissue between the atria and ventricle. Future studies will investigate the presence of correlation between ATS with other parameters, such as age, gender, and race.

Effect of High Body Mass Index on the Prognosis of Diffuse Large B-Cell Lymphoma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5368-5368
Author(s):  
Yukako Hattori ◽  
Naoto Tomita ◽  
Taisei Suzuki ◽  
Yasufumi Ishiyama ◽  
Kumiko Kishimoto ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Prognostic Factor ◽  
B Cell ◽  
Body Mass ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Low Bmi ◽  
Large B Cell ◽  
High Bmi

Abstract Background Obesity has been pointed out as one of the risk factors for the development in several neoplastic diseases including malignant lymphoma. However the impact of obesity on the outcome of malignant diseases is unclear. L.Weiss et al have shown that high body mass index (BMI) is a significantly better prognostic factor in diffuse large B-cell lymphoma (DLBCL) (Increased body mass index is associated with improved overall survival in diffuse large B-cell lymphoma. Annals of Oncology 2014; 25: 171-176.). We evaluated this hypothesis in Japanese patients with DLBCL. Patients and Methods We analyzed 338 patients with newly diagnosed DLBCL who received full-dose (80% or more of the prescribed dose) R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) between April 2003 and December 2009 across 7 institutes. Patients of all stages were treated 6 or 8 cycles of full-dose R-CHOP therapy. All the patients were classified into 2 groups: high BMI (≥25 kg/m2 ) or low BMI (<25 kg/m2). Results The median patient age was 65 years (19–80 years); 192 were men and 146 were women. The median BMI was 22.9 kg/m2 (14.1–40.4 kg/m2); 66 patients (19.5%) were in the high BMI group (median, 27.4 kg/m2) and 272 (80.5%) were in the low BMI group (median, 21.6 kg/m2). The median follow-up of patients who were alive (n = 271) was 67.5 months (12.6–121.8 months). The 5-year progression-free survival (PFS) and overall survival (OS) of the high versus low BMI groups were 63.9% versus 74.0% (P = 0.196) and 77.2% versus 84.2% (P = 0.230), respectively (Figure1,2). Multivariate analysis considering the sex, International Prognostic Index, B symptoms, bulky mass, and BMI showed that high BMI (≥25 kg/m2) was a significant adverse prognostic factor for both OS (hazard ratio [HR], 1.906; 95% confidence interval [CI], 1.08-3.376; P = 0.027) and PFS (HR, 1.710; 95% CI, 1.054-2.774; P = 0.030). Conclusion The results of our study indicated that high BMI was an adverse prognostic factor of DLBCL. It is necessary to investigate BMI and its influence on patient background or treatment in much more cases. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

Low Body Mass Index Is Adversely Associated with Radiographic Joint Damage in Indian Patients with Early Rheumatoid Arthritis

2010 ◽  
Vol 38 (3) ◽  
pp. 434-438 ◽  
Author(s):  
UMA D. VELPULA ◽  
SUMEET AGRAWAL ◽  
JOE THOMAS ◽  
V.N. NAGA PRABU ◽  
LIZA RAJASEKHAR ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Body Mass Index ◽  
Body Mass ◽  
Negative Correlation ◽  
Joint Damage ◽  
Significant Negative Correlation ◽  
Early Ra ◽  
Low Bmi ◽  
Hands And Feet ◽  
High Bmi

Objective.Various factors affect joint damage in rheumatoid arthritis (RA). The influence of body mass index (BMI) is not adequately known. As BMI is potentially modifiable, we studied its influence on radiological joint damage in patients with RA.Methods.Treatment-naive patients with early RA (< 24 mo) were included. Demographic data were collected along with swollen joint count (SJC), tender joint count (TJC), erythrocyte sedimentation rate (ESR), and IgM-rheumatoid factor (IgM-RF). Radiographs of hands and feet were obtained. BMI and Disease Activity Score for 28-joint count (DAS28-ESR) were calculated. Joint damage was assessed using the Simplified Erosions Narrowing Score (SENS).Results.A total of 101 patients were studied (81 women; mean age 41.91 ± 11.99 yrs). Mean disease duration was 10.77 ± 6.73 months; 55 patients (54.5%) were IgM-RF-positive. Mean BMI was 22.82 ± 4.66 kg/m2 with 24 (23.8%) patients having low, 42 (41.6%) normal, and 35 (34.7%) high BMI. Mean SENS score was 16.81 ± 11.10; mean DAS28 was 6.23 ± 0.96. Significant correlation was noted between SENS and DAS28 (r = 0.28; p < 0.005). There was significant negative correlation between BMI and SENS (r = −0.509; p < 0.0005). In patients with low BMI, mean SENS (26.62 ± 13.45) was significantly higher than in patients with normal (15.88 ± 8.38; p < 0.001) and high BMI (11.20 ± 7.32; p < 0.001). Patients with normal BMI also had significantly higher SENS scores than those with high BMI (p < 0.05). One-way ANOVA did not reveal significant differences in DAS28 between groups. SENS was significantly higher in the IgM-RF-positive group (19.55 ± 11.36) than in the IgM-RF-negative group (13.54 ± 9.94; p < 0.01); DAS28 was not different between the 2 groups (6.22 ± 0.98 vs 6.26 ± 0.96, respectively). Within the 2 IgM-RF groups, a significant negative correlation was seen between BMI and SENS. Multiple regression analysis revealed RF, DAS28, and BMI were independently associated with SENS. BMI accounted for 23.04% of the variance in SENS independent of DAS28 and IgM-RF.Conclusion.Low BMI is adversely associated with joint damage in patients with early RA.

scholarly journals Body mass index and mortality in UK Biobank: revised estimates using Mendelian randomization

2018 ◽  
Author(s):  
Kaitlin H Wade ◽  
David Carslake ◽  
Naveed Sattar ◽  
George Davey Smith ◽  
Nicholas J Timpson
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Mendelian Randomization ◽  
Causal Effect ◽  
Genotypic Variation ◽  
Lung Cancer Mortality ◽  
Causal Role ◽  
Uk Biobank ◽  
All Cause Mortality

AbstractObjectiveObtain estimates of the causal relationship between different levels of body mass index (BMI) and mortality.MethodsMendelian randomization (MR) was conducted using genotypic variation reliably associated with BMI to test the causal effect of increasing BMI on all-cause and cause-specific mortality in participants of White British ancestry in UK Biobank.ResultsMR analyses supported existing evidence for a causal association between higher levels of BMI and greater risk of all-cause mortality (hazard ratio (HR) per 1kg/m2: 1.02; 95% CI: 0.97,1.06) and mortality from cardiovascular diseases (HR: 1.12; 95% CI: 1.02, 1.23), specifically coronary heart disease (HR: 1.19; 95% CI: 1.05, 1.35) and those other than stroke/aortic aneurysm (HR: 1.13; 95% CI: 0.93, 1.38), stomach cancer (HR: 1.30; 95% CI: 0.91, 1.86) and oesophageal cancer (HR: 1.08; 95% CI: 0.84, 1.38), and with decreased risk of lung cancer mortality (HR: 0.97; 95% CI: 0.84, 1.11). Sex-stratified analyses supported a causal role of higher BMI in increasing the risk of mortality from bladder cancer in males and other causes in females, but in decreasing the risk of respiratory disease mortality in males. The characteristic J-shaped observational association between BMI and mortality was visible with MR analyses but with a smaller value of BMI at which mortality risk was lowest and apparently flatter over a larger range of BMI.ConclusionResults support a causal role of higher BMI in increasing the risk of all-cause mortality and mortality from other causes. However, studies with greater numbers of deaths are needed to confirm the current findings.

scholarly journals Homogeneity in the association of body mass index with type 2 diabetes across the UK Biobank: A Mendelian randomization study

PLoS Medicine ◽  
2019 ◽  
Vol 16 (12) ◽  
pp. e1002982 ◽  
Author(s):  
Michael Wainberg ◽  
Anubha Mahajan ◽  
Anshul Kundaje ◽  
Mark I. McCarthy ◽  
Erik Ingelsson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Body Mass ◽  
Mendelian Randomization ◽  
Uk Biobank ◽  
The Uk

Longitudinal Change of Body Mass Index Is Associated With Alanine Aminotransferase Elevation After Complete Viral Suppression in Chronic Hepatitis B Patients

2019 ◽  
Vol 220 (9) ◽  
pp. 1469-1476 ◽  
Author(s):  
Kaifeng Wang ◽  
Weiyin Lin ◽  
Zhe Kuang ◽  
Rong Fan ◽  
Xieer Liang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Body Mass ◽  
Alanine Aminotransferase ◽  
Viral Suppression ◽  
Low Bmi ◽  
High Bmi

Abstract Background Little is known about cause and intervention for alanine aminotransferase (ALT) elevation after complete viral suppression in patients with chronic hepatitis B (CHB). Methods In this prospective cohort study, patients with CHB who were treated with nucleos(t)ide analogs and maintained undetectable levels of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) for at least 6 months were enrolled. Patients were followed up at 6-month intervals, and anthropometric, biochemical, and virological assessments were performed. Results Of 1965 patients with median follow-up of 18.36 months, one third of patients experienced ALT elevation. Baseline high body mass index ([BMI] defined as ≥25 kg/m2), younger age, and liver cirrhosis independently increased the risk of longitudinal ALT elevation. At the end of follow-up, 89 (4.8%) patients reverted to low BMI, and 92 (5.0%) developed to high BMI. Compared with persistent high BMI, reversion to low BMI reduced the risk of ALT elevation (adjusted odds ratio [aOR], 0.38; 95% confidence interval [CI], 0.19–0.77); compared with persistent low BMI, onset of high BMI increased the risk of ALT elevation (aOR, 1.78; 95% CI, 1.02–3.11). Conclusions High BMI is an independent predictor for ALT elevation after complete HBV DNA suppression. Improvement of BMI may have a beneficial effect on ALT normalization and even long-term outcomes.

scholarly journals Prognostic Value of Preoperative Body Mass Index for Diabetic Patients with Non-metastasis Gastric Cancer: A Single Center Experience

2021 ◽  
Author(s):  
Zaisheng Ye ◽  
Shenghong Wei ◽  
Yi Zeng ◽  
Yi Wang ◽  
Zhitao Lin ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Cox Regression ◽  
Categorical Variables ◽  
Diabetic Patients ◽  
Preoperative Body Mass Index ◽  
Serum Carcinoembryonic Antigen ◽  
Low Bmi ◽  
High Bmi

Abstract AIM: This study was designed to investigate the prognostic effect of preoperative body mass index (BMI) for Type 2 diabetes mellitus (T2DM) patients with non-metastasis gastric cancer (GC) who underwent D2 gastrectomy.METHODS：T2DM patients with pT1-4bN0-3bM0 GC were retrospectively collected in our cancer center from January, 2000 to December, 2010. Chi-square test was used to analyze unordered categorical variables and ranked data, followed by Kaplan-Meier analysis as well as Cox regression models to detect risk factors for survival outcomes. In addition, the cut-off point was determined by the X-tile program. All analyses were carried out using survival package of R and SPSS Software. RESULTS： A total of 302 T2DM patients with pT1-4bN0-3bM0 GC were collected and analyzed. The cut-off point of BMI, identified by the X-tile program, was 19 kg/m2. Patients with low BMI (< 19 kg/m2) had a higher percentage of advanced T stage (T4a and T4b), more advanced TNM stage(stage IIIA, IIIB and IIIC), and more elevated level of serum carcinoembryonic antigen(CEA), compared to those with high BMI(>19 kg/m2)(all P < 0.05). In the low BMI subgroup, the 5-year overall survival rate was 39.02%, which was as high as 58.11% in the high BMI subgroup (P < 0.05). In the multivariate Cox regression model revealed that IIIC stage (OR= 3.101), N3b stage (OR= 3.113) were the most important prognostic indicators, followed by pretreatment BMI (OR= 2.136). CONCLUSION: Low preoperative BMI (<19 kg/m2) was a poor prognostic marker for T2DM patients with pT1-4bN0-3bM0 GC.

scholarly journals Prognostic value of preoperative body mass index for diabetic patients with non-metastasis gastric cancer: a single center experience

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zaisheng Ye ◽  
Shenghong Wei ◽  
Yi Zeng ◽  
Yi Wang ◽  
Zhitao Lin ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Cox Regression ◽  
Categorical Variables ◽  
Diabetic Patients ◽  
Preoperative Body Mass Index ◽  
Cancer Hospital ◽  
Low Bmi ◽  
High Bmi

Abstract Aim This study was designed to investigate the prognostic effect of preoperative body mass index (BMI) for Type 2 diabetes mellitus (T2DM) patients with non-metastasis gastric cancer (GC) who underwent D2 gastrectomy. Methods T2DM patients with pT1–4bN0–3bM0 GC were retrospectively collected in Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital from January, 2000 to December, 2010. These patients underwent D2 radical resection of the stomach combined with regional lymphadenectomy. Chi-square test was used to analyze unordered categorical variables and ranked data, followed by Kaplan–Meier analysis as well as Cox regression models to detect risk factors for survival outcomes. In addition, the cut-off point was determined by the X-tile program. All analyses were carried out using survival package of R and SPSS Software. Results A total of 302 T2DM patients with pT1–4bN0–3bM0 GC were collected and analyzed. The cut-off points of BMI, identified by the X-tile program, was 19 kg/m2. Patients with low BMI (< 19 kg/m2) had a higher percentage of advanced T stage (T4a and T4b), more advanced TNM stage (stage IIIA, IIIB and IIIC), and more elevated level of serum carcinoembryonic antigen (CEA), compared to those with high BMI (> 19 kg/m2) (all P < 0.05). In the low BMI subgroup, the 5-year overall survival rate was 39.02%, which was as high as 58.11% in the high BMI subgroup (P < 0.05). In the multivariate Cox regression model revealed that IIIC stage (OR = 3.101), N3b stage (OR = 3.113) were the most important prognostic indicators, followed by pretreatment BMI (OR = 2.136). Conclusion Low preoperative BMI (< 19 kg/m2) was a poor prognostic marker for T2DM patients with pT1–4bN0–3bM0 GC.

scholarly journals Body mass index and efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndromes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Lahu ◽  
M Behnes ◽  
G Ndrepepa ◽  
F J Neumann ◽  
D Sibbing ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Primary Endpoint ◽  
Acute Coronary Syndromes ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Coronary Syndromes ◽  
Low Bmi ◽  
Type 3 ◽  
High Bmi

Abstract Background The efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndromes (ACS) according to body mass index (BMI) remain unknown. Purpose To assess the efficacy and safety of ticagrelor versus prasugrel in patients with ACS according to BMI. Methods This post-hoc analysis of the ISAR-REACT 5 trial included 3987 patients with BMI data available. BMI was grouped in 3 categories: low (BMI&lt;25 kg/m2, n=1084), intermediate (BMI ≥25 to &lt;30 kg/m2, n=1890) and high (BMI≥30 kg/m2, n=1013). The primary endpoint was the 12-month incidence of all-cause death, myocardial infarction, or stroke. The secondary endpoint was the 12-month incidence of Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Results There was no significant treatment arm-by-BMI interaction regarding the primary endpoint (Pint=0.578). However, the primary endpoint occurred in 63 patients assigned to ticagrelor and 39 patients assigned to prasugrel in the low BMI group (11.7% vs. 7.5%; hazard ratio [HR]=1.62; 95% confidence interval [CI], 1.09–2.42; P=0.018), 78 patients assigned to ticagrelor and 58 patients assigned to prasugrel in the intermediate BMI group (8.3% vs. 6.2%; HR=1.36 [0.97–1.91]; P=0.076), and 43 patients assigned to ticagrelor and 37 patients assigned to prasugrel in the high BMI group (8.6% vs. 7.3%; HR=1.18 [0.76–1.84]; P=0.451). BARC type 3 to 5 bleeding events did not differ between ticagrelor and prasugrel in patients with low (6.5% vs. 6.6%), intermediate (5.6% vs. 5.0%), or high (4.4% vs. 2.8%) BMI. Conclusions BMI of patients with ACS did not impact significantly on the treatment effect of ticagrelor vs. prasugrel in terms of both efficacy and safety. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research;Deutsches Herzzentrum München, Germany

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