scholarly journals Obesity as a risk factor for heart failure: overview of systematic reviews

2022 ◽  
Vol 11 (1) ◽  
pp. e0811124380
Author(s):  
Cleyton Oliveira Bezerra ◽  
Rafael Marinho de Lima Paiva ◽  
Thamires Lucena da Silva ◽  
Vinicius Soares Ribeiro ◽  
Cinthia Caldas Rios ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Meta Analysis ◽  
Obesity Paradox ◽  
Overweight And Obesity ◽  
Risk Of Death ◽  
Increased Risk ◽  
Overview Of Systematic Reviews

The overweight and population with obesity has an increased risk of mortality from HF. However, some studies point to the existence of an "obesity paradox" where there could be a protective effect on the relative risk of death by HF in these populations with high BMI. In this way, the present study aimed to investigate obesity as a risk factor for heart failure. For this, an overview of systematic reviews was performed by selecting articles from the following databases: "Pubmed", "Scopus" and "SciElo”. A total of 615 articles were found from this initial search, leaving 59 articles for full-text reading, of which 22 articles were included for data extraction using the predefined inclusion criteria. From these 22 studies 73% were meta-analysis and 64% of the studies are of high methodological quality according to AMSTAR-2. Overweight and obesity have demonstrated a close relationship with the onset and increase of mortality by HF, studies have even been found that point to a gene interference in this relationship. In studies reporting on the obesity paradox, the results pointed to a momentary protection from mortality risk.

scholarly journals Obesity Paradox" – another look at the problem of cardiovascular disease

2013 ◽  
Vol 10 (4) ◽  
pp. 3-9
Author(s):  
O V Shpagina ◽  
I Z Bondarenko
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Obesity Paradox ◽  
Developed Countries ◽  
Epidemiologic Studies ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Published Data ◽  
Risk Of Death ◽  
Cardiovascular Prognosis

Major epidemiologic studies over the last century demonstrated that obesity leads to several severe diseases such as diabetes mellitus, hypertension, coronary heart disease, chronic heart failure, cerebrovascular accidents. In developed countries cardiovascular diseases became the main cause of death. In the last 5–6 years some studies showed that people with overweight and obesity of the first degree have a higher life expectancy than people with normal weight. In 2009, the published data showed that the presence of obesity in patients with chronic heart failure does not impair cardiovascular prognosis. Overweight correlates with a decrease in overall mortality by 25%. And in a first degree of obesity the risk of death is reduced by 12%. This phenomenon is called "obesity paradox" and the causes of which are discussed in this review.

Peri-discharge complex interventions for reducing 30-day hospital readmissions among heart failure patients: overview of systematic reviews and network meta-analysis

2021 ◽  
pp. 175791392098525
Author(s):  
CCW Zhong ◽  
CHL Wong ◽  
WKW Cheung ◽  
E-K Yeoh ◽  
CT Hung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Disease Management ◽  
Systematic Reviews ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Hospital Readmissions ◽  
Complex Interventions ◽  
Emergency Department Visits ◽  
Day Hospital ◽  
Overview Of Systematic Reviews

Aims: An overview of systematic reviews (SRs) and network meta-analysis (NMA) was conducted to synthesize evidence of comparative effectiveness of different peri-discharge complex interventions for reducing 30-day hospital readmissions among heart failure (HF) patients. Methods: We searched five databases for SRs from their inception to August 2019 and conducted additional search for randomized controlled trials (RCTs) published between 2003 and 2020. We used random-effect pairwise meta-analysis with pooled risk ratios (RRs) and 95% confidence intervals (CIs) to quantify the effect of complex interventions, and NMA to evaluate comparative effectiveness among complex interventions. Primary outcome was 30-day all-cause hospital readmissions, while secondary outcomes were 30-day HF-related hospital readmissions, 30-day mortality, and 30-day emergency department visits. Results: From 20 SRs and additional RCT search, 21 eligible RCTs ( n = 5362) assessing eight different peri-discharge complex interventions were included. Pairwise meta-analysis showed no significant difference between peri-discharge complex interventions and controls on all outcomes, except that peri-discharge complex interventions were significantly more effective than controls in reducing 30-day mortality (pooled RR = 0.68, 95% CI: 0.49–0.95, 5 RCTs). NMA indicated that for reducing 30-day all-cause hospital readmissions, supportive–educative intervention had the highest probability to be the best intervention, followed by disease management; while for reducing 30-day HF-related hospital readmissions, disease management is likely to be the best intervention. Conclusions: Our results suggest that disease management has the best potential to reduce 30-day all-cause and HF-related hospital readmissions. Benefits of the interventions may vary across health system contexts. Evidence-based complex interventions require local adaptation prior to implementation.

scholarly journals Risks of and From SARS-CoV-2 Infection and COVID-19 in People With Diabetes: a Systematic Review of Reviews

2021 ◽  
Author(s):  
Jamie Hartmann-Boyce ◽  
Karen Rees ◽  
James C Perring ◽  
Sven A Kerneis ◽  
Elizabeth M. Morris ◽  
...  
Keyword(s):  
Risk Factor ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Severe Disease ◽  
World Health ◽  
Glucose Levels ◽  
Study Selection ◽  
Increased Risk ◽  
Health Organization ◽  
The Impact

Background <p>This review was commissioned by the World Health Organization and presents a summary of the latest research evidence on the impact of COVID-19 in people with diabetes (PWD).</p> <p>Purpose </p> <p>To review the evidence regarding the extent to which PWD are at increased risk of SARS-CoV-2 infection, and/or of suffering its complications including associated mortality.</p> <p>Data sources</p> <p>We searched the Cochrane COVID-19 study register, Embase, MEDLINE, and LitCOVID on 3 December 2020.</p> <p>Study selection</p> <p>Systematic reviews synthesising data on PWD exposed to SARS-CoV-2 infection, reporting data on confirmed SARS-CoV-2 infection, admission to hospital and/or to ICU with COVID-19, death with COVID-19.</p> <p>Data extraction</p> <p>One reviewer appraised and extracted data; data were checked by a second.</p> <p>Data synthesis</p> <p>Data from 112 systematic reviews were narratively synthesised and displayed using effect direction plots. Reviews provided consistent evidence that diabetes is a risk factor for severe disease and death from COVID-19. There was less data available on ICU admission, but where available this data also signalled increased risk. Within PWD, higher blood glucose levels both prior to COVID-19 illness and during COVID-19 illness were associated with worse COVID-19 outcomes. Type 1 diabetes was associated with worse outcomes compared to type 2 diabetes. There was no appropriate data for discerning whether diabetes was a risk factor for acquiring SARS-CoV-2 infection.</p> <p>Limitations</p> <p>Due to the nature of the review questions, the majority of data contributing to included reviews come from retrospective observational studies. Reviews varied in the extent to which they assessed risk of bias.</p> <p>Conclusions</p> <p>There are no data on whether diabetes predisposes to infection with SARS-CoV-2. Data consistently show that diabetes increases risk of severe COVID-19. As both diabetes and worse COVID-19 outcomes are associated with socioeconomic disadvantage, their intersection warrants particular attention.</p>

scholarly journals The value of N-terminal pro-B-type natriuretic peptide (NT Pro-BNP) to predict sudden cardiac death in chronic heart failure patients with normal renal function; a systematic review and meta-analysis

2018 ◽  
Vol 7 (2) ◽  
pp. 164-168
Author(s):  
Mehrdad Sheikhvatan ◽  
Zhaleh Ataei ◽  
Aigin Heydari ◽  
Aryan Zahergivar
Keyword(s):  
Heart Failure ◽  
Sudden Cardiac Death ◽  
Chronic Heart Failure ◽  
Natriuretic Peptide ◽  
Cardiac Death ◽  
Data Extraction ◽  
Meta Analysis ◽  
Study Endpoint ◽  
Increased Risk ◽  
Statistical Heterogeneity

Context: The role of N-terminal pro-B-type natriuretic peptide (NT pro-BNP) has been understood as an important and critical biomarker in the diagnosis and predicting poor outcome of cardiac dysfunction. Objectives: We aimed to systematically review the papers on the value of NT pro-BNP in prediction of sudden cardiac death (SCD) in chronic heart failure (CHF) patients. Data Sources: This study was based on the Systematic Reviews and Meta-analysis (PRISMA) study reporting system. Study Selection: During the deep searches using the keywords, 67 studies were initially considered for primary assessment. Of those, 12 were completely matched with the study endpoint. In final, six were excluded because of unavailability of full texts or acquired data and thus six studies were finally analyzed. Data Extraction: Two researchers independently used the key words "chronic heart failure, B-type natriuretic peptide, sudden cardiac death" and their combination and searched the national and international databases including Scopus, PubMed, Science Direct, Web of Science, Springer, and the Google Scholar search engine. Results: The pooled prevalence of SCD in CHF patients was found to be 6.9% (95% CI: 5.2% to 9.0%). The statistical heterogeneity was high with an I2 of 84.488. Abnormal elevated level of NT pro-BNP was significantly associated with the increased risk for SCD with a hazard ratio of 4.2 (95% CI: 2.2 to 8.7). Conclusion: Measuring the serum level of NT pro-BNP in CHF patients can be valuable to predict long-term SCD. In this regard, significant elevation of this biomarker may be associated with the four-fold risk of SCD in such patients.

scholarly journals Obesity paradox in patients with cancer: A systematic review and meta-analysis of 6,320,365 patients

2020 ◽  
Author(s):  
Fausto Petrelli ◽  
Alessio Cortellini ◽  
Alice Indini ◽  
Gianluca Tomasello ◽  
Michele Ghidini ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Renal Cell Carcinoma ◽  
Meta Analysis ◽  
Obesity Paradox ◽  
Obese Patients ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
Increased Risk ◽  
Obesity And Cancer

AbstractBACKGROUNDObesity, defined as a body mass index (BMI) > 30 kg/m2, is associated with a significant increase in risk of many cancers. In last years, various studies suggested that obese cancer patients have better outcomes than non-obese patients. This phenomenon, also known as “the obesity paradox”, is not well understood and presents controversial explanations. We performed a systematic review and meta-analysis to assess the association between obesity and outcome after a diagnosis of cancer.PATIENTS AND METHODSPubMed, the Cochrane Library, and EMBASE were searched from inception to January 2020, for studies reporting prognosis of patients with obesity and cancer. Risk of death, cancer-specific survival (CSS) and progression were pooled to provide an adjusted hazard ratio with a 95% confidence interval (HR 95%CI). The primary outcome of the study refers to overall survival (OS) in obese vs non-obese patients with malignancies. Secondary endpoints were CSS and progression- or disease-free survival (PFS or RFS).RESULTSMortality and relapse associated with obesity in patients with cancer were evaluated among n=6,320,365 participants (n=203 studies). Overall, association of obesity and cancer was associated with a reduced OS (HR =1.14, 95% CI: 1.09-1.19; P<.01) and CSS (HR=1.17, 95%CI 1.12-1.23; P<.01). Patients were also at increased risk for relapse (HR=1.13, 95%CI 1.07-1.19; P<.01). Patients with breast, colorectal and uterine tumors were at increased risk of death. Conversely, obese with lung cancer, renal cell carcinoma and melanoma survived longer that non-obese.CONCLUSIONSIn many cancer patients, obesity reduces survival and increases the risk of relapse. In lung cancer, renal cell carcinoma and melanoma obesity was protective in terms of outcome. More intensive follow up, adequate dosing of oncological treatments, calories intake restrictions, physical activity and monitoring of obesity-related complications are effective measures for reducing mortality in these subjects.

scholarly journals Risks of and From SARS-CoV-2 Infection and COVID-19 in People With Diabetes: a Systematic Review of Reviews

2021 ◽  
Author(s):  
Jamie Hartmann-Boyce ◽  
Karen Rees ◽  
James C Perring ◽  
Sven A Kerneis ◽  
Elizabeth M. Morris ◽  
...  
Keyword(s):  
Risk Factor ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Severe Disease ◽  
World Health ◽  
Glucose Levels ◽  
Study Selection ◽  
Increased Risk ◽  
Health Organization ◽  
The Impact

Background <p>This review was commissioned by the World Health Organization and presents a summary of the latest research evidence on the impact of COVID-19 in people with diabetes (PWD).</p> <p>Purpose </p> <p>To review the evidence regarding the extent to which PWD are at increased risk of SARS-CoV-2 infection, and/or of suffering its complications including associated mortality.</p> <p>Data sources</p> <p>We searched the Cochrane COVID-19 study register, Embase, MEDLINE, and LitCOVID on 3 December 2020.</p> <p>Study selection</p> <p>Systematic reviews synthesising data on PWD exposed to SARS-CoV-2 infection, reporting data on confirmed SARS-CoV-2 infection, admission to hospital and/or to ICU with COVID-19, death with COVID-19.</p> <p>Data extraction</p> <p>One reviewer appraised and extracted data; data were checked by a second.</p> <p>Data synthesis</p> <p>Data from 112 systematic reviews were narratively synthesised and displayed using effect direction plots. Reviews provided consistent evidence that diabetes is a risk factor for severe disease and death from COVID-19. There was less data available on ICU admission, but where available this data also signalled increased risk. Within PWD, higher blood glucose levels both prior to COVID-19 illness and during COVID-19 illness were associated with worse COVID-19 outcomes. Type 1 diabetes was associated with worse outcomes compared to type 2 diabetes. There was no appropriate data for discerning whether diabetes was a risk factor for acquiring SARS-CoV-2 infection.</p> <p>Limitations</p> <p>Due to the nature of the review questions, the majority of data contributing to included reviews come from retrospective observational studies. Reviews varied in the extent to which they assessed risk of bias.</p> <p>Conclusions</p> <p>There are no data on whether diabetes predisposes to infection with SARS-CoV-2. Data consistently show that diabetes increases risk of severe COVID-19. As both diabetes and worse COVID-19 outcomes are associated with socioeconomic disadvantage, their intersection warrants particular attention.</p>

scholarly journals Current Clinical and Pharmacological Approaches to the Prescription of Loop Diuretics in Patients with Chronic Heart Failure

2020 ◽  
Vol 16 (4) ◽  
pp. 595-600
Author(s):  
N. M. Gafurova ◽  
E. V. Shikh ◽  
O. D. Ostroumova
Keyword(s):  
Heart Failure ◽  
Meta Analysis ◽  
Diuretic Therapy ◽  
Public Health Problem ◽  
Evidence Base ◽  
Convincing Evidence ◽  
Loop Diuretics ◽  
Risk Of Death ◽  
Randomized Controlled Studies ◽  
Increased Risk

Heart failure (HF) is a growing public health problem with an estimated prevalence of 38 million patients worldwide. Congestion and formation of edema – are typical symptoms of heart failure. Diuretics are the mainstay of therapy in heart failure and are used to relieve congestion and improve exercise tolerance. Also, the administration of diuretics should be considered to reduce the risk of HF hospitalization. Loop diuretics are used by nearly 80% of all chronic HF patients and remain the drugs of choice. Although diuretics are one of the most prescribed classes of drugs, recommendations for their titration scheme for long-term use have not yet been finalized, nor have there been major prospective randomized controlled studies on the effect of diuretics on morbidity and mortality. A Cochrane meta-analysis has shown that in patients with chronic HF, loop and thiazide diuretics might reduce the risk of death and worsening of HF in comparison to placebo and could lead to improved exercise capacity. Guideline recommends the use lowest possible dose of diuretics due to probable electrolyte disturbances, further neurohormonal activation, accelerated kidney function decline, and symptomatic hypotension. Diuretic resistance is associated with an unfavorable prognosis and an increased risk of readmission. There are significant pharmacokinetic differences between the loop diuretics. Compared with furosemide, torasemide has a high bioavailability irrespective of food intake, and carries a longer half‐life and duration of effect; also, the benefits of torasemide are its additional anti-fibrotic and neurohormonal effects. Optimization of diuretic therapy in patients with HF remains a challenge and requires further research, as well as an individual approach to patients, since there is no convincing evidence base.

scholarly journals Overweight and Obesity Among Adult HIV Infected Peoples Receiving ART in Ethiopia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
pp. 215013272199364
Author(s):  
Robel Hussen Kabthymer ◽  
Solomon Nega Techane ◽  
Temesgen Muche ◽  
Helen Ali Ewune ◽  
Semagn Mekonnen Abate ◽  
...  
Keyword(s):  
Publication Bias ◽  
Addis Ababa ◽  
Data Extraction ◽  
Meta Analysis ◽  
Overweight And Obesity ◽  
Obesity And Overweight ◽  
Pooled Prevalence ◽  
Nutrition And Diet ◽  
Prevalence Of Obesity ◽  
Trim And Fill

Background: Over-nutrition and diet-linked non-communicable morbidities are showing increasing trend overtime. Even if there are different factors that affect the change in BMI other than ART, several authors have reported increases in BMI among PLHIV on treatment that are equal to or surpass the general population. This study is aimed to estimate the prevalence of obesity and overweight among adult HIV infected peoples taking ART in Ethiopia. Method: PubMed, CINAHL, Web of science, global health and Google scholar electronic databases were used to perform a systematic literature search. Two authors independently extracted all the necessary data using a structured data extraction format. Data analysis was done using STATA Version 14. The heterogeneity of the studies was assessed by using I2 test. A random-effects model was used to estimate the pooled prevalence. Publication bias was checked using Funnel plot and Egger’s test. Result: Two thousand seven hundred and fifty-one studies were reviewed and 13 studies fulfilling the inclusion criteria were included in the meta-analysis. The meta-analysis of 13 studies, comprising 4994 participants resulted in pooled prevalence of overweight to be 17.85% (95% CI: 12.22-23.47). Whereas, the pooled prevalence of overweight was found to be 3.90 (95% CI: 2.31-5.49) but after adjusting for publication bias using trim and fill analysis it has become 3.58 (95% CI: 2.04-5.13). Magnitude of both overweight and obesity was higher in studies conducted in Addis Ababa, studies done after 2016 and studies having sample size of less than 400, in subgroup analysis. Conclusion: The magnitude of overweight and obesity among HIV infected peoples taking ART in Ethiopia is high. There is a need to have a routine screening to PLWHA on the risk of over-nutrition in order to facilitate early detection.

scholarly journals Prediction of all-cause mortality with malnutrition assessed by controlling nutritional status score in patients with heart failure: a systematic review and meta-analysis

2021 ◽  
pp. 1-8
Author(s):  
Huiyang Li ◽  
Peng Zhou ◽  
Yikai Zhao ◽  
Huaichun Ni ◽  
Xinping Luo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Nutritional Status ◽  
Meta Analysis ◽  
Predictive Values ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Conut Score

Abstract Objective: The aim of this meta-analysis was to investigate the association between malnutrition assessed by the controlling nutritional status (CONUT) score and all-cause mortality in patients with heart failure. Design: Systematic review and meta-analysis. Settings: A comprehensively literature search of PubMed and Embase databases was performed until 30 November 2020. Studies reporting the utility of CONUT score in prediction of all-cause mortality among patients with heart failure were eligible. Patients with a CONUT score ≥2 are grouped as malnourished. Predictive values of the CONUT score were summarized by pooling the multivariable-adjusted risk ratios (RR) with 95 % CI for the malnourished v. normal nutritional status or per point CONUT score increase. Participants: Ten studies involving 5196 patients with heart failure. Results: Malnourished patients with heart failure conferred a higher risk of all-cause mortality (RR 1·92; 95 % CI 1·58, 2·34) compared with the normal nutritional status. Subgroup analysis showed the malnourished patients with heart failure had an increased risk of in-hospital mortality (RR 1·78; 95 % CI 1·29, 2·46) and follow-up mortality (RR 2·01; 95 % CI 1·58, 2·57). Moreover, per point increase in CONUT score significantly increased 16% risk of all-cause mortality during the follow-up. Conclusions: Malnutrition defined by the CONUT score is an independent predictor of all-cause mortality in patients with heart failure. Assessment of nutritional status using CONUT score would be helpful for improving risk stratification of heart failure.

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