Prognostic Impact of Metabolic Syndrome in Patients With Heart Failure: A Meta-Analysis of Observational Studies

Background: The metabolic syndrome (MS) is significantly associated with the risk of incident heart failure (HF). However, there are still great controversies about the impact of MS on the prognosis in patients with established HF. This meta-analysis aimed to ascertain the effect of MS on the prognosis in patients with HF.Methods: We searched multiple electronic databases, including PubMed, Opengrey, EMBASE, and Cochran Library, for potential studies up to February 15, 2021. Observational studies that reported the impact of MS on the prognosis in patients with established HF were included for meta-analysis.Results: Ten studies comprising 18,590 patients with HF were included for meta-analysis. The median follow-up duration of the included studies was 2.4 years. Compared with HF patients without MS, the risk of all-cause mortality and cardiovascular mortality was not increased in HF with MS (HR = 1.04, 95% CI = 0.88–1.23 for all-cause mortality; HR = 1.66, 95% CI = 0.56–4.88 for cardiovascular mortality, respectively). However, there was a significant increase in composited cardiovascular events in the HF patients with MS compared with those without MS (HR = 1.73, 95% CI = 1.23–2.45).Conclusions: In patients with established HF, the presence of MS did not show an association on the risk of all-cause mortality or cardiovascular mortality, while it may increase the risk of composite cardiovascular events.

Download Full-text

Effects of Beta-Blockers on Cardiovascular Events and Mortality in Dialysis Patients: A Systematic Review and Meta-Analysis

Blood Purification ◽

10.1159/000496083 ◽

2019 ◽

Vol 48 (1) ◽

pp. 51-59 ◽

Cited By ~ 3

Author(s):

Jingjing Jin ◽

Xiaoyang Guo ◽

Qiyao Yu

Keyword(s):

Cardiovascular Mortality ◽

Cardiovascular Events ◽

Observational Studies ◽

Beta Blockers ◽

Meta Analysis ◽

Cochrane Library ◽

Dialysis Patients ◽

Statistical Heterogeneity ◽

All Cause Mortality ◽

Β Blockers

Background: The effects of beta-blockers are uncertain in dialysis patients. Except antihypertension, β-blockers may play a unique cardiovascular protective role in the population. This meta-analysis aimed to explore the effects of β-blockers therapy in adult patients treated with dialysis. Methods: We searched MEDLINE, EMBASE, and the Cochrane library from inception to May 2018 for randomized controlled trials (RCTs) and observational studies about the role of β-blockers on all-cause mortality, cardiovascular mortality, cardiovascular events, or hospitalizations in dialysis population. Results: Three RCTs and 9 observational studies met the predefined inclusion criteria. The RCTs showed significant association between β-blockers and reduced all-cause mortality (n = 363; risk ratio [RR] 0.73; 95% CI 0.54–0.97), cardiovascular mortality (n = 314; RR 0.44; 95% CI 0.29–0.68), cardiovascular events (n = 363; RR 0.52; 95% CI 0.31–0.88), or hospitalizations (n = 314; RR 0.61; 95% CI 0.48–0.78) in dialysis patients. The observational studies showed significant difference in all-cause mortality (n = 35,233; hazard ratio [HR] 0.86; 95% CI 0.80–0.92) between β-blockers and no β-blockers therapy in patients with dialysis, while the studies showed no difference in cardiovascular mortality (n = 19,413; HR 0.79; 95% CI 0.57–1.11), or cardiovascular events (n = 87,060; HR 0.79; 95% CI 0.50–1.26). Conclusions: β-blockers seem to be associated with reduced mortality in patients on dialysis. Both the statistical heterogeneity in observational studies and the small number of participants and studies in RCTs limit the strength of these findings. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/496083?sponsor=52

Download Full-text

Abstract 118: Right Bundle Branch Block and Clinical Outcomes in Patients with Heart Failure: A Systematic Review and Meta-analysis

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.118 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Ahmad Hazem ◽

Sunita Sharma ◽

Amit Sharma ◽

Cameron Leitch ◽

Roopalakshmi Sharadanant ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Clinical Outcomes ◽

Cardiovascular Mortality ◽

Observational Studies ◽

Meta Analysis ◽

Bundle Branch Block ◽

Increased Risk ◽

Patients With Heart Failure ◽

All Cause Mortality

Importance: Right bundle branch block (RBBB) is observed in approximately 5-14% of patients with heart failure (HF). Multiple observational studies have reported the association of RBBB with clinical outcomes in patients with HF. We performed a systematic review and meta-analysis to determine the prognostic significance of RBBB for patients with HF. Data Sources: We have systematically searched MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and Scopus through January 2014. Study Selection: Reviewers working independently and in duplicate screened all eligible abstracts that described all cause or cardiovascular mortality in patients with RBBB and HF. We excluded studies that reported unadjusted outcome, i.e.: unadjusted event rates. Knowledge synthesis: We pooled reported risk ratio and hazard ratio. Main Outcomes: All-cause mortality and cardiovascular mortality (death). Results: We found 12 relevant observational studies enrolling over 38,000 patients. Risk of bias was assessed using the Newcastle-Ottawa Scale. Included studies had at least a moderate quality. Seven of those evaluated prognosis of patients with RBBB and heart failure. After a mean follow up period of 2.5 years (range: 1-5 years), RBBB was associated with a statistically significant increased risk of all-cause mortality compared to patients with heart failure but no BBB, RR 1.27, 95% CI (1.08-1.50), Figure 1. The other 5 studies evaluated CHF patients receiving cardiac resynchronization therapy (CRT), comparing outcomes of patients with RBBB to those with LBBB. After a mean f/u period of 3 years, patients with RBBB were once again found to have an increased risk of all-cause mortality, RR 1.45, 95% CI 1.12-1.89. Conclusion and Relevance: RBBB in patients with HF is associated with higher all-cause mortality in comparison to patients without inter-ventricular conduction defects, as well as LBBB patients in patients undergoing CRT setting.

Download Full-text

Outcomes of cardiac resynchronisation therapy in patients with heart failure with atrial fibrillation: a systematic review and meta-analysis of observational studies

Open Heart ◽

10.1136/openhrt-2018-000937 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000937 ◽

Cited By ~ 2

Author(s):

Usman Mustafa ◽

Jessica Atkins ◽

George Mina ◽

Desiree Dawson ◽

Catherine Vanchiere ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Mortality ◽

Observational Studies ◽

Meta Analysis ◽

Cardiac Resynchronisation Therapy ◽

Patients With Heart Failure ◽

Cardiac Resynchronisation ◽

All Cause Mortality ◽

Resynchronisation Therapy

BackgroundCardiac resynchronisation therapy (CRT) is beneficial in selected patients with heart failure (HF) in normal sinus rhythm (NSR). We sought to evaluate the impact of CRT with or without atrioventricular junction (AVJ) ablation in patients with HF with concomitant atrial fibrillation (AF)Methods and resultsLiterature was searched (inception through 30 August 2017) for observational studies that reported outcomes in patients with HF with CRT and AF that reported all-cause and cardiovascular mortality. Thirty-one studies with 83, 571 patients were included. CRT did not decrease mortality compared with internal cardioverter defibrillator or medical therapy alone in patients with HF and AF with indications for CRT (OR: 0.851, 95% CI 0.616 to 1.176, p=0.328, I2=86.954). CRT-AF patients had significantly higher all-cause and cardiovascular mortality than CRT-NSR patients ([OR: 1.472, 95% CI 1.301 to 1.664, p=0.000] and [OR: 1.857, 95% CI 1.350 to 2.554, p=0.000] respectively). Change in left ventricular ejection fraction was not different between CRT patients with and without AF (p=0.705). AVJ ablation, however, improved all-cause mortality in CRT-AF patients when compared with CRT-AF patients without AVJ ablation (OR: 0.485, 95% CI 0.247 to 0.952, p=0.035). With AVJ ablation, there was no difference in all-cause mortality in CRT-AF patients compared with CRT-NSR patients (OR: 1.245, 95% CI 0.914 to 1.696, p=0.165).ConclusionThe results of our meta-analysis suggest that AF was associated with decreased CRT benefits in patients with HF. CRT, however, benefits patients with AF with AVJ ablation.

Download Full-text

Faculty Opinions recommendation of Testosterone, sex hormone-binding globulin and the metabolic syndrome: a systematic review and meta-analysis of observational studies.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.6105964.6144055 ◽

2010 ◽

Author(s):

Erik Buskens ◽

Henk Groen

Keyword(s):

Systematic Review ◽

Metabolic Syndrome ◽

Observational Studies ◽

Meta Analysis ◽

Sex Hormone ◽

Sex Hormone Binding Globulin ◽

Hormone Binding ◽

The Metabolic Syndrome

Download Full-text

Prognostic Value of Serum Magnesium in Mortality Risk among Patients on Hemodialysis: A Meta-Analysis of Observational Studies

Kidney Diseases ◽

10.1159/000510513 ◽

2020 ◽

pp. 1-10

Author(s):

Hongwei Wu ◽

Qiang Li ◽

Lijing Fan ◽

Dewang Zeng ◽

Xianggeng Chi ◽

...

Keyword(s):

Mortality Risk ◽

Cardiovascular Mortality ◽

Observational Studies ◽

Prognostic Value ◽

Meta Analysis ◽

Serum Magnesium ◽

Cochrane Library ◽

Lower Serum ◽

All Cause Mortality ◽

End Stage

Background: Previous studies have reported that serum magnesium (Mg) deficiency is involved in the development of heart failure, particularly in patients with end-stage kidney disease. The association between serum Mg levels and mortality risk in patients receiving hemodialysis is controversial. We aimed to estimate the prognostic value of serum Mg concentration on all-cause mortality and cardiovascular mortality in patients receiving hemodialysis. Methods: We did a systematic literature search in PubMed, EMBASE, Cochrane Library, and Web of Science to identify eligible studies that reported the prognostic value of serum Mg levels in mortality risk among patients on hemodialysis. We performed a meta-analysis by pooling and analyzing hazard ratios (HRs) and 95% confidence intervals (CIs). Results: We identified 13 observational studies with an overall sample of 42,967 hemodialysis patients. Higher all-cause mortality (adjusted HR 1.58 [95% CI: 1.31–1.91]) and higher cardiovascular mortality (adjusted HR 3.08 [95% CI: 1.27–7.50]) were found in patients with lower serum Mg levels after multivariable adjustment. There was marked heterogeneity (I2 = 79.6%, p < 0.001) that was partly explained by differences in age stratification and study area. In addition, subgroup analysis showed that a serum Mg concentration of ≤1.1 mmol/L might be the vigilant cutoff value. Conclusion: A lower serum Mg level was associated with higher all-cause mortality and cardiovascular mortality in patients receiving hemodialysis.

Download Full-text

Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension

Heart ◽

10.1136/heartjnl-2017-311857 ◽

2017 ◽

Vol 104 (6) ◽

pp. 487-493 ◽

Cited By ~ 14

Author(s):

Ekrem Yasa ◽

Fabrizio Ricci ◽

Martin Magnusson ◽

Richard Sutton ◽

Sabina Gallina ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Orthostatic Hypotension ◽

Cardiovascular Events ◽

Hospital Admissions ◽

Cox Regression ◽

All Cause Mortality ◽

Unexplained Syncope ◽

The Impact

ObjectiveTo investigate the relationship of hospital admissions due to unexplained syncope and orthostatic hypotension (OH) with subsequent cardiovascular events and mortality.MethodsWe analysed a population-based prospective cohort of 30 528 middle-aged individuals (age 58±8 years; males, 40%). Adjusted Cox regression models were applied to assess the impact of unexplained syncope/OH hospitalisations on cardiovascular events and mortality, excluding subjects with prevalent cardiovascular disease.ResultsAfter a median follow-up of 15±4 years, 524 (1.7%) and 504 (1.7%) participants were hospitalised for syncope or OH, respectively, yielding 1.2 hospital admissions per 1000 person-years for each diagnosis. Syncope hospitalisations increased with age (HR, per 1 year: 1.07, 95% CI 1.05 to 1.09), higher systolic blood pressure (HR, per 10 mm Hg: 1.06, 95% CI 1.01 to 1.12), antihypertensive treatment (HR: 1.26, 95% CI 1.00 to 1.59), use of diuretics (HR: 1.77, 95% CI 1.31 to 2.38) and prevalent cardiovascular disease (HR: 1.59, 95% CI 1.14 to 2.23), whereas OH hospitalisations increased with age (HR: 1.11, 95% CI 1.08 to 1.12) and prevalent diabetes (HR: 1.82, 95% CI 1.23 to 2.70). After exclusion of 1399 patients with prevalent cardiovascular disease, a total of 473/464 patients were hospitalised for unexplained syncope/OH before any cardiovascular event. Hospitalisation for unexplained syncope predicted coronary events (HR: 1.85, 95% CI 1.49 to 2.30), heart failure (HR: 2.24, 95% CI 1.65 to 3.04), atrial fibrillation (HR: 1.84, 95% CI 1.50 to 2.26), aortic valve stenosis (HR: 2.06, 95% CI 1.28 to 3.32), all-cause mortality (HR: 1.22, 95% CI 1.09 to 1.37) and cardiovascular death (HR: 1.72, 95% CI 1.23 to 2.42). OH-hospitalisation predicted stroke (HR: 1.66, 95% CI 1.24 to 2.23), heart failure (HR: 1.78, 95% CI 1.21 to 2.62), atrial fibrillation (HR: 1.89, 95% CI 1.48 to 2.41) and all-cause mortality (HR: 1.14, 95% CI 1.01 to 1.30).ConclusionsPatients discharged with the diagnosis of unexplained syncope or OH show higher incidence of cardiovascular disease and mortality with only partial overlap between these two conditions.

Download Full-text

Fried-food consumption and risk of cardiovascular disease and all-cause mortality: a meta-analysis of observational studies

Heart ◽

10.1136/heartjnl-2020-317883 ◽

2021 ◽

pp. heartjnl-2020-317883 ◽

Cited By ~ 1

Author(s):

Pei Qin ◽

Ming Zhang ◽

Minghui Han ◽

Dechen Liu ◽

Xinping Luo ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Food Consumption ◽

Cardiovascular Events ◽

Meta Analysis ◽

Case Control ◽

Fried Food ◽

Major Cardiovascular Events ◽

All Cause Mortality

ObjectiveWe performed a meta-analysis, including dose–response analysis, to quantitatively determine the association of fried-food consumption and risk of cardiovascular disease and all-cause mortality in the general adult population.MethodsWe searched PubMed, EMBASE and Web of Science for all articles before 11 April 2020. Random-effects models were used to estimate the summary relative risks (RRs) and 95% CIs.ResultsIn comparing the highest with lowest fried-food intake, summary RRs (95% CIs) were 1.28 (1.15 to 1.43; n=17, I2=82.0%) for major cardiovascular events (prospective: 1.24 (1.12 to 1.38), n=13, I2=75.7%; case–control: 1.91 (1.15 to 3.17), n=4, I2=92.1%); 1.22 (1.07 to 1.40; n=11, I2=77.9%) for coronary heart disease (prospective: 1.16 (1.05 to 1.29), n=8, I2=44.6%; case–control: 1.91 (1.05 to 3.47), n=3, I2=93.9%); 1.37 (0.97 to 1.94; n=4, I2=80.7%) for stroke (cohort: 1.21 (0.87 to 1.69), n=3, I2=77.3%; case–control: 2.01 (1.27 to 3.19), n=1); 1.37 (1.07 to 1.75; n=4, I2=80.0%) for heart failure; 1.02 (0.93 to 1.14; n=3, I2=27.3%) for cardiovascular mortality; and 1.03 (95% CI 0.96 to 1.12; n=6, I2=38.0%) for all-cause mortality. The association was linear for major cardiovascular events, coronary heart disease and heart failure.ConclusionsFried-food consumption may increase the risk of cardiovascular disease and presents a linear dose–response relation. However, the high heterogeneity and potential recall and misclassification biases for fried-food consumption from the original studies should be considered.

Download Full-text

Efficacy of statin treatment based on cardiovascular outcomes in elderly patients: a standard meta-analysis and Bayesian network analysis

Journal of International Medical Research ◽

10.1177/0300060520926349 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052092634 ◽

Cited By ~ 2

Author(s):

Chuannan Zhai ◽

Kai Hou ◽

Rui Li ◽

YueCheng Hu ◽

JingXia Zhang ◽

...

Keyword(s):

Secondary Prevention ◽

Cardiovascular Mortality ◽

Cardiovascular Events ◽

Meta Analysis ◽

The Elderly ◽

Statin Treatment ◽

Comparative Effect ◽

Randomized Controlled ◽

All Cause Mortality ◽

Central Database

Objective Statins have been shown to be beneficial for the prevention of cardiovascular events. In elderly individuals, the efficacy of statins remains controversial and the comparative effect of statins has not been assessed. Methods MEDLINE, Embase, and the Cochrane Central database were searched for randomized controlled trials that assessed statins in older patients. Results Seventeen trials were analyzed. When used for secondary prevention, statins were associated with reduced risk of cardiovascular events, all-cause mortality, cardiovascular mortality, revascularization, and stroke. When used for primary prevention, statins reduced the risk of myocardial infarction and revascularization, but did not significantly affect other outcomes. A modest difference between pharmaceutical statin products was found, and high-quality evidence indicated that intensive atorvastatin had the greatest benefits for secondary prevention. Conclusions In secondary prevention, evidence strongly suggests that statins are associated with a reduction in the risk of all-cause mortality, cardiovascular events, cardiovascular mortality, and revascularization. However, differences in the effects of various statins do not appear to have significant effects on therapy in secondary prevention for the elderly.

Download Full-text

A Bayesian network meta-analysis of PCSK9 inhibitors, statins and ezetimibe with or without statins for cardiovascular outcomes

European Journal of Preventive Cardiology ◽

10.1177/2047487318766612 ◽

2018 ◽

Vol 25 (8) ◽

pp. 844-853 ◽

Cited By ~ 21

Author(s):

Safi U Khan ◽

Swapna Talluri ◽

Haris Riaz ◽

Hammad Rahman ◽

Fahad Nasir ◽

...

Keyword(s):

Myocardial Infarction ◽

Bayesian Network ◽

Cardiovascular Mortality ◽

Cardiovascular Events ◽

Meta Analysis ◽

Credible Interval ◽

Major Adverse Cardiovascular Events ◽

Pcsk9 Inhibitors ◽

Adverse Cardiovascular Event ◽

All Cause Mortality

Background The comparative effects of statins, ezetimibe with or without statins and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors remain unassessed. Design Bayesian network meta-analysis was conducted to compare treatment groups. Methods Thirty-nine randomized controlled trials were selected using MEDLINE, EMBASE, and CENTRAL (inception – September 2017). Results In network meta-analysis of 189,116 patients, PCSK9 inhibitors were ranked as the best treatment for prevention of major adverse cardiovascular events (Surface Under Cumulative Ranking Curve (SUCRA), 85%), myocardial infarction (SUCRA, 84%) and stroke (SUCRA, 80%). PCSK9 inhibitors reduced the risk of major adverse cardiovascular events compared with ezetimibe + statin (odds ratio (OR): 0.72; 95% credible interval (CrI), 0.55–0.95; Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria: moderate), statin (OR: 0.78; 95% CrI: 0.62–0.97; GRADE: moderate) and placebo (OR: 0.63; 95% CrI: 0.49–0.79; GRADE: high). The PCSK9 inhibitors were consistently superior to groups for major adverse cardiovascular event reduction in secondary prevention trials (SUCRA, 95%). Statins had the highest probability of having lowest rates of all-cause mortality (SUCRA, 82%) and cardiovascular mortality (SUCRA, 84%). Compared with placebo, statins reduced the risk of all-cause mortality (OR: 0.88; 95% CrI: 0.83–0.94; GRADE: moderate) and cardiovascular mortality (OR: 0.84; 95% CrI: 0.77–0.90; GRADE: high). For cardiovascular mortality, PCSK9 inhibitors were ranked as the second best treatment (SUCRA, 78%) followed by ezetimibe + statin (SUCRA, 50%). Conclusion PCSK9 inhibitors were ranked as the most effective treatment for reducing major adverse cardiovascular events, myocardial infarction and stroke, without having major safety concerns. Statins were ranked as the most effective therapy for reducing mortality.

Download Full-text

The Metabolic SYNDROME and the RISK of Venous Thrombosis: RESULTS of AN Individual LEVEL Patient Meta-ANALYSIS

Blood ◽

10.1182/blood.v116.21.3177.3177 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3177-3177

Author(s):

Francesco Dentali ◽

Cihan Ay ◽

Moon Jang ◽

Matteo di Minno ◽

Ingrid Pabinger ◽

...

Keyword(s):

Metabolic Syndrome ◽

Multivariate Analysis ◽

Conflicts Of Interest ◽

Meta Analysis ◽

Visceral Obesity ◽

The Metabolic Syndrome ◽

Increased Risk ◽

Individual Features ◽

The Individual ◽

The Impact

Abstract Abstract 3177 Background: The metabolic syndrome (MS) is a cluster of interrelated risk factors that identify patients at increased risk of cardiovascular events. Recent studies also suggested an association between MS and venous thromboembolism (VTE). However, the role of the individual features of MS and whether MS and its features are more important than obesity alone to predict VTE remain to be established. Methods: We performed an individual patient level meta-analysis of case-control studies comparing the prevalence of MS in patients with unprovoked VTE and in controls. MEDLINE, EMBASE databases, and abstract books were searched up to January 2010. Odds ratios (OR) and 95% confidence intervals of pooled results were calculated. The influence of individual variables (age, sex, BMI and MS) on the likelihood of VTE was compared using logistic regression analysis. Multivariate analysis was subsequently performed including the individual components of MS in the place of MS. The impact of increasing number of individual components of MS on the risk of VTE was investigated. Results: Four studies were identified and analyzed, for a total of 1332 patients (479 cases and 833 controls). Mean age was 53.3 and 52.7, respectively (p=n.s.), 49.5% cases and 42.4% controls were males (p=0.0003), 38.8% and 30.0% were obese (p=0.0001). MS was significantly associated with VTE (OR 1.97, 1.57–2.47), and the association linearly increased with the number of MS features (p for trend <0.001). At multivariate analysis, MS but not obesity remained associated with VTE (OR 1.92, 1.50–2.46 and 1.14, 0.88–1.47, respectively). All individual features of MS, but HDL cholesterol, were independently associated with VTE. Conclusions: The results of this meta-analysis confirm the association between MS and VTE and suggest that MS (and visceral obesity defined by increased waist circumference) could be a more important predictor of VTE than obesity defined by BMI. Disclosures: No relevant conflicts of interest to declare.

Download Full-text