Effects of left ventricular geometry and obesity on mortality in women with normal ejection fraction.

Left ventricular (LV) geometry is an independent predictor of cardiovascular morbidity and mortality. Although obesity is a known risk factor for cardiovascular diseases, studies have suggested a paradoxical relation between obesity and prognosis. We retrospectively assessed 26,126 female patients with normal LV ejection fraction to determine the impact of LV geometry, including normal structure, concentric remodeling, and eccentric or concentric LV hypertrophy, and obesity on mortality during an average follow-up of 1.

Relation of body fat categories by Gallagher classification and by continuous variables to mortality in patients with coronary heart disease.

Although obesity is a coronary heart disease risk factor, in cohorts of patients with coronary heart disease, an "obesity paradox" exists whereby patients with obesity have a better prognosis than do leaner patients. Obesity is generally defined by body mass index, with relatively little described regarding body fat (BF). In this study, 581 consecutive patients with coronary heart disease divided into the Gallagher BF categories of underweight (n = 12), normal (n = 189), overweight (n = 214), and obese (n = 166) were evaluated, and 3-year mortality was assessed using the National Death Index.

Body composition and survival in stable coronary heart disease: impact of lean mass index and body fat in the "obesity paradox".

Objectives: Our goal was to determine the impact of lean mass index (LMI) and body fat (BF) on survival in patients with coronary heart disease (CHD).

Background: An inverse relationship between obesity and prognosis has been demonstrated (the "obesity paradox") in CHD, which has been explained by limitations in the use of body mass index in defining body composition.

Methods: We studied 570 consecutive patients with CHD who were referred to cardiac rehabilitation, stratified as Low (≤25% in men and ≤35% in women) and High (>25% in men and >35% in women) BF and as Low (≤18.

Body composition and coronary heart disease mortality--an obesity or a lean paradox?

Objective: To determine the combined effects of body mass index (BMI) and body fat (BF) on prognosis in coronary heart disease (CHD) to better understand the obesity paradox.

Patients And Methods: We studied 581 patients with CHD between January 1, 2000, and July 31, 2005, who were divided into low (<25) and high BMI (≥25), as well as low (≤25% men and ≤35% women) and high BF (>25% in men and >35% in women). Four groups were analyzed by total mortality during the 3-year follow-up by National Death Index: low BF/low BMI (n=119), high BF/low BMI (n=26), low BF/high BMI (n=125), and high BF/high BMI (n=311).

Value of weight reduction in patients with cardiovascular disease.

Obesity is an independent risk factor for cardiovascular (CV) disease and contributes markedly to individual CV risk factors, including hypertension, diabetes mellitus, dyslipidemia, and other chronic conditions, such as osteoarthritis, obstructive sleep apnea, and physical deconditioning. Obesity, defined as a body mass index ≥30 kg/m(2), is associated with increased morbidity and mortality, particularly in severely obese patients with a body mass index ≥35 kg/m(2). Physical activity, healthy eating and behavioral modification are three pivotal approaches to treating obesity.

Obesity and hypertension, heart failure, and coronary heart disease-risk factor, paradox, and recommendations for weight loss.

Obesity prevalence has reached epidemic proportions and is independently associated with numerous cardiovascular disease (CVD) risk factors, including diabetes mellitus, hypertension, dyslipidemia, cancers, sleep apnea, and other major CVDs. Obesity has significant negative impact on CVD, including hypertension, coronary heart disease, heart failure, and arrhythmias via its maladaptive effects on individual CVD risk factors and cardiac structure and function. Despite this negative association between obesity and the incidence and prevalence of CVD, many studies have demonstrated that obese patients with established CVD might have better short- and long-term prognosis, suggesting an "obesity paradox.

Clinical impact of left ventricular hypertrophy and implications for regression.

Left ventricular hypertrophy (LVH) is an independent risk factor and predictor of cardiovascular (CV) events and all-cause mortality. Patients with LVH are at increased risk for stroke, congestive heart failure, coronary heart disease, and sudden cardiac death. Left ventricular hypertrophy represents both a manifestation of the effects of hypertension and other CV risk factors over time as well as an intrinsic condition causing pathologic changes in the CV structure and function.

The obesity paradox, weight loss, and coronary disease.

Purpose: Because obesity is a cardiovascular risk factor but is associated with a more favorable prognosis among cohorts of cardiac patients, we assessed this "obesity paradox" in overweight and obese patients with coronary heart disease enrolled in a cardiac rehabilitation and exercise training (CRET) program, making this assessment in patients classified as overweight/obese using both traditional body mass index (BMI) and percent body fat assessments. Additionally, we assessed the efficacy and safety of purposeful weight loss in overweight and obese coronary patients.

Patients And Methods: We retrospectively studied 529 consecutive CRET patients following major coronary events before and after CRET, and compared baseline and post program data in 393 overweight and obese patients (body mass index [BMI] > or =25 kg/m(2)) divided by median weight change (median=-1.

Disparate effects of obesity and left ventricular geometry on mortality in 8088 elderly patients with preserved systolic function.

Background: Although left ventricular (LV) geometry has predicted cardiovascular (CV) prognosis, including in elderly cohorts, the role of obesity on CV prognosis has been more controversial.

Objective: To assess the independent effects of obesity and LV geometry on all-cause mortality in a large cohort of elderly patients with preserved LV systolic function.

Patients And Methods: We retrospectively assessed 8088 elderly patients (> 70 years) with an LV ejection fraction (LVEF) > or = 50% who were referred for echocardiography at a large primary, secondary, and tertiary health care system in New Orleans.

Major recent trials in cardiovascular diseases.

This article provides information and commentary on recent clinical trials related to primary prevention in cardiovascular diseases including lipids, hypertension, and diabetes. It also focuses on novel therapeutic advances in heart failure with devices and therapeutic agents. In addition, we explore trials looking at the effects of the investigational agents azimilide and dronedarone in the treatment of arrhythmias, application of established therapies/devices to larger populations, and the impact of hypercoagulability and aortic arch plaques on the incidence of stroke.

Impact of obesity on the risk of heart failure and its prognosis.

Obesity is becoming a global epidemic in both children and adults, and it is associated with numerous comorbidities such as coronary heart disease, stroke/cerebrovascular disease, type 2 diabetes, hypertension, certain cancers, and sleep-disordered breathing. Over the past 2 decades, the incidence of and mortality from coronary heart disease and cardiovascular diseases has been continuously declining. In contrast, the incidence of and mortality from heart failure (HF) have been increasing, with HF diagnosed in approximately 5 million Americans and 550,000 new cases diagnosed each year and a death rate looming at 300,000 per year.

The obesity paradox: impact of obesity on the prevalence and prognosis of cardiovascular diseases.

Obesity has reached global epidemic proportions and is associated with numerous comorbidities such as hypertension (HTN), type 2 diabetes mellitus, dyslipidemia, certain cancers, and chronic kidney disease (CKD). Obesity, via its direct maladaptive effects on cardiac structure and through its impact on conventional risk factors, is strongly associated with cardiovascular (CV) diseases such as heart failure (HF) and coronary heart disease (CHD). Despite these adverse associations, numerous studies indicate an "obesity paradox" in that being overweight or obese is associated with a favorable prognosis in many patients with established CV disease, particularly in patients with HTN, HF, and CHD.

Fish oil in primary and secondary cardiovascular prevention.

Omega-3 fatty acid therapy shows great promise in both primary and secondary prevention of cardiovascular (CV) diseases, especially coronary heart disease (CHD). In this review, we discuss the evidence available from prospective and retrospective observational epidemiologic studies and controlled clinical trials demonstrating the effects of omega-3 fatty acids (fish oil) in primary and especially secondary prevention of major CV events, including CV mortality, fatal and nonfatal myocardial infarction (MI), and sudden cardiac death (SCD). Significant reductions in total mortality and SCD to the extent of 20% to 50% have been found in studies using doses ranging from 0.

Cardiac rehabilitation programs markedly improve high-risk profiles in coronary patients with high psychological distress.

Objectives: Adverse behavioral profiles, particularly depression and hostility, increase the risk of coronary artery disease (CAD) and affect recovery after CAD events. We sought to determine the effects of outpatient phase II cardiac rehabilitation and exercise training (CRET) programs in CAD patients with high levels of psychological distress.

Methods: We studied 500 consecutive patients both before and after phase II CRET programs and compared 109 patients with the highest quintile of psychological distress (HD) with 115 patients with the lowest quintile of psychological distress (LD).

The obesity paradox and discrepancy between peak oxygen consumption and heart failure prognosis--it's all in the fat.

The authors present the case of an obese patient with advanced heart failure that demonstrates the paradox between obesity and heart failure prognosis. In addition, the authors discuss the rationale for the correction of cardiopulmonary stress data (used as predictors of survival and listing for cardiac transplantation) for lean weight (as opposed to total body weight), a consideration that may be particularly important in obese patients with a high percentage of body fat.

Psychological factors and cardiac risk and impact of exercise training programs-a review of ochsner studies.

Although under-emphasized, substantial evidence indicates that psychological distress, especially depression, hostility, and anxiety, are risk factors for coronary heart disease (CHD) and affect recovery following major coronary heart disease events. We review several major studies from Ochsner Medical Center demonstrating the high prevalence of psychological distress in CHD patients and the marked benefits that occur following formal cardiac rehabilitation and exercise training programs. These benefits include reductions in psychological stress, improvements in CHD risk factors that accompany high stress, and reduced all-cause mortality.