Prevalence Of Cardiometabolic Comorbidities Research Articles

The spectrum of cardiac abnormalities in patients with acromegaly: results from a case-control cardiac magnetic resonance study

PurposeCardiac abnormalities are common in patients with acromegaly, contributing to the increased morbidity and mortality. Cardiac magnetic resonance (CMR) is the gold standard for measuring cardiac morpho-functional changes. This study aims to detect cardiac alterations in acromegaly through CMR, even when the disease is adequately controlled.MethodsIn this, multicentre, case-control study, we compared consecutive patients with acromegaly, cured after surgery or requiring medical treatment, with matched controls recruited among patients harbouring non-functioning adrenal incidentalomas.ResultsWe included 20 patients with acromegaly (7 females, mean age 50 years) and 17 controls. Indexed left ventricular-end-diastolic volume (LV-EDVi) and LV-end-systolic volume (LV-ESVi) were higher in patients than in controls (p < 0.001), as were left ventricular mass (LVMi) (p = 0.001) and LV-stroke volume (LV-SVi) (p = 0.028). Right ventricle (RV) EDVi and ESVi were higher, whereas RV-ejection fraction (RV-EF) was lower (p = 0.002) in patients than in controls (p < 0.001). No significant differences were observed in the prevalence of cardiometabolic comorbidities, including hypertension, glucose and lipid metabolism impairment, obstructive sleep apnoea syndrome, and obesity. IGF1 x upper limit of normal significantly predicted LVMi (b = 0.575; p = 0.008). Subgroup analysis showed higher LVMi (p = 0.025) and interventricular septum thickness (p = 0.003) in male than female patients, even after adjusting cardiac parameters for confounding factors.ConclusionsThe CMR analysis reveals a cluster of biventricular structural and functional impairment in acromegaly, even when the biochemical control if achieved. These findings appear specifically triggered by the exposure to GH-IGF1 excess and show sex-related differences advocating a possible interaction with sex hormones in cardiac disease progression.

Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: an international, retrospective, cohort study

The association between cortisol secretion and mortality in patients with adrenal incidentalomas is controversial. We aimed to assess all-cause mortality, prevalence of comorbidities, and occurrence of cardiovascular events in uniformly stratified patients with adrenal incidentalomas and cortisol autonomy (defined as non-suppressible serum cortisol on dexamethasone suppression testing). We conducted an international, retrospective, cohort study (NAPACA Outcome) at 30 centres in 16 countries. Eligible patients were aged 18 years or older with an adrenal incidentaloma (diameter ≥1 cm) detected between Jan 1, 1996, and Dec 31, 2015, and availability of a 1 mg dexamethasone suppression test result from the time of the initial diagnosis. Patients with clinically apparent hormone excess, active malignancy, or follow-up of less than 36 months were excluded. Patients were stratified according to the 0800-0900 h serum cortisol values after an overnight 1 mg dexamethasone suppression test; less than 50 nmol/L was classed as non-functioning adenoma, 50-138 nmol/L as possible autonomous cortisol secretion, and greater than 138 nmol/L as autonomous cortisol secretion. The primary endpoint was all-cause mortality. Secondary endpoints were the prevalence of cardiometabolic comorbidities, cardiovascular events, and cause-specific mortality. The primary and secondary endpoints were assessed in all study participants. Of 4374 potentially eligible patients, 3656 (2089 [57·1%] with non-functioning adenoma, 1320 [36·1%] with possible autonomous cortisol secretion, and 247 [6·8%] with autonomous cortisol secretion) were included in the study cohort for mortality analysis (2350 [64·3%] women and 1306 [35·7%] men; median age 61 years [IQR 53-68]; median follow-up 7·0 years [IQR 4·7-10·2]). During follow-up, 352 (9·6%) patients died. All-cause mortality (adjusted for age, sex, comorbidities, and previous cardiovascular events) was significantly increased in patients with possible autonomous cortisol secretion (HR 1·52, 95% CI 1·19-1·94) and autonomous cortisol secretion (1·77, 1·20-2·62) compared with patients with non-functioning adenoma. In women younger than 65 years, autonomous cortisol secretion was associated with higher all-cause mortality than non-functioning adenoma (HR 4·39, 95% CI 1·93-9·96), although this was not observed in men. Cardiometabolic comorbidities were significantly less frequent with non-functioning adenoma than with possible autonomous cortisol secretion and autonomous cortisol secretion (hypertension occurred in 1186 [58·6%] of 2024 patients with non-functioning adenoma, 944 [74·0%] of 1275 with possible autonomous cortisol secretion, and 179 [75·2%] of 238 with autonomous cortisol secretion; dyslipidaemia occurred in 724 [36·2%] of 1999 patients, 547 [43·8%] of 1250, and 123 [51·9%] of 237; and any diabetes occurred in 365 [18·2%] of 2002, 288 [23·0%] of 1250, and 62 [26·7%] of 232; all p values <0·001). Cortisol autonomy is associated with increased all-cause mortality, particularly in women younger than 65 years. However, until results from randomised interventional trials are available, a conservative therapeutic approach seems to be justified in most patients with adrenal incidentaloma. Deutsche Forschungsgemeinschaft, Associazione Italiana per la Ricerca sul Cancro, Università di Torino.

Long-term cardiometabolic outcome in patients with pituitary adenoma diagnosed in chilhood and adolescence

Pituitary adenomas (PAs) rarely occur in childhood and adolescence. Management of PAs in this critical age can be particularly challenging considering the auxological sequelae and potential long-term cardiometabolic consequences. We aimed to describe the clinical characteristics of patients with PA aged < 18years at diagnosis and during long-term follow-up, focusing on the prevalence of cardio-metabolic comorbidities and the impact of different therapeutic strategies. Clinical data at diagnosis and at last follow-up visit (mean 10.3 ± 9.2years) of 101 patients aged < 18years with PA, referred to our University Hospital from 1990 to 2017, were retrospectively evaluated. At diagnosis, 11.9% of patients presented with pituitary hormone deficiencies, whose number was positively correlated with pituitary tumor diameter (p < 0.001). At diagnosis, 26.7% of patients were overweight and 15.8% were obese. In patients with hypercortisolism or GH excess the prevalence of obesity was more than 2-fold greater than in general population. No correlation was found between pituitary tumor size and BMI. At baseline, the greater the number of pituitary hormone deficits, the higher BMI (p = 0.039). In prolactinoma patients still on medical therapy at last visit, BMI was higher than at baseline. We found an increased prevalence of overweight/obesity only in pediatric and adolescent patients with GH- or ACTH-secreting PA. Regarding cardio-metabolic comorbidities other than obesity/overweight, we have not found anything worth of mention. The remission of hypercortisolism positively impacted on BMI, while medical therapy in patients with prolactinoma seemed unable to avoid weight gain, suggesting a careful metabolic management of these patients.

P5 Clinical utility of stress echocardiography in remote indigenous and non-indigenous populations: a 10-year study in central Australia

Abstract Background Central Australia is a vast, geographical region spanning some 830,000 square kilometres. It is the most populous Indigenous region in Australia (44%) and a great distance from tertiary centres (1,500km). Non-invasive testing is important in this setting due to the high prevalence of cardiovascular disease and long-distance travel required for coronary angiography, the latter with significant logistical, financial, and cultural barriers. Although stress echocardiography has been extensively validated as a long-term prognostic tool in selected populations, we are not aware of prior studies in remote Indigenous and non-Indigenous individuals. Purpose To determine whether stress echocardiography can adequately risk stratify and quantify the long-term prognosis of Indigenous and non-Indigenous individuals in remote Central Australia. Methods Consecutive individuals undergoing stress echocardiography in Central Australia between 2007 and 2017 were included. Exercise or dobutamine stress echocardiography was performed and reported via standard protocols. Individuals were followed up for the primary outcome of all-cause mortality. Results One thousand and eight patients (54% Indigenous, 63% dobutamine stress) were included. Indigenous patients were younger, more likely to be female, and had a greater prevalence of cardiometabolic comorbidities (p &amp;lt; 0.05 for all). Overall, 797 (79%) patients had no abnormality during rest or stress echocardiography, with no difference according to ethnicity (p &amp;gt; 0.05). After a mean follow up of 3.5 ± 2.4 years, 54 (5%) of patients were deceased; 127 (14%) patients underwent revascularization and were censored from follow-up. In patients with a normal test, annual mortality averaged 1.3% over 5 years of follow up, with annual mortality being significantly higher in Indigenous compared to non-Indigenous individuals (2.0% vs 0.6% respectively). Individuals with either ischemia or scar had a significantly worse long-term outcome compared to those with a normal test (Figure). In multivariate analyses, increasing age (HR 1.04 [95% CI 1.01-1.08]), chronic kidney disease (HR 4.83 [1.79-13.02]), and lack of ACEI/ARB use (HR 0.19 [95% CI 0.09-0.42]) were associated with all-cause mortality. Although Indigenous ethnicity was a univariate predictor of mortality, this association was attenuated and non-significant in multivariate analyses. Conclusion Indigenous patients in remote Central Australia with a normal stress echocardiogram had a significantly higher annual rate of mortality compared to their non-Indigenous counterparts. However, this association may be in large part due to comorbid conditions. A normal test in Indigenous individuals was still able to adequately risk-stratify and identify a lower risk group of patients in whom ongoing local medical management and focusing on cardiometabolic risk factor reduction is likely to be appropriate. Abstract P5 Figure. Kaplan Meier survival curve

Cardiometabolic comorbidities and epidemiological features among rural Chinese elderly people.

China had already entered the aging society and taken up the largest number of elderly among the world. We intend to estimate cardiometabolic comorbidities situation among elderly coming from rural China. We conducted a survey during 2012 to 2013 which enrolled 1744 elderly from rural Northeast China. Data regarding the demographic and lifestyle characteristics and the blood biochemical indexes of these participants were collected by well-trained personnel. Data in this study shows that the prevalence of hypertension, diabetes, dyslipidemia, obesity, stroke and hyperuricemia was 74.8%, 14.9%, 67.4%, 39.9%, 18.9% and 13.1%, respectively. Female had significantly higher prevalence of dyslipidemia (79.3% vs. 55.9%), diabetes (18.4% vs. 11.4%) and obesity (42.1% vs. 37.7%) than male. Elder subjects (> 75years) had higher prevalence of hypertension (80.4% vs. 73.4%) than younger ones (65-75years) while obesity was more prevalent among younger subjects (41.4% vs. 34.1%). Multivariate logistic regression revealed that moderate physical activity and current smoking show beneficial effect on cardiometabolic comorbidities. Higher family income (> 20, 000 CNY/year) was risk factor of diabetes and obesity only while sleep duration between 7 and 8h/day and married status were risk factors for hypertension only. Current drinking increases the risk of hypertension and dyslipidemia but as protective factor for obesity and stroke. The prevalence of cardiometabolic comorbidities among was high among rural elderly from China. Physical activity, current smoking and drinking, family income, sleep duration and married status were associated with cardiometabolic comorbidities. Metabolic screen was recommended in the older subjects in rural China.

2081-P: Obesity and Bariatric Surgery Trends in Type 1 Diabetes

The prevalence of obesity and its complications and comorbidities continue to increase. It is well established that obesity is a major etiologic factor in the onset of type 2 diabetes (T2DM) and that bariatric surgery (BS) is an effective management strategy for both weight and glycemic control in obese T2DM patients. The relationship between obesity and type 1 diabetes (T1DM) is less clear though recent reports suggest a recent surge in the prevalence of obesity among T1DM patients. To explore the prevalence of obesity in T1DM and the impact of bariatric surgery in these patients a 1 year (2018) retrospective chart review of T1DM patients was done and the identified patients were compared to T2DM patients seen over the same time period in the Ochsner clinical network. Of 93,367 subjects with T2DM seen over the 1 year period, 62, 034 (66.4%) are obese and of these 18,670 (30%) are morbidly obese. The T1DM patients over the same period are 7,143 of which 3,728 (52%) are obese and 969 (26%) are morbidly obese. Over this period while 1,818 Obese T2DM patients (2.9% of the cohort) had BS only 6 obese T1DM patients (0.16%) of the cohort had BS. This group consists of mostly Caucasian (5/6) women (5/6) with 3 having gastric bypass and 4 having sleeve gastrectomy. While the prevalence of cardiometabolic comorbidities (hypertension, dyslipidemia, ESRD, CAD, and CVD) were essentially similar in both cohorts of obese diabetics, the effects of bariatric surgery on weight, HBA1c, blood pressure and lipids were more variable in the T1DM patient than the T2DM patients. Obesity is presently nearly as prevalent in T1DM as T2DM. Morbid obesity is just as prevalent in both diabetes cohorts. While BS remains underutilized as a management strategy in obese T2DM it remains a rarity in obese T1DM and the little data available suggests that its impact on cardiometabolic surrogates may be more variable in this unique cohort. More study is needed of the potential utility and impact of BS in weight management of obese T1DM. Disclosure G.I. Uwaifo: None.

Obesity related changes in cardiac structure and function: role of blood pressure and metabolic abnormalities

Background: It has been reported that changes in cardiac structure and ventricular function associated with obesity have to be attributable to hemodynamic and non-hemodynamic alterations. Accordingly, the aim of this was to evaluate left ventricular hypertrophy (LVH) prevalence and its effect on left ventricular systolic and diastolic function in a cohort of obese patients.Materials and Methods: LV internal diameter (LVID), left ventricular mass (LVM) and LVM/height2.7(LVMI), relative wall thickness (RWT), LV ejection fraction (LVEF), E/A ratio, isovolumic relaxation time, deceleration time of E velocity by echocardiography and pulsed-wave Doppler and total circulating adiponectin (ADPN) by radioimmunoassay were measured in 319 obese subjects with and without LVH.Results: Increased values of BMI, WHR, SBP, DBP, MBP LVID, LVM, LVMI, IVST (p < .001), increased prevalence of subjects with LVEF< 50%,(p < .001), central fat distribution (p < .001), hypertension (p < .001), diabetes (p < .001), metabolic syndrome (p < .02), and reduced value of ADPN (p < .0001) and LVEF (p < .001) were detected in LVH obese subjects than controls without LVH. No significant differences in diastolic parameters were observed between the two groups. LVEF correlated directly with ADPN (p < .0001) and inversely with age (p < .01), BMI (p < .01), WHR (p < .001), MBP (p < .01) MetS (p < .02) and LVMI (p < .001). WHR, MBP, LVMI and ADPN were independently associated with LVEF.Conclusions: In conclusion, our data indicate that obese subjects with LVH might be considered a distinct phenotype of obesity, characterised by LVH, increased prevalence of cardiometabolic comorbidities, central fat distribution, hypoadiponectinemia and early left ventricular systolic dysfunction.