1.
A nutraceutical combination reduces left ventricular mass in subjects with metabolic syndrome and left ventricular hypertrophy: A multicenter, randomized, double-blind, placebo-controlled trial.
Mercurio, V, Pucci, G, Bosso, G, Fazio, V, Battista, F, Iannuzzi, A, Brambilla, N, Vitalini, C, D'Amato, M, Giacovelli, G, et al
Clinical nutrition (Edinburgh, Scotland). 2020;(5):1379-1384
Abstract
BACKGROUND & AIMS Increased left ventricular mass (LVM) is often present in metabolic syndrome (MS), also in the setting of well-controlled blood pressure (BP). Aim of the present study was to evaluate the efficacy of a nutraceutical combination of berberine, red yeast rice extract and policosanol (Armolipid Plus™, AP) in reducing LVM in patients with MS and left ventricular hypertrophy (LVH). METHODS In this multicenter, randomized, double-blind, placebo-controlled trial, 158 patients with MS (IDF criteria) and LVH (LVM > 48 g/m2.7 in men and > 44 g/m2.7 in women), were randomized 1:1 to receive AP or placebo for 24 weeks. Reduction of LVM, regression of LVH, and changes in lipids were analysed. RESULTS One-hundred-and-forty-five patients (AP n = 74, placebo n = 71) completed the study. A significant percentage reduction in LVM was observed in AP group vs baseline (-2.7%, p < 0.0001), and compared to placebo (-4.1%, p < 0.0001), and remained significant after adjustment for age, sex, baseline systolic BP and BMI and their changes during the study period. The proportion of subjects showing LVM reduction was higher in AP group than in the placebo group (57% vs 28%, adjusted p = 0.007). Treatment with AP was associated with improvement of lipid profile. CONCLUSIONS 24-week of treatment with AP is associated with a significant reduction in LVM in subjects with MS and LVH, in addition to favourable effects on lipid profile, and could represent an effective strategy aiming at reducing the associated cardiovascular risk. The trial was registered at clinicaltrials.gov with ID NCT02295176.
2.
Obesity and Ventricular Repolarization: a Comprehensive Review.
Omran, J, Bostick, BP, Chan, AK, Alpert, MA
Progress in cardiovascular diseases. 2018;(2):124-135
Abstract
Obesity is known to be a strong predictor of sudden cardiac death. For this reason, concern exists that this association may be related to delayed ventricular repolarization (VR), which has been extensively studied in overweight and obese patients. The corrected QT interval (QTc) and QT or QTc dispersion have been the most commonly-used electrocardiographic methods for assessing VR. Multiple controlled studies demonstrated that QTc and QT or QTc dispersion were significantly longer/greater in overweight and obese subjects than in normal weight controls. The preponderance of evidence indicates that weight loss in overweight and obese patients, whether achieved by diet or bariatric surgery, significantly shortens QTc and decreases QT or QTc dispersion. Several co-morbidities that are commonly associated with obesity may delay VR. These include diabetes mellitus, the metabolic syndrome, systemic hypertension, left ventricular hypertrophy, heart failure, and obstructive sleep apnea. It is unclear whether overweight and obesity are independent predictors of delayed VR. It is also uncertain whether prolongation of QTc in such patients is sufficient to predispose to potentially fatal ventricular arrhythmias.
3.
Interrelationship between diabetes mellitus and heart failure: the role of peroxisome proliferator-activated receptors in left ventricle performance.
Oikonomou, E, Mourouzis, K, Fountoulakis, P, Papamikroulis, GA, Siasos, G, Antonopoulos, A, Vogiatzi, G, Tsalamadris, S, Vavuranakis, M, Tousoulis, D
Heart failure reviews. 2018;(3):389-408
Abstract
Heart failure (HF) is a common cardiac syndrome, whose pathophysiology involves complex mechanisms, some of which remain unknown. Diabetes mellitus (DM) constitutes not only a glucose metabolic disorder accompanied by insulin resistance but also a risk factor for cardiovascular disease and HF. During the last years though emerging data set up, a bidirectional interrelationship between these two entities. In the case of DM impaired calcium homeostasis, free fatty acid metabolism, redox state, and advance glycation end products may accelerate cardiac dysfunction. On the other hand, when HF exists, hypoperfusion of the liver and pancreas, b-blocker and diuretic treatment, and autonomic nervous system dysfunction may cause impairment of glucose metabolism. These molecular pathways may be used as therapeutic targets for novel antidiabetic agents. Peroxisome proliferator-activated receptors (PPARs) not only improve insulin resistance and glucose and lipid metabolism but also manifest a diversity of actions directly or indirectly associated with systolic or diastolic performance of left ventricle and symptoms of HF. Interestingly, they may beneficially affect remodeling of the left ventricle, fibrosis, and diastolic performance but they may cause impaired water handing, sodium retention, and decompensation of HF which should be taken into consideration in the management of patients with DM. In this review article, we present the pathophysiological data linking HF with DM and we focus on the molecular mechanisms of PPARs agonists in left ventricle systolic and diastolic performance providing useful insights in the molecular mechanism of this class of metabolically active regiments.
4.
Metabolic syndrome and its association with left ventricular dysfunction in patients with left bundle branch block.
Gharipour, M, Hashemi Jazi, M, Nilforoush, P, Batvandi, A, Mohammadi, R, Najafi, R
Acta bio-medica : Atenei Parmensis. 2015;(2):157-61
Abstract
BACKGROUND The present study and for the first time hypothesizes that the patients with left bundle branch block (LBBB) suffer considerably from metabolic syndrome (MetS) and this metabolic phenomenon can be associated with cardiac dysfunction status such as ventricular dilation and reduced left ventricular ejection fraction (LVEF) in these patients. METHODS A retrospective study was conducted on 220 consecutive patients with diagnosed LBBB. MetS status was diagnosed using the Adult Treatment Panel III of the National Cholesterol Education Program criteria. Systolic function state was assessed using two-dimensional echocardiography. RESULTS The overall prevalence of MetS among studied LBBB patients was 16.8%. Regarding left ventricular functional status in the two groups, the mean LVEF in the groups with and without MetS was 37.03 ± 9.09% and 43.43 ± 15.62% with a significant difference (p = 0.017). However, left ventricular dilation was similarly detected in both groups with and without MetS (21.6% versus 30.6%, p = 0.273). Multivariable linear regression model showed subjects with MetS had lower LVEF in the presence of confounders (Beta = 6.915, p = 0.039). CONCLUSION A notable number of LBBB patients suffered from MetS and this metabolic phenomenon is significantly associated with lowering left ventricular function in LBBB patients.