Audrey Auclair

Daily Steps Threshold to Improve Cardiovascular Disease Risk Factors During the Year After an Acute Coronary Syndrome

PURPOSE: To evaluate the daily steps threshold associated with improved cardiovascular disease risk factors during the first year following an acute coronary syndrome. METHODS: Subjects (N = 41) were recruited during hospitalization for an acute coronary syndrome. A blinded pedometer with a 7-day memory (NL-2000) was used at baseline, 3, 6, 9, and 12 months following hospitalization. Cardiovascular disease risk factors were measured at baseline, 6, and 12 months after discharge. Subjects who maintained a mean of 7500 steps per day or more at each time period were classified into the active group, whereas those who did not maintain this threshold were classified into the less active group. RESULTS: The active group included 25 subjects, whereas 16 subjects were included in the less active group. Daily steps mean ± SEM was different between groups at 6 and 12 months followup (11 320 ± 3380 vs 5503 ± 1502 and 10 507 ± 2861 vs 6624 ± 3295 steps per day, respectively; both P < .001). Based on the analysis of variance for repeated measures (ANOVA-RM), the active group showed lower triglycerides (P < .01), lower waist circumference (P < .01), and higher high-density lipoprotein–cholesterol (HDL-C) (P = .04) at 12 months. Interaction effects (group × followup) were also significant for HDL-C (P = .01) and triglycerides (P = .01) after adjustment for age, gender, and baseline waist circumference. CONCLUSION: Targeting

Effect of bariatric surgery on heart failure

7500 daily steps during 1 year may be efficient to maintain lowest waist circumference and to improve lipid profile during the year following an acute coronary syndrome. It could be considered a starting target point to initiate changes in physical activity behavior.

Blood Pressure Measurement in Severely Obese Patients: Validation of the Forearm Approach in Different Arm Positions

ABSTRACT Introduction: Obesity increases the risk of heart failure (HF), which continues to be a significant proportion of all cardiovascular diseases and affects increasingly younger populations. The cross-talk between adipose and the heart involves insulin resistance, adipokine signaling and inflammation, with the capacity of adipose tissue to mediate hemodynamic signals, promoting progressive cardiomyopathy. Areas covered: From a therapeutic perspective, there is not yet a single obesity-related pathway that when addressed, can ameliorate cardiomyopathy in obese patients and this is a matter of ongoing research. There is poor evidence of the beneficial long-term effect of small nonsurgical intentional weight loss on HF outcomes, in contrast to the field of HF accompanying severe obesity where observational studies have shown that bariatric surgery is associated with improved cardiac structure/function in severely obese patients with HF and preserved ejection fraction (HFpEF) as well as with improved cardiac structure/function in those with HF and reduced ejection fraction (HFrEF). Few studies report positive outcomes in subjects with obesity and HF, both severe, who underwent bariatric surgery as a rescue treatment, including bridge to heart transplantation. Expert commentary: The fast growing prevalence of obesity will continue to require the development of appropriate interventions directed at controlling or slowing pathways of cardiac damage in these patients, but at present, bariatric surgery should be considered an option to try to decrease morbidity associated with HF in severely obese adults.

Acute and Chronic Impact of Bariatric Surgery on Plasma LDL Cholesterol and PCSK9 Levels in Patients With Severe Obesity

BACKGROUND Blood pressure measurement in severe obesity may be technically challenging as the cuff of the device may not fit adequately around the upper arm. The aim of the study was to assess the agreement between intra-arterial blood pressure values (gold standard) compared with forearm blood pressure measurements in severely obese patients in different arm positions. METHODS Thirty-three severely obese patients and 21 controls participated in the study. Pairs of intra-arterial blood pressures were compared with simultaneous forearm blood pressure measurement using an oscillometric device in 4 positions: (i) supine, (ii) semi-fowler with the forearm resting at heart level, (iii) semi-fowler with the arm downward, and (iv) semi-fowler with the arm raised overhead. Degree of agreement between measurements was assessed. RESULTS Overall, correlations of systolic and diastolic blood pressure measurements between the gold standard and forearm blood pressure were 0.95 (n = 722; P < 0.001) and 0.89 (n = 482; P < 0.001), respectively. Systolic blood pressure measured using the forearm approach in the supine and the semi-fowler positions with arm downward showed the best agreement when compared with the gold standard (-4 ± 11 (P < 0.001) and 2 ± 14 mm Hg (P = 0.19), respectively). In the control group, better agreement was found between the supine and semi-fowler positions with the arm resting at heart level (1 ± 9 mm Hg (P = 0.29) and -3 ± 10 mm Hg (P = 0.01), respectively). CONCLUSIONS Forearm systolic blood pressure consistently agreed with the gold standard in the supine position. This method can be of use in clinical settings when upper-arm measurement is challenging in severe obesity.

If not dieting, how to lose weight? Tips and tricks for a better global and cardiovascular health

Context: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key regulator of low‐density lipoprotein cholesterol (LDL‐C) concentrations. In patients with severe obesity, biliopancreatic diversion with duodenal switch (BPD‐DS) surgery induces substantial weight loss and influences lipoprotein metabolism. The effect of BPD‐DS on PCSK9 levels is unknown. Objectives: To determine the acute and chronic impact of BPD‐DS on PCSK9 levels and whether the acute impact of BPD‐DS could be explained by BPD‐DS‐associated caloric restriction (CR). Design, Settings, and Participants: PCSK9 levels were measured in 20 men and 49 women (age, 41.5 ± 11.1 years) with severe obesity before, 24 hours, 5 days, and 6 and 12 months after BPD‐DS and in a comparable control group (n = 31) at baseline and at 6 and 12 months. PCSK9 levels were also measured during 3‐day CR in patients (n = 7) with severe obesity and type 2 diabetes. Results: PCSK9 levels increased 13.4% after 24 hours (248.7 ± 64.8 to 269.7 ± 63.8 ng/mL; P = 0,02) and decreased 9.5% at 12 months compared with baseline (217.6 ± 43.0 ng/mL; P < 0,0001). LDL‐C levels decreased 36.2% after 24 hours (2.6 ± 0.7 to 1.7 ± 0.6 mmol/L; P < 0.0001) and 30% at 12 months compared with baseline (1.7 ± 0.5 mmol/L; P < 0.0001). Compared with baseline levels, PCSK9 levels were lower at day 2 but not at day 1 or 3 after CR. Conclusion: BPD‐DS is associated with acute increases in PCSK9 levels that do not appear to be explained by CR but may be due to an acute response following surgery. BPD‐DS induces chronic reductions in both PCSK9 and LDL‐C levels.

How to Choose and Use Bariatric Surgery in 2015

Abstract Weight loss is a popular topic and may be of serious concern for many patients. Even with the abundant literature on obesity and cardiometabolic risk, it is always challenging to demystify and reinforce the determinants of safe approaches to lose weight. Measures of central obesity are essential to characterize the patient’s adiposity distribution and should be part of the routine medical examination. Beyond this, screening for fasting lipids and glucose are important for the assessment of the cardiometabolic risk which may lead to increased cardiovascular morbidity and mortality. Differences in adiposity as well as in weight loss exist between sexes and should be taken into consideration. Rather than avoiding some food or following certain type of diet, any planned weight loss interventions should promote lifestyle and environmental modifications with healthy eating and appropriate physical activity. With clear objectives, this appears to be the best way in order to achieve weight loss goals permanently.