HF exacerbation was substantial and
consistent across different statistical
assumptions. The researchers explain
that the rate of emergency department visits and hospitalizations for
other conditions that may mimic HF
exacerbation remained stable after
bariatric surgery, which limits the
possibility of misdiagnosis of HF
exacerbations as non-HF events after
surgery. They also demonstrated
that nonbariatric surgeries had no
favorable impact on the rate of HF
exacerbation, addressing the possibility that the reduction in the rate
of HF exacerbation was related to
greater HF management.
The authors acknowledge the
theory of an “obesity paradox” in
patients with HF, when mild to
moderate obesity is associated with
improved survival. However, they
explain that there is no evidence that
weight reduction in morbidly obese
patients leads to increased mortality
or HF morbidity.
Finally, the authors add that because a large proportion of obese HF
patients cannot or will not undergo
bariatric surgery, it is important to
develop effective nonsurgical interventions to achieve substantial and
sustained weight loss. “Research for
establishing such methods should
progress hand-in-hand with extensive public health programs to prevent development of obesity to begin
with, which will, in turn, benefit
many obese patient with HF,” they
conclude.
In an accompanying editorial
comment, Amanda R. Vest, MBBS,
MPH, and colleagues write that this
study is “a very important first step
in determining whether bariatric
surgery or other weight loss interventions relieve the burden of illness
experienced by HF patients who are
obese.” They add that “the relationship between heart failure and obesity is complex, with the public health
implications of both conditions underscoring the urgency of evaluating
the effect of weight loss on clinical
HF outcomes. This analysis of HF
exacerbations turns a much-needed
focus towards the potential for bariatric surgery to address not only the
epidemic of fatness, but the epidemic
of failure too.”
Shimada YJ, Tsugawa Y, Brown DFM,
Hasegawa K. J Am Coll Cardiol. 2016;doi:
10.1016/j.jacc.2015.12.016.
ACC.org/CSWN
Beetroot Juice
Linked with
Improved Exercise
Tolerance in HFpEF
ACC Imaging Council
Weighs Screening
Options for Diabetic
Patients
Coronary artery calcium (CAC) screening is the best non-invasive tool for measuring the risk of cardiovascular disease
in asymptomatic patients with diabetes,
according to a state-of-the-art paper
from ACC’s Imaging Council published
Feb. 1 in JACC: Cardiovascular Imaging.
The Council examined all screening tools currently used for risk
assessment in patients with diabetes, including stress testing, carotid
intima-media thickness, CAC screening, echocardiography, radionuclide
imaging, coronary computed tomography angiogram (CTA) and cardiac
magnetic resonance imaging.
Current guidelines support risk factor assessment, CAC scanning and hemoglobin A1c for risk assessment, but
not carotid intima-media thickness or
routine function tests in asymptomatic
diabetic patients. These patients are
considered to be at high risk for coronary artery disease, for which exercise
electrocardiogram is rated “appropri-
ate” and stress radionuclide imaging,
stress echocardiography, stress cardiac
magnetic resonance, calcium scoring
and coronary CTA are all rated “may
be appropriate.”
According to the aut