Role of visceral obesity in the progression of main arteries rigidity in chronic heart failure patients


DOI: https://dx.doi.org/10.18565/therapy.2023.9.70-78

Statsenko M.E., Derevyanchenko M.V., Fabritskaya S.V., Ryndina Yu.A., Streltsova A.M.

Volgograd State Medical University of the Ministry of Healthcare of Russia
Abstract. Obesity is one of the leading risk factors for chronic heart failure (CHF) development and progression.
The aim: to estimate the role of visceral obesity in the progression of rigidity of main arteries in CHF patients.
Material and methods. 165 patients with CHF stages I–IIA, FC I–III, aged 40–65 years were examined. They were randomized into three groups: 1st – with CHF and normal BMI (n=55), 2nd – with CHF and excess BMI (n=53), 3rd – with CHF and obesity of 1–2nd degree (n=57). Patients underwent a clinical examination, BMI calculation, measurements of waist circumference (WC), hip circumference (HC), waist/hip width measurement, bioimpedance measurements, also thickness of epicardial adipose tissue (EAT) was assessed using EchoCG, pulse wave velocity through elastic and muscular vessels ( PWVe and PWVm), serum levels of leptin and adiponectin were identified.
Results. A high incidence of abdominal obesity, an increase in visceral fat content and an increase in EAT thickness among patients with excess BMI and obesity were revealed. In the group of patients with CHF and obesity, PWVe was significantly higher – 10,8 [9,2; 12,9] m/s. In group 3, patients with PWVe >10 m/s were significantly more common – 82% versus 57% and 65% in groups 1 and 2, respectively. Significant correlations were established between PWVe and WC (r=0,42), WC/HC (r=-0,44), PWVe and BMI (r=0,38), PWWm and WC (r=0,40), PWWm and WC/TB (r=-0,42), PWWm and BMI (r=0,32) among patients with CHF and obesity. When assessing the dependence of PWVe on the percentage of visceral fat and PWEv on the thickness of EAT, a linear regression dependence and a high-close correlation were obtained. In the 3rd group, statistically significant correlations were revealed between PWVe and the concentration of leptin and (r=0,58), PWVe and the level of adiponectin (r=-0,76). A statistically significant correlation was found between EAT thickness and leptin level (r=0,62), EAT thickness and adiponectin level (r=-0,56).
Conclusion. Reliable associations between the severity of visceral obesity and indexes of vascular wall elasticity reflect the important pathogenetic role of visceral adipose tissue in the development and progression of arterial stiffness in patients with CHF.
Keywords: epicardial adipose tissue, arterial rigidity, visceral obesity, chronic heart failure
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Literature

1. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский кардиологический журнал. 2020; 25(11): 311–374. [Clinical practice guidelines for chronic heart failure. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020; 25(11): 311–374 (In Russ.)]. https://dx.doi.org/10.15829/1560-4071-2020-4083. EDN: LJGGQV.


2. Гриценко О.В., Чумакова Г.А., Шевляков И.В., Трубина Е.В. Механизмы развития сердечной недостаточности при ожирении. Российский кардиологический журнал. 2018; 23(5): 81–86. [Gritsenko О.V., Chumakova G.А., Shevlyakov I.V., Trubina Е.V. The mechanisms of heart failure development in obesity. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2018; 23(5): 81–86 (In Russ.)]. https://dx.doi.org/10.15829/1560-4071-2018-5-81-86. EDN: XOTJHF.


3. Гиоева З.М., Богданов А.Р., Залетова Т.С., Богданова А.А. Ожирение как фактор риска развития хронической сердечной недостаточности (литературный обзор). Доктор.Ру. 2017; (10): 21–25. [Gioeva Z.M., Bogdanov A.R., Zaletova T.S., Bogdanova A.A. Obesity as a risk factor for chronic heart failure: A review of the literature. Doctor.Ru. 2017; (10): 21–25 (In Russ.)]. EDN: ZXWOHX.


4. Попова И.Р., Драпкина О.М. Роль ожирения в развитии хронической сердечной недостаточности. Лечебное дело. 2012; (3): 68–73. [Popova I.R., Drapkina O.M. Obesity and chronic heart failure. Lechebnoe delo = General Medicine. 2012; (3): 68–73 (In Russ.)]. EDN: THQLUB.


5. Драпкина О.М., Дадаева В.А. Жесткость сосудистой стенки при хронической сердечной недостаточности. Клиницист. 2013; 7(3–4): 27–30. [Drapkina O.M., Dadaeva V.A. Vascular stiffness in heart failure. Klinitsist = The Сlinician. 2013; 7(3–4): 27–30 (In Russ.)]. EDN: SHUGOT.


6. Yildiran T., Koc M., Bozkurt A. et al. Low pulse pressure as a predictor of death in patients with mild to advanced heart failure. Tex Heart Inst J. 2010; 37(3): 284–90.


7. Feola M., Testa M., Ferreri C. et al. The analysis of arterial stiffness in heart failure patients in comparison with healthy subjects and patients with cardiovascular risk factors. J Clin Med. 2019; 8(10): 1721. https://dx.doi.org/10.3390/jcm8101721.


8. Anastasio F., Testa M., Ferreri C. et al. The analysis of arterial stiffness in heart failure patients: The prognostic role of pulse wave velocity, augmentation index and stiffness index. J Clin Med. 2022; 11(12): 3507. https://dx.doi.org/10.3390/ jcm11123507.


9. Kim H.L., Ahn D.W., Kim S.H. et al. Association between body fat parameters and arterial stiffness. Sci Rep. 2021; 11(1): 20536.https://dx.doi.org/10.1038/s41598-021-00175-z.


10. Дружилова О.Ю., Дружилов М.А., Кузнецова Т.Ю. Прогностическое значение показателей артериальной жесткости при оценке кардиометаболического риска у пациентов с ожирением. Российский кардиологический журнал. 2018; 23(5): 15–20. [Druzhilova O.Yu., Druzhilov M.A., Kuznetsova T.Yu. Predictive significance of arterial stiffness parameters in evaluation of cardiometabolic risk in obesity patients. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2018; 23(5): 15–20 (In Russ.)]. https://dx.doi.org/10.15829/1560-4071-2018-5-15-20. EDN: XOTJED.


11. Para I., Albu A., Porojan M.D. Adipokines and arterial stiffness in obesity. Medicina (Kaunas). 2021; 57(7): 653.https://dx.doi.org/10.3390/medicina57070653.


12. Клинические рекомендации. Ожирение. Российская ассоциация эндокринологов, Общество бариатрических хирургов. Рубрикатор клинических рекомендаций Минздрава России. 2020. ID: 28. Доступ: https://cr.minzdrav.gov.ru/schema/28_2 (дата обращения – 01.11.2023). [Clinical guidelines. Obesity. Russian Association of Endocrinologists, Society of Bariatric Surgeons. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2020. ID: 28. URL:https://cr.minzdrav.gov.ru/schema/28_2 (date of access – 01.11.2023) (In Russ.)].


13. Дедов И.И., Мокрышева Н.Г., Мельниченко Г.А. с соавт. Ожирение. Consilium Medicum. 2021; 23(4): 311–325. [Dedov I.I., Mokrysheva N.G., Mel’nichenko G.A. et al. Obesity. Consilium Medicum. 2021; 23(4): 311–325 (In Russ.)].https://dx.doi.org/10.26442/20751753.2021.4.200832. EDN: GYUVLJ.


14. Шляхто Е.В., Недогода С.В., Конради А.О. Национальные клинические рекомендации «Диагностика, лечение, профилактика ожирения и ассоциированных с ним заболеваний». СПб. 2017; с. 1–164. [Shlyakhto E.V., Nedogoda S.V., Konradi A.O. National clinical guidelines «Diagnostics, treatment, prevention of obesity and associated diseases». Saint Petersburg. 2017; pp. 1–164 (In Russ.)].


15. Amato M.C., Giordano C., Galia M. et al. Visceral adiposity index: A reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010; 33(4): 920–22. https://dx.doi.org/10.2337/dc09-1825.


16. Драпкина О.М., Корнеев О.Н., Драпкина Ю.С. Эпикардиальный жир: нападающий или запасной? Рациональная фармакотерапия в кардиологии. 2013; 9(3): 287–291. [Drapkina O.M., Korneeva O.N., Drapkina Yu.S. Epicardial fat: A striker or a spare? Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology. 2013; 9(3): 287–291 (In Russ.)].https://dx.doi.org/10.20996/1819-6446-2013-9-3-287-291. EDN: QIKZSH.


17. Чумакова Г.А., Веселовская Н.Г., Козаренко А.А. с соавт. Эпикардиальное жировое депо: морфология, диагностика, клиническое значение. Сердце: журнал для практикующих врачей. 2011; 10(3): 146–150. [Chumakova G.А., Veselovskaya N.G., Kozarenko А.А. Epicardial fat depot: Morphology, diagnosis, clinical significance. Serdtse: zhurnal dlya praktikuyushchikh vrachey = Heart: Journal for Medical Practitioners. 2011; 10(3): 146–150 (In Russ.)]. EDN: OZDSPT.


18. Gonzalez N., Moreno-Villegas Z., Gonzalez-Bris A. et al. Regulation of visceral and epicardial adipose tissue for preventing cardiovascular injuries associated to obesity and diabetes. Cardiovasc Diabetol. 2017; 16(1): 44.https://dx.doi.org/10.1186/s12933-017-0528-4.


19. Christensen R.H., von Scholten B.J., Lehrskov L.L. et al. Epicardial adipose tissue: An emerging biomarker of cardiovascular complications in type 2 diabetes? Ther Adv Endocrinol Metab. 2020; 11: 2042018820928824. https://dx.doi.org/10.1177/2042018820928824.


20. Hendricks S., Dykun I., Balcer B. et al. Epicardial adipose tissue is a robust measure of increased risk of myocardial infarction - a meta-analysis on over 6600 patients and rationale for the EPIC-ACS study. Medicine (Baltimore). 2021; 100(52): e28060.https://dx.doi.org/10.1097/MD.0000000000028060.


21. Sato F., Maeda N., Yamada T. et al. Association of epicardial, visceral, and subcutaneous fat with cardiometabolic diseases. Circ J. 2018; 82(2): 502–8. https://dx.doi.org/10.1253/circj.CJ-17-0820.


22. Natale F., Tedesco M.A., Mocerino R. et al. Visceral adiposity and arterial stiffness: Echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives. Eur J Echocardiogr. 2009; 10(4): 549–55. https://dx.doi.org/10.1093/ejechocard/jep002.


23. Juge-Aubry C.E., Henrichot E., Meier C.A. Adipose tissue: A regulator of inflammation. Best Pract Res Clin Endocrinol Metab. 2005; 19(4): 547–66. https://dx.doi.org/10.1016/j.beem.2005.07.009.


24. Engin A. Adiponectin-resistance in obesity. Adv Exp Med Biol. 2017; 960: 415–41. https://dx.doi.org/10.1007/978-3-319-48382-5_18.


25. Youn J.C., Kim C., Park S. et al. Adiponectin and progression of arterial stiffness in hypertensive patients. Int J Cardiol. 2013; 163(3): 316–19. https://dx.doi.org/10.1016/j.ijcard.2011.06.061.


26. Zachariah J.P., Hwang S., Hamburg N.M. et al. Circulating adipokines and vascular function: Cross-sectional associations in a community-based cohort. Hypertension. 2016; 67(2): 294–300. https://dx.doi.org/10.1161/hypertensionaha.115.05949.


27. Nakamura K., Fuster J.J., Walsh K. Adipokines: A link between obesity and cardiovascular disease. Cardiol. 2014; 63(4):250–59. https://dx.doi.org/10.1016/j.jjcc.2013.11.006.


28. Windham B.G., Griswold M.E., Farasat S.M. et al. Influence of leptin, adiponectin, and resistin on the association between abdominal adiposity and arterial stiffness. Am J Hypertens. 2010; 23(5): 501–7. https://dx.doi.org/10.1038/ajh.2010.8.


29. Stork S., Bots M.L., Angerer P. et al. Low levels of adiponectin predict worsening of arterial morphology and function. Atherosclerosis. 2007; 194(2): e147–53. https://dx.doi.org/10.1016/j.atherosclerosis.2006.11.044.


30. Martinez-Martinez E., Miana M., Jurado-Lopez R. The potential role of leptin in the vascular remodeling associated with obesity. Int J Obes (Lond). 2014; 38(12): 1565–72. https://dx.doi.org/10.1038/ijo.2014.37.


31. Wu Q., Chen Y., Chen S. et al. Correlation between adiponectin, chemerin, vascular endothelial growth factor and epicardialfat volume in patients with coronary artery disease. Exp Ther Med. 2020; 19(2): 1095–102. https://dx.doi.org/10.3892/etm.2019.8299.


32. Kim B.J., Kim B.S., Kang J.H. Echocardiographic epicardial fat thickness is associated with arterial stiffness. Int J Cardiol. 2013; 167(5): 2234–38. https://dx.doi.org/10.1016/j.ijcard.2012.06.013.


33. Korkmaz L., Cirakoglu O.F., Agac M.T. et al. Relation of epicardial adipose tissue with arterial compliance and stiffness in patients with hypertension. Angiology. 2014; 65(8): 691–95. https://dx.doi.org/10.1177/0003319713502120.


About the Autors

Mikhail E. Statsenko, MD, professor, vice-rector for research work, head of the Department of internal medicine, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400131, Volgograd, 1 Pavshykh Bortzov Sq.
E-mail: mestatsenko@rambler.ru
ORCID: https://orcid.org/0000-0002-3306-0312
Maria V. Derevyanchenko, MD, professor of the Department of internal medicine, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400131, Volgograd, 1 Pavshykh Bortzov Sq.
E-mail: derevjanchenko@gmail.com
ORCID: https://orcid.org/0000-0002-6232-4583
Svetlana V. Fabritskaya, PhD in Medical Sciences, associate professor of the Department of internal medicine, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400131, Volgograd, 1 Pavshykh Bortzov Sq.
E-mail: lanabelenkova@mail.ru
ORCID: https://orcid.org/0000-0002-5736-2235
Yulia A. Ryndina, postgraduate student of the Department of internal medicine, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400131, Volgograd, 1 Pavshykh Bortzov Sq.
E-mail: rindina91@yandex.ru
ORCID: https://orcid.org/0000-0002-9351-3002
Anastasia M. Streltsova, assistant at the Department of internal medicine, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400131, Volgograd, 1 Pavshykh Bortzov Sq.
E-mail:nastyc03@mail.ru
ORCID: https://orcid.org/0000-0001-9016-3011


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