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Novel Pathogenesis and Treatments for Cardiovascular Disease
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with obesity or when stress test is equivocal, uninterpretable stress test, or in cases when
a discrepancy exists between clinical presentation and stress test results. This technique
allows evaluation of luminal stenosis and plaque characterization and quantification [].
One major challenge with CT coronary angiography is that image quality degrades
as BMI increases; this degradation increases in background noise. In patients with
overweight can reduce signal-to-noise ratio, and low vessel opacification may occur
when contrast is inspected.
. Invasive evaluation of CAD in obesity
6.2.1 Coronary angiography
Patients undergoing catheterization have potential difficulties: suboptimal radiographic visualization, vascular access laborious, bleeding, radial access is preferred in
obesity patients because it has been associated with three times lower rate of complications than transfemoral access and higher radiation exposure to both patients with
obesity and staff [].
6.2.2 PCI and obesity
In the Cath PCI Registry after multivariable adjustment obesity was independently associated with a greater mortality rate and lower bleeding rate. Adequate
anticoagulation is important in this subpopulation [, ]. Another study reported
that patients with severe obesity have major risk of contrast-induced nephropathy.
Dialysis and vascular complications, gastrointestinal bleeding, and MACE (Major
Adverse Cardiovascular Events) are not statistically different [].
6.2.3 Intravascular ultrasound
Several intravascular imaging techniques such as intravascular ultrasound, virtual
histology intravascular ultrasound, and optical coherence tomography allow in vivo
assessment of plaque burden, plaque morphology, and response to therapy.
Abdominal visceral adiposity independently predicted the presence and extent of
noncalcified coronary plaque that also contained multiple features of plaque vulnerability [].
The appropriate choice of test to assess CVD depends on local expertise, the relative strengths and weaknesses of each modality, and individual patient characteristics
that contribute to the pretest likelihood of CVD and the risk/benefit ratio of using a
given modality.
. Clinical management, treatment, and secondary cardiac disease
Obesity paradox refers to the fact that although obesity increases the risk of CVD
for those who had already an CVD, excess weight is not a risk factor to develop adverse
outcomes including death [].
Although weight loss would be believed to significantly benefit cardiovascular
outcomes, this benefit has only been shown in weight loss performed through bariatric surgery in which more than – of body weight is lost; therefore, that modest
weight loss has not been shown to impact cardiovascular outcomes [, ].
Obesity and Cardiovascular Risk
DOI: http://dx.doi.org/10.5772/.106877
To treat obesity requires a multidisciplinary management in which the eating
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pattern, amount of exercise, stress, sleep pattern are evaluated. So, it is not enough
exercise and nutrition to evaluate all the factors related to weight gain together.
Some clinical trials demonstrate the cardiovascular impact of Mediterranean
diet in reducing MACE in patients with high cardiovascular risk. However, lifestyle
changes in diabetes patients have failed to show a significant reduction in MACE, only
those with weight loss greater than had significant results [, ].
Pharmacological treatment has impact on weight reduction as well. For example,
liraglutide has been shown to reduce death by and from cardiovascular
causes in patients with type diabetes in LEADER trial [].
Recently semaglutide at .mg dose in obese patients without diabetes has
demonstrated a significant body weight reduction (. vs. . with placebo).
In total, of body weight reduction ≥ at weeks and body weight
reduction ≥ .
Further reduction in waist circumference, systolic blood pressure, and improve
-
ment of physical function [].
Orlistat was approver in for the treatment of obesity and demonstrated
reduction in progression from prediabetes to diabetes and significant reduction of
associated disease such as hypertension and blood lipid levels [].
Naltrexone SR/Bupropion SR is another drug approved in the United States
for the treatment of obesity and has cardiovascular security trial (LIGHT trial –
Cardiovascular Outcomes Study of Naltrexone SR/Bupropion SR in Overweight
and obese subjects with cardiovascular risk factors). Bupropion suppresses appetite
transiently due to an endorphin-mediated mechanism of action. Naltrexone blocks
the endorphin, which allows a long-term appetite suppression effect []. However,
because of the early unanticipated termination of the trial, it is not possible to assess
non-inferiority to the prespecified upper limit of .. Consequently, the cardiovascular safety of this treatment remains uncertain and will require evaluation in a new
adequately powered outcome trial.
Lorcaserine was approved in the obesity treatment but recently was removed
forthe Food and Drug Administration (FDA), due to a possible increased risk
ofcancer [].
Finally, patients with body mass index greater than kg/m
or greater than kg/m
without them get benefit from bariatric surgery. Non-
with comorbidities
randomized prospective studies desmonstrated a reduction of cardiovascular death in
this group of patients [].
. Conclusions
In conclusion, obesity patients have an important difference than patients with
normal weight. First, the chronic inflammation is the principal cause of molecular
and cellular changes that have been linked to development of chronic diseases and
manifestations due to decreased expansibility of adipose tissue. Endothelial dysfunction is an important factor that contributes to vascular calcification and atherosclerosis. In addition, the intestinal microbiota plays an important role in the development
and inflammation of atherosclerotic plaque. Obesity is linked to major risk of CVD
and is directly proportional to the amount of excess weight, it can be explained by
blood pressure, cholesterol, and glucose levels. Diagnosis must be evaluated according
to the risk and the clinical probability of suffering an event, evaluating the expected
Novel Pathogenesis and Treatments for Cardiovascular Disease
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ges at the electrocardiographic level that can lead to overdiagnosis. Finally,
chan
remember that there are currently multiple noninvasive studies for the early diagnosis
of cardiovascular disease, which have allowed more timely diagnoses to be made in
obese patients.
Obesity and Cardiovascular Risk
DOI: http://dx.doi.org/10.5772/.106877
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Chapter 6
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Thrombotic Events in
Cancer
Patients
AzinAlizadehasl and Haniye HajialiFini
Abstract
Cancer poses the highest clinical and social burden throughout the world and is
the second cause of death after is chemic heart disease, although will be predicted the
first in 2060. Cancer patients are high risk for thrombotic events that are characterized as the second cause of death after cancer itself. Thrombotic events seem to be
increasing over recent years according to improved patients survival, novel thrombogenic cancer treatment and central catheter using. As we know thromboprophylaxis
reduces the risk of VTE and primary prevention seems to be more effective way to
reduce morbidity and mortality in these patients several criteria was designed to
reduce this risk. Khorana risk score is the most important of them which designed
for ambulatory cancer patients. Some other risk factors for thrombotic events consist
of major abdominal surgery and prolonged immobility after surgery, use of thrombogenic medications (chemotherapy agents), old age, obesity, distant metastasis or
advanced stage at the time of diagnosis, hyperthermic intraperitoneal chemotherapy
(HIPEC) as a new surgery technique, anemia that requires blood transfusion that
recommend special attention should be paid to them.
Keywords: cancer, cancer-associated thrombosis, thromboprophylaxis, Khorana score,
venous thromboembolism, arterial thromboembolism, cardiotoxicity, cardiooncology
. Introduction
Cancer poses the highest clinical and social burden throughout the world which is
nonsignificantly higher in men than women. The risk of developing cancer is 20.2%
for lifelong (22.4% in men and 18.2% in women). Cancer is the second cause of death
after ischemic heart disease, although it will be predicted the first in 2060 [1]. The
Studies demonstrated 19.3 million new cancer patients and about 10 million cancer
deaths occurred in 2020 [2].
Breast cancer has recognized as the most common malignancy followed by lung,
liver, colorectal, prostate, and stomach cancers [1, 2]. Despite breast cancer prevalence outstrip lung cancer over the time, the most common causes of death include
lung, liver, and stomach cancers, respectively [2, 3].
Thrombus can involve either veins or arteries and is associated with substantial
morbidity and mortality as the third most common cardiovascular disease [4]. Acute
vein and artery thrombosis is computed as the most common causes of death in
developed country. The epidemiology of thrombus depends on if it is venous versus
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