Search

Body weight, and its extreme of obesity, has emerged as a major public health concern. Nearly 1/3 of the adult US population is now estimated to be obese, as defined by a body mass index (BMI, the weight in kilograms divided by the square of the height in meters) ≥ 30.1 The cost of obesity on the healthcare system is substantial; an estimated $147 billion in medical costs were attributed to obesity alone in US in 2008.2 Furthermore, the prevalence of childhood and adolescent obesity, which now affects 17% of children and adolescents,1 raises concerns for its impact on adulthood obesity and long-term health outcomes. In this month’s topic review in Circulation: Cardiovascular Quality and Outcomes , we concentrate on contemporary issues around body weight, obesity, and cardiovascular outcomes. Many hurdles remain in evaluating the relationship between body weight and cardiovascular (CV) outcomes. Debate continues as to the optimal measure of adiposity; body mass composition, and specifically excess adiposity, is perhaps a more appropriate marker of cardiovascular risk compared to body weight. BMI, although widely used, is an imperfect measure of excess adiposity with evidence favoring central obesity, as measured by the waist circumference, as a more sensitive indicator of adverse long-term cardiovascular events.3 Moreover, the effects of obesity on cardiovascular outcomes are complex. Studies have suggested that patients with higher BMIs had better survival compared with those with low BMIs; a phenomenon frequently referred to as the obesity-risk paradox.4 Obesity itself is often associated with multitude of other cardiovascular risk factors such as hyperlipidemia, diabetes, and hypertension; untangling the independent effects of obesity on outcomes thus remains challenging. Lastly, while evidence now suggests obesity is an independent risk factor for long-term adverse cardiovascular events, weight reduction remains an extremely challenging exercise for obese patients. …

The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the Editor, that have been published in the Circulation portfolio. The objective of this series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes, and general cardiology audience. The studies included in this article represent the most significant research related to treatment of stable coronary artery disease (CAD).

The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Reviews. This series will summarize the most important manuscripts, as selected by the Editor, which have been published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes as well as general cardiology audience. The studies included in this article represent the most significant research in the area of valvular heart disease. ( Circ Cardiovasc Quality and Outcomes . 2012;5:-e103.) In recent years, no field of clinical cardiology has experienced a great influx of transformational therapeutic options as has the area of valvular heart disease. Treatment of severe aortic stenosis (AS) has been revolutionized by transcatheter aortic valve replacement (TAVR), which has been shown to improve life expectancy and functional outcomes in patients with inoperable AS1,2 and to have short-term outcomes comparable to surgical aortic valve replacement (AVR) in patients at high perioperative risk.3,4 Analogously, mitral valve disease has been amenable to percutaneous valve replacement,5,6 as well as clipping procedures7 that can substantively reduce severe mitral regurgitation (MR) and improve functional outcomes. Even right-sided heart disease involving valves in pulmonary8,9 and tricuspid10 positions has been treated successfully with endovascular techniques. Yet, even with this growing focus on percutaneous valvular interventions, open surgical techniques remain the dominant treatment strategies and standard of care for most advanced lesions. Surgical valve repair and replacement account for 10% to 20% of all cardiac surgical procedures,11–13 approximately two thirds of which are for AS.11–13 For patients undergoing surgery, there remains considerable debate about risk stratification,14 intraoperative technique,15 and postoperative …

The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the Editor, that have been published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes, and general cardiology audience. The studies included in this article represent the most significant research in the area of anticoagulation for cardiovascular disease.