Obesity May Cause ‘Subtle’ Heart Changes Starting in Early Adulthood

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by Margarida Maia PhD |

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Subtle heart changes in people with Prader–Willi syndrome (PWS) may begin relatively early in adulthood, and being overweight may be related to these cardiovascular abnormalities, a small study reported.

“We need to manage obesity and obesity-related disorders in order to prevent heart failure and ischemic heart disease [reduced blood flow to the heart] in patients with PWS,” its researchers wrote.

The study, “Subtle Cardiovascular Abnormalities in Prader-Willi Syndrome Might Begin in Young Adulthood,” was published in the journal Internal Medicine by a team of researchers in Japan.

One symptom of PWS is insatiable appetite with continuous food foraging, which often leads to excessive weight gain beginning in childhood. Weight gain continuing into adulthood can cause obesity, which can lead to other health problems, including heart and lung problems, diabetes mellitus (high blood sugar levels), and hypertension (high blood pressure).

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To know more about cardiovascular (heart and blood vessel) problems arising during the development of PWS, researchers assessed changes in clinical, blood, and imaging biomarkers in a group of young adults with the disease.

The study included 18 patients (11 men and seven women) with no history of cardiovascular disease. Their mean age was 28, and their mean body mass index — a measure of body fat based on height and weight — was 45.1 kg/m2, indicating obesity or morbid obesity.

Most patients had hypertension (83%), diabetes mellitus (82%), and dyslipidemia, or unhealthy levels of fat in the blood (82%). All but one patient had elevated levels of high-sensitivity C-reactive protein, a marker of inflammation in the body and a predictor of future heart disease.

Of the 18 patients, 14 had taken a transthoracic echocardiogram, which is an imaging test that uses sound waves to produce images of the inside of the heart. Test results showed that global longitudinal systolic strain of the left ventricle (one of the two bottom heart chambers) was decreased in this measure of how well the heart muscle contracts to pump blood from the chambers to the arteries.

Changes in the left ventricle “may have already begun in young adulthood in patients with PWS, even those without a history of heart disease,” the researchers wrote.

Tricuspid annular plane systolic excursion, a measure of how well the right ventricle (the other of two bottom heart chambers) is working, also was mildly reduced.

Overall, the results “highlight the difficulties in the long-term management of PWS patients,” the researchers wrote, and show “that subtle cardiac dysfunction … might begin in young adulthood in patients with PWS.”

While many patients were on heart-protecting medications, they seemed to be ineffective, according to the team.

“Several potential reasons for this are proposed,” the researchers wrote. “First, since adults with PWS continued to be treated by pediatricians, the necessary management may have been inadequate due to the lack of involvement of appropriate specialists. Second, given the rarity of adult patients with PWS, definite medication guidelines for their treatment are currently lacking.”