Vascular health in the obese heart: A mechanism for the ‘obesity paradox’ for cardiovascular disease

Description

An ‘obesity paradox’ is evident in relation to cardiovascular disease, where obese patients seem to have better cardiovascular outcomes [Stroke. 2017 Apr; 48(4):857-866].

This PhD will test the hypothesis is that altered vascular function parameters (including myocardial microvascular function and cardiac fibrosis abnormalities) are paradoxically better with obesity. Impairments in myocardial perfusion, evident on myocardial contact echocardiography, have been shown to have prognostic significance in patients with cardiovascular comorbidities but without coronary artery stenosis [J Am Soc Echocardiogr. 2015;28:1358-65]. Mechanistic studies show an associations of myocardial flow impairment and increased pulse pressure in the absence of coronary artery stenosis [J Am Heart Assoc. 2017 Jun 29;6]. Increased pulse pressure is an indicator of arterial stiffening of peripheral small arteries and microcirculation.

The impact of comorbidities will be tested in a cross-sectional design, and weight loss will be investigated in a prospective arm. As part of the PhD work, a systematic review would be undertaken, and training would be provided in methodology and evidence appraisal.
Training will include systemic investigation of endothelial function (and the impact of exercise training), autonomic function testing and myocardial contrast echocardiography.

The Institute of Ageing and Chronic Disease is fully committed to promoting gender equality in all activities. In recruitment we emphasize the supportive nature of the working environment and the flexible family support that the University provides. The Institute holds a silver Athena SWAN award in recognition of on-going commitment to ensuring that the Athena SWAN principles are embedded in its activities and strategic initiatives.

To apply, please send your CV and a covering letter to Professor Gregory Lip with a copy to

Availability

Open to students worldwide

Funding information

Please note: there is NO funding attached to this project. The successful applicant will be expected to provide the funding for tuition fees, bench fees of between £5,000 and £10,000 per year and all living expenses. Details of the cost of study can be found on the University website.

Supervisors

References

Proietti M, Guiducci E, Cheli P, Lip GY. Is There an Obesity Paradox for Outcomes in Atrial Fibrillation? A Systematic Review and Meta-Analysis of Non-Vitamin K Antagonist Oral Anticoagulant Trials. Stroke. 2017 Apr;48(4):857-866.

Shah BN, Gonzalez-Gonzalez AM, Drakopoulou M, Chahal NS, Bhattacharyya S, Li W, Khattar RS, Senior R. The incremental prognostic value of the incorporation of myocardial perfusion assessment into clinical testing with stress echocardiography study. J Am Soc Echocardiogr. 2015;28:1358-65.
Lembo M, Sicari R, Esposito R, Rigo F, Cortigiani L, Lo Iudice F, Picano E, Trimarco B, Galderisi M. Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries. J Am Heart Assoc. 2017 Jun 29;6. pii: e005710.  

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