Skip to main content
Top
Published in: Cardiovascular Diabetology 1/2015

Open Access 01-12-2015 | Original investigation

Early impairment of coronary microvascular perfusion capacity in rats on a high fat diet

Authors: Judith van Haare, M. Eline Kooi, Hans Vink, Mark J. Post, Jurgen W. G. E. van Teeffelen, Jos Slenter, Chantal Munts, Hanneke Cobelens, Gustav J. Strijkers, Dennis Koehn, Marc van Bilsen

Published in: Cardiovascular Diabetology | Issue 1/2015

Login to get access

Abstract

Background

It remains to be established if, and to what extent, the coronary microcirculation becomes compromised during the development of obesity and insulin resistance. Recent studies suggest that changes in endothelial glycocalyx properties contribute to microvascular dysfunction under (pre-)diabetic conditions. Accordingly, early effects of diet-induced obesity on myocardial perfusion and function were studied in rats under baseline and hyperaemic conditions.

Methods

Rats were fed a high fat diet (HFD) for 6 weeks and myocardial microvascular perfusion was determined using first-pass perfusion MRI before and after adenosine infusion. The effect of HFD on microcirculatory properties was also assessed by sidestream darkfield (SDF) imaging of the gastrocnemius muscle.

Results

HFD-fed rats developed central obesity and insulin sensitivity was reduced as evidenced by the marked reduction in insulin-induced phosphorylation of Akt in both cardiac and gastrocnemius muscle. Early diet-induced obesity did not lead to hypertension or cardiac hypertrophic remodeling. In chow-fed, control rats a robust increase in cardiac microvascular perfusion was observed upon adenosine infusion (+40 %; p < 0.05). In contrast, the adenosine response was abrogated in rats on a HFD (+8 %; N.S.). HFD neither resulted in rarefaction or loss of glycocalyx integrity in skeletal muscle, nor reduced staining intensity of the glycocalyx of cardiac capillaries.

Conclusions

Alterations in coronary microcirculatory function as assessed by first-pass perfusion MRI represent one of the earliest obesity-related cardiac adaptations that can be assessed non-invasively. In this early stage of insulin resistance, disturbances in glycocalyx barrier properties appeared not to contribute to the observed changes in coronary microvascular function.
Literature
4.
go back to reference Reaven GM, Banting lecture. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595–607.CrossRefPubMed Reaven GM, Banting lecture. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595–607.CrossRefPubMed
5.
go back to reference De Filippis E, Cusi K, Ocampo G, Berria R, Buck S, Consoli A, et al. Exercise-induced improvement in vasodilatory function accompanies increased insulin sensitivity in obesity and type 2 diabetes mellitus. J Clin Endocrinol Metab. 2006. doi:10.1210/jc.2006-1142.PubMed De Filippis E, Cusi K, Ocampo G, Berria R, Buck S, Consoli A, et al. Exercise-induced improvement in vasodilatory function accompanies increased insulin sensitivity in obesity and type 2 diabetes mellitus. J Clin Endocrinol Metab. 2006. doi:10.​1210/​jc.​2006-1142.PubMed
7.
go back to reference Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest. 1996. doi:10.1172/JCI118709.PubMedCentralPubMed Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest. 1996. doi:10.​1172/​JCI118709.PubMedCentralPubMed
8.
go back to reference Gavin TP, Stallings HW 3rd, Zwetsloot KA, Westerkamp LM, Ryan NA, Moore RA, et al. Lower capillary density but no difference in VEGF expression in obese vs. lean young skeletal muscle in humans. J Appl Physiol. 2005. doi:10.1152/japplphysiol.00353.2004. Gavin TP, Stallings HW 3rd, Zwetsloot KA, Westerkamp LM, Ryan NA, Moore RA, et al. Lower capillary density but no difference in VEGF expression in obese vs. lean young skeletal muscle in humans. J Appl Physiol. 2005. doi:10.​1152/​japplphysiol.​00353.​2004.
9.
go back to reference Houben AJ, Canoy MC, Paling HA, Derhaag PJ, de Leeuw PW. Quantitative analysis of retinal vascular changes in essential and renovascular hypertension. J Hypertens. 1995;13(12 Pt 2):1729–33.PubMed Houben AJ, Canoy MC, Paling HA, Derhaag PJ, de Leeuw PW. Quantitative analysis of retinal vascular changes in essential and renovascular hypertension. J Hypertens. 1995;13(12 Pt 2):1729–33.PubMed
10.
go back to reference Serne EH, Gans RO, ter Maaten JC, ter Wee PM, Donker AJ, Stehouwer CD. Capillary recruitment is impaired in essential hypertension and relates to insulin’s metabolic and vascular actions. Cardiovasc Res. 2001;49(1):161–8.CrossRefPubMed Serne EH, Gans RO, ter Maaten JC, ter Wee PM, Donker AJ, Stehouwer CD. Capillary recruitment is impaired in essential hypertension and relates to insulin’s metabolic and vascular actions. Cardiovasc Res. 2001;49(1):161–8.CrossRefPubMed
11.
go back to reference Struijker Boudier HA, le Noble JL, Messing MW, Huijberts MS, le Noble FA, van Essen H. The microcirculation and hypertension. J Hypertens Suppl. 1992;10(7):S147–56.PubMed Struijker Boudier HA, le Noble JL, Messing MW, Huijberts MS, le Noble FA, van Essen H. The microcirculation and hypertension. J Hypertens Suppl. 1992;10(7):S147–56.PubMed
12.
go back to reference Tanner CJ, Barakat HA, Dohm GL, Pories WJ, MacDonald KG, Cunningham PR, et al. Muscle fiber type is associated with obesity and weight loss. Am J Physiol Endocrinol Metab. 2002. doi:10.1152/ajpendo.00416.2001. Tanner CJ, Barakat HA, Dohm GL, Pories WJ, MacDonald KG, Cunningham PR, et al. Muscle fiber type is associated with obesity and weight loss. Am J Physiol Endocrinol Metab. 2002. doi:10.​1152/​ajpendo.​00416.​2001.
13.
go back to reference Eskens BJ, Leurgans TM, vink H, vanteeffelen JW. Early impairment of skeletal muscle endothelial glycocalyx barrier properties in diet-induced obesity in mice. Physiol Rep. 2014;2(1). Eskens BJ, Leurgans TM, vink H, vanteeffelen JW. Early impairment of skeletal muscle endothelial glycocalyx barrier properties in diet-induced obesity in mice. Physiol Rep. 2014;2(1).
14.
15.
go back to reference Nieuwdorp M, Meuwese MC, Mooij HL, Ince C, Broekhuizen LN, Kastelein JJ, et al. Measuring endothelial glycocalyx dimensions in humans: a potential novel tool to monitor vascular vulnerability. J Appl Physiol. 2008. doi:10.1152/japplphysiol.00440.2007.PubMed Nieuwdorp M, Meuwese MC, Mooij HL, Ince C, Broekhuizen LN, Kastelein JJ, et al. Measuring endothelial glycocalyx dimensions in humans: a potential novel tool to monitor vascular vulnerability. J Appl Physiol. 2008. doi:10.​1152/​japplphysiol.​00440.​2007.PubMed
16.
go back to reference Nieuwdorp M, Meuwese MC, Vink H, Hoekstra JB, Kastelein JJ, Stroes ES. The endothelial glycocalyx: a potential barrier between health and vascular disease. Curr Opin Lipidol. 2005;16(5):507–11.CrossRefPubMed Nieuwdorp M, Meuwese MC, Vink H, Hoekstra JB, Kastelein JJ, Stroes ES. The endothelial glycocalyx: a potential barrier between health and vascular disease. Curr Opin Lipidol. 2005;16(5):507–11.CrossRefPubMed
19.
20.
go back to reference Jebelovszki E, Kiraly C, Erdei N, Feher A, Pasztor ET, Rutkai I, et al. High-fat diet-induced obesity leads to increased NO sensitivity of rat coronary arterioles: role of soluble guanylate cyclase activation. Am J Physiol Heart Circ Physiol. 2008. doi:10.1152/ajpheart.01198.2007.PubMed Jebelovszki E, Kiraly C, Erdei N, Feher A, Pasztor ET, Rutkai I, et al. High-fat diet-induced obesity leads to increased NO sensitivity of rat coronary arterioles: role of soluble guanylate cyclase activation. Am J Physiol Heart Circ Physiol. 2008. doi:10.​1152/​ajpheart.​01198.​2007.PubMed
21.
go back to reference Mourmoura E, Chate V, Couturier K, Laillet B, Vial G, Rigaudiere JP, et al. Body adiposity dictates different mechanisms of increased coronary reactivity related to improved in vivo cardiac function. Cardiovasc Diabetol. 2014. doi:10.1186/1475-2840-13-54.PubMedCentralPubMed Mourmoura E, Chate V, Couturier K, Laillet B, Vial G, Rigaudiere JP, et al. Body adiposity dictates different mechanisms of increased coronary reactivity related to improved in vivo cardiac function. Cardiovasc Diabetol. 2014. doi:10.​1186/​1475-2840-13-54.PubMedCentralPubMed
22.
go back to reference Naresh NK, Chen X, Roy RJ, Antkowiak PF, Annex BH, Epstein FH. Accelerated dual-contrast first-pass perfusion MRI of the mouse heart: development and application to diet-induced obese mice. Magn Reson Med. 2015. doi:10.1002/mrm.25238. Naresh NK, Chen X, Roy RJ, Antkowiak PF, Annex BH, Epstein FH. Accelerated dual-contrast first-pass perfusion MRI of the mouse heart: development and application to diet-induced obese mice. Magn Reson Med. 2015. doi:10.​1002/​mrm.​25238.
24.
go back to reference Schindler TH, Cardenas J, Prior JO, Facta AD, Kreissl MC, Zhang XL, et al. Relationship between increasing body weight, insulin resistance, inflammation, adipocytokine leptin, and coronary circulatory function. JACC. 2006. doi:10.1016/j.jacc.2005.10.062.PubMed Schindler TH, Cardenas J, Prior JO, Facta AD, Kreissl MC, Zhang XL, et al. Relationship between increasing body weight, insulin resistance, inflammation, adipocytokine leptin, and coronary circulatory function. JACC. 2006. doi:10.​1016/​j.​jacc.​2005.​10.​062.PubMed
25.
go back to reference van den Brom CE, Bulte CS, Kloeze BM, Loer SA, Boer C, Bouwman RA. High fat diet-induced glucose intolerance impairs myocardial function, but not myocardial perfusion during hyperaemia: a pilot study. Cardiovasc Diabetol. 2012. doi:10.1186/1475-2840-11-74.PubMedCentralPubMed van den Brom CE, Bulte CS, Kloeze BM, Loer SA, Boer C, Bouwman RA. High fat diet-induced glucose intolerance impairs myocardial function, but not myocardial perfusion during hyperaemia: a pilot study. Cardiovasc Diabetol. 2012. doi:10.​1186/​1475-2840-11-74.PubMedCentralPubMed
26.
go back to reference Chappell D, Heindl B, Jacob M, Annecke T, Chen C, Rehm M, et al. Sevoflurane reduces leukocyte and platelet adhesion after ischemia-reperfusion by protecting the endothelial glycocalyx. Anesthesiology. 2011. doi:10.1097/ALN.0b013e3182289988. Chappell D, Heindl B, Jacob M, Annecke T, Chen C, Rehm M, et al. Sevoflurane reduces leukocyte and platelet adhesion after ischemia-reperfusion by protecting the endothelial glycocalyx. Anesthesiology. 2011. doi:10.​1097/​ALN.​0b013e3182289988​.
28.
30.
31.
go back to reference van de Weijer T, van Ewijk PA, Zandbergen HR, Slenter JM, Kessels AG, Wildberger JE, et al. Geometrical models for cardiac MRI in rodents: comparison of quantification of left ventricular volumes and function by various geometrical models with a full-volume MRI data set in rodents. Am J Physiol Heart Circ Physiol. 2012. doi:10.1152/ajpheart.00710.2011.PubMed van de Weijer T, van Ewijk PA, Zandbergen HR, Slenter JM, Kessels AG, Wildberger JE, et al. Geometrical models for cardiac MRI in rodents: comparison of quantification of left ventricular volumes and function by various geometrical models with a full-volume MRI data set in rodents. Am J Physiol Heart Circ Physiol. 2012. doi:10.​1152/​ajpheart.​00710.​2011.PubMed
32.
33.
go back to reference van Nierop BJ, Coolen BF, Dijk WJ, Hendriks AD, de Graaf L, Nicolay K, et al. Quantitative first-pass perfusion MRI of the mouse myocardium. Magn Reson Med. 2013. doi:10.1002/mrm.24424. van Nierop BJ, Coolen BF, Dijk WJ, Hendriks AD, de Graaf L, Nicolay K, et al. Quantitative first-pass perfusion MRI of the mouse myocardium. Magn Reson Med. 2013. doi:10.​1002/​mrm.​24424.
34.
go back to reference Goedhart PT, Khalilzada M, Bezemer R, Merza J, Ince C. Sidestream Dark Field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express. 2007;15(23):15101–14.CrossRefPubMed Goedhart PT, Khalilzada M, Bezemer R, Merza J, Ince C. Sidestream Dark Field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express. 2007;15(23):15101–14.CrossRefPubMed
35.
go back to reference Lee DH, Dane MJ, van den Berg BM, Boels MG, van Teeffelen JW, de Mutsert R, et al. Deeper penetration of erythrocytes into the endothelial glycocalyx is associated with impaired microvascular perfusion. PLoS One. 2014. doi:10.1371/journal.pone.0096477. Lee DH, Dane MJ, van den Berg BM, Boels MG, van Teeffelen JW, de Mutsert R, et al. Deeper penetration of erythrocytes into the endothelial glycocalyx is associated with impaired microvascular perfusion. PLoS One. 2014. doi:10.​1371/​journal.​pone.​0096477.
36.
go back to reference Amraoui F, Olde Engberink RH, van Gorp J, Ramdani A, Vogt L, van den Born BJ. Microvascular glycocalyx dimension estimated by automated SDF imaging is not related to cardiovascular disease. Microcirculation. 2014. doi:10.1111/micc.12125.PubMed Amraoui F, Olde Engberink RH, van Gorp J, Ramdani A, Vogt L, van den Born BJ. Microvascular glycocalyx dimension estimated by automated SDF imaging is not related to cardiovascular disease. Microcirculation. 2014. doi:10.​1111/​micc.​12125.PubMed
37.
go back to reference Daniels A, Linz D, van Bilsen M, Rutten H, Sadowski T, Ruf S, et al. Long-term severe diabetes only leads to mild cardiac diastolic dysfunction in Zucker diabetic fatty rats. Eur J Heart Fail. 2012. doi:10.1093/eurjhf/hfr166.PubMedCentral Daniels A, Linz D, van Bilsen M, Rutten H, Sadowski T, Ruf S, et al. Long-term severe diabetes only leads to mild cardiac diastolic dysfunction in Zucker diabetic fatty rats. Eur J Heart Fail. 2012. doi:10.​1093/​eurjhf/​hfr166.PubMedCentral
39.
go back to reference Nagy N, Freudenberger T, Melchior-Becker A, Rock K, Ter Braak M, Jastrow H, et al. Inhibition of hyaluronan synthesis accelerates murine atherosclerosis: novel insights into the role of hyaluronan synthesis. Circulation. 2010. doi:10.1161/CIRCULATIONAHA.110.972653.PubMed Nagy N, Freudenberger T, Melchior-Becker A, Rock K, Ter Braak M, Jastrow H, et al. Inhibition of hyaluronan synthesis accelerates murine atherosclerosis: novel insights into the role of hyaluronan synthesis. Circulation. 2010. doi:10.​1161/​CIRCULATIONAHA.​110.​972653.PubMed
40.
41.
go back to reference Sinitskaya N, Gourmelen S, Schuster-Klein C, Guardiola-Lemaitre B, Pevet P, Challet E. Increasing the fat-to-carbohydrate ratio in a high-fat diet prevents the development of obesity but not a prediabetic state in rats. Clin Sci. 2007. doi:10.1042/CS20070182.PubMed Sinitskaya N, Gourmelen S, Schuster-Klein C, Guardiola-Lemaitre B, Pevet P, Challet E. Increasing the fat-to-carbohydrate ratio in a high-fat diet prevents the development of obesity but not a prediabetic state in rats. Clin Sci. 2007. doi:10.​1042/​CS20070182.PubMed
42.
go back to reference Wilson CR, Tran MK, Salazar KL, Young ME, Taegtmeyer H. Western diet, but not high fat diet, causes derangements of fatty acid metabolism and contractile dysfunction in the heart of Wistar rats. Biochem J. 2007. doi:10.1042/BJ20070392. Wilson CR, Tran MK, Salazar KL, Young ME, Taegtmeyer H. Western diet, but not high fat diet, causes derangements of fatty acid metabolism and contractile dysfunction in the heart of Wistar rats. Biochem J. 2007. doi:10.​1042/​BJ20070392.
44.
go back to reference Cho H, Mu J, Kim JK, Thorvaldsen JL, Chu Q, Crenshaw EB 3rd, et al. Insulin resistance and a diabetes mellitus-like syndrome in mice lacking the protein kinase Akt2 (PKB beta). Science. 2001. doi:10.1126/science.292.5522.1728. Cho H, Mu J, Kim JK, Thorvaldsen JL, Chu Q, Crenshaw EB 3rd, et al. Insulin resistance and a diabetes mellitus-like syndrome in mice lacking the protein kinase Akt2 (PKB beta). Science. 2001. doi:10.​1126/​science.​292.​5522.​1728.
45.
go back to reference Laviola L, Belsanti G, Davalli AM, Napoli R, Perrini S, Weir GC, et al. Effects of streptozocin diabetes and diabetes treatment by islet transplantation on in vivo insulin signaling in rat heart. Diabetes. 2001;50(12):2709–20.CrossRefPubMed Laviola L, Belsanti G, Davalli AM, Napoli R, Perrini S, Weir GC, et al. Effects of streptozocin diabetes and diabetes treatment by islet transplantation on in vivo insulin signaling in rat heart. Diabetes. 2001;50(12):2709–20.CrossRefPubMed
46.
go back to reference Ouwens DM, Diamant M, Fodor M, Habets DD, Pelsers MM, El Hasnaoui M, et al. Cardiac contractile dysfunction in insulin-resistant rats fed a high-fat diet is associated with elevated CD36-mediated fatty acid uptake and esterification. Diabetologia. 2007. doi:10.1007/s00125-007-0735-8.PubMedCentral Ouwens DM, Diamant M, Fodor M, Habets DD, Pelsers MM, El Hasnaoui M, et al. Cardiac contractile dysfunction in insulin-resistant rats fed a high-fat diet is associated with elevated CD36-mediated fatty acid uptake and esterification. Diabetologia. 2007. doi:10.​1007/​s00125-007-0735-8.PubMedCentral
48.
go back to reference Li ZL, Woollard JR, Ebrahimi B, Crane JA, Jordan KL, Lerman A, et al. Transition from obesity to metabolic syndrome is associated with altered myocardial autophagy and apoptosis. Arterioscler Thromb Vasc Biol. 2012. doi:10.1161/ATVBAHA.111.244061. Li ZL, Woollard JR, Ebrahimi B, Crane JA, Jordan KL, Lerman A, et al. Transition from obesity to metabolic syndrome is associated with altered myocardial autophagy and apoptosis. Arterioscler Thromb Vasc Biol. 2012. doi:10.​1161/​ATVBAHA.​111.​244061.
51.
go back to reference Mourmoura E, Vial G, Laillet B, Rigaudiere JP, Hininger-Favier I, Dubouchaud H, et al. Preserved endothelium-dependent dilatation of the coronary microvasculature at the early phase of diabetes mellitus despite the increased oxidative stress and depressed cardiac mechanical function ex vivo. Cardiovasc Diabetol. 2013. doi:10.1186/1475-2840-12-49.PubMedCentralPubMed Mourmoura E, Vial G, Laillet B, Rigaudiere JP, Hininger-Favier I, Dubouchaud H, et al. Preserved endothelium-dependent dilatation of the coronary microvasculature at the early phase of diabetes mellitus despite the increased oxidative stress and depressed cardiac mechanical function ex vivo. Cardiovasc Diabetol. 2013. doi:10.​1186/​1475-2840-12-49.PubMedCentralPubMed
52.
go back to reference Vink H, Constantinescu AA, Spaan JA. Oxidized lipoproteins degrade the endothelial surface layer : implications for platelet-endothelial cell adhesion. Circulation. 2000;101(13):1500–2.CrossRefPubMed Vink H, Constantinescu AA, Spaan JA. Oxidized lipoproteins degrade the endothelial surface layer : implications for platelet-endothelial cell adhesion. Circulation. 2000;101(13):1500–2.CrossRefPubMed
53.
go back to reference Ariano MA, Armstrong RB, Edgerton VR. Hindlimb muscle fiber populations of five mammals. J Histochem Cytochem. 1973;21(1):51–5.CrossRefPubMed Ariano MA, Armstrong RB, Edgerton VR. Hindlimb muscle fiber populations of five mammals. J Histochem Cytochem. 1973;21(1):51–5.CrossRefPubMed
55.
go back to reference Stanley WC, Lopaschuk GD, McCormack JG. Regulation of energy substrate metabolism in the diabetic heart. Cardiovasc Res. 1997;34(1):25–33.CrossRefPubMed Stanley WC, Lopaschuk GD, McCormack JG. Regulation of energy substrate metabolism in the diabetic heart. Cardiovasc Res. 1997;34(1):25–33.CrossRefPubMed
56.
go back to reference van den Brom CE, Huisman MC, Vlasblom R, Boontje NM, Duijst S, Lubberink M, et al. Altered myocardial substrate metabolism is associated with myocardial dysfunction in early diabetic cardiomyopathy in rats: studies using positron emission tomography. Cardiovasc Diabetol. 2009. doi:10.1186/1475-2840-8-39.PubMedCentralPubMed van den Brom CE, Huisman MC, Vlasblom R, Boontje NM, Duijst S, Lubberink M, et al. Altered myocardial substrate metabolism is associated with myocardial dysfunction in early diabetic cardiomyopathy in rats: studies using positron emission tomography. Cardiovasc Diabetol. 2009. doi:10.​1186/​1475-2840-8-39.PubMedCentralPubMed
57.
go back to reference How OJ, Aasum E, Severson DL, Chan WY, Essop MF, Larsen TS. Increased myocardial oxygen consumption reduces cardiac efficiency in diabetic mice. Diabetes. 2006;55(2):466–73.CrossRefPubMed How OJ, Aasum E, Severson DL, Chan WY, Essop MF, Larsen TS. Increased myocardial oxygen consumption reduces cardiac efficiency in diabetic mice. Diabetes. 2006;55(2):466–73.CrossRefPubMed
58.
go back to reference Pawar AS, Zhu XY, Eirin A, Tang H, Jordan KL, Woollard JR, et al. Adipose tissue remodeling in a novel domestic porcine model of diet-induced obesity. Obesity. 2015. doi:10.1002/oby.20971.PubMed Pawar AS, Zhu XY, Eirin A, Tang H, Jordan KL, Woollard JR, et al. Adipose tissue remodeling in a novel domestic porcine model of diet-induced obesity. Obesity. 2015. doi:10.​1002/​oby.​20971.PubMed
Metadata
Title
Early impairment of coronary microvascular perfusion capacity in rats on a high fat diet
Authors
Judith van Haare
M. Eline Kooi
Hans Vink
Mark J. Post
Jurgen W. G. E. van Teeffelen
Jos Slenter
Chantal Munts
Hanneke Cobelens
Gustav J. Strijkers
Dennis Koehn
Marc van Bilsen
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Cardiovascular Diabetology / Issue 1/2015
Electronic ISSN: 1475-2840
DOI
https://doi.org/10.1186/s12933-015-0312-2

Other articles of this Issue 1/2015

Cardiovascular Diabetology 1/2015 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.