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Marzano L, Ronco C. Clinical and biochemical outcomes after adrenalectomy for primary aldosteronism in tertiary and quaternary referral centers: data from SOPRANO study. Hypertens Res 2024; 47:721-734. [PMID: 38182902 DOI: 10.1038/s41440-023-01554-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/04/2023] [Accepted: 11/20/2023] [Indexed: 01/07/2024]
Abstract
Hypertension cure following adrenalectomy in unilateral primary aldosteronism (PA) remains uncertain. Previous meta-analyses have shown highly variable surgical outcomes. Our study aimed to determine the unknown proportion of complete clinical and biochemical success in tertiary and quaternary referral centers. We conducted a systematic review and meta-analysis of studies reporting surgical outcomes of unilateral PA patients within the Surgical Outcome of PRimary Aldosteronism progNostic mOdels (SOPRANO) study. From 27 publications we identified 32 eligible studies, of which 22 were judged to be at low risk of bias. Eighteen were single-center studies, while fourteen were multi-center studies, with patients recruited from 132 referral centers worldwide. Adrenalectomy was performed on 5887 patients, with 4861 (83%) included in the final analysis. The pooled estimates of complete clinical and biochemical success for all studies were 39% (95% CI: 34-44%) and 99% (95% CI: 96-99%), respectively, similar to that found for studies at low risk of bias. Multivariate meta-regression analyses for all studies and low-bias risk studies revealed that BMI (P < 0.01), recruitment time period (P < 0.01), and hypertension duration (P < 0.05) inversely correlated with complete clinical success, while BMI (P < 0.05) and the number of enrolled centers (P < 0.05) inversely correlated with complete biochemical success. In summary, our findings offer robust estimates of complete clinical and biochemical success rates following adrenalectomy for unilateral PA in tertiary and quaternary referral centers and identify new potential effect modifiers that can help clinicians to inform and counsel patients about post-surgery expectations, guaranteeing effective treatment and ultimately enhancing outcomes.
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Affiliation(s)
- Luigi Marzano
- Centro per lo Studio e la Cura dell'Ipertensione Arteriosa, Internal Medicine Unit, San Bortolo Hospital, U.L.S.S. 8 Berica, Vicenza, Italy.
- Internal Medicine Unit, San Bortolo Hospital, U.L.S.S. 8 Berica, 36100, Vicenza, Italy.
| | - Claudio Ronco
- Department of Medicine (DIMED), University of Padova, 35128, Padova, Italy
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, 36100, Vicenza, Italy
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2
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Ruiz-Sánchez JG, Paja-Fano M, González Boillos M, Pla Peris B, Pascual-Corrales E, García Cano AM, Parra Ramírez P, Martín Rojas-Marcos P, Vicente Delgado A, Gómez Hoyos E, Ferreira R, García Sanz I, Recasens Sala M, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, García González JJ, Perdomo CM, Manjón Miguélez L, García Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales-Ruiz M, Hanzu FA, Araujo-Castro M. Effect of Obesity on Clinical Characteristics of Primary Aldosteronism Patients at Diagnosis and Postsurgical Response. J Clin Endocrinol Metab 2023; 109:e379-e388. [PMID: 37428898 PMCID: PMC10735298 DOI: 10.1210/clinem/dgad400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/20/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
CONTEXT Patients with obesity have an overactivated renin-angiotensin-aldosterone system (RAAS) that is associated with essential hypertension. However, the influence of obesity in primary aldosteronism (PA) is unknown. OBJECTIVE We analyzed the effect of obesity on the characteristics of PA, and the association between obesity and RAAS components. METHODS A retrospective study was conducted of the Spanish PA Registry (SPAIN-ALDO Registry), which included patients with PA seen at 20 tertiary centers between 2018 and 2022. Differences between patients with and without obesity were analyzed. RESULTS A total of 415 patients were included; 189 (45.5%) with obesity. Median age was 55 years (range, 47.3-65.2 years) and 240 (58.4%) were male. Compared to those without obesity, patients with obesity had higher rates of diabetes mellitus, chronic kidney disease, obstructive apnea syndrome, left ventricular hypertrophy, prior cardiovascular events, higher means of systolic blood pressure, and required more antihypertensive drugs. Patients with PA and obesity also had higher values of serum glucose, glycated hemoglobin A1c, creatinine, uric acid, and triglycerides, and lower levels of high-density lipoprotein cholesterol. Levels of blood aldosterone (PAC) and renin were similar between patients with and without obesity. Body mass index was not correlated with PAC nor renin. The rates of adrenal lesions on imaging studies, as well as the rates of unilateral disease assessed by adrenal vein sampling or I-6β-iodomethyl-19-norcholesterol scintigraphy, were similar between groups. CONCLUSION Obesity in PA patients involves a worse cardiometabolic profile, and need for more antihypertensive drugs but similar PAC and renin levels, and rates of adrenal lesions and lateral disease than patients without obesity. However, obesity implicates a lower rate of hypertension cure after adrenalectomy.
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Affiliation(s)
- Jorge Gabriel Ruiz-Sánchez
- Endocrinology & Nutrition Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS FJD, UAM), Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Miguel Paja-Fano
- Endocrinology & Nutrition Department, OSI Bilbao-Basurto, Medicine Department, Basque Country University, Hospital Universitario de Basurto, 48013 Bilbao, Spain
| | - Marga González Boillos
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, 12004 Castellón, Spain
| | - Begoña Pla Peris
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, 12004 Castellón, Spain
| | - Eider Pascual-Corrales
- Endocrinology & Nutrition Department, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | | | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | | | | | - Emilia Gómez Hoyos
- Endocrinology & Nutrition Department, Hospital Universitario de Valladolid, 47003 Valladolid, Spain
| | - Rui Ferreira
- Endocrinology & Nutrition Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Monica Recasens Sala
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, 17007 Girona, Spain
| | | | - María José Picón César
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Victoria de Málaga, IBIMA, 29010 Málaga, Spain
- CIBEROBN, 28029 Madrid, Spain
| | - Patricia Díaz Guardiola
- Endocrinology & Nutrition Department, Hospital Universitario Infanta Sofía, 28702 Madrid, Spain
| | - Juan Jesús García González
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, 41009 Sevilla, Spain
| | - Carolina M Perdomo
- Endocrinology & Nutrition Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Laura Manjón Miguélez
- Endocrinology & Nutrition Department, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Rogelio García Centeno
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Juan Carlos Percovich
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Ángel Rebollo Román
- Endocrinology & Nutrition Department, Hospital Reina Sofía, 14004 Córdoba, Spain
| | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanova, 50015 Zaragoza, Spain
| | - Cristina Robles Lázaro
- Endocrinology & Nutrition Department, Complejo Universitario de Salamanca, 37007 Salamanca, Spain
| | - Manuel Morales-Ruiz
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, 08036 Barcelona, Spain
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, IDIBAPS, CIBERDEM, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Marta Araujo-Castro
- Endocrinology & Nutrition Department, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Department of Medicine, University of Alcalá, 28801 Madrid, Spain
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3
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Katsuragawa S, Goto A, Shinoda S, Inoue K, Nakai K, Saito J, Nishikawa T, Tsurutani Y. Association of Reversal of Renin Suppression With Long-Term Renal Outcome in Medically Treated Primary Aldosteronism. Hypertension 2023; 80:1909-1920. [PMID: 37449450 DOI: 10.1161/hypertensionaha.123.21096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Renin suppression in primary aldosteronism indicates mineralocorticoid receptor activation via excessive aldosterone secretion, inducing renal damage. We investigated whether the reversal of renin suppression after the initiation of mineralocorticoid receptor antagonist therapy was associated with long-term renal outcomes in medically treated patients with primary aldosteronism. METHODS This retrospective cohort study included 318 patients with primary aldosteronism treated with mineralocorticoid receptor antagonist between 2008 and 2020 at the Yokohama Rosai Hospital in Japan. The posttreatment renin status was defined as unsuppressed (ie, reversal of renin suppression) when individual plasma renin activity after the initiation of mineralocorticoid receptor antagonist (post-plasma renin activity) was ≥1.0 ng/mL per hour; otherwise, it was defined as suppressed. We analyzed the association of posttreatment renin status with subsequent longitudinal estimated glomerular filtration rate changes using linear mixed-effects models for repeated measurements, adjusting for potential confounders. RESULTS The posttreatment renin status of 119 patients was unsuppressed (median post-plasma renin activity, 1.7 ng/mL per hour) and that of 199 patients was suppressed (median post-PRA, 0.5 ng/mL per hour). Through the median follow-up period of 3.1 years, the decline in estimated glomerular filtration rate was milder among patients with the unsuppressed posttreatment renin (-0.46 [95% CI, -0.63 to -0.28] mL/min per 1.73 m2 per year) than those with suppressed posttreatment renin (-1.41 [95% CI, -1.56 to -1.27] mL/min per 1.73 m2 per year; difference, 0.96 [95% CI, 0.72-1.20] mL/min per 1.73 m2 per year). CONCLUSIONS Our findings may highlight the importance of reversing renin suppression with optimal mineralocorticoid receptor antagonist titration in medically treated primary aldosteronism, which could mitigate adverse renal outcomes.
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Affiliation(s)
- Sho Katsuragawa
- Department of Health Data Science, Graduate School of Data Science (S.K., A.G., S.S.), Yokohama City University, Japan
- Melbourne School of Population and Global Heath, The University of Melbourne, Australia (S.K.)
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science (S.K., A.G., S.S.), Yokohama City University, Japan
- Department of Public Health, School of Medicine (A.G.), Yokohama City University, Japan
| | - Satoru Shinoda
- Department of Health Data Science, Graduate School of Data Science (S.K., A.G., S.S.), Yokohama City University, Japan
- Department of Biostatistics, School of Medicine (S.S.), Yokohama City University, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Japan (K.I.)
| | - Kazuki Nakai
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan (K.N., J.S., T.N., Y.T.)
| | - Jun Saito
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan (K.N., J.S., T.N., Y.T.)
| | - Tetsuo Nishikawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan (K.N., J.S., T.N., Y.T.)
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan (K.N., J.S., T.N., Y.T.)
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4
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Lee G, Kluwe B, Zhao S, Kline D, Nedungadi D, Brock GN, Odei JB, Kesireddy V, Pohlman N, Sims M, Effoe VS, Wu WC, Kalyani RR, Wand GS, Echouffo-Tcheugui J, Golden SH, Joseph JJ. Adiposity, aldosterone and plasma renin activity among African Americans: The Jackson Heart Study. ENDOCRINE AND METABOLIC SCIENCE 2023; 11:100126. [PMID: 37475849 PMCID: PMC10358448 DOI: 10.1016/j.endmts.2023.100126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Objective To analyze associations between adiposity and the renin-angiotensin-aldosterone system (RAAS) in a large African American (AA) cohort. Methods Cross-sectional associations of adiposity (body mass index [BMI], waist circumference [WC], waist:height ratio, waist:hip ratio, leptin, adiponectin, leptin:adiponectin ratio [LAR], subcutaneous [SAT] and visceral adipose tissue [VAT], and liver attenuation [LA]) with aldosterone, plasma renin activity (renin), and aldosterone:renin ratio (ARR) were assessed in the Jackson Heart Study using adjusted linear regression models. Results A 1-SD higher BMI was associated with a 4.8 % higher aldosterone, 9.4 % higher renin, and 5.0 % lower ARR (all p < 0.05). Log-leptin had the largest magnitude of association with renin (30.2 % higher) and ARR (9.6 % lower), while the strongest association of aldosterone existed for log-LAR (15.3 % higher) (all 1-SD, p < 0.05). SAT was only associated with renin. VAT was associated with higher aldosterone, renin, and ARR. Liver fat was associated with aldosterone and renin, but not ARR. Associations of WC, BMI, and SAT with aldosterone were greater in men while the association with VAT was greater in women (p-interactions < 0.05). Conclusion Multiple measures of adiposity are associated with the RAAS in AAs. Further studies should examine the role of RAAS in obesity-driven cardiometabolic diseases.
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Affiliation(s)
- Grace Lee
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| | - Bjorn Kluwe
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics, Center for
Biostatistics, The Ohio State University, Columbus, OH, USA
| | - David Kline
- Department of Biomedical Informatics, Center for
Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Divya Nedungadi
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| | - Guy N. Brock
- Department of Biomedical Informatics, Center for
Biostatistics, The Ohio State University, Columbus, OH, USA
| | - James B. Odei
- Division of Biostatistics, The Ohio State University
College of Public Health, Columbus, OH, USA
| | - Veena Kesireddy
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| | - Neal Pohlman
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical
Center, Jackson, MS, USA
| | - Valery S. Effoe
- Department of Medicine, Morehouse School of Medicine,
Atlanta, GA, USA
| | - Wen-Chih Wu
- Department of Medicine, Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | - Rita R. Kalyani
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Gary S. Wand
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | | | - Sherita H. Golden
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Joshua J. Joseph
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
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5
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Belany P, Kackley ML, Zhao S, Kluwe B, Buga A, Crabtree CD, Nedungadi D, Kline D, Brock G, Simonetti OP, Volek JS, Joseph JJ. Effects of Hypocaloric Low-Fat, Ketogenic, and Ketogenic and Ketone Supplement Diets on Aldosterone and Renin. J Clin Endocrinol Metab 2023; 108:1727-1739. [PMID: 36629058 PMCID: PMC10271230 DOI: 10.1210/clinem/dgad009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
CONTEXT Ketogenic diets (KDs) and low-fat diets (LFD) result in similar weight loss, but have differential cardiometabolic effects on lipids and insulin. Generally, weight loss decreases renin-angiotensin-aldosterone system (RAAS) activity. OBJECTIVE Investigate the effects of KDs with varying sodium content vs LFD on RAAS in overweight and obese adults. METHODS Twenty-eight participants were randomized 1:1 to a KD + ketone salt supplement (KD + KS) or a KD + placebo (KD + PL) arm with prepared hypocaloric meals. Twelve participants were enrolled in a post hoc LFD arm. Serum renin, aldosterone, and anthropometric and metabolic biomarkers were assessed at 0, 2, 4, and 6 weeks. Linear mixed models with random intercepts were used to compare between group differences controlling for sex and body mass index. RESULTS Participants had a median age of 33 years, 51% female, weighed 91.3 kg, with body mass index 30.6 kg/m2. At 6 weeks, weight decreased by 6, 8, and 7 kg on average in the KD + KS, KD + PL, and LFD groups, respectively (P < .05). Aldosterone increased by 88% and 144% in the KD + PL and KD + KS groups, respectively, but did not change in the LFD after 6 weeks while renin decreased across groups. Systolic and diastolic blood pressure did not change in the KD + PL and KD + KS groups. Log ketones were positively associated with aldosterone (P < .001). Aldosterone was not associated with cardiovascular measures including blood pressure and ejection fraction (P > .05). CONCLUSION KD reduced weight and increased aldosterone without worsening cardiometabolic risk factors. Future KD studies are needed to elucidate mechanistic connections between ketones and aldosterone.
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Affiliation(s)
- Paul Belany
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Madison L Kackley
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Songzhu Zhao
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Bjorn Kluwe
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Alex Buga
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | | | - Divya Nedungadi
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - David Kline
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Orlando P Simonetti
- Department of Radiology, Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH 43210, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | - Jeff S Volek
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH 43210, USA
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6
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Kluwe B, Pohlman N, Kesireddy V, Zhao S, Tan Y, Kline D, Brock G, Odei JB, Effoe VS, Tcheugui JBE, Kalyani RR, Sims M, Taylor HA, Mongraw-Chaffin M, Akhabue E, Joseph JJ. The Role of Aldosterone and Ideal Cardiovascular Health in Incident Cardiovascular Disease: The Jackson Heart Study. Am J Prev Cardiol 2023; 14:100494. [PMID: 37114212 PMCID: PMC10126856 DOI: 10.1016/j.ajpc.2023.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023] Open
Abstract
Background Higher levels of ideal cardiovascular health (ICH) are associated with lower levels of aldosterone and incidence of cardiovascular disease (CVD). However, the degree to which aldosterone mediates the association between ICH and CVD incidence has not been explored. Thus, we investigated the mediational role of aldosterone in the association of 5 components of ICH (cholesterol, body mass index (BMI), physical activity, diet and smoking) with incident CVD and the mediational role of blood pressure (BP) and glucose in the association of aldosterone with incident CVD in a cohort of African Americans (AA). Methods The Jackson Heart Study is a prospective cohort of AAs adults with data on CVD outcomes. Aldosterone, ICH metrics and baseline characteristics were collected at exam 1 (2000-2004). ICH score was developed by summing 5 ICH metrics (smoking, dietary intake, physical activity, BMI, and total cholesterol) and grouped into two categories (0-2 and ≥3 metrics). Incident CVD was defined as stroke, coronary heart disease, or heart failure. Cox proportional hazard regression models were used to model the association of categorical ICH score with incident CVD. The R Package Mediation was utilized to examine: 1) The mediational role of aldosterone in the association of ICH with incident CVD and 2) The mediational role of blood pressure and glucose in the association of aldosterone with incident CVD. Results Among 3,274 individuals (mean age: 54±12.4 years, 65% female), there were 368 cases of incident CVD over a median of 12.7 years. The risk of incident CVD was 46% lower (HR: 0.54; 95%CI 0.36, 0.80) in those with ≥3 ICH metrics at baseline compared to 0-2. Aldosterone mediated 5.4% (p = 0.006) of the effect of ICH on incident CVD. A 1-unit increase in log-aldosterone was associated with a 38% higher risk of incident CVD (HR 1.38, 95%CI: 1.19, 1.61) with BP and glucose mediating 25.6% (p<0.001) and 4.8% (p = 0.048), respectively. Conclusion Aldosterone partially mediates the association of ICH with incident CVD and both blood pressure and glucose partially mediate the association of aldosterone with incident CVD, emphasizing the potential importance of aldosterone and ICH in risk of CVD among AAs.
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7
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The Effect of Aldosterone on Cardiorenal and Metabolic Systems. Int J Mol Sci 2023; 24:ijms24065370. [PMID: 36982445 PMCID: PMC10049192 DOI: 10.3390/ijms24065370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
Aldosterone, a vital hormone of the human body, has various pathophysiological roles. The excess of aldosterone, also known as primary aldosteronism, is the most common secondary cause of hypertension. Primary aldosteronism is associated with an increased risk of cardiovascular disease and kidney dysfunction compared to essential hypertension. Excess aldosterone can lead to harmful metabolic and other pathophysiological alterations, as well as cause inflammatory, oxidative, and fibrotic effects in the heart, kidney, and blood vessels. These alterations can result in coronary artery disease, including ischemia and myocardial infarction, left ventricular hypertrophy, heart failure, arterial fibrillation, intracarotid intima thickening, cerebrovascular disease, and chronic kidney disease. Thus, aldosterone affects several tissues, especially in the cardiovascular system, and the metabolic and pathophysiological alterations are related to severe diseases. Therefore, understanding the effects of aldosterone on the body is important for health maintenance in hypertensive patients. In this review, we focus on currently available evidence regarding the role of aldosterone in alterations of the cardiovascular and renal systems. We also describe the risk of cardiovascular events and renal dysfunction in hyperaldosteronism.
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8
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Ling G, Bruno J, Albert SG, Dhindsa S. Fatty acids as a direct regulator of aldosterone hypersecretion. Mol Cell Endocrinol 2023; 561:111836. [PMID: 36549461 DOI: 10.1016/j.mce.2022.111836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022]
Abstract
Primary hyperaldosteronism is a major cause of secondary hypertension and carries additional cardiovascular risks beyond that of the elevated blood pressure. Primary hyperaldosteronism is more prevalent in obese people, and weight loss reduces aldosterone levels. It needs to be determined whether obesity related factors directly contribute to the pathogenesis of primary hyperaldosteronism. Here we show that the non-esterified fatty acids (NEFA) palmitic acid, and to a lesser extent, linoleic acid significantly stimulated aldosterone production and steroid enzyme induction in adrenocortical HAC15 cells of human origin. Palmitic acid, linoleic acid, and to a much lesser extent, oleic acid induced the expression of aldosterone synthase. Induction of the Steroidogenic Acute Regulatory Protein (StAR) was modest. Increased aldosterone secretion was independent of fatty acid beta-oxidation in the mitochondria but may involve free fatty acid receptor 1 (FFAR1/GPR40) and endoplasmic reticulum (ER) stress. Palmitic acid and linoleic acid induced the expression of C/EBP Homologous Protein (CHOP), a marker of ER stress, correlating with their ability to induce aldosterone synthase gene expression. Palmitic acid, but not linoleic acid decreased mitochondrial potentials and induced uncoupling protein 2 (UCP2). Palmitic acid enhanced, while docosahexaenoic acid (DHA) suppressed aldosterone response to angiotensin II (Ang-II). Our study provides evidence that NEFAs modulate aldosterone production, and further suggests that hyperaldosteronism shares similar pathogenesis with other obesity-related disorders such as metabolic syndrome.
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Affiliation(s)
- Guoyu Ling
- Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, Saint Louis, MO, 63110, USA.
| | - Jonathan Bruno
- Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, Saint Louis, MO, 63110, USA
| | - Stewart G Albert
- Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, Saint Louis, MO, 63110, USA
| | - Sandeep Dhindsa
- Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, Saint Louis, MO, 63110, USA
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9
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Loh HH, Lim QH, Chai CS, Goh SL, Lim LL, Yee A, Sukor N. Influence and implications of the renin-angiotensin-aldosterone system in obstructive sleep apnea: An updated systematic review and meta-analysis. J Sleep Res 2023; 32:e13726. [PMID: 36104933 PMCID: PMC10078316 DOI: 10.1111/jsr.13726] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 02/03/2023]
Abstract
Obstructive sleep apnea is a chronic, sleep-related breathing disorder, which is an independent risk factor for cardiovascular disease. The renin-angiotensin-aldosterone system regulates salt and water homeostasis, blood pressure, and cardiovascular remodelling. Elevated aldosterone levels are associated with excess morbidity and mortality. We aimed to analyse the influence and implications of renin-angiotensin-aldosterone system derangement in individuals with and without obstructive sleep apnea. We pooled data from 20 relevant studies involving 2828 participants (1554 with obstructive sleep apnea, 1274 without obstructive sleep apnea). The study outcomes were the levels of renin-angiotensin-aldosterone system hormones, blood pressure and heart rate. Patients with obstructive sleep apnea had higher levels of plasma renin activity (pooled wmd+ 0.25 [95% confidence interval 0.04-0.46], p = 0.0219), plasma aldosterone (pooled wmd+ 30.79 [95% confidence interval 1.05-60.53], p = 0.0424), angiotensin II (pooled wmd+ 5.19 [95% confidence interval 3.11-7.27], p < 0.001), systolic (pooled wmd+ 5.87 [95% confidence interval 1.42-10.32], p = 0.0098) and diastolic (pooled wmd+ 3.40 [95% confidence interval 0.86-5.94], p = 0.0086) blood pressure, and heart rate (pooled wmd+ 3.83 [95% confidence interval 1.57-6.01], p = 0.0009) compared with those without obstructive sleep apnea. The elevation remained significant (except for renin levels) when studies involving patients with resistant hypertension were removed. Sub-group analysis demonstrated that levels of angiotensin II were significantly higher only among the Asian population with obstructive sleep apnea compared with those without obstructive sleep apnea. Body mass index accounted for less than 10% of the between-study variance in elevation of the renin-angiotensin-aldosterone system parameters. Patients with obstructive sleep apnea have higher levels of renin-angiotensin-aldosterone system hormones, blood pressure and heart rate compared with those without obstructive sleep apnea, which remains significant even among patients without resistant hypertension.
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Affiliation(s)
- Huai Heng Loh
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.,Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Quan Hziung Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Shee Chai
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Siew Li Goh
- Sports and Exercise Medicine Research and Education Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlela Sukor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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10
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Wolter NL, Jaffe IZ. Emerging vascular cell-specific roles for mineralocorticoid receptor: implications for understanding sex differences in cardiovascular disease. Am J Physiol Cell Physiol 2023; 324:C193-C204. [PMID: 36440858 PMCID: PMC9902217 DOI: 10.1152/ajpcell.00372.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/04/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
As growing evidence implicates extrarenal mineralocorticoid receptor (MR) in cardiovascular disease (CVD), recent studies have defined both cell- and sex-specific roles. MR is expressed in vascular smooth muscle (SMC) and endothelial cells (ECs). This review integrates published data from the past 5 years to identify novel roles for vascular MR in CVD, with a focus on understanding sex differences. Four areas are reviewed in which there is recently expanded understanding of the cell type- or sex-specific role of MR in 1) obesity-induced microvascular endothelial dysfunction, 2) vascular inflammation in atherosclerosis, 3) pulmonary hypertension, and 4) chronic kidney disease (CKD)-related CVD. The review focuses on preclinical data on each topic describing new mechanistic paradigms, cell type-specific mechanisms, sexual dimorphism if addressed, and clinical implications are then considered. New data support that MR drives vascular dysfunction induced by cardiovascular risk factors via sexually dimorphic mechanisms. In females, EC-MR contributes to obesity-induced endothelial dysfunction by regulating epithelial sodium channel expression and by inhibiting estrogen-induced nitric oxide production. In males with hyperlipidemia, EC-MR promotes large vessel inflammation by genomic regulation of leukocyte adhesion molecules, which is inhibited by the estrogen receptor. In pulmonary hypertension models, MRs in EC and SMC contribute to distinct components of disease pathologies including pulmonary vessel remodeling and RV dysfunction. Despite a female predominance in pulmonary hypertension, sex-specific roles for MR have not been explored. Vascular MR has also been directly implicated in CKD-related vascular dysfunction, independent of blood pressure. Despite these advances, sex differences in MR function remain understudied.
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Affiliation(s)
- Nicole L Wolter
- Molecular Cardiology Research Institute, https://ror.org/002hsbm82Tufts Medical Center, Boston, Massachusetts
- Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, https://ror.org/002hsbm82Tufts Medical Center, Boston, Massachusetts
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11
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Maaliki D, Itani MM, Itani HA. Pathophysiology and genetics of salt-sensitive hypertension. Front Physiol 2022; 13:1001434. [PMID: 36176775 PMCID: PMC9513236 DOI: 10.3389/fphys.2022.1001434] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Most hypertensive cases are primary and heavily associated with modifiable risk factors like salt intake. Evidence suggests that even small reductions in salt consumption reduce blood pressure in all age groups. In that regard, the ACC/AHA described a distinct set of individuals who exhibit salt-sensitivity, regardless of their hypertensive status. Data has shown that salt-sensitivity is an independent risk factor for cardiovascular events and mortality. However, despite extensive research, the pathogenesis of salt-sensitive hypertension is still unclear and tremendously challenged by its multifactorial etiology, complicated genetic influences, and the unavailability of a diagnostic tool. So far, the important roles of the renin-angiotensin-aldosterone system, sympathetic nervous system, and immune system in the pathogenesis of salt-sensitive hypertension have been studied. In the first part of this review, we focus on how the systems mentioned above are aberrantly regulated in salt-sensitive hypertension. We follow this with an emphasis on genetic variants in those systems that are associated with and/or increase predisposition to salt-sensitivity in humans.
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Affiliation(s)
- Dina Maaliki
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha M. Itani
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hana A. Itani
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- *Correspondence: Hana A. Itani,
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12
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Spyroglou A, Handgriff L, Müller L, Schwarzlmüller P, Parasiliti-Caprino M, Fuss CT, Remde H, Hirsch A, O'Toole SM, Thuzar M, Petramala L, Letizia C, Deflorenne E, Amar L, Vrckovnik R, Kocjan T, Zhang CD, Li D, Singh S, Katabami T, Yoneda T, Murakami M, Wada N, Inagaki N, Quinkler M, Ghigo E, Maccario M, Stowasser M, Drake WM, Fassnacht M, Bancos I, Reincke M, Naruse M, Beuschlein F. The metabolic phenotype of patients with primary aldosteronism: impact of subtype and sex - a multicenter-study of 3566 Caucasian and Asian subjects. Eur J Endocrinol 2022; 187:361-372. [PMID: 35895721 DOI: 10.1530/eje-22-0040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Accumulating evidence suggests that primary aldosteronism (PA) is associated with several features of the metabolic syndrome, in particular with obesity, type 2 diabetes mellitus, and dyslipidemia. Whether these manifestations are primarily linked to aldosterone-producing adenoma (APA) or bilateral idiopathic hyperaldosteronism (IHA) remains unclear. The aim of the present study was to investigate differences in metabolic parameters between APA and IHA patients and to assess the impact of treatment on these clinical characteristics. METHODS We conducted a retrospective multicenter study including 3566 patients with APA or IHA of Caucasian and Asian origin. We compared the prevalence of metabolic disorders between APA and IHA patients at the time of diagnosis and 1-year post-intervention, with special references to sex differences. Furthermore, correlations between metabolic parameters and plasma aldosterone, renin, or plasma cortisol levels after 1 mg dexamethasone (DST) were performed. RESULTS As expected, APA patients were characterized by higher plasma aldosterone and lower serum potassium levels. Only female IHA patients demonstrated significantly worse metabolic parameters than age-matched female APA patients, which were associated with lower cortisol levels upon DST. One-year post-intervention, female adrenalectomized patients showed deterioration of their lipid profile, when compared to patients treated with mineralocorticoid receptor antagonists. Plasma aldosterone levels negatively correlated with the BMI only in APA patients. CONCLUSIONS Metabolic alterations appear more prominent in women with IHA. Although IHA patients have worse metabolic profiles, a correlation with cortisol autonomy is documented only in APAs, suggesting an uncoupling of cortisol action from metabolic traits in IHA patients.
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Affiliation(s)
- Ariadni Spyroglou
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich (USZ) and Universität Zürich (UZH), Zurich, Switzerland
| | - Laura Handgriff
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Lisa Müller
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Paul Schwarzlmüller
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Carmina Teresa Fuss
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Hana Remde
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Anna Hirsch
- Endokrinologie in Charlottenburg, Berlin, Germany
| | | | - Moe Thuzar
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia
| | - Luigi Petramala
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Claudio Letizia
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Elisa Deflorenne
- Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital européen Georges-Pompidou, Université de Paris, PARCC, Inserm, Paris, France
| | - Laurence Amar
- Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital européen Georges-Pompidou, Université de Paris, PARCC, Inserm, Paris, France
| | - Rok Vrckovnik
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tomaz Kocjan
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Catherine D Zhang
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Dingfeng Li
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Sumitabh Singh
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Takuyuki Katabami
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Takashi Yoneda
- Department of Health Promotion and Medicine of the Future, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Masanori Murakami
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norio Wada
- Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Ezio Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mauro Maccario
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia
| | - William M Drake
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Mitsuhide Naruse
- Endocrine Center and Clinical Research Center, Ijinkai Takeda General Hospital, Kyoto, Japan
- Clinical Research Institute of Endocrinology and Metabolism, NHO Kyoto Medical Center, Kyoto, Japan
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich (USZ) and Universität Zürich (UZH), Zurich, Switzerland
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
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13
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Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood. Nutrients 2021; 13:nu13114176. [PMID: 34836431 PMCID: PMC8624977 DOI: 10.3390/nu13114176] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of 'tracking' of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed.
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14
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Srinivasa S, Thomas TS, Feldpausch MN, Adler GK, Grinspoon SK. Coronary Vasculature and Myocardial Structure in HIV: Physiologic Insights From the Renin-Angiotensin-Aldosterone System. J Clin Endocrinol Metab 2021; 106:3398-3412. [PMID: 33624807 PMCID: PMC8864747 DOI: 10.1210/clinem/dgab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 11/19/2022]
Abstract
The landscape of HIV medicine dramatically changed with the advent of contemporary antiretroviral therapies, which has allowed persons with HIV (PWH) to achieve good virologic control, essentially eliminating HIV-related complications and increasing life expectancy. As PWH are living longer, noncommunicable diseases, such as cardiovascular disease (CVD), have become a leading cause of morbidity and mortality in PWH with rates that are 50% to 100% higher than in well-matched persons without HIV. In this review, we focus on disease of the coronary microvasculature and myocardium in HIV. We highlight a key hormonal system important to cardiovascular endocrinology, the renin-angiotensin-aldosterone system (RAAS), as a potential mediator of inflammatory driven-vascular and myocardial injury and consider RAAS blockade as a physiologically targeted strategy to reduce CVD in HIV.
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Affiliation(s)
- Suman Srinivasa
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Teressa S Thomas
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Meghan N Feldpausch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gail K Adler
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Correspondence: Steven K. Grinspoon, MD, Metabolism Unit, Massachusetts General Hospital, 55 Fruit Street, 5LON207, Boston, MA 02114, USA. E-mail:
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15
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Chiriacò M, Tricò D, Leonetti S, Petrie JR, Balkau B, Højlund K, Pataky Z, Nilsson PM, Natali A. Female Sex and Angiotensin-Converting Enzyme (ACE) Insertion/Deletion Polymorphism Amplify the Effects of Adiposity on Blood Pressure. Hypertension 2021; 79:36-46. [PMID: 34689596 DOI: 10.1161/hypertensionaha.121.18048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pathophysiological link between adiposity and blood pressure is not completely understood, and evidence suggests an influence of sex and genetic determinants. We aimed to identify the relationship between adiposity and blood pressure, independent of a robust set of lifestyle and metabolic factors, and to examine the modulating role of sex and Angiotensin-Converting Enzyme (ACE) insertion/deletion (I/D) polymorphisms. In the Relationship Between Insulin Sensitivity and Cardiovascular Disease (RISC) study cohort, 1211 normotensive individuals, aged 30 to 60 years and followed-up after 3.3 years, were characterized for lifestyle and metabolic factors, body composition, and ACE genotype. Body mass index (BMI) and waist circumference (WC) were independently associated with mean arterial pressure, with a stronger relationship in women than men (BMI: r=0.40 versus 0.30; WC: r=0.40 versus 0.30, both P<0.01) and in individuals with the ID and II ACE genotypes in both sexes (P<0.01). The associations of BMI and WC with mean arterial pressure were independent of age, sex, lifestyle, and metabolic variables (standardized regression coefficient=0.17 and 0.18 for BMI and WC, respectively) and showed a significant interaction with the ACE genotype only in women (P=0.03). A 5 cm larger WC at baseline increased the risk of developing hypertension at follow-up only in women (odds ratio, 1.56 [95% CI, 1.15-2.10], P=0.004) and in II genotype carriers (odds ratio, 1.87 [95% CI, 1.09-3.20], P=0.023). The hypertensive effect of adiposity is more pronounced in women and in people carrying the II variant of the ACE genotype, a marker of salt sensitivity.
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Affiliation(s)
- Martina Chiriacò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Italy. (M.C., D.T., S.L., A.N.)
| | - Domenico Tricò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Italy. (M.C., D.T., S.L., A.N.).,Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy. (D.T.)
| | - Simone Leonetti
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Italy. (M.C., D.T., S.L., A.N.)
| | - John R Petrie
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.R.P.)
| | - Beverley Balkau
- Clinical Epidemiology, CESP, University Paris-Saclay, UVSQ, University Paris-Sud, Inserm U1018, Villejuif, France (B.B.)
| | - Kurt Højlund
- Steno Diabetes Center Odense, Odense University Hospital, Denmark (K.H.)
| | - Zoltan Pataky
- Division of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, WHO Collaborating Centre, University Hospitals of Geneva, University of Geneva, Switzerland (Z.P.)
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden (P.M.N.)
| | - Andrea Natali
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Italy. (M.C., D.T., S.L., A.N.)
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16
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do Carmo JM, da Silva AA, Hall JE. Impact of Mineralocorticoid Receptor and Angiotensin II Type 1 Receptor Antagonism on Blood Pressure Regulation in Obese Zucker Rats: Role of Sex Differences. Am J Hypertens 2021; 34:999-1005. [PMID: 33075125 DOI: 10.1093/ajh/hpaa170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies suggest that obesity-induced hypertension in females, but not males, is due to leptin-mediated stimulation of aldosterone secretion and subsequent activation of the mineralocorticoid receptor (MR). Although angiotensin II type 1 receptor (AT1R) antagonism lowers blood pressure (BP) in male obese Zucker rats (OZR), which have defective leptin signaling, the potential role of sex differences in BP responses to renin-angiotensin-aldosterone system blockade, including MR antagonism, in obesity is still unclear. We tested the cardiovascular effects of MR antagonism, alone or in combination with AT1R blockade in male and female OZR (n = 5/sex) and lean Zucker rats (n = 7/sex). METHODS BP and heart rate (HR) were measured by telemetry 24 hour/day. After a 6-day control period, spironolactone (40 mg/kg/day) was given for 10 days followed by a 7-day combined treatment with losartan (20 mg/kg/day), and followed by 6-day post-treatment recovery period. RESULTS Compared with lean rats, OZR were hypertensive (mean arterial pressure: 115 ± 4 vs. 104 ± 2 and 111 ± 1 vs. 100 ± 3 mm Hg for males and females) and had lower HR (355 ± 9 vs. 393 ± 7 and 367 ± 10 vs. 412 ± 13 bpm). MR blockade alone did not alter BP or HR in lean or obese male and female Zucker rats, whereas combined treatment reduced BP in obese and lean rats by 31 ± 3 vs. 21 ± 1 and 8 ± 1 vs. 5 ± 1 mm Hg in males and females, respectively. No changes were observed in HR. CONCLUSIONS These results suggest that there are important sex differences in BP responses to chronic AT1R blockade but no major involvement of MR activation in BP regulation in OZR.
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Affiliation(s)
- Jussara M do Carmo
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Alexandre A da Silva
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - John E Hall
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
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17
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Quesada O, Claggett B, Rodriguez F, Cai J, Moncrieft AE, Garcia K, Del Rios Rivera M, Hanna DB, Daviglus ML, Talavera GA, Bairey Merz CN, Solomon SD, Cheng S, Bello NA. Associations of Insulin Resistance With Systolic and Diastolic Blood Pressure: A Study From the HCHS/SOL. Hypertension 2021; 78:716-725. [PMID: 34379440 PMCID: PMC8650976 DOI: 10.1161/hypertensionaha.120.16905] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (O.Q.)
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA (O.Q., C.N.B.M., S.C.)
| | - Brian Claggett
- Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.D.S.)
| | - Fatima Rodriguez
- Divison of Cardiovascular Medicine, Stanford University; CA (F.R.)
| | - Jianwen Cai
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill (J.C.)
| | | | - Karin Garcia
- Department of Psychology, University of Miami, FL (A.E.M., K.G.)
| | - Marina Del Rios Rivera
- Institute for Minority Health Research, University of Illinois at Chicago (M.D.R.R., M.L.D.)
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (D.B.H.)
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago (M.D.R.R., M.L.D.)
| | - Gregory A Talavera
- Division of Health Promotion and Behavioral Science, San Diego State University, CA (G.T.)
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA (O.Q., C.N.B.M., S.C.)
| | - Scott D Solomon
- Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.D.S.)
| | - Susan Cheng
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA (O.Q., C.N.B.M., S.C.)
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY (N.A.B.)
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18
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Zuo J, Chao H, Tang B, Avolio AP, Schlaich MP, Nolde JM, Adji A, Carnagarin R. Female Gender Is Associated with Higher Susceptibility of Weight Induced Arterial Stiffening and Rise in Blood Pressure. J Clin Med 2021; 10:jcm10163479. [PMID: 34441775 PMCID: PMC8396951 DOI: 10.3390/jcm10163479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 01/13/2023] Open
Abstract
Arterial stiffness is an important predictor of cardiovascular events, independent of traditional risk factors. Stiffening of arteries, though an adaptive process to hemodynamic load, results in substantial increase in the pulsatile hemodynamic forces that detrimentally affects the microcirculation perfusing the vital organs such as the brain, heart and kidneys. Studies have proposed that arterial stiffness precedes and may contribute to the development of hypertension in individuals with obesity. Our study sought to determine the gender-based effects on arterial stiffening in obesity which may predispose to the development of hypertension. We found female sex is associated with higher susceptibility of weight-related arterial stiffening and rise in blood pressure in obesity. Women had significantly higher carotid-femoral pulse wave velocity (CF-PWV) with higher body mass index (BMI) status (normal: 7.9 ± 2 m/s; overweight: 9.1 ± 2 m/s; obese: 9 ± 2 m/s, p < 0.001), whereas it was similar in males across all BMI categories. The linear association between arterial stiffness and BMI following adjustment for age and brachial systolic and diastolic blood pressure (BP), remained significant in females (β = 0.06; 95% CI 0.01 to 0.1; p < 0.05) but not in males (β = 0.04; 95% CI -0.01 to 0.1; p > 0.05). The mean CF-PWV values increased by 0.1 m/s for every 1 kg/m2 increase in BMI in the female subjects in the age adjusted linear model, while such effect was not seen in the male subjects. In line with arterial stiffening, the overweight and obese females demonstrated significantly higher systolic brachial BP. (BP difference: ΔBP 9-11 mmHg, p < 0.01) and central systolic pressure (ΔBP 8-10 mmHg, p < 0.05) compared to their lean counterparts, unlike the male subjects. Our results suggest that female gender is associated with higher susceptibility of weight-related arterial stiffening and rise in blood pressure.
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Affiliation(s)
- Junli Zuo
- Department of Geriatrics and Geriatrics Centre, Ruijin Hospital/Jiaotong University School of Medicine, Shanghai 200240, China; (J.Z.); (H.C.); (B.T.)
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia;
| | - Huijuan Chao
- Department of Geriatrics and Geriatrics Centre, Ruijin Hospital/Jiaotong University School of Medicine, Shanghai 200240, China; (J.Z.); (H.C.); (B.T.)
| | - Biwen Tang
- Department of Geriatrics and Geriatrics Centre, Ruijin Hospital/Jiaotong University School of Medicine, Shanghai 200240, China; (J.Z.); (H.C.); (B.T.)
| | - Alberto P. Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia;
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine—Royal Perth Hospital Research Foundation, University of Western Australia, Perth, WA 6000, Australia; (M.P.S.); (J.M.N.)
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA 6000, Australia
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Janis Marc Nolde
- Dobney Hypertension Centre, School of Medicine—Royal Perth Hospital Research Foundation, University of Western Australia, Perth, WA 6000, Australia; (M.P.S.); (J.M.N.)
| | - Audrey Adji
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia;
- St Vincent’s Hospital and Clinical School UNSW, Sydney, NSW 2000, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW 2010, Australia
- Correspondence: (A.A.); (R.C.); Tel.: +61-2-8382-1111 (A.A.); +61-8-9224-0316 (R.C.)
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine—Royal Perth Hospital Research Foundation, University of Western Australia, Perth, WA 6000, Australia; (M.P.S.); (J.M.N.)
- Correspondence: (A.A.); (R.C.); Tel.: +61-2-8382-1111 (A.A.); +61-8-9224-0316 (R.C.)
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19
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Aldosterone Negatively Regulates Nrf2 Activity: An Additional Mechanism Contributing to Oxidative Stress and Vascular Dysfunction by Aldosterone. Int J Mol Sci 2021; 22:ijms22116154. [PMID: 34200377 PMCID: PMC8201089 DOI: 10.3390/ijms22116154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
High levels of aldosterone (Aldo) trigger oxidative stress and vascular dysfunction independent of effects on blood pressure. We sought to determine whether Aldo disrupts Nrf2 signaling, the main transcriptional factor involved in antioxidant responses that aggravate cell injury. Thoracic aorta from male C57Bl/6J mice and cultured human endothelial cells (EA.hy926) were stimulated with Aldo (100 nM) in the presence of tiron [reactive oxygen species (ROS) scavenger, eplerenone [mineralocorticoid receptor (MR) antagonist], and L-sulforaphane (SFN; Nrf2 activator). Thoracic aortas were also isolated from mice infused with Aldo (600 μg/kg per day) for 14 days. Aldo decreased endothelium-dependent vasorelaxation and increased ROS generation, effects prevented by tiron and MR blockade. Pharmacological activation of Nrf2 with SFN abrogated Aldo-induced vascular dysfunction and ROS generation. In EA.hy926 cells, Aldo increased ROS generation, which was prevented by eplerenone, tiron, and SFN. At short times, Aldo-induced ROS generation was linked to increased Nrf2 activation. However, after three hours, Aldo decreased the nuclear accumulation of Nrf2. Increased Keap1 protein expression, but not activation of p38 MAPK, was linked to Aldo-induced reduced Nrf2 activity. Arteries from Aldo-infused mice also exhibited decreased nuclear Nrf2 and increased Keap1 expression. Our findings suggest that Aldo reduces vascular Nrf2 transcriptional activity by Keap1-dependent mechanisms, contributing to mineralocorticoid-induced vascular dysfunction.
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20
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Biwer LA, Carvajal BV, Lu Q, Man JJ, Jaffe IZ. Mineralocorticoid and Estrogen Receptors in Endothelial Cells Coordinately Regulate Microvascular Function in Obese Female Mice. Hypertension 2021; 77:2117-2126. [PMID: 33934622 DOI: 10.1161/hypertensionaha.120.16911] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Lauren A Biwer
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (L.A.B., B.V.C., Q.L., J.J.M., I.Z.J.)
| | - Brigett V Carvajal
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (L.A.B., B.V.C., Q.L., J.J.M., I.Z.J.).,Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston MA (B.V.C., J.J.M., I.Z.J.)
| | - Qing Lu
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (L.A.B., B.V.C., Q.L., J.J.M., I.Z.J.)
| | - Joshua J Man
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (L.A.B., B.V.C., Q.L., J.J.M., I.Z.J.).,Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston MA (B.V.C., J.J.M., I.Z.J.)
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (L.A.B., B.V.C., Q.L., J.J.M., I.Z.J.).,Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston MA (B.V.C., J.J.M., I.Z.J.)
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21
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Aguilar M, Rose RA, Takawale A, Nattel S, Reilly S. New aspects of endocrine control of atrial fibrillation and possibilities for clinical translation. Cardiovasc Res 2021; 117:1645-1661. [PMID: 33723575 PMCID: PMC8208746 DOI: 10.1093/cvr/cvab080] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Hormones are potent endo-, para-, and autocrine endogenous regulators of the function of multiple organs, including the heart. Endocrine dysfunction promotes a number of cardiovascular diseases, including atrial fibrillation (AF). While the heart is a target for endocrine regulation, it is also an active endocrine organ itself, secreting a number of important bioactive hormones that convey significant endocrine effects, but also through para-/autocrine actions, actively participate in cardiac self-regulation. The hormones regulating heart-function work in concert to support myocardial performance. AF is a serious clinical problem associated with increased morbidity and mortality, mainly due to stroke and heart failure. Current therapies for AF remain inadequate. AF is characterized by altered atrial function and structure, including electrical and profibrotic remodelling in the atria and ventricles, which facilitates AF progression and hampers its treatment. Although features of this remodelling are well-established and its mechanisms are partly understood, important pathways pertinent to AF arrhythmogenesis are still unidentified. The discovery of these missing pathways has the potential to lead to therapeutic breakthroughs. Endocrine dysfunction is well-recognized to lead to AF. In this review, we discuss endocrine and cardiocrine signalling systems that directly, or as a consequence of an underlying cardiac pathology, contribute to AF pathogenesis. More specifically, we consider the roles of products from the hypothalamic-pituitary axis, the adrenal glands, adipose tissue, the renin–angiotensin system, atrial cardiomyocytes, and the thyroid gland in controlling atrial electrical and structural properties. The influence of endocrine/paracrine dysfunction on AF risk and mechanisms is evaluated and discussed. We focus on the most recent findings and reflect on the potential of translating them into clinical application.
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Affiliation(s)
- Martin Aguilar
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Robert A Rose
- Department of Cardiac Sciences, Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, Health Research Innovation Center, University of Calgary, AB, Canada
| | - Abhijit Takawale
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Stanley Nattel
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada.,Faculty of Medicine, Department of Pharmacology and Physiology, and Research Centre, Montreal Heart Institute and University of Montreal, Montreal, QC, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
| | - Svetlana Reilly
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
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22
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Jia G, Lockette W, Sowers JR. Mineralocorticoid receptors in the pathogenesis of insulin resistance and related disorders: from basic studies to clinical disease. Am J Physiol Regul Integr Comp Physiol 2021; 320:R276-R286. [PMID: 33438511 DOI: 10.1152/ajpregu.00280.2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aldosterone is a steroid hormone that regulates blood pressure and cardiovascular function by acting on renal and vascular mineralocorticoid receptors (MRs) to promote sodium retention and modulate endothelial function. Indeed, MRs are expressed in endothelial cells, vascular smooth muscle cells, adipocytes, immune cells, skeletal muscle cells, and cardiomyocytes. Excessive aldosterone and associated MR activation impair insulin secretion, insulin metabolic signaling to promote development of diabetes, and the related cardiometabolic syndrome. These adverse effects of aldosterone are mediated, in part, via increased inflammation, oxidative stress, dyslipidemia, and ectopic fat deposition. Therefore, inhibition of MR activation may have a beneficial effect in prevention of impaired insulin metabolic signaling, type 2 diabetes, and cardiometabolic disorders. This review highlights findings from the recent surge in research regarding MR-related cardiometabolic disorders as well as our contemporary understanding of the detrimental effects of excess MR activation on insulin metabolic signaling.
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Affiliation(s)
- Guanghong Jia
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri.,Research Service, Truman Memorial Veterans Hospital, Columbia, Missouri
| | - Warren Lockette
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri.,Department of Medicine and Physiology, Wayne State University, Detroit, Michigan
| | - James R Sowers
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri.,Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, Missouri.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri
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23
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Ayuzawa N, Fujita T. The Mineralocorticoid Receptor in Salt-Sensitive Hypertension and Renal Injury. J Am Soc Nephrol 2021; 32:279-289. [PMID: 33397690 PMCID: PMC8054893 DOI: 10.1681/asn.2020071041] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hypertension and its comorbidities pose a major public health problem associated with disease-associated factors related to a modern lifestyle, such high salt intake or obesity. Accumulating evidence has demonstrated that aldosterone and its receptor, the mineralocorticoid receptor (MR), have crucial roles in the development of salt-sensitive hypertension and coexisting cardiovascular and renal injuries. Accordingly, clinical trials have repetitively shown the promising effects of MR blockers in these diseases. We and other researchers have identified novel mechanisms of MR activation involved in salt-sensitive hypertension and renal injury, including the obesity-derived overproduction of aldosterone and ligand-independent signaling. Moreover, recent advances in the analysis of cell-specific and context-dependent mechanisms of MR activation in various tissues-including a classic target of aldosterone, aldosterone-sensitive distal nephrons-are now providing new insights. In this review, we summarize recent updates to our understanding of aldosterone-MR signaling, focusing on its role in salt-sensitive hypertension and renal injury.
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Affiliation(s)
- Nobuhiro Ayuzawa
- Division of Clinical Epigenetics, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Toshiro Fujita
- Division of Clinical Epigenetics, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan,Shinshu University School of Medicine, Nagano, Japan,Research Center for Social Systems, Shinshu University, Nagano, Japan
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24
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Thuzar M, Stowasser M. The mineralocorticoid receptor-an emerging player in metabolic syndrome? J Hum Hypertens 2021; 35:117-123. [PMID: 33526798 DOI: 10.1038/s41371-020-00467-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 01/30/2023]
Abstract
Metabolic syndrome is a cluster of conditions that increase the risk of cardiovascular diseases, and comprises obesity, hypertension, impaired glucose metabolism and dyslipidaemia. It is well recognised that the mineralocorticoid receptor (MR) plays an important role in blood pressure regulation via its effect on salt and water retention in renal tubules, with hypertension being a key feature in primary aldosteronism patients with excess adrenal production of aldosterone, the primary ligand for MRs in the epithelial tissues. MRs are also expressed in a number of non-epithelial tissues including adipose tissue; in these tissues, glucocorticoids or cortisol can also activate MRs due to low levels of 11-beta-hydroxysteroid-dehydrogenase type 2 (11-βHSD2), the enzyme which inactivates cortisol. There is increasing evidence suggesting that over-activation of MRs plays a role in the pathophysiology of the other components of metabolic syndrome, promoting adiposity, inflammation and glucose intolerance, and that MR antagonists may confer beneficial effects on energy and substrate homeostasis and cardiometabolic diseases. This review discusses the advances in the literature shedding light on the MR as an emerging player in metabolic syndrome.
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Affiliation(s)
- Moe Thuzar
- Endocrine Hypertension Research Centre, The University of Queensland Diamantina Institute & Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia. .,Department of Endocrinology & Diabetes, Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia.
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, The University of Queensland Diamantina Institute & Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia
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25
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Faulkner JL, Harwood D, Kennard S, Antonova G, Clere N, Belin de Chantemèle EJ. Dietary sodium restriction sex specifically impairs endothelial function via mineralocorticoid receptor-dependent reduction in NO bioavailability in Balb/C mice. Am J Physiol Heart Circ Physiol 2021; 320:H211-H220. [PMID: 33095056 PMCID: PMC7847080 DOI: 10.1152/ajpheart.00413.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
Recent findings from our group demonstrated that females exhibit higher endothelial mineralocorticoid receptor (MR) expression than males, which predisposes them to aldosterone-mediated endothelial dysfunction in the context of metabolic disorders. However, whether the endothelium of female mice presents a higher propensity to MR-mediated dysfunction than that of males in the absence of comorbidities remains unknown. We therefore sought to investigate whether increasing aldosterone production endogenously with sodium restriction impairs endothelial function in otherwise healthy female mice. We fed male and female Balb/C mice a normal (0.4% NaCl; NSD) or sodium-restricted diet (0.05% NaCl; SRD) for 4 wk. Females exhibited higher baseline endothelial function (relaxation to acetylcholine) and lower vascular contractility (constriction to phenylephrine, serotonin, and KCl). However, SRD impaired endothelial-dependent relaxation and increased vascular contractility in female mice, effectively ablating the baseline sex difference. Female sex also increased baseline adrenal CYP11B2 expression; however, SRD significantly enhanced CYP11B2 expression in male and female mice and ablated the sex difference. Nitric oxide synthase (NOS) inhibition with Nω-nitro-l-arginine methyl ester hydrochloride eliminated both sex as well as diet-induced differences in endothelial dysfunction. In accordance, females demonstrated higher vascular endothelial NOS expression at baseline, which SRD significantly decreased. In addition, SRD diminished vascular NOX4 expression in female mice only. MR blockade with spironolactone-protected female mice from decreases in endothelial-dependent relaxation but not increases in vascular contractility. Utilizing sodium restriction as a method to increase plasma aldosterone levels in healthy female mice, we demonstrated that female mice are more susceptible to vascular damage via MR activation in the vascular endothelium only.NEW & NOTEWORTHY Female sex confers improved endothelial relaxation and vascular constriction responses in female Balb/C mice compared with males under baseline conditions. Sodium restriction impairs endothelial function, which is nitric oxide dependent, and increases vascular contractility in association with reduced vascular endothelial nitric oxide synthase and NOX4 expression in female mice ablating the baseline sex difference. Mineralocorticoid receptor antagonism ablates sodium restriction-induced endothelial dysfunction, but not increased vascular contractility, in female mice.
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Affiliation(s)
- Jessica L Faulkner
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Daisy Harwood
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Simone Kennard
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Galina Antonova
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Nicolas Clere
- Micro and Nanomédecines Translationelles-MINT, UNIV Angers, INSERM U1066, CNRS UMR 6021, Université Bretagne Loire, Angers, France
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia
- Department of Cardiology, Medical College of Georgia at Augusta University, Augusta, Georgia
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26
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Hammoud SH, AlZaim I, Al-Dhaheri Y, Eid AH, El-Yazbi AF. Perirenal Adipose Tissue Inflammation: Novel Insights Linking Metabolic Dysfunction to Renal Diseases. Front Endocrinol (Lausanne) 2021; 12:707126. [PMID: 34408726 PMCID: PMC8366229 DOI: 10.3389/fendo.2021.707126] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
A healthy adipose tissue (AT) is indispensable to human wellbeing. Among other roles, it contributes to energy homeostasis and provides insulation for internal organs. Adipocytes were previously thought to be a passive store of excess calories, however this view evolved to include an endocrine role. Adipose tissue was shown to synthesize and secrete adipokines that are pertinent to glucose and lipid homeostasis, as well as inflammation. Importantly, the obesity-induced adipose tissue expansion stimulates a plethora of signals capable of triggering an inflammatory response. These inflammatory manifestations of obese AT have been linked to insulin resistance, metabolic syndrome, and type 2 diabetes, and proposed to evoke obesity-induced comorbidities including cardiovascular diseases (CVDs). A growing body of evidence suggests that metabolic disorders, characterized by AT inflammation and accumulation around organs may eventually induce organ dysfunction through a direct local mechanism. Interestingly, perirenal adipose tissue (PRAT), surrounding the kidney, influences renal function and metabolism. In this regard, PRAT emerged as an independent risk factor for chronic kidney disease (CKD) and is even correlated with CVD. Here, we review the available evidence on the impact of PRAT alteration in different metabolic states on the renal and cardiovascular function. We present a broad overview of novel insights linking cardiovascular derangements and CKD with a focus on metabolic disorders affecting PRAT. We also argue that the confluence among these pathways may open several perspectives for future pharmacological therapies against CKD and CVD possibly by modulating PRAT immunometabolism.
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Affiliation(s)
- Safaa H. Hammoud
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Ibrahim AlZaim
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Departmment of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yusra Al-Dhaheri
- Department of Biology, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Ali H. Eid
- Department of Basic Medical Sciences, College of Medicine, Qatar University, Doha, Qatar
- Biomedical and Pharmaceutical Research Unit, Qatar University (QU) Health, Qatar University, Doha, Qatar
| | - Ahmed F. El-Yazbi
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
- Faculty of Pharmacy, Alalamein International University, Alalamein, Egypt
- *Correspondence: Ahmed F. El-Yazbi,
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27
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Berney M, Vakilzadeh N, Maillard M, Faouzi M, Grouzmann E, Bonny O, Favre L, Wuerzner G. Bariatric Surgery Induces a Differential Effect on Plasma Aldosterone in Comparison to Dietary Advice Alone. Front Endocrinol (Lausanne) 2021; 12:745045. [PMID: 34675881 PMCID: PMC8525894 DOI: 10.3389/fendo.2021.745045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The pathophysiological mechanisms linking weight loss to blood pressure (BP) reduction are not completely understood. The objective of this study was to compare the effect of weight loss after Roux-en-Y gastric bypass (RYGB) on BP, renin-angiotensin-aldosterone system (RAAS), and urinary electrolytes excretion to those of dietary advice. METHODS This was a case-control prospective study including obese patients referred for RYGB (cases) and obese receiving diet advice only (controls). Ambulatory BP, plasma renin activity (PRA), plasma aldosterone concentration (PAC), and urinary electrolytes were measured before (M0) and after intervention (M3: 3 months and M12: 12 months). RESULTS Twenty-five patients were included in the RYGB group and twelve patients in the control group. After 12 months, weight loss (-42 ± 11.5 vs -12.3 ± 6.3 kg in the control group, p=0.001) and decrease in PAC were more pronounced in the RYGB group (-34 ± 76 vs +14 ± 45 pg/ml in the control group, p=0.002). There was no difference in PRA between both groups (-0.08 ± 1.68 vs 0.01 ± 0.37 ng/ml/h, p=0.31). Sodium excretion was more marked in the RYGB group after 3 months only (-89 ± 14.9 vs -9.9 ± 27.9 mmol/day, p=0.009). The decrease in SBP was similar between both groups (-6.9 ± 9.9 vs -7.1 ± 11.9 mmHg in the control group, p=0.96). CONCLUSIONS Bariatric-induced weight loss induces a progressive decrease in PAC independently of PRA and sodium excretion. Whether this decrease in PAC affects target organ damage in the long term remains to be determined. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT02218112.
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Affiliation(s)
- Maxime Berney
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nima Vakilzadeh
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marc Maillard
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mohamed Faouzi
- Département de Formation, Recherche et Innovation, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Eric Grouzmann
- Laboratoire des Catécholamines et Peptides, Service de Biomédecine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Bonny
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Lucie Favre
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Grégoire Wuerzner
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Grégoire Wuerzner, ; orcid.org/0000-0002-6424-7630
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28
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Haze T, Hatakeyama M, Komiya S, Kawano R, Ohki Y, Suzuki S, Kobayashi Y, Fujiwara A, Saka S, Tamura K, Hirawa N. Association of the ratio of visceral-to-subcutaneous fat volume with renal function among patients with primary aldosteronism. Hypertens Res 2021; 44:1341-1351. [PMID: 34363052 PMCID: PMC8490149 DOI: 10.1038/s41440-021-00719-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 02/07/2023]
Abstract
Patients with primary aldosteronism have a higher risk of chronic kidney disease. Visceral fat tissue is hypothesized to stimulate the adrenal glands to overproduce aldosterone, and aldosterone promotes visceral fat tissue to produce inflammatory cytokines. However, it is unclear whether the volume of accumulated visceral fat tissue is associated with renal impairment among patients with hyperaldosteronism. We conducted a single-center cross-sectional study to assess the association between the estimated glomerular filtration rate and the ratio of the visceral-to-subcutaneous fat volume calculated by computed tomography. One hundred eighty patients with primary aldosteronism were enrolled. The mean ± SD age was 52.7 ± 11.0 years, and 60.0% were women. The ratio of visceral-to-subcutaneous fat volume was highly correlated with the estimated glomerular filtration rate (r = 0.49, p < 0.001). In multiple linear regression models, the ratio of visceral-to-subcutaneous fat tissue volume was significantly associated with the estimated glomerular filtration rate (estimates: -4.56 mL/min/1.73 m² per 1-SD), and there was an interaction effect between the plasma aldosterone concentration and the ratio of visceral-to-subcutaneous fat volume (p < 0.05). The group with a higher plasma aldosterone concentration exhibited a steeper decline in eGFR than the lower plasma aldosterone concentration group when the ratio increased. The ratio of visceral-to-subcutaneous fat tissue volume was an independent risk factor for renal dysfunction. This association increased in the presence of a high plasma aldosterone concentration. Clinicians should pay attention to the ratio of visceral-to-subcutaneous fat tissue volume and encourage primary aldosteronism patients to improve their lifestyle in addition to treating renin-aldosterone activity.
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Affiliation(s)
- Tatsuya Haze
- grid.268441.d0000 0001 1033 6139Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan ,grid.413045.70000 0004 0467 212XDepartment of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Moe Hatakeyama
- grid.268441.d0000 0001 1033 6139Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan ,grid.413045.70000 0004 0467 212XDepartment of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Shiro Komiya
- grid.268441.d0000 0001 1033 6139Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan ,grid.413045.70000 0004 0467 212XDepartment of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Rina Kawano
- grid.413045.70000 0004 0467 212XDepartment of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuki Ohki
- grid.413045.70000 0004 0467 212XDepartment of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Shota Suzuki
- grid.413045.70000 0004 0467 212XDepartment of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Kobayashi
- grid.268441.d0000 0001 1033 6139Center for Nobel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University, Yokohama, Japan
| | - Akira Fujiwara
- grid.413045.70000 0004 0467 212XDepartment of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Sanae Saka
- grid.413045.70000 0004 0467 212XDepartment of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- grid.268441.d0000 0001 1033 6139Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhito Hirawa
- grid.413045.70000 0004 0467 212XDepartment of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
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Faulkner JL, Lluch E, Kennard S, Antonova G, Jaffe IZ, Belin de Chantemèle EJ. Selective deletion of endothelial mineralocorticoid receptor protects from vascular dysfunction in sodium-restricted female mice. Biol Sex Differ 2020; 11:64. [PMID: 33228767 PMCID: PMC7685592 DOI: 10.1186/s13293-020-00340-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/02/2020] [Indexed: 12/20/2022] Open
Abstract
Background Recent evidence by our laboratory demonstrates that women and female mice endogenously express higher endothelial mineralocorticoid receptor (ECMR) than males. Mounting clinical evidence also indicates that aldosterone production is higher in pathological conditions in females compared to males. However, the role for increased activation of ECMR by aldosterone in the absence of a comorbid condition is yet to be explored. The current study hypothesized that increased ECMR activation induced by elevated aldosterone production predisposes healthy female mice to endothelial dysfunction. Method Vascular reactivity was assessed in aortic rings from wild-type (WT) and ECMR KO (KO) mice fed either a normal salt (NSD, 0.4% NaCl) or sodium-restricted diet (SRD, 0.05% NaCl) for 28 days. Results SRD elevated plasma aldosterone levels as well as adrenal CYP11B2 and angiotensin II type 1 receptor (AT1R) expressions in female, but not male, WT mice. In baseline conditions (NSD), endothelial function, assessed by vascular relaxation to acetylcholine, was higher while vascular contractility to phenylephrine, serotonin, and KCl lower in female than male WT mice. SRD impaired endothelial function and increased vascular contractility in female, but not male, WT mice effectively ablating the baseline sex differences. NOS inhibition with LNAME ablated endothelial relaxation to a higher extent in male than female mice on NSD and ablated differences in acetylcholine relaxation responses between NSD- and SRD-fed females, indicating a role for NO in SRD-mediated endothelial function. In association, SRD significantly reduced vascular NOX4 expression in female, but not male, mice. Lastly, selective deletion of ECMR protected female mice from SRD-mediated endothelial dysfunction and increased vascular contractility. Conclusion Collectively, these data indicate that female mice develop aldosterone-induced endothelial dysfunction via endothelial MR-mediated reductions in NO bioavailability. In addition, these data support a role for ECMR to promote vascular contractility in female mice in response to sodium restriction.
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Affiliation(s)
- Jessica L Faulkner
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA.
| | - Emily Lluch
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA
| | - Simone Kennard
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA
| | - Galina Antonova
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, USA
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA, 30912, USA.,Department of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
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30
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Gafane-Matemane LF, Mokae NL, Breet Y, Poglitsch M, Schutte AE. Associations of central and peripheral blood pressure with the renin-angiotensin-aldosterone system in healthy young adults: the African-PREDICT study. Hypertens Res 2020; 44:435-445. [PMID: 33122821 DOI: 10.1038/s41440-020-00566-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 11/09/2022]
Abstract
This study investigated associations of brachial and central blood pressure (BP) with detailed renin-angiotensin-aldosterone system (RAAS) components in a healthy young population stratified according to ethnicity and sex. We included healthy black men (n = 285) and women (n = 304) and white men (n = 278) and women (n = 305) aged 20-30 years old. We derived central systolic BP (cSBP), measured clinic and 24-h systolic and diastolic BP. Aldosterone and equilibrium angiotensin levels were assessed and used for calculating angiotensin-derived markers for plasma renin activity (PRA-S, Angiotensin I + Angiotensin II), angiotensin-converting enzyme (ACE-S, Angiotensin II/Angiotensin I), and two markers for adrenal effects of angiotensin II, the aldosterone-to-renin ratio (ARR-S, Aldosterone/PRA-S) and the aldosterone-to-angiotensin II-ratio (AA2-R, Aldosterone/Angiotensin II). Young black men and women presented with lower RAAS components and higher cSBP compared to their white counterparts (all p ≤ 0.001). In multivariable-adjusted regression analyses, positive associations of cSBP with ARR-S and AA2-R and negative associations with PRA-S and angiotensin II were found for black women (all p ≤ 0.001); this pattern was also observed for 24-h and clinic BP (p ≤ 0.045). A similar trend of RAAS associations was present in black men but only for clinic BP (all p ≤ 0.047). In white men, negative associations between clinic SBP and PRA-S, angiotensin II and aldosterone were detected (all p ≤ 0.048). No associations were observed in white women. Positive associations of central and peripheral BP with the ratio of aldosterone to PRA-S and angiotensin II only in healthy, young black adults suggest that relative aldosterone excess may contribute to early hypertension development in this group.
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa. .,Medical Research Council, Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Nametsegang L Mokae
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council, Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Yolandi Breet
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council, Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | | | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council, Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
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Sex differences in cardiovascular actions of the renin-angiotensin system. Clin Auton Res 2020; 30:393-408. [PMID: 32860555 DOI: 10.1007/s10286-020-00720-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease (CVD) remains a worldwide public health concern despite decades of research and the availability of numerous targeted therapies. While the intrinsic physiological mechanisms regulating cardiovascular function are similar between males and females, marked sex differences have been established in terms of CVD onset, pathophysiology, manifestation, susceptibility, prevalence, treatment responses and outcomes in animal models and clinical populations. Premenopausal females are generally protected from CVD in comparison to men of similar age, with females tending to develop cardiovascular complications later in life following menopause. Emerging evidence suggests this cardioprotection in females is, in part, attributed to sex differences in hormonal regulators, such as the renin-angiotensin system (RAS). To date, research has largely focused on canonical RAS pathways and shown that premenopausal females are protected from cardiovascular derangements produced by activation of angiotensin II pathways. More recently, a vasodilatory arm of the RAS has emerged that is characterized by angiotensin-(1-7) [(Ang-(1-7)], angiotensin-converting enzyme 2 and Mas receptors. Emerging studies provide evidence for a shift towards these cardioprotective Ang-(1-7) pathways in females, with effects modulated by interactions with estrogen. Despite well-established sex differences, female comparison studies on cardiovascular outcomes are lacking at both the preclinical and clinical levels. Furthermore, there are no specific guidelines in place for the treatment of cardiovascular disease in men versus women, including therapies targeting the RAS. This review summarizes current knowledge on sex differences in the cardiovascular actions of the RAS, focusing on interactions with gonadal hormones, emerging data for protective Ang-(1-7) pathways and potential clinical implications for established and novel therapies.
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Nostell K, Lindåse S, Winqvist E, Bröjer J. The effect of diet-induced obesity and pasture on blood pressure and serum cortisol in Standardbred mares. Equine Vet J 2020; 53:542-548. [PMID: 32483866 DOI: 10.1111/evj.13294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/27/2020] [Accepted: 05/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Obesity is associated with insulin resistance, vascular dysfunction and altered cortisol metabolism both in humans and in horses. OBJECTIVES Evaluate the effect of weight gain induced by a haylage diet low in nonstructural carbohydrates (NSC) on insulin sensitivity, blood pressure and serum cortisol concentrations. STUDY DESIGN In vivo experiment. METHODS Nine adult Standardbred mares fed a fat supplemented haylage diet at 250% of the horses' daily metabolisable energy requirements for 22 weeks. Horses were then turned out on pasture for 4 weeks. Insulin sensitivity (SICLAMP ) was measured before and after weight gain and after 4 weeks of pasture using the euglycemic hyperinsulinaemic clamp (EHC) method. Body condition score (BCS), blood pressure and serum cortisol were monitored throughout the study. All data were analysed using the linear mixed model procedure. Values of P < 0.05 were considered as statistically different. RESULTS All horses became obese during the weight gain period (BCS> 7). Mean arterial blood pressure (MAP) increased during the weight gain period and was significantly higher than initial values at the end of the weight gain period (78 ± 3 mm Hg vs 92 ± 3 mmHg). MAP remained increased on pasture (93 ± 3 mmHg). SICLAMP was unaffected by weight gain 0.9 ± 0.1 vs 1.0 ± 0.1 ([mg/kg/min × 103 ]/[µIU/mL × mmol/L])) but improved after pasture (1.6 ± 0.1 ([mg/kg/min × 103 ]/ [mU/L]). Serum cortisol concentrations increased during the weight gain period (80 ± 9 nmol/L vs 112 ± 9 nmol/L) and remained increased during pasture. MAIN LIMITATIONS Limited number of horses and no control group. CONCLUSIONS Obesity was associated with a linear increase in blood pressure and an increase in serum cortisol that was not associated with insulin sensitivity.
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Affiliation(s)
| | - Sanna Lindåse
- Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Johan Bröjer
- Department of Clinical Sciences, Uppsala, Sweden
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Er LK, Lin MC, Tsai YC, Hsiao JK, Yang CY, Chang CC, Peng KY, Chueh JS, Wu VC. Association of visceral adiposity and clinical outcome among patients with aldosterone producing adenoma. BMJ Open Diabetes Res Care 2020; 8:8/1/e001153. [PMID: 32713841 PMCID: PMC7383952 DOI: 10.1136/bmjdrc-2019-001153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/11/2020] [Accepted: 06/10/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Primary aldosteronism (PA) is a common form of secondary hypertension that has significant cardiovascular events and increased prevalence of metabolic syndrome and diabetics. Although plasma aldosterone concentration is positively correlated with visceral fat area (VFA) in non-PA individuals, the role of visceral adiposity associated with clinical success after surgery is not known. RESEARCH DESIGN AND METHODS We analyzed patients who underwent adrenalectomy for aldosterone-producing adenoma (APA) at the Taiwan PA Investigator group. VFA was calculated from the abdominal CT scan at APA diagnosis, and all patients received adrenalectomy. RESULTS The study involved 100 consecutive patients with APA (42 males; mean age 49.3 years) matched with 41 essential hypertension (EH) patients. Patients with APA had smaller VFA (p=0.010) than their EH counterparts. Multiple linear regression analysis revealed that the duration of hypertension (p=0.007), but not plasma aldosterone, was negatively correlated with VFA in patients with APA. Logistic regression analysis showed that log VFA (OR=0.065, p<0.001) and duration of hypertension before PA diagnosis (OR=0.919, p=0.011) can predict complete clinical success after adrenalectomy. Multifactor-adjusted generalized additive model demonstrated that log VFA <9.2 was associated with complete cure of hypertension. Furthermore, VFA was increased at 6 months after adrenalectomy (p=0.045). CONCLUSIONS Patients with APA had smaller VFA than their EH counterparts, and VFA increased after adrenalectomy. Clinical complete cure of hypertension after surgery was associated with smaller VFA and shorter duration of hypertension at PA diagnosis, suggesting a potential interplay of visceral adiposity and aldosterone of the patients with APA.
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Affiliation(s)
- Leay Kiaw Er
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University College of Medicine, Hualien, Taiwan
| | - Meng-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital, Chu-Tung Branch, Chu-Tung, Taiwan
| | - Yao-Chou Tsai
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Urology, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jong-Kai Hsiao
- College of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Radiology, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan
| | - Chung-Yi Yang
- Department of Radiology, E-Da Hospital, Kaohsiung City, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kang-Yung Peng
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jeff S Chueh
- Department of Urology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vin-Cent Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Manrique-Acevedo C, Chinnakotla B, Padilla J, Martinez-Lemus LA, Gozal D. Obesity and cardiovascular disease in women. Int J Obes (Lond) 2020; 44:1210-1226. [PMID: 32066824 PMCID: PMC7478041 DOI: 10.1038/s41366-020-0548-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
Abstract
As the prevalence of obesity continues to grow worldwide, the health and financial burden of obesity-related comorbidities grows too. Cardiovascular disease (CVD) is clearly associated with increased adiposity. Importantly, women are at higher risk of CVD when obese and insulin resistant, in particular at higher risk of developing heart failure with preserved ejection fraction and ischemic heart disease. Increased aldosterone and mineralocorticoid receptor activation, aberrant estrogenic signaling and elevated levels of androgens are among some of the proposed mechanisms explaining the heightened CVD risk. In addition to traditional cardiovascular risk factors, understanding nontraditional risk factors specific to women, like excess weight gain during pregnancy, preeclampsia, gestational diabetes, and menopause are central to designing personalized interventions aimed to curb the epidemic of CVD. In the present review, we examine the available evidence supporting a differential cardiovascular impact of increased adiposity in women compared with men and the proposed pathophysiological mechanisms behind these differences. We also discuss women-specific cardiovascular risk factors associated with obesity and insulin resistance.
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Affiliation(s)
- Camila Manrique-Acevedo
- Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri, Columbia, MO, USA
- Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
| | - Bhavana Chinnakotla
- Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Jaume Padilla
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Luis A Martinez-Lemus
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA
| | - David Gozal
- Department of Child Health, University of Missouri, Columbia, MO, USA.
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The Association Between Vascular Inflammation and Depressive Disorder. Causality, Biomarkers and Targeted Treatment. Pharmaceuticals (Basel) 2020; 13:ph13050092. [PMID: 32408603 PMCID: PMC7281196 DOI: 10.3390/ph13050092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 12/18/2022] Open
Abstract
Diabetes, obesity, atherosclerosis, and myocardial infarction are frequently co-morbid with major depressive disorder. In the current review, it is argued that vascular inflammation is a factor that is common to all disorders and that an endothelial dysfunction of the blood-brain barrier could be involved in the induction of depression symptoms. Biomarkers for vascular inflammation include a high plasma level of C-reactive protein, soluble cell-adhesion molecules, von Willebrand factor, aldosterone, and proinflammatory cytokines like interleukin-6 or tumor necrosis factor α. A further possible biomarker is flow-mediated dilation of the brachial artery. Treatment of vascular inflammation is expected to prevent or to reduce symptoms of depression. Several tentative treatments for this form of depression can be envisioned: eicosapentaenoic acid (EPA), valproate, Vagus-nerve stimulation, nicotinic α7 agonists, and agonists of the cannabinoid CB2-receptor.
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Packer M. Obesity-Associated Heart Failure as a Theoretical Target for Treatment With Mineralocorticoid Receptor Antagonists. JAMA Cardiol 2019; 3:883-887. [PMID: 30046826 DOI: 10.1001/jamacardio.2018.2090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Despite their clinical benefits, mineralocorticoid receptor antagonists are greatly underprescribed by most practitioners who treat patients with chronic heart failure. A novel approach to encouraging the use of these drugs is to enhance awareness about the intimate link between aldosterone and obesity. Observations There is a strong association between abdominal obesity and circulating levels of aldosterone, and markers of abdominal obesity identify patients most likely to benefit from mineralocorticoid receptor antagonism. In a trial of patients with heart failure and a reduced ejection fraction, patients with an increased waist circumference exhibited an approximately 50% reduction in the risk of a primary end point. The magnitude of benefit was more than twice as great in patients with abdominal obesity than in those with a normal waist circumference, and patients with abdominal obesity tolerated treatment better than nonobese patients. Similarly, in a trial of patients with heart failure and a preserved ejection fraction, those who were most likely to have abdominal obesity (identified by their level of natriuretic peptides) were most likely to demonstrate a benefit of treatment with spironolactone, exhibiting an approximately 80% reduction in the risk of a primary end point (based on a small number of events). Conclusions and Relevance Although these analyses are post hoc, their concordance and strong biological foundation suggests that abdominal obesity may identify patients who respond most favorably to mineralocorticoid receptor antagonism. Given the easy availability of its measurement, targeting patients with an increased waist circumference could enhance the adoption of these important drugs for the treatment of chronic heart failure in clinical practice.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
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Evaluation of the pathophysiological mechanisms of salt-sensitive hypertension. Hypertens Res 2019; 42:1848-1857. [PMID: 31541221 DOI: 10.1038/s41440-019-0332-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/23/2022]
Abstract
The currently available data have indicated that dietary salt is directly correlated with blood pressure (BP) and the occurrence of hypertension. However, the salt sensitivity of BP is different in each individual. Genetic factors and environmental factors influence the salt sensitivity of BP. Obesity, stress, and aging are strongly associated with increased BP salt sensitivity. Indeed, a complex and interactive genetic and environmental system can determine an individual's BP salt sensitivity. However, the genetic/epigenetic determinants leading to salt sensitivity of BP are still challenging to identify primarily because lifestyle-related diseases, including hypertension, usually become a medical problem during adulthood, although their causes may be attributed to the earlier stages of ontogeny. The association between distinct developmental periods involves changes in gene expression, which include epigenetic phenomena. The role of epigenetic modification in the development of salt-sensitive hypertension is presently under investigation. Recently, we identified aberrant DNA methylation in the context of prenatally programmed hypertension. In this review, we summarize the existing knowledge regarding the pathophysiological mechanisms of salt-sensitive hypertension. Additionally, we discuss the contribution of epigenetic mechanisms in the development of salt-sensitive hypertension.
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Faulkner JL, Belin de Chantemèle EJ. Mineralocorticoid Receptor and Endothelial Dysfunction in Hypertension. Curr Hypertens Rep 2019; 21:78. [PMID: 31485760 DOI: 10.1007/s11906-019-0981-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To review the latest reports of the contributions of the endothelial mineralocorticoid receptor to endothelial dysfunction and hypertension to begin to determine the clinical potential for this pathway for hypertension treatment. RECENT FINDINGS Endothelial mineralocorticoid receptor expression is sex-specifically increased in female mice and humans compared with males. Moreover, the expression of endothelial mineralocorticoid receptors is increased by endothelial progesterone receptor activation and naturally occurring fluctuations in progesterone levels (estrous, pregnancy) predict endothelial mineralocorticoid receptor expression levels in female mice. These data follow many previous reports that have indicated that endothelial mineralocorticoid receptor deletion is protective in the development of obesity- and diabetes-associated endothelial dysfunction in female mouse models. These studies have more recently been followed up by reports indicating that both intact endothelial mineralocorticoid receptor and progesterone receptor expression are required for obesity-associated, leptin-mediated endothelial dysfunction in female mice. In addition, the intra-endothelial signaling pathway for endothelial mineralocorticoid receptors to induce dysfunction requires the intact expression of α-epithelial sodium channels (αENaC) in endothelial cells in females. Endothelial mineralocorticoid receptors are sex-specifically upregulated in the vasculature of females, a sex difference which is driven by endothelial progesterone receptor activation, and increased activity of these endothelial mineralocorticoid receptors is a crucial mediator of endothelial dysfunction, and potentially hypertension, in obese female experimental models.
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Affiliation(s)
- Jessica L Faulkner
- Vascular Biology Center, Department of Medicine (Cardiology), Medical College of Georgia, Augusta University, 1460 Laney Walker Blvd., Augusta, GA, 30912, USA
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Department of Medicine (Cardiology), Medical College of Georgia, Augusta University, 1460 Laney Walker Blvd., Augusta, GA, 30912, USA.
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Syme C, Shin J, Richer L, Gaudet D, Paus T, Pausova Z. Sex Differences in Blood Pressure Hemodynamics in Middle-Aged Adults With Overweight and Obesity. Hypertension 2019; 74:407-412. [DOI: 10.1161/hypertensionaha.119.13058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
High blood pressure (BP) is the strongest modifiable risk factor for cardiovascular disease. Overweight/obesity is a major risk factor of high BP. Multiple sex differences exist in mechanistic pathways that increase BP in overweight/obesity. They may result in a sex-specific pattern of BP hemodynamics—males and females may vary in the relative contributions of stroke volume, total peripheral resistance (TPR), and heart rate to higher BP. We investigated this possibility in a population-based sample of middle-aged adults (36–65 years). The total sample (n=618) included 289 males and 329 females; 79% of males and 66% of females were overweight. In all, we measured BP, stroke volume, TPR, and heart rate beat-by-beat during a 52-minute protocol that included changes in posture and mental stress. We assessed the relative contributions of stroke volume, TPR, and heart rate to BP at each minute of the protocol. We observed marked sex differences in BP hemodynamics in overweight/obese individuals: the main determinant of higher BP was TPR in males (49% versus only 35% in females,
P
=0.008), whereas it was stroke volume in females (51% versus only 35% in males,
P
=0.006). These sex differences were most apparent when standing or sitting at rest. No such differences were seen in normal-weight individuals in whom the main determinant of higher BP was TPR in both sexes. Our study suggests that, in middle-aged adults, marked sex differences exist in BP hemodynamics, contributing to high BP in overweight/obese but not normal-weight individuals. As such, this study may contribute to precision medicine in hypertension.
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Affiliation(s)
- Catriona Syme
- From the Hospital for Sick Children (C.S., J.S., Z.P.), University of Toronto, Canada
- Departments of Physiology and Nutritional Sciences (C.S., J.S., Z.P.), University of Toronto, Canada
| | - Jean Shin
- From the Hospital for Sick Children (C.S., J.S., Z.P.), University of Toronto, Canada
- Departments of Physiology and Nutritional Sciences (C.S., J.S., Z.P.), University of Toronto, Canada
| | - Louis Richer
- Department of Health Sciences Université du Québec à Chicoutimi, Canada (L.R.)
| | - Daniel Gaudet
- Community Genomic Centre, Université de Montréal, Chicoutimi, Canada (D.G.)
| | - Tomáš Paus
- Departments of Psychology and Psychiatry (T.P.), University of Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada (T.P.)
| | - Zdenka Pausova
- From the Hospital for Sick Children (C.S., J.S., Z.P.), University of Toronto, Canada
- Departments of Physiology and Nutritional Sciences (C.S., J.S., Z.P.), University of Toronto, Canada
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41
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Li L, Hou X, Geng X, Xu Y. Body mass index predicts aldosterone production in hypertensive postmenopausal women. Clin Exp Hypertens 2019; 42:281-286. [PMID: 31362536 DOI: 10.1080/10641963.2019.1649683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hypertension is a common clinical problem, and increased aldosterone is the most prevalent underlying characteristic. Related works have shown exciting results on the effects of various conditions on aldosterone content, but the correlation between aldosterone levels and body mass index (BMI) in premenopausal women has not yet been investigated. We herein report a cross-sectional analysis aimed to determine whether BMI is proportional to plasma aldosterone concentration in premenopausal and postmenopausal hypertensive women. The analysis of consecutive admitted female patients with hypertension revealed potential relationships among plasma aldosterone concentration, plasma renin activity, oestrogen, and BMI. It should be noted that plasma aldosterone concentration was significantly correlated with BMI (p < .05) in postmenopausal women, and both plasma aldosterone and oestrogen levels were decreased in premenopausal women. These findings suggest that BMI has a positive impact on aldosterone in postmenopausal hypertensive women but not in premenopausal women. Additionally, we predict that endogenous oestrogen may be an important indication of aldosterone changes in premenopausal hypertensive women of different body weights.
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Affiliation(s)
- Lijun Li
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Hou
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xiaowen Geng
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yong Xu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
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42
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Faulkner JL, Kennard S, Huby AC, Antonova G, Lu Q, Jaffe IZ, Patel VS, Fulton DJR, Belin de Chantemèle EJ. Progesterone Predisposes Females to Obesity-Associated Leptin-Mediated Endothelial Dysfunction via Upregulating Endothelial MR (Mineralocorticoid Receptor) Expression. Hypertension 2019; 74:678-686. [PMID: 31327274 DOI: 10.1161/hypertensionaha.119.12802] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Compelling clinical evidence indicates that obesity and its associated metabolic abnormalities supersede the protective effects of female sex-hormones and predisposes premenopausal women to cardiovascular disease. The underlying mechanisms remain poorly defined; however, recent studies have implicated overactivation of the aldosterone-MR (mineralocorticoid receptor) axis as a cause of sex-specific cardiovascular risk in obese females. Experimental evidence indicates that the MR on endothelial cells contributes to obesity-associated, leptin-induced endothelial dysfunction in female experimental models, however, the vascular-specific mechanisms via which females are predisposed to heightened endothelial MR activation remain unknown. Therefore, we hypothesized that endogenous expression of endothelial MR is higher in females than males, which predisposes them to obesity-associated, leptin-mediated endothelial dysfunction. We found that endothelial MR expression is higher in blood vessels from female mice and humans compared with those of males, and further, that PrR (progesterone receptor) activation in endothelial cells is the driving mechanism for sex-dependent increases in endothelial MR expression in females. In addition, we show that genetic deletion of either the endothelial MR or PrR in female mice prevents leptin-induced endothelial dysfunction, providing direct evidence that interaction between the PrR and MR mediates obesity-associated endothelial impairment in females. Collectively, these novel findings suggest that progesterone drives sex-differences in endothelial MR expression and predisposes female mice to leptin-induced endothelial dysfunction, which indicates that MR antagonists may be a promising sex-specific therapy to reduce the risk of cardiovascular diseases in obese premenopausal women.
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Affiliation(s)
- Jessica L Faulkner
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
| | - Simone Kennard
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
| | - Anne-Cecile Huby
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
| | - Galina Antonova
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
| | - Qing Lu
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (Q.L., I.Z.J.)
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (Q.L., I.Z.J.)
| | - Vijay S Patel
- Department of Surgery, Section of Cardiothoracic Surgery (V.S.P.), Medical College of Georgia, Augusta University, GA
| | - David J R Fulton
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
| | - Eric J Belin de Chantemèle
- From the Vascular Biology Center (J.L.F., S.K., A.-C.H., G.A., D.J.R.F., E.J.B.d.C.), Medical College of Georgia, Augusta University, GA.,Department of Medicine, Section of Cardiology (E.J.B.d.C.), Medical College of Georgia, Augusta University, GA
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43
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Faulkner JL, Belin de Chantemèle EJ. Sex hormones, aging and cardiometabolic syndrome. Biol Sex Differ 2019; 10:30. [PMID: 31262349 PMCID: PMC6604485 DOI: 10.1186/s13293-019-0246-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/14/2019] [Indexed: 12/22/2022] Open
Abstract
It is well documented that the metabolic syndrome predisposes patients to increased cardiovascular risk. Emerging data indicates that cardiovascular risk conferred by metabolic syndrome is highly dependent on sex and sex hormone status throughout the lifetime. Both male and female sex hormones, as well as sex chromosomes themselves, contribute to the development of obesity and intervene in the control of insulin homeostasis and blood pressure. Furthermore, men and women develop age-associated cardiometabolic risk in a sex-specific fashion in association with changes in these sex hormonal levels. Therefore, the current notion of the metabolic syndrome as a sex-independent diagnosis is antiquated, and novel studies and clinical trials utilizing these known sex differences in the development of metabolic dysregulation and cardiometabolic risk are warranted.
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Affiliation(s)
- Jessica L. Faulkner
- Department of Medicine (Cardiology), Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA 30912 USA
| | - Eric J. Belin de Chantemèle
- Department of Medicine (Cardiology), Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd, Augusta, GA 30912 USA
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44
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Akasaka H, Yamamoto K, Rakugi H, Nagasawa M, Nakamaru R, Ichijo T, Takeda Y, Kurihara I, Katabami T, Tsuiki M, Wada N, Ogawa Y, Kawashima J, Sone M, Kamemura K, Yoshimoto T, Matsuda Y, Fujita M, Kobayashi H, Watanabe M, Tamura K, Okamura S, Miyauchi S, Izawa S, Chiba Y, Tanabe A, Naruse M. Sex Difference in the Association Between Subtype Distribution and Age at Diagnosis in Patients With Primary Aldosteronism. Hypertension 2019; 74:368-374. [PMID: 31230553 DOI: 10.1161/hypertensionaha.119.13006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Adrenal vein sampling (AVS) is an established method for finding patients with the unilateral subtype of PA, for which adrenalectomy is an applicable treatment. In this study, we analyzed a large database of patients with PA who underwent adrenal vein sampling, to investigate the sex differences in the impact of age at diagnosis on the subtype and cause of PA. In 2122 patients, women with the unilateral subtype were younger than men with the same subtype and women with the bilateral subtype. Younger age and older age were associated with unilateral PA in women and men, respectively. After stratification by tertiles of age, there was a trend of decreased and increased incidence of unilateral PA with aging in women and men, respectively. Male sex was a predictor of unilateral PA in middle-aged and older patients but not in younger patients. We also found that obesity, a known factor associated with idiopathic hyperaldosteronism, was positively associated with bilateral PA in younger patients but not in older patients. These findings suggest that the proportion of operable patients with unilateral PA differs depending on the combination of sex and age, and that other than obesity, the cause of PA is also associated with the bilateral subtype in older patients.
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Affiliation(s)
- Hiroshi Akasaka
- From the Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.A., K.Y., H.R., M.N., R.N.)
| | - Koichi Yamamoto
- From the Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.A., K.Y., H.R., M.N., R.N.)
| | - Hiromi Rakugi
- From the Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.A., K.Y., H.R., M.N., R.N.)
| | - Motonori Nagasawa
- From the Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.A., K.Y., H.R., M.N., R.N.)
| | - Ryo Nakamaru
- From the Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.A., K.Y., H.R., M.N., R.N.)
| | - Takamasa Ichijo
- Department of Diabetes and Endocrinology, Saiseikai Yokohama Tobu Hospital, Japan (T.I.)
| | - Yoshiyu Takeda
- Department of Health Promotion and Medicine of the Future, Graduate School of Medical Science, Kanazawa University, Japan (Y.T.)
| | - Isao Kurihara
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan (I.K.)
| | - Takuyuki Katabami
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Japan (T.K.)
| | - Mika Tsuiki
- Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan (M.T., M.N.)
| | - Norio Wada
- Department of Diabetes and Endocrinology, Sapporo City General Hospital, Japan (N.W.)
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (Y.O.)
| | - Junji Kawashima
- Department of Metabolic Medicine, Kumamoto University Faculty of Life Sciences, Japan (J.K.)
| | - Masakatsu Sone
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan (M.S.)
| | - Kohei Kamemura
- Department of Cardiology, Shinko Hospital, Kobe, Japan (K.K.)
| | - Takanobu Yoshimoto
- Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University Graduate School of Medicine, Japan (T.Y.)
| | - Yuichi Matsuda
- Department of Cardiology, Sanda City Hospital, Japan (Y.M.)
| | - Megumi Fujita
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan (M.F.)
| | - Hiroki Kobayashi
- Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan (H.K.)
| | - Minemori Watanabe
- Department of Endocrinology and Diabetes, Okazaki City Hospital, Japan (M.W.)
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Japan (K.T.)
| | - Shintaro Okamura
- Department of Endocrinology, Tenri Yorozu Hospital, Japan (S.O.)
| | - Shozo Miyauchi
- Department of Diabetes and Endocrinology, Ehime Prefectural Central Hospital, Matsuyama, Japan (S.M.)
| | - Shoichiro Izawa
- Department of Molecular Medicine and Therapeutics, Tottori University School of Medicine, Yonago, Japan (S.I.)
| | - Yoshiro Chiba
- Endovascular Treatment Group, Mito Saiseikai General Hospital, Japan (Y.C.)
| | - Akiyo Tanabe
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan (A.T.)
| | - Mitsuhide Naruse
- Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan (M.T., M.N.)
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45
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Clemmer JS, Faulkner JL, Mullen AJ, Butler KR, Hester RL. Sex-specific responses to mineralocorticoid receptor antagonism in hypertensive African American males and females. Biol Sex Differ 2019; 10:24. [PMID: 31072402 PMCID: PMC6507140 DOI: 10.1186/s13293-019-0238-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/16/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND African Americans (AA) develop hypertension (HTN) at an earlier age, have a greater frequency and severity of HTN, and greater prevalence of uncontrolled HTN as compared to the white population. Mineralocorticoid antagonists have been shown to be very effective in treating uncontrolled HTN in both AA and white patients, but sex-specific responses are unclear. METHODS We evaluated the sex-specific impact of mineralocorticoid antagonism in an AA population. An AA cohort (n = 1483) from the Genetic Epidemiology Network of Arteriopathy study was stratified based on sex and whether they were taking spironolactone, a mineralocorticoid antagonist, in their antihypertensive regimen. RESULTS As compared to AA women not prescribed a mineralocorticoid antagonist, AA women taking spironolactone (n = 9) had lower systolic and diastolic blood pressure despite having a similar number of antihypertensive medications. The proportion of AA women with uncontrolled HTN was significantly less for patients taking spironolactone than for patients not prescribed spironolactone. Interestingly, none of these associations were found in the AA males or in white females. CONCLUSIONS Our data suggests that spironolactone is particularly effective in reducing blood pressure and controlling HTN in AA women. Further research into the impact of this therapy in this underserved and understudied minority is warranted.
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Affiliation(s)
- John S Clemmer
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216-4505, USA.
| | - Jessica L Faulkner
- Vascular Biology Center, Medical College of Georgia, Augusta University, Augusta, GA, 30912-5563, USA
| | - Alex J Mullen
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216-4505, USA
| | - Kenneth R Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA
| | - Robert L Hester
- Department of Physiology and Biophysics, Center for Computational Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216-4505, USA.,Department of Data Sciences, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA
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46
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The Association of Life's Simple 7 with Aldosterone among African Americans in the Jackson Heart Study. Nutrients 2019; 11:nu11050955. [PMID: 31035479 PMCID: PMC6566676 DOI: 10.3390/nu11050955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Among African Americans (AAs), attaining higher levels of American Heart Association (AHA) ideal cardiovascular health (Life’s Simple 7 [LS7]) is associated with lower risk of diabetes and cardiovascular disease (CVD). We previously showed that aldosterone is associated with higher risk of diabetes and CVD in AAs. Thus, we investigated the association of LS7 metrics with aldosterone in the Jackson Heart Study (JHS). Methods: Ideal metrics were defined by AHA 2020 goals for health behaviors (smoking, dietary intake, physical activity, and body mass index) and health factors (total cholesterol, blood pressure, and fasting glucose). The number of ideal LS7 metrics attained at baseline were summed into a continuous score (0–7) and categorical groups (Poor: 0–1, Intermediate: 2–3, and Ideal: ≥4 ideal LS7 metrics). Multivariable linear regression was used. Results: Among 4,095 JHS participants (mean age 55 ± 13 years, 65% female), median serum aldosterone was 4.90, 4.30, and 3.70 ng/dL in the poor (n = 1132), intermediate (n = 2288) and ideal (n = 675) categories respectively. Aldosterone was 15% [0.85 (0.80, 0.90)] and 33% [0.67 (0.61, 0.75)] lower in the intermediate and ideal LS7 categories compared to the poor LS7 category. Each additional LS7 metric attained on continuous LS7 score (0–7) was associated with an 11% [0.89 (0.86, 0.91)] lower aldosterone level with variation by sex with women having a 15% lower aldosterone vs. 5% in men. Conclusions: Higher attainment of ideal LS7 metrics was associated with lower serum aldosterone among AAs with a greater magnitude of association among women compared to men.
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Vecchiola A, Fuentes CA, Barros ER, Martínez-Aguayo A, García H, Allende F, Solari S, Olmos R, Carvajal C, Tapia-Castillo A, Campino C, Kalergis AM, Baudrand R, Fardella CE. The Aldosterone/Renin Ratio Predicts Cardiometabolic Disorders in Subjects Without Classic Primary Aldosteronism. Am J Hypertens 2019; 32:468-475. [PMID: 30753255 DOI: 10.1093/ajh/hpz023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Aldosterone has been linked with obesity, metabolic syndrome (MetS), pro-inflammatory, and prothrombotic states; however, most studies relate these indicators with primary aldosteronism (PA), excluding non-PA patients. OBJECTIVE To determine whether aldosterone, renin, or the plasma aldosterone/renin ratio (ARR) are associated with metabolic disorders and inflammatory/vascular biomarkers in a non-PA population. METHODS We studied 275 patients including adolescents and adults of both genders and measured plasma and urinary aldosterone and determined the plasma renin activity. In all subjects, the presence of MetS was determined according to Adult Treatment Panel III. Renal, vascular, inflammatory, and mineralocorticoid activity biomarkers were evaluated. RESULTS The ARR correlated with the number of variables of MetS (r = 0.191, P = 0.002), body mass index (BMI; r = 0.136, P = 0.026), systolic blood pressure (r = 0.183, P = 0.002), diastolic blood pressure (r = 0.1917, P = 0.0014), potassium excreted fraction (r = 0.174, P = 0.004), low-density lipoprotein (r = 0.156, P = 0.01), plasminogen activator inhibitor type 1 (r = 0.158, P = 0.009), microalbuminuria (r = 0.136, P = 0.029), and leptin (r = 0.142, P = 0.019). In a linear regression model adjusted by age, BMI, and gender, only the ARR was still significant (r = 0.108, P = 0.05). In a logistic regression analysis, the ARR predicted MetS index (odds ratio (OR) = 1.07 [95% confidence interval (CI) = 1.011-1.131], P= 0.02) even after adjusting for age, BMI, and gender. On the other hand, aldosterone showed no association with MetS or inflammatory markers. CONCLUSION These results suggest a continuum of cardiometabolic risk beyond the classic PA threshold screening. The ARR could be a more sensitive marker of obesity, MetS, and endothelial damage in non-PA patients than aldosterone or renin alone. Prospective studies are needed to develop future screening cutoff values.
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Affiliation(s)
- Andrea Vecchiola
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
- Center of Translational Endocrinology (CETREN), Faculty of Medicine, Endocrinology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristóbal Andrés Fuentes
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
- Center of Translational Endocrinology (CETREN), Faculty of Medicine, Endocrinology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eric Raúl Barros
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center of Translational Endocrinology (CETREN), Faculty of Medicine, Endocrinology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Martínez-Aguayo
- Endocrinology Pediatrics Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hernán García
- Endocrinology Pediatrics Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fidel Allende
- Department of Clinical Laboratories, School of Medicine, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
| | - Sandra Solari
- Department of Clinical Laboratories, School of Medicine, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
| | - Roberto Olmos
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center of Translational Endocrinology (CETREN), Faculty of Medicine, Endocrinology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Carvajal
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
- Center of Translational Endocrinology (CETREN), Faculty of Medicine, Endocrinology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Tapia-Castillo
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center of Translational Endocrinology (CETREN), Faculty of Medicine, Endocrinology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carmen Campino
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
- Center of Translational Endocrinology (CETREN), Faculty of Medicine, Endocrinology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis Mikes Kalergis
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
- Departamento de Gentica Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rene Baudrand
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center of Translational Endocrinology (CETREN), Faculty of Medicine, Endocrinology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Enrique Fardella
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
- Center of Translational Endocrinology (CETREN), Faculty of Medicine, Endocrinology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
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Bothou C, Beuschlein F, Spyroglou A. Links between aldosterone excess and metabolic complications: A comprehensive review. DIABETES & METABOLISM 2019; 46:1-7. [PMID: 30825519 DOI: 10.1016/j.diabet.2019.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 02/04/2023]
Abstract
Shortly after the first description of primary aldosteronism (PA) appeared in the 1950s by Jerome Conn, an association of the condition with diabetes mellitus was documented. However, a clear pathophysiological interrelationship linking the two entities has yet to be established. Nevertheless, so far, many mechanisms contributing to insulin resistance and dysregulation of glucose uptake have been described. At the same time, many observational studies have reported an increased prevalence of the metabolic syndrome (MetS) among patients with PA. Regarding the relationship between aldosterone levels and obesity, a vicious cycle of adipokine-induced aldosterone production and aldosterone adipogenic action may be further contributing to MetS manifestations in PA patients. However, whether aldosterone excess affects lipid metabolism is still under investigation. Also, recent findings of the coexistence of glucocorticoid excess in many cases of PA highlight the need for further studies to examine the presumed link between high aldosterone levels and various metabolic parameters. In the present review, our focus is to comprehensively present the spectrum of available research findings concerning the possible associations between aldosterone excess and metabolic alterations, including impaired glucose metabolism, insulin resistance and, consequently, diabetes, altered lipid metabolism and the development of fatty liver. In addition, the complex relationship between obesity and aldosterone is discussed in detail.
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Affiliation(s)
- C Bothou
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland; Competence Centre of Personalized Medicine, Molecular and Translational Biomedicine PhD Program, University of Zurich, Zurich, Switzerland
| | - F Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU, Munich, Germany.
| | - A Spyroglou
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland
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Obesity cardiomyopathy: the role of obstructive sleep apnea and obesity hypoventilation syndrome. Ir J Med Sci 2019; 188:783-790. [DOI: 10.1007/s11845-018-01959-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023]
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Biwer LA, Wallingford MC, Jaffe IZ. Vascular Mineralocorticoid Receptor: Evolutionary Mediator of Wound Healing Turned Harmful by Our Modern Lifestyle. Am J Hypertens 2019; 32:123-134. [PMID: 30380007 DOI: 10.1093/ajh/hpy158] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/30/2018] [Indexed: 12/28/2022] Open
Abstract
The mineralocorticoid receptor (MR) is indispensable for survival through its critical role in maintaining blood pressure in response to sodium scarcity or bleeding. Activation of MR by aldosterone in the kidney controls water and electrolyte homeostasis. This review summarizes recent advances in our understanding of MR function, specifically in vascular endothelial and smooth muscle cells. The evolving roles for vascular MR are summarized in the areas of (i) vascular tone regulation, (ii) thrombosis, (iii) inflammation, and (iv) vascular remodeling/fibrosis. Synthesis of the data supports the concept that vascular MR does not contribute substantially to basal homeostasis but rather, MR is poised to be activated when the vasculature is damaged to coordinate blood pressure maintenance and wound healing. Specifically, MR activation in the vascular wall promotes vasoconstriction, inflammation, and exuberant vascular remodeling with fibrosis. A teleological model is proposed in which these functions of vascular MR may have provided a critical evolutionary survival advantage in the face of mechanical vascular injury with bleeding. However, modern lifestyle is characterized by physical inactivity and high fat/high sodium diet resulting in diffuse vascular damage. Under these modern conditions, diffuse, persistent and unregulated activation of vascular MR contributes to post-reproductive cardiovascular disease in growing populations with hypertension, obesity, and advanced age.
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MESH Headings
- Animals
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/metabolism
- Cardiovascular Diseases/pathology
- Cardiovascular Diseases/physiopathology
- Diet, High-Fat
- Endothelial Cells/metabolism
- Endothelial Cells/pathology
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/pathology
- Endothelium, Vascular/physiopathology
- Evolution, Molecular
- Hemodynamics
- Humans
- Life Style
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiopathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Receptors, Mineralocorticoid/metabolism
- Risk Factors
- Sedentary Behavior
- Signal Transduction
- Sodium, Dietary/adverse effects
- Vascular Remodeling
- Wound Healing
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Affiliation(s)
- Lauren A Biwer
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mary C Wallingford
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
- Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
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