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Olasińska-Wiśniewska A, Urbanowicz T, Grodecki K, Kübler P, Perek B, Grygier M, Misterski M, Walczak M, Szot M, Jemielity M. Monocyte-to-lymphocyte ratio correlates with parathyroid hormone concentration in patients with severe symptomatic aortic stenosis. Adv Med Sci 2023; 68:396-401. [PMID: 37837798 DOI: 10.1016/j.advms.2023.09.011] [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: 05/09/2023] [Revised: 07/17/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE The normal healthy valve is devoid of inflammatory cells, however background of aortic stenosis (AS) may include inflammatory processes. Moreover, the link between hyperparathyroidism and heart failure is postulated. Simple whole blood analysis with indices is a beneficial tool in cardiovascular diseases' assessment. The purpose of the study was to evaluate correlation between parathyroid hormone (PTH) and simple blood parameters in severe AS. MATERIAL AND METHODS The study included 62 patients with severe AS. Patients with inflammatory or autoimmune co-morbidities were excluded. Blood samples were collected, and clinical and demographic data were analyzed. RESULTS The final study group comprised 55 patients (31 females, 56.4%; mean age 77.13 (SD 6.76)). In 23 patients (41.8%), PTH concentration was markedly increased. The study group was divided into two subgroups according to the PTH concentration. Patients from both groups did not differ significantly in terms of age and co-morbidities. PTH concentration correlated positively with monocyte-lymphocyte ratio (MLR) (p = 0.008, Spearman rho 0.356) and platelet-lymphocyte ratio (PLR) (p = 0.047, Spearman rho 0.269), creatinine level (p = 0.001, Spearman rho 0.425) and glomerular filtration rate (GFR-MDRD) (p = 0.009, Spearman rho -0.349). The multivariable logistic regression with backward analysis revealed MLR (p = 0.029) and GFR (p = 0.028) as independent significant predictors of abnormal PTH values. The receiver operator characteristics (ROC) curve was performed for the model of MLR and GFR-MDRD (AUC = 0.777), yielding the sensitivity of 60.9% and specificity of 90.6%. CONCLUSIONS PTH concentration correlates with monocyte-to-lymphocyte and platelet-to-lymphocyte ratios in calcified AS.
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Affiliation(s)
- Anna Olasińska-Wiśniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
| | - Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kajetan Grodecki
- I Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kübler
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Grygier
- I Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Misterski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Walczak
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Szot
- Cardiac Surgery Students' Scientific Group, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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NT-proBNP Levels Influence the Prognostic Value of Mineral Metabolism Biomarkers in Coronary Artery Disease. J Clin Med 2022; 11:jcm11144153. [PMID: 35887917 PMCID: PMC9319637 DOI: 10.3390/jcm11144153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/10/2022] Open
Abstract
Background. Mineral metabolism (MM) system and N-terminal pro-brain natriuretic peptide (NT-ProBNP) have been shown to add prognostic value in patients with stable coronary artery disease (SCAD). However, the influence of NT-ProBNP on the prognostic role of MM in patients with SCAD has not been shown yet. The objective of this study is to assess the influence of NT-ProBNP on the prognostic role of MM markers in patients with SCAD. Methods: We analyzed the prognostic value of MM markers (parathormone (PTH), klotho, phosphate, calcidiol (25-hydroxyvitamin D3), and fibroblast growth factor-23) in 964 patients with SCAD and NT-ProBNP > 125 pg/mL vs. patient with NT-ProBNP ≤ 125 pg/mL included in five hospitals in Spain. The main outcome was the combination of death, heart failure, and ischemic events (any acute coronary syndrome, ischemic stroke, or transient ischemic attack). Results: A total of 622 patients had NT-proBNP > 125 pg/mL and 342 patients had NT-ProBNP ≤ 125 pg/mL. The median follow-up was 5.1 years. In the group of NT-proBNP > 125 pg/mL, the patients were older, and there were more females and smokers than in the group of patients with normal NT-proBNP. Additionally, the proportion of patients with hypertension, atrial fibrillation, ejection fraction < 40%, cerebrovascular attack, or prior coronary artery bypass graft was higher in the high NT-proBNP group. In the high NT-proBNP patients, the predictors of poor prognosis were PTH (HR = 1.06 (1.01−1.10), p < 0.001) and NT-proBNP (HR = 1.02 (1.01−1.03), p = 0.011), along with age (HR = 1.039 (1.02−1.06), p < 0.001), prior coronary artery bypass graft (HR = 1.624 (1.02−2.59), p = 0.041), treatment with statins (HR = 0.32 (0.19−0.53), p < 0.001), insulin (HR = 2.49 (1.59−4.09), p < 0.001), angiotensin receptor blockers (HR = 1.73 (1.16−2.56), p = 0.007), nitrates (HR = 1.65 (1.10−2.45), p = 0.014), and proton pump inhibitors (HR = 2.75 (1.74−4.36), p < 0.001). In the NT-proBNP ≤ 125 pg/mL subgroup, poor prognosis predictors were plasma levels of non-high-density lipoprotein (non-HDL) cholesterol (HR = 1.01 (1.00−1.02), p = 0.014) and calcidiol (HR = 0.96 (0.92−0.99), p = 0.045), as well as treatment with verapamil (HR = 11.28 (2.54−50.00), p = 0.001), and dihydropyridines (HR = 3.16 (1.63−6.13), p = 0.001). Conclusion: In patients with SCAD and NT-ProBNP > 125 pg/mL, PTH and NT-ProBNP, which are markers related to ventricular damage, are predictors of poor outcome. In the subgroup of patients with NT-ProBNP ≤ 125 pgm/L, calcidiol and non-HDL cholesterol, which are more related to vascular damage, are the independent predictors of poor outcome. Then, in patients with SCAD, baseline NT-ProBNP may influence the type of biomarker that is effective in risk prediction.
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Aceña Á, Pello-Lázaro AM, Martínez-Milla J, González-Lorenzo Ó, Tarín N, Cristóbal C, Blanco-Colio LM, Martín-Ventura JL, Huelmos A, López-Castillo M, Alonso J, Gutiérrez-Landaluce C, López Bescós L, Alonso-Pulpón L, González-Parra E, Egido J, Mahíllo-Fernández I, Lorenzo Ó, González-Casaus ML, Tuñón J. Impact of renal function on the prognostic value of mineral metabolism in patients with chronic ischaemic heart disease patients with chronic ischaemic heart disease. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34:1-9. [PMID: 34876305 DOI: 10.1016/j.arteri.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Parathormone (PTH) is a component of the Mineral Metabolism (MM) system that has been shown recently to add prognostic value in pts. with stable coronary artery disease (SCAD) and average renal function. However, the influence of renal function on the prognostic role of PTH in pts. with SCAD has not been shown yet. PURPOSE To assess the influence of estimated glomerular filtration rate (eGFR) on the prognostic role of PTH and other MM markers in pts. with SCAD. METHODS We analyzed the prognostic value of MM markers (PTH, klotho, phosphate, calcidiol [25-hydroxyvitamin D], and fibroblast growth factor-23 [FGF23]) in 964 pts. with SCAD and eGFR<60ml/min/1.73 m2 (LGFR) vs pts. with eGFR≥60ml/min/1.73 m2 (HGFR) included in five hospitals of Madrid. The main outcome was the combination of death with ischemic events (any acute coronary syndrome, ischemic stroke or transient ischemic attack). eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). RESULTS Age was 60.0 (52.0-72.0) years, 76.2% of patients were men, and eGFR was 80.4 (65.3-93.1) ml/min/1,73 m2. Median follow-up was 5.39 (2.81-6.92) years. There were 790 pts. with HGFR and 174 with LGFR. In HGFR pts., predictors of ischemic events or death were plasma levels of calcidiol [HR=0.023 (0.94-0.99) p=0.023], FGF23 [HR=1.00 (1.00-1.003) p=0.036], non-HDL cholesterol [HR=1.01 (1.00-1.01) p=0.026] and high sensitivity troponin I [HR=5.12 (1.67-15.59) p=0.004], along with age [HR=1.03 (1.01-1.05) p=0.01], treatment with statins [HR=0.36 (0.19-0.68) p=0.002], nitrates [HR=1.13 (1.07-2.79) p=0.027], dihydropyridines [HR=1.71 (1.05-2.77) p=0.032], verapamil [HR=5.71 (1.35-24.1) p=0.018], and proton-pump inhibitors [HR=2.23 (1.36-3.68) p= 0.002]. In the LGFR subgroup, predictors of death or ischemic events were PTH plasma levels, [HR=1.01 (1.00-1.01) p=0.005], eGFR [HR=0.96 (0.94-0.99) p=0.004], age [HR=1.06 (1.02-1.10) p=0.003], caucasian race [HR=0.04 (0.004-0.380) p=0.005], and treatment with insulin [HR=2.6 (1.20-5.63) p=0.015]. CONCLUSIONS In pts. with SCAD, PTH is an independent predictor of poor outcomes only in those with eGFR<60ml/min/1.73 m2, while in pts. with eGFR≥60ml/min/1.73 m2 calcidiol and FGF23 become the only components of MM that may predict prognosis. Then, renal function influences the predictive power of MM markers in pts. with SCAD.
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Affiliation(s)
- Álvaro Aceña
- Departamento de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, España; Universidad Autónoma de Madrid, Madrid, España
| | | | | | | | - Nieves Tarín
- Departamento de Cardiología, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - Carmen Cristóbal
- Departamento de Cardiología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España; Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Luis M Blanco-Colio
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERCV, Madrid, España
| | - José Luis Martín-Ventura
- Universidad Autónoma de Madrid, Madrid, España; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERCV, Madrid, España
| | - Ana Huelmos
- Departamento de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - Joaquín Alonso
- Universidad Rey Juan Carlos, Alcorcón, Madrid, España; Departamento de Cardiología, Hospital de Getafe, Getafe, Madrid, España
| | | | | | - Luis Alonso-Pulpón
- Universidad Autónoma de Madrid, Madrid, España; Departamento de Cardiología, Hospital Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Emilio González-Parra
- Universidad Autónoma de Madrid, Madrid, España; Departamento de Nefrología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Jesús Egido
- Universidad Autónoma de Madrid, Madrid, España; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, España; Departamento de Nefrología, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERDEM, Madrid, España
| | | | - Óscar Lorenzo
- Universidad Autónoma de Madrid, Madrid, España; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERDEM, Madrid, España
| | | | - José Tuñón
- Departamento de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, España; Universidad Autónoma de Madrid, Madrid, España; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, España; CIBERCV, Madrid, España.
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Gutiérrez-Landaluce C, Aceña Á, Pello A, Martínez-Milla J, González-Lorenzo Ó, Tarín N, Cristóbal C, Blanco-Colio LM, Martín-Ventura JL, Huelmos A, López-Castillo M, Alonso J, López Bescós L, Alonso-Pulpón L, González-Parra E, Egido J, Mahíllo-Fernández I, Lorenzo Ó, González-Casaus ML, Tuñón J. Parathormone levels add prognostic ability to N-terminal pro-brain natriuretic peptide in stable coronary patients. ESC Heart Fail 2021; 8:2713-2722. [PMID: 33932116 PMCID: PMC8318437 DOI: 10.1002/ehf2.13331] [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: 12/22/2020] [Revised: 02/20/2021] [Accepted: 03/19/2021] [Indexed: 12/15/2022] Open
Abstract
Aims There are controversial data on the ability of the components of mineral metabolism (vitamin D, phosphate, parathormone [PTH], fibroblast growth factor‐23 [FGF23], and klotho) to predict cardiovascular events. In addition, it is unknown whether they add any prognostic value to other well‐known biomarkers. Methods and results In 969 stable coronary patients, we determined plasma levels of all the aforementioned components of mineral metabolism with a complete set of clinical and biochemical variables, including N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), high‐sensitivity troponin I (hs‐TnI), and high‐sensitivity C‐reactive protein. Secondary outcomes were ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and heart failure or death. The primary outcome was a composite of the secondary outcomes. Median follow‐up was 5.39 years. Age was 60 (52–72) years. Median glomerular filtration rate was 80.4 (65.3–93.1) mL/min/1.73 m2. One‐hundred and eighty‐five patients developed the primary outcome. FGF23, PTH, hs‐TnI, and NT‐proBNP were directly related with the primary outcome on univariate Cox analysis, while Klotho and calcidiol were inversely related. On multivariate analysis, only PTH (HR 1.058 [CI 1.021–1.097]; P = 0.002) and NT‐proBNP (HR 1.020 [CI 1.012–1.028]; P < 0.001) were independent predictors of the primary outcome but also for the secondary outcome of heart failure or death (HR 1.066 [CI 1.016–1.119]; P = 0.009 and HR 1.024 [CI 1.014–1.034]; P < 0.001, respectively). PTH was the only biomarker that predicted ischaemic events (HR 1.052 [1.010–1.096]; P = 0.016). Patients were divided in two subgroups according to FGF23 plasma levels. PTH retained its prognostic value only in patients with FGF23 levels above the median (>85.5 RU/mL) (P < 0.001) but not in patients with low FGF23 levels (P = 0.551). There was a significant interaction between FGF23 and PTH (P = 0.002). However, there was no significant interaction between PTH and both klotho and calcidiol levels. Conclusions Parathormone is an independent predictor of cardiovascular events in coronary patients, adding complimentary prognostic information to NT‐proBNP plasma levels. This predictive value is restricted to patients with high FGF23 plasma levels. This should be considered in the design of future studies in this field.
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Affiliation(s)
| | - Álvaro Aceña
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain.,Autónoma University, Madrid, Spain
| | - Ana Pello
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain.,Autónoma University, Madrid, Spain
| | - Juan Martínez-Milla
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain.,Autónoma University, Madrid, Spain
| | - Óscar González-Lorenzo
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain.,Autónoma University, Madrid, Spain
| | - Nieves Tarín
- Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain
| | - Carmen Cristóbal
- Department of Cardiology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Rey Juan Carlos University, Madrid, Spain
| | - Luis M Blanco-Colio
- Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBERCV, Madrid, Spain
| | - José Luis Martín-Ventura
- Autónoma University, Madrid, Spain.,Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBERCV, Madrid, Spain
| | - Ana Huelmos
- Department of Cardiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Marta López-Castillo
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain
| | - Joaquín Alonso
- Rey Juan Carlos University, Madrid, Spain.,Department of Cardiology, Hospital de Getafe, Madrid, Spain
| | | | - Luis Alonso-Pulpón
- Autónoma University, Madrid, Spain.,Department of Cardiology, Hospital Puerta de Hierro, Madrid, Spain
| | - Emilio González-Parra
- Autónoma University, Madrid, Spain.,Department of Nephrology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús Egido
- Autónoma University, Madrid, Spain.,Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,Department of Nephrology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBERDEM, Madrid, Spain
| | | | - Óscar Lorenzo
- Autónoma University, Madrid, Spain.,Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBERDEM, Madrid, Spain
| | | | - José Tuñón
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, Madrid, 28040, Spain.,Autónoma University, Madrid, Spain.,Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.,CIBERCV, Madrid, Spain
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Carrillo-López N, Martínez-Arias L, Fernández-Villabrille S, Ruiz-Torres MP, Dusso A, Cannata-Andía JB, Naves-Díaz M, Panizo S. Role of the RANK/RANKL/OPG and Wnt/β-Catenin Systems in CKD Bone and Cardiovascular Disorders. Calcif Tissue Int 2021; 108:439-451. [PMID: 33586001 DOI: 10.1007/s00223-020-00803-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/19/2020] [Indexed: 12/23/2022]
Abstract
In the course of chronic kidney disease (CKD), alterations in the bone-vascular axis augment the risk of bone loss, fractures, vascular and soft tissue calcification, left ventricular hypertrophy, renal and myocardial fibrosis, which markedly increase morbidity and mortality rates. A major challenge to improve skeletal and cardiovascular outcomes in CKD patients requires a better understanding of the increasing complex interactions among the main modulators of the bone-vascular axis. Serum parathyroid hormone (PTH), phosphorus (P), calcium (Ca), fibroblast growth factor 23 (FGF23), calcidiol, calcitriol and Klotho are involved in this axis interact with RANK/RANKL/OPG system and the Wnt/β-catenin pathway. The RANK/RANKL/OPG system controls bone remodeling by inducing osteoblast synthesis of RANKL and downregulating OPG production and it is also implicated in vascular calcification. The complexity of this system has recently increased due the discovery of LGR4, a novel RANKL receptor involved in bone formation, but possibly also in vascular calcification. The Wnt/β-catenin pathway plays a key role in bone formation: when this pathway is activated, bone is formed, but when it is inhibited, bone formation is stopped. In the progression of CKD, a downregulation of the Wnt/β-catenin pathway has been described which occurs mainly through the not coincident elevations of sclerostin, Dickkopf1 (Dkk1) and the secreted Frizzled Related Proteins (sFRPs). This review analyzes the interactions of PTH, P, Ca, FGF23, calcidiol, calcitriol and Klotho with the RANKL/RANKL/OPG system and the Wnt/β-catenin, pathway and their implications in bone and cardiovascular disorders in CKD.
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Affiliation(s)
- Natalia Carrillo-López
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain
| | - Laura Martínez-Arias
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain
| | - Sara Fernández-Villabrille
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain
| | - María Piedad Ruiz-Torres
- Department of System Biology, Universidad de Alcalá, Retic REDinREN-ISCIII, Alcalá de Henares, Spain
| | - Adriana Dusso
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain.
| | - Manuel Naves-Díaz
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain
| | - Sara Panizo
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Retic REDinREN-ISCIII, Avda. Roma, sn., 33011, Oviedo, Spain.
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Markers of Bone Mineral Metabolism and Cardiac Structure and Function in Perinatally HIV-Infected and HIV-Exposed but Uninfected Children and Adolescents. J Acquir Immune Defic Syndr 2020; 81:238-246. [PMID: 30865170 DOI: 10.1097/qai.0000000000002007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Disordered bone mineral metabolism and low vitamin D concentrations are associated with cardiovascular abnormalities; few studies have evaluated this relationship in HIV-infected youth. SETTING The Adolescent Master Protocol is a Pediatric HIV/AIDS Cohort Study network study conducted across 14 US sites. METHODS Among perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected (PHEU) youth enrolled in the Adolescent Master Protocol, we evaluated associations of vitamin D [measured as 25-hydroxy-vitamin D (25-OHD)], parathyroid hormone (PTH), calcium, phosphate, and fibroblast growth factor-23 (FGF-23) concentrations with echocardiographic measures of left ventricular (LV) structure, function, and concentrations of NT-proBNP, a biomarker of cardiac damage. RESULTS Among 485 participants (305 PHIV and 180 PHEU) with echocardiograms and bone mineralization measures, low 25-OHD (<20 ng/mL) was common among all participants (48% PHIV and 44% PHEU), but elevated PTH (>65 pg/mL) was identified more often among PHIV participants than PHEU participants (9% vs 3%, P = 0.02). After adjusting for HIV status and demographic covariates, both low 25-OHD and elevated PTH were associated with lower mean LV mass z-scores, whereas elevated PTH was associated with higher mean fractional shortening z-scores. Participants with low 25-OHD also had slightly higher mean LV end-systolic wall stress z-scores, but differences were more pronounced in PHEU participants than in PHIV participants. FGF-23 was inversely related to end-diastolic septal thickness, both overall and among PHIV participants. CONCLUSIONS In this cohort of PHIV and PHEU youth, we observed associations of 25-OHD, PTH, and FGF-23 with both structural and functional cardiac parameters, supporting links between bone mineral metabolism and cardiac status.
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Balashanmugam MV, Shivanandappa TB, Nagarethinam S, Vastrad B, Vastrad C. Analysis of Differentially Expressed Genes in Coronary Artery Disease by Integrated Microarray Analysis. Biomolecules 2019; 10:biom10010035. [PMID: 31881747 PMCID: PMC7022900 DOI: 10.3390/biom10010035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/13/2019] [Accepted: 12/20/2019] [Indexed: 12/31/2022] Open
Abstract
Coronary artery disease (CAD) is a major cause of end-stage cardiac disease. Although profound efforts have been made to illuminate the pathogenesis, the molecular mechanisms of CAD remain to be analyzed. To identify the candidate genes in the advancement of CAD, microarray dataset GSE23766 was downloaded from the Gene Expression Omnibus database. The differentially expressed genes (DEGs) were identified, and pathway and gene ontology (GO) enrichment analyses were performed. The protein-protein interaction network was constructed and the module analysis was performed using the Biological General Repository for Interaction Datasets (BioGRID) and Cytoscape. Additionally, target genes-miRNA regulatory network and target genes-TF regulatory network were constructed and analyzed. There were 894 DEGs between male human CAD samples and female human CAD samples, including 456 up regulated genes and 438 down regulated genes. Pathway enrichment analyses revealed that DEGs (up and down regulated) were mostly enriched in the superpathway of steroid hormone biosynthesis, ABC transporters, oxidative ethanol degradation III and Complement and coagulation cascades. Similarly, geneontology enrichment analyses revealed that DEGs (up and down regulated) were mostly enriched in the forebrain neuron differentiation, filopodium membrane, platelet degranulation and blood microparticle. In the PPI network and modules (up and down regulated), MYC, NPM1, TRPC7, UBC, FN1, HEMK1, IFT74 and VHL were hub genes. In the target genes-miRNA regulatory network and target genes—TF regulatory network (up and down regulated), TAOK1, KHSRP, HSD17B11 and PAH were target genes. In conclusion, the pathway and GO ontology enriched by DEGs may reveal the molecular mechanism of CAD. Its hub and target genes, MYC, NPM1, TRPC7, UBC, FN1, HEMK1, IFT74, VHL, TAOK1, KHSRP, HSD17B11 and PAH were expected to be new targets for CAD. Our finding provided clues for exploring molecular mechanism and developing new prognostics, diagnostic and therapeutic strategies for CAD.
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Affiliation(s)
- Meenashi Vanathi Balashanmugam
- Department of Biomedical Sciences, College of Pharmacy, Shaqra University, Al Dawadmi 11911, Saudi Arabia; (M.V.B.); (T.B.S.); (S.N.)
| | - Thippeswamy Boreddy Shivanandappa
- Department of Biomedical Sciences, College of Pharmacy, Shaqra University, Al Dawadmi 11911, Saudi Arabia; (M.V.B.); (T.B.S.); (S.N.)
| | - Sivagurunathan Nagarethinam
- Department of Biomedical Sciences, College of Pharmacy, Shaqra University, Al Dawadmi 11911, Saudi Arabia; (M.V.B.); (T.B.S.); (S.N.)
| | - Basavaraj Vastrad
- Department of Pharmaceutics, SET’S College of Pharmacy, Dharwad, Karnataka 580002, India;
| | - Chanabasayya Vastrad
- Biostatistics and Bioinformatics, Chanabasava Nilaya, Bharthinagar, Dharwad 580001, Karanataka
- Correspondence: ; Tel.: +91-9480-073398
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8
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Nutrients Turned into Toxins: Microbiota Modulation of Nutrient Properties in Chronic Kidney Disease. Nutrients 2017; 9:nu9050489. [PMID: 28498348 PMCID: PMC5452219 DOI: 10.3390/nu9050489] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/22/2017] [Accepted: 05/09/2017] [Indexed: 12/24/2022] Open
Abstract
In chronic kidney disease (CKD), accumulation of uremic toxins is associated with an increased risk of death. Some uremic toxins are ingested with the diet, such as phosphate and star fruit-derived caramboxin. Others result from nutrient processing by gut microbiota, yielding precursors of uremic toxins or uremic toxins themselves. These nutrients include l-carnitine, choline/phosphatidylcholine, tryptophan and tyrosine, which are also sold over-the-counter as nutritional supplements. Physicians and patients alike should be aware that, in CKD patients, the use of these supplements may lead to potentially toxic effects. Unfortunately, most patients with CKD are not aware of their condition. Some of the dietary components may modify the gut microbiota, increasing the number of bacteria that process them to yield uremic toxins, such as trimethylamine N-Oxide (TMAO), p-cresyl sulfate, indoxyl sulfate and indole-3 acetic acid. Circulating levels of nutrient-derived uremic toxins are associated to increased risk of death and cardiovascular disease and there is evidence that this association may be causal. Future developments may include maneuvers to modify gut processing or absorption of these nutrients or derivatives to improve CKD patient outcomes.
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9
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Tuñón J, Fernández-Fernández B, Carda R, Pello AM, Cristóbal C, Tarín N, Aceña Á, González-Casaus ML, Huelmos A, Alonso J, Lorenzo Ó, González-Parra E, Hernández-González I, Mahíllo-Fernández I, López-Bescós L, Egido J. Circulating fibroblast growth factor-23 plasma levels predict adverse cardiovascular outcomes in patients with diabetes mellitus with coronary artery disease. Diabetes Metab Res Rev 2016; 32:685-693. [PMID: 26888181 DOI: 10.1002/dmrr.2787] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/16/2016] [Accepted: 02/09/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Abnormalities of fibroblast growth factor-23 (FGF-23) plasma levels predict adverse outcomes in patients with coronary artery disease. However, FGF-23 has a different behaviour in the presence of type 2 diabetes mellitus (T2D). We explored whether the presence of T2D affects the predictive power of FGF-23. METHODS In 704 patients with stable coronary artery disease, FGF-23, calcidiol, parathormone (PTH) and phosphate plasma levels were prospectively assessed. The primary outcome was the development of acute ischemic events (acute coronary syndrome, stroke or transient ischemic attack), heart failure or death. RESULTS One hundred seventy-three (24.6%) patients had T2D, without differences in age, sex or estimated glomerular filtration rate as compared with non-diabetic patients. Serum PTH was lower and phosphate higher in T2D than in non-diabetic patients, without differences in FGF-23 or calcidiol levels. During follow-up (2.15 ± 0.99 years), 26 (15.2%) T2D and 51 (9.6%) non-diabetic patients developed the outcome (p = 0.048). T2D patients who developed the outcome had higher FGF-23 [112.0 (59.9, 167.6) vs 68.9 (54.2, 93.0) RU/mL; p = 0.002], PTH [71.3 (47.3, 106.6) vs 51.9 (40.8, 66.2) pg/mL; p = 0.004) and phosphate (3.53 ± 0.71 vs 3.25 ± 0.50 mg/dL; p = 0.017) levels than T2D subjects who remained stable. These differences were not significant in non-diabetic patients. By multivariable Cox proportional hazard model, FGF-23 predicted independently the outcome in T2D patients [hazard ratio = 1.277; 95% CI (1.132, 1.442)] but not in those without T2D. CONCLUSIONS FGF-23 plasma levels predict adverse cardiovascular outcomes in coronary artery disease patients who have T2D but not in those without T2D. This finding should be confirmed in larger studies. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- José Tuñón
- IIS-Fundación Jiménez Díaz, Madrid, Spain.
- Autónoma University, Madrid, Spain.
| | | | | | | | - Carmen Cristóbal
- Hospital de Fuenlabrada, Fuenlabrada, Spain
- Rey Juan Carlos University, Alcorcón, Spain
| | - Nieves Tarín
- University Hospital of Móstoles, Móstoles, Spain
| | | | | | - Ana Huelmos
- University Hospital Fundación Alcorcón, Alcorcón, Spain
| | - Joaquín Alonso
- Rey Juan Carlos University, Alcorcón, Spain
- University Hospital of Getafe, Getafe, Spain
| | - Óscar Lorenzo
- IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | | | | | | | | | - Jesús Egido
- IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
- CIBERDEM, Madrid, Spain
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10
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Tuñón J, González-Hernández I, Llanos-Jiménez L, Alonso-Martín J, Escudier-Villa JM, Tarín N, Cristóbal C, Sanz P, Pello AM, Aceña Á, Carda R, Orejas M, Tomás M, Beltrán P, Calero Rueda M, Marcos E, Serrano-Antolín JM, Gutiérrez-Landaluce C, Jiménez R, Cabezudo J, Curcio A, Peces-Barba G, González-Parra E, Muñoz-Siscart R, González-Casaus ML, Lorenzo A, Huelmos A, Goicolea J, Ibáñez B, Hernández G, Alonso-Pulpón LM, Farré J, Lorenzo Ó, Mahíllo-Fernández I, Egido J. Design and rationale of a multicentre, randomised, double-blind, placebo-controlled clinical trial to evaluate the effect of vitamin D on ventricular remodelling in patients with anterior myocardial infarction: the VITamin D in Acute Myocardial Infarction (VITDAMI) trial. BMJ Open 2016; 6:e011287. [PMID: 27496232 PMCID: PMC4985833 DOI: 10.1136/bmjopen-2016-011287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Decreased plasma vitamin D (VD) levels are linked to cardiovascular damage. However, clinical trials have not demonstrated a benefit of VD supplements on left ventricular (LV) remodelling. Anterior ST-elevation acute myocardial infarction (STEMI) is the best human model to study the effect of treatments on LV remodelling. We present a proof-of-concept study that aims to investigate whether VD improves LV remodelling in patients with anterior STEMI. METHODS AND ANALYSIS The VITamin D in Acute Myocardial Infarction (VITDAMI) trial is a multicentre, randomised, double-blind, placebo-controlled trial. 144 patients with anterior STEMI will be assigned to receive calcifediol 0.266 mg capsules (Hidroferol SGC)/15 days or placebo on a 2:1 basis during 12 months. PRIMARY OBJECTIVE to evaluate the effect of calcifediol on LV remodelling defined as an increase in LV end-diastolic volume ≥10% (MRI). SECONDARY OBJECTIVES change in LV end-diastolic and end-systolic volumes, ejection fraction, LV mass, diastolic function, sphericity index and size of fibrotic area; endothelial function; plasma levels of aminoterminal fragment of B-type natriuretic peptide, galectin-3 and monocyte chemoattractant protein-1; levels of calcidiol (VD metabolite) and other components of mineral metabolism (fibroblast growth factor-23 (FGF-23), the soluble form of its receptor klotho, parathormone and phosphate). Differences in the effect of VD will be investigated according to the plasma levels of FGF-23 and klotho. Treatment safety and tolerability will be assessed. This is the first study to evaluate the effect of VD on cardiac remodelling in patients with STEMI. ETHICS AND DISSEMINATION This trial has been approved by the corresponding Institutional Review Board (IRB) and National Competent Authority (Agencia Española de Medicamentos y Productos Sanitarios (AEMPS)). It will be conducted in accordance with good clinical practice (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use - Good Clinical Practice (ICH-GCP)) requirements, ethical principles of the Declaration of Helsinki and national laws. The results will be submitted to indexed medical journals and national and international meetings. TRIAL REGISTRATION NUMBER NCT02548364; Pre-results.
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Affiliation(s)
- José Tuñón
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Joaquín Alonso-Martín
- Department of Cardiology, University Hospital of Getafe, Madrid, Spain
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | | | - Nieves Tarín
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | - Carmen Cristóbal
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Petra Sanz
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Cardiology, Hospital Rey Juan Carlos, Madrid, Spain
| | - Ana M Pello
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Rocío Carda
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Miguel Orejas
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Marta Tomás
- Department of Radiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Paula Beltrán
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Esther Marcos
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | | | | | - Rosa Jiménez
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Jorge Cabezudo
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Alejandro Curcio
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Germán Peces-Barba
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Pneumology, Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio González-Parra
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Antonio Lorenzo
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | - Ana Huelmos
- Department of Cardiology, Fundación Hospital Alcorcón, Madrid, Spain
| | - Javier Goicolea
- Department of Cardiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Borja Ibáñez
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | - Luis M Alonso-Pulpón
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Cardiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Jerónimo Farré
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Department of Medicine, Autónoma University, Madrid, Spain
| | - Óscar Lorenzo
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Jesús Egido
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
- CIBERDEM, Madrid, Spain
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