1
|
Sun X, Xin C, Yao J, Wang H. Relationship Between Leptin and Heart Failure: A Meta-Analysis. Glob Heart 2025; 20:44. [PMID: 40417460 PMCID: PMC12101114 DOI: 10.5334/gh.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 05/12/2025] [Indexed: 05/27/2025] Open
Abstract
Background Heart failure (HF) is a diverse and potentially fatal condition affecting more than 60 million people worldwide. Previous studies have identified a close relationship between leptin levels and HF, and that leptin levels in patients with HF are higher than those in healthy individuals. However, some studies have reported inconsistent results. Therefore, the association between leptin levels and HF remains controversial. Methods A literature search was conducted on the Web of Science, Wiley Online Library, Embase, and PubMed databases. The title or abstract search term 'leptin' was used in combination with 'heart failure' and 'HF'. Meta-analysis results were reported as standardized mean differences (SMD) with corresponding 95% confidence intervals (CI). Results Eighteen studies comprising 1149 patients with HF and 622 healthy controls were included in the meta-analysis. Leptin levels in patients with HF were significantly higher than those in healthy individuals (SMD, 0.54; 95% CI [0.15, 0.93]). Conclusions To our knowledge, this systematic review is the first to evaluate the relationship between leptin and HF. Determining the role of leptin in HF will significantly contribute to its diagnosis and treatment.
Collapse
Affiliation(s)
- Xin Sun
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, CN
| | - Caihong Xin
- Department of Endocrinology and Metabolism, The Fourth People’s Hospital of Soochow University, Shenyang, CN
| | - Jiayi Yao
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, CN
| | - Hongli Wang
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, CN
| |
Collapse
|
2
|
Ohnewein B, Shomanova Z, Paar V, Topf A, Jirak P, Fiedler L, Granitz C, Van Almsick V, Semo D, Zagidullin N, Dieplinger AM, Sindermann J, Reinecke H, Hoppe UC, Pistulli R, Motloch LJ. Effects of Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) on the Glucose and Fat Metabolism Biomarkers Leptin and Fructosamine. J Clin Med 2023; 12:3083. [PMID: 37176525 PMCID: PMC10179018 DOI: 10.3390/jcm12093083] [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: 03/31/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: Heart failure with reduced ejection fraction (HFrEF) remains a major health burden. Angiotensin-Receptor-Neprilysin-Inhibitors (ARNIs) are an established HFrEF therapy which increases natriuretic peptide levels by inhibiting neprilysin. Leptin is a lipid metabolism parameter, which is also involved in glucose metabolism and is suggested to correlate with HF burden. While the hormone also seems to interact with neprilysin, potential associations with ARNI therapy have not been investigated yet. (2) Methods: To study this issue, we measured levels of leptin and fructosamine in consecutive 72 HFrEF patients before initiation of ARNI therapy and 3-6 months after initiation of therapy in two European centers. Biomarker levels were correlated with clinical parameters including ejection fraction, LVEF, and NYHA class. (3) Results: During a follow-up of up to 6 months, clinical parameters improved significantly (LVEF: 30.2 ± 7.8% to 37.6 ± 10.0%, (p < 0.001) and a significant improvement of the mean NYHA class with initial 32 patients in NYHA III or IV and 8 patients in NYHA class III/IV during the follow up (p < 0.001). The initial NT-proBNP levels of 2251.5 ± 2566.8 pg/mL significantly improved to 1416.7 ± 2145 pg/mL, p = 0.008) during follow up. ARNI therapy was also associated with an increase in leptin levels (17.5 ± 23.4 µg/L to 22.9 ± 29.3, p < 0.001) and furthermore, affected glucose metabolism indicated by elevation of fructosamine values (333.9 ± 156.8 µmol/L to 454.8 ± 197.8 µmol/L, p = 0.013). (4) Conclusion: while in the early phase of therapy, ARNI promotes clinical improvement of HFrEF, and it also seems to affect fat and glucose parameters, indicating significant metabolic implications of this therapy regime.
Collapse
Affiliation(s)
- Bernhard Ohnewein
- Department for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Zornitsa Shomanova
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany (R.P.)
| | - Vera Paar
- Department for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Albert Topf
- Department for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Peter Jirak
- Department for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Fiedler
- Department of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria
| | - Christina Granitz
- Department for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Vincent Van Almsick
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany (R.P.)
| | - Dilvin Semo
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany (R.P.)
| | - Naufal Zagidullin
- Department of Internal Diseases, Bashkir State Medical University, Lenin str., 3, 450008 Ufa, Russia
| | - Anna-Maria Dieplinger
- Institute for Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria
- Medical Faculty, Johannes Kepler University Linz, 4040 Linz, Austria
| | - Juergen Sindermann
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany (R.P.)
| | - Holger Reinecke
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany (R.P.)
| | - Uta C. Hoppe
- Department for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Rudin Pistulli
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany (R.P.)
| | - Lukas J. Motloch
- Department for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| |
Collapse
|
3
|
Costa YC, Mauro V, Fairman E, Charask A, Olguín L, Cáceres L, Barrero C. Prognostic Value of Insulin Resistance Assessed by HOMA-IR in Non-Diabetic Patients with Decompensated Heart Failure. Curr Probl Cardiol 2022; 48:101112. [PMID: 35007641 DOI: 10.1016/j.cpcardiol.2022.101112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 12/30/2022]
Abstract
The predictive value of insulin resistance in patients hospitalized with heart failure is unknown. OBJECTIVE To evaluate prognostic value of insulin resistance (defined by a HOMA IR ≥ 2.5) for the combined event of death and readmission at 90 and 365 days post discharge and to determine if there are differences according to ejection fraction. METHODS prospective study of 156 p hospitalized for acute heart failure without diabetes. RESULTS 83 years, 48% female, EF≤45% 48%. 28% presented HOMA ≥2.5. HOMA IR ≥2.5 was associated with combined event (OR 2.4; 95% CI 1.9-5.1; p 0.02) at 90 days. A multivariate analysis demonstrated its independent predictive value (OR 2.5, 95% CI 1.1-5.8; p: 0.03). At one year follow-up HOMA IR did not predict events. The predictive value of HOMA-IR was not associated with ventricular function. CONCLUSIONS HOMA IR index was a predictor of a combined event at 90 days in our population. It is a simple determination that could contribute to identify higher risk patients during this vulnerable post-discharge phase. These data must be validated in larger studies.
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Heart failure is a frequent problem in an ageing population, associated with high rates of morbidity and mortality. Today, it is important to not only treat heart failure itself but also the related comorbidities. Among them, cardiac cachexia is one of the major challenges. It is a complex multifactorial disease with a negative impact on quality of life and prognosis. Therefore, prevention, early recognition and treatment of cardiac cachexia is essential. RECENT FINDINGS Cardiac cachexia frequently presents with skeletal as well as heart muscle depletion. Imaging-based diagnostic techniques can help to identify patients with cardiac cachexia and muscle wasting. Several blood biomarkers are available to detect metabolic changes in cardiac cachexia. SUMMARY Several studies are currently ongoing to better comprehend the underlying pathophysiological mechanisms of cardiac cachexia and to find new treatments. It is essential to diagnose it as early as possible to initiate therapy.
Collapse
|
5
|
Rodríguez-González MJ, Contreras J. De la insuficiencia cardiaca a la diabetes. ¿Existe un mecanismo común? REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
6
|
Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX
| |
Collapse
|
7
|
Saitoh M, Rodrigues Dos Santos M, von Haehling S. Muscle wasting in heart failure : The role of nutrition. Wien Klin Wochenschr 2016; 128:455-465. [PMID: 27761739 DOI: 10.1007/s00508-016-1100-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/14/2016] [Indexed: 12/25/2022]
Abstract
Muscle wasting and malnutrition are common complications in patients with advanced heart failure (HF); however, both remain underdiagnosed and undertreated although they both play relevant roles in the progression of HF. The risk of muscle wasting in patients with HF increases in those patients with malnutrition or at risk of malnutrition. Muscle wasting and malnutrition are thought to be positively influenced by adequate therapeutic interventions such as physical activity and nutritional support. Consequently, early detection of malnutrition in patients with HF is recommended. This review discusses muscle wasting and nutritional status, describing the effects of malnutrition on muscle wasting in patients with HF. We review specific issues related to muscle wasting and nutritional status in patients with HF; however, no established strategies currently exist to focus on patients suffering from muscle wasting with malnutrition.
Collapse
Affiliation(s)
- Masakazu Saitoh
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Marcelo Rodrigues Dos Santos
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.,Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Stephan von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| |
Collapse
|
8
|
Abstract
Heart failure is associated with generalized insulin resistance. Moreover, insulin-resistant states such as type 2 diabetes mellitus and obesity increases the risk of heart failure even after adjusting for traditional risk factors. Insulin resistance or type 2 diabetes mellitus alters the systemic and neurohumoral milieu, leading to changes in metabolism and signaling pathways in the heart that may contribute to myocardial dysfunction. In addition, changes in insulin signaling within cardiomyocytes develop in the failing heart. The changes range from activation of proximal insulin signaling pathways that may contribute to adverse left ventricular remodeling and mitochondrial dysfunction to repression of distal elements of insulin signaling pathways such as forkhead box O transcriptional signaling or glucose transport, which may also impair cardiac metabolism, structure, and function. This article will review the complexities of insulin signaling within the myocardium and ways in which these pathways are altered in heart failure or in conditions associated with generalized insulin resistance. The implications of these changes for therapeutic approaches to treating or preventing heart failure will be discussed.
Collapse
Affiliation(s)
- Christian Riehle
- From the Division of Endocrinology and Metabolism, Fraternal Order of Eagles Diabetes Research Center, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City
| | - E Dale Abel
- From the Division of Endocrinology and Metabolism, Fraternal Order of Eagles Diabetes Research Center, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City.
| |
Collapse
|
9
|
Scherbakov N, Bauer M, Sandek A, Szabó T, Töpper A, Jankowska EA, Springer J, von Haehling S, Anker SD, Lainscak M, Engeli S, Düngen HD, Doehner W. Insulin resistance in heart failure: differences between patients with reduced and preserved left ventricular ejection fraction. Eur J Heart Fail 2015. [DOI: 10.1002/ejhf.317] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Nadja Scherbakov
- Center for Stroke Research Berlin; Charite Universitätsmedizin Berlin; Germany
- German Centre for Cardiovascular Research (DZHK); partner site Berlin Germany
| | - Maximiliane Bauer
- Department of Cardiology, Campus Virchow; Charite Universitätsmedizin Berlin; Germany
| | - Anja Sandek
- Department of Cardiology, Campus Virchow; Charite Universitätsmedizin Berlin; Germany
| | - Tibor Szabó
- Department of Cardiology, Campus Virchow; Charite Universitätsmedizin Berlin; Germany
| | - Agnieszka Töpper
- Working Group on Cardiovascular Magnetic Resonance; Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine Berlin; Germany
- HELIOS Klinikum Berlin Buch; Department of Cardiology and Nephrology; Berlin Germany
| | - Ewa A. Jankowska
- Cardiology Department, Centre for Heart Diseases; Military Hospital; Wroclaw Poland
- Department of Heart Diseases; Wroclaw Medical University, Wroclaw; Poland
| | - Jochen Springer
- Innovative Clinical Trials, Dept of Cardiology and Pneumology; University Medicine Göttingen (UMG); Göttingen Germany
| | | | - Stefan D. Anker
- Department of Heart Diseases; Wroclaw Medical University, Wroclaw; Poland
| | - Mitja Lainscak
- Division of Cardiology; General Hospital Celje; Slovenia
| | - Stefan Engeli
- Institute of Clinical Pharmacology; Hannover Medical School; Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Campus Virchow; Charite Universitätsmedizin Berlin; Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin; Charite Universitätsmedizin Berlin; Germany
- German Centre for Cardiovascular Research (DZHK); partner site Berlin Germany
- Department of Cardiology, Campus Virchow; Charite Universitätsmedizin Berlin; Germany
| |
Collapse
|
10
|
Takahashi A, Ihara M, Yamazaki S, Asanuma H, Asakura M, Kitakaze M. Impact of Either GLP-1 Agonists or DPP-4 Inhibitors on Pathophysiology of Heart Failure. Int Heart J 2015; 56:372-6. [PMID: 26104180 DOI: 10.1536/ihj.15-028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Since diabetes mellitus (DM) is the most common cause of heart failure (HF), it is critically important to clarify whether incretin hormones including glucagon-like peptide-1 (GLP-1), which play an important role in blood glucose control, mediate cardioprotection. There are many lines of basic research evidence indicating that GLP-1 improves the pathophysiology of HF: In murine and canine HF models, either GLP-1 analogues or DPP-IV inhibitors improved cardiac functions. The first question that arises is how either GLP-1 analogues or DPP-IV inhibitors mediate cardioprotection. Cardiovascular diseases are tightly linked to impaired glucose tolerance (IGT): IGT is not only one of the causes of cardiovascular events but also the result of HF. Indeed, the treatment of IGT improved HF, showing that one of the mechanisms attributable to DPP-IV inhibitors is related to the improvement of IGT. Intriguingly, either DPP-IV inhibitors or GLP-1 analogues mediate cardioprotection even without IGT, suggesting two possible explanations: One is that GLP-1 analogues directly activate the prosurvival kinases, such as Akt and Erk1/2, and another is that DPP-IV inhibition increases cardioprotective peptides such as BNP and SDF-1α. The next question is whether cardioprotection is translated to clinical medicine. Small scale clinical trials proved their cardioprotective effects; however, several large scale clinical trials have not proved the beneficial effects of DPP-IV inhibitors. Taken together, GLP-1 analogues or DPP-IV inhibitors can mediate cardioprotection, however, what needs to be clarified is who mainly receives their benefits among the patients with cardiovascular diseases and/or DM.
Collapse
Affiliation(s)
- Ayako Takahashi
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | | | | | | | | | | |
Collapse
|
11
|
Doehner W, Turhan G, Leyva F, Rauchhaus M, Sandek A, Jankowska EA, von Haehling S, Anker SD. Skeletal muscle weakness is related to insulin resistance in patients with chronic heart failure. ESC Heart Fail 2015; 2:85-89. [PMID: 28834658 PMCID: PMC6410535 DOI: 10.1002/ehf2.12035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 11/23/2022] Open
Abstract
Background Chronic heart failure (CHF) is associated with insulin resistance, indicating impairment in the control of energy metabolism. Insulin resistance in CHF relates to symptomatic status and independently predicts poor prognosis. We sought to determine whether insulin sensitivity is related to skeletal muscle strength in patients with CHF, taking into account muscle size and perfusion. Methods Quadriceps muscle size (square centimetre cross‐sectional area at mid‐femur level, computed tomography), isometric quadriceps muscle strength [absolute (in N) and strength per unit muscle area (N/cm2)], resting‐leg blood flow (plethysmography) and maximal oxygen consumption (treadmill exercise test) were measured in 33 patients with CHF (left ventricular ejection fraction 28 ± 3.2%, mean ± Standard Error of the mean (SEM)) and 20 healthy controls. Insulin sensitivity was assessed by intravenous glucose tolerance tests and minimal modelling analysis. Results Right quadriceps strength (−27.0%, P < 0.0001), strength per muscle area (−18.0%, P < 0.003) and insulin sensitivity (−64.2%, P < 0.001) were lower in patients with CHF. The correlation between insulin sensitivity and absolute muscle strength was significant in the CHF group (r = 0.54, P = 0.001) and borderline in controls (r = 0.47, P = 0.06). This association remained significant between insulin sensitivity and strength per muscle area (CHF: r = 0.52, P < 0.01; controls: r = 0.62, P < 0.05). In stepwise regression analyses in CHF, only insulin sensitivity emerged as a predictor of strength per unit area of muscle [standardized coefficient (SC) = 0.45, P = 0.006; diuretic dose, SC = −0.31, P = 0.051; R2 = 0.37, P = 0.001], while age, left ventricular ejection fraction, maximal oxygen consumption, fasting glucose and insulin and blood flow were excluded. In controls, only insulin sensitivity remained in the final regression model (SC = 0.62, P = 0.004; R2 = 0.39, P = 0.004). Conclusions The myofibril contractile function of the quadriceps, i.e. functional quality of skeletal muscle, is strongly related to insulin sensitivity in patients with CHF and in healthy controls, independently of muscle size. Therapies aimed at improving insulin sensitivity in patients with CHF may clarify whether this relationship is causal.
Collapse
Affiliation(s)
- Wolfram Doehner
- Center for Stroke Research Berlin (CSB), Charite - Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Berlin, Germany
| | - Guelistan Turhan
- Centre for Cardiovascular Sciences, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | - Francisco Leyva
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mathias Rauchhaus
- Centre for Cardiovascular Sciences, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | - Anja Sandek
- Centre for Cardiovascular Sciences, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | - Ewa A Jankowska
- Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Stephan von Haehling
- Division of Innovative Clinical Trials, Department of Cardiology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Stefan D Anker
- Division of Innovative Clinical Trials, Department of Cardiology, University Medical Center Göttingen (UMG), Göttingen, Germany
| |
Collapse
|
12
|
Rahman A, Jafry S, Jeejeebhoy K, Nagpal AD, Pisani B, Agarwala R. Malnutrition and Cachexia in Heart Failure. JPEN J Parenter Enteral Nutr 2015; 40:475-86. [PMID: 25634161 DOI: 10.1177/0148607114566854] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/04/2014] [Indexed: 12/12/2022]
Abstract
Heart failure is a growing public health concern. Advanced heart failure is frequently associated with severe muscle wasting, termed cardiac cachexia This process is driven by systemic inflammation and tumor necrosis factor in a manner common to other forms of disease-related wasting seen with cancer or human immunodeficiency virus. A variable degree of malnutrition is often superimposed from poor nutrient intake. Cardiac cachexia significantly decreases quality of life and survival in patients with heart failure. This review outlines the evaluation of nutrition status in heart failure, explores the pathophysiology of cardiac cachexia, and discusses therapeutic interventions targeting wasting in these patients.
Collapse
Affiliation(s)
- Adam Rahman
- University of Western Ontario, London, Ontario, Canada Lawson Health Research Institute Program of Experimental Medicine (POEM), London, Ontario, Canada
| | - Syed Jafry
- University of Western Ontario, London, Ontario, Canada
| | - Khursheed Jeejeebhoy
- Department of Medicine, University of Toronto, Ancaster, Ontario, Canada Department of Nutritional Sciences, University of Toronto, Ancaster, Ontario, Canada Department of Physiology, University of Toronto, Ancaster, Ontario, Canada
| | - A Dave Nagpal
- University of Western Ontario, London, Ontario, Canada
| | - Barbara Pisani
- Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ravi Agarwala
- Department of Anesthesia, Section on Critical Care, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
13
|
Yu L, Zhao Y, Xu S, Jin C, Wang M, Fu G. Leptin confers protection against TNF-α-induced apoptosis in rat cardiomyocytes. Biochem Biophys Res Commun 2014; 455:126-32. [DOI: 10.1016/j.bbrc.2014.10.134] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 10/27/2014] [Indexed: 12/29/2022]
|
14
|
Doehner W, Frenneaux M, Anker SD. Metabolic impairment in heart failure: the myocardial and systemic perspective. J Am Coll Cardiol 2014; 64:1388-400. [PMID: 25257642 DOI: 10.1016/j.jacc.2014.04.083] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/03/2014] [Accepted: 04/21/2014] [Indexed: 01/08/2023]
Abstract
Although bioenergetic starvation is not a new concept in heart failure (HF), recent research has led to a growing appreciation of the complexity of metabolic aspects of HF pathophysiology. All steps of energy extraction, transfer, and utilization are affected, and structural metabolism is impaired, leading to compromised functional integrity of tissues. Not only the myocardium, but also peripheral tissues and organs are affected by metabolic failure, resulting in a global imbalance between catabolic and anabolic signals, leading to tissue wasting and, ultimately, to cachexia. Metabolic feedback signals from muscle and fat actively contribute to further myocardial strain, promoting disease progression. The prolonged survival of patients with stable, compensated HF will increasingly bring chronic metabolic complications of HF to the fore and gradually shift its clinical presentation. This paper reviews recent evidence on myocardial and systemic metabolic impairment in HF and summarizes current and emerging therapeutic concepts with specific metabolic targets.
Collapse
Affiliation(s)
- Wolfram Doehner
- Centre for Stroke Research Berlin and Department of Cardiology, Campus Virchow-Klinikum Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Michael Frenneaux
- University of Aberdeen School of Medicine and Dentistry, Aberdeen, United Kingdom
| | - Stefan D Anker
- Department of Innovative Clinical Trials, University Medical Centre, Göttingen, Germany
| |
Collapse
|
15
|
Abstract
The concept of skeletal muscle myopathy as a main determinant of exercise intolerance in chronic heart failure (HF) is gaining acceptance. Symptoms that typify HF patients, including shortness of breath and fatigue, are often directly related to the abnormalities of the skeletal muscle in HF. Besides muscular wasting, alterations in skeletal muscle energy metabolism, including insulin resistance, have been implicated in HF. Adiponectin, an adipocytokine with insulin-sensitizing properties, receives increasing interest in HF. Circulating adiponectin levels are elevated in HF patients, but high levels are paradoxically associated with poor outcome. Previous analysis of m. vastus lateralis biopsies in HF patients highlighted a striking functional adiponectin resistance. Together with increased circulating adiponectin levels, adiponectin expression within the skeletal muscle is elevated in HF patients, whereas the expression of the main adiponectin receptor and genes involved in the downstream pathway of lipid and glucose metabolism is downregulated. In addition, the adiponectin-related metabolic disturbances strongly correlate with aerobic capacity (VO2 peak), sub-maximal exercise performance and muscle strength. These observations strengthen our hypothesis that adiponectin and its receptors play a key role in the development and progression of the "heart failure myopathy". The question whether adiponectin exerts beneficial rather than detrimental effects in HF is still left unanswered. This current research overview will elucidate the emerging role of adiponectin in HF and suggests potential therapeutic targets to tackle energy wasting in these patients.
Collapse
|
16
|
Gan XT, Ettinger G, Huang CX, Burton JP, Haist JV, Rajapurohitam V, Sidaway JE, Martin G, Gloor GB, Swann JR, Reid G, Karmazyn M. Probiotic administration attenuates myocardial hypertrophy and heart failure after myocardial infarction in the rat. Circ Heart Fail 2014; 7:491-9. [PMID: 24625365 DOI: 10.1161/circheartfailure.113.000978] [Citation(s) in RCA: 226] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Probiotics are extensively used to promote gastrointestinal health, and emerging evidence suggests that their beneficial properties can extend beyond the local environment of the gut. Here, we determined whether oral probiotic administration can alter the progression of postinfarction heart failure. METHODS AND RESULTS Rats were subjected to 6 weeks of sustained coronary artery occlusion and administered the probiotic Lactobacillus rhamnosus GR-1 or placebo in the drinking water ad libitum. Culture and 16s rRNA sequencing showed no evidence of GR-1 colonization or a significant shift in the composition of the cecal microbiome. However, animals administered GR-1 exhibited a significant attenuation of left ventricular hypertrophy based on tissue weight assessment and gene expression of atrial natriuretic peptide. Moreover, these animals demonstrated improved hemodynamic parameters reflecting both improved systolic and diastolic left ventricular function. Serial echocardiography revealed significantly improved left ventricular parameters throughout the 6-week follow-up period including a marked preservation of left ventricular ejection fraction and fractional shortening. Beneficial effects of GR-1 were still evident in those animals in which GR-1 was withdrawn at 4 weeks, suggesting persistence of the GR-1 effects after cessation of therapy. Investigation of mechanisms showed a significant increase in the leptin:adiponectin plasma concentration ratio in rats subjected to coronary ligation, which was abrogated by GR-1. Metabonomic analysis showed differences between sham control and coronary artery ligated hearts particularly with respect to preservation of myocardial taurine levels. CONCLUSIONS The study suggests that probiotics offer promise as a potential therapy for the attenuation of heart failure.
Collapse
Affiliation(s)
- Xiaohong Tracey Gan
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - Grace Ettinger
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - Cathy X Huang
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - Jeremy P Burton
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - James V Haist
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - Venkatesh Rajapurohitam
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - James E Sidaway
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - Glynn Martin
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - Gregory B Gloor
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - Jonathan R Swann
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - Gregor Reid
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.)
| | - Morris Karmazyn
- From the Departments of Physiology and Pharmacology (X.T.G., C.X.H., J.V.H., V.R., M.K.), Microbiology and Immunology (G.E., J.P.B., G.R.), Surgery (J.P.B., G.R.), and Biochemistry (G.B.G.), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada (G.E., J.P.B., G.B.G., G.R.); and Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Whiteknights, Reading, United Kingdom (J.E.S., G.M., J.R.S.).
| |
Collapse
|
17
|
Karmazyn M, Gan XT, Rajapurohitam V. The potential contribution of circulating and locally produced leptin to cardiac hypertrophy and failure. Can J Physiol Pharmacol 2013; 91:883-8. [DOI: 10.1139/cjpp-2013-0057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Leptin is a 16 kDa peptide that was first identified in 1994 through positional cloning of the mouse obesity gene. Although the primary function of leptin is to act a satiety factor through its actions on the hypothalamus, it is now widely recognized that leptin can exert effects on many other organs through activation of its receptors, which are ubiquitously expressed. Leptin is secreted primarily by white adipocytes, but it is also produced by other tissues including the heart where it can exert effects in an autocrine or paracrine manner. One of these effects involves the induction of cardiomyocyte hypertrophy, which appears to occur via multiple cell signalling mechanisms. As adipocytes are the primary site of leptin production, plasma leptin concentrations are generally positively related with body mass index and the degree of adiposity. However, hyperleptinemia is also associated with cardiovascular disease, including heart failure, in the absence of obesity. Here we review the potential role of leptin in heart disease, particularly pertaining to its potential contribution to myocardial remodelling and heart failure, as well as the underlying mechanisms. We further discuss potential interactions between leptin and another adipokine, adiponectin, and the potential implications of this interaction in terms of fully understanding leptin’s effects.
Collapse
Affiliation(s)
- Morris Karmazyn
- Department of Physiology and Pharmacology, University of Western Ontario, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada
| | - Xiaohong Tracey Gan
- Department of Physiology and Pharmacology, University of Western Ontario, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada
| | - Venkatesh Rajapurohitam
- Department of Physiology and Pharmacology, University of Western Ontario, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada
| |
Collapse
|
18
|
|
19
|
Doehner W, Todorovic J, Kennecke C, Rauchhaus M, Sandek A, Lainscak M, van Linthout S, Tschöpe C, von Haehling S, Anker SD. Improved insulin sensitivity by the angiotensin receptor antagonist irbesartan in patients with systolic heart failure: A randomized double-blinded placebo-controlled study. Int J Cardiol 2012; 161:137-42. [DOI: 10.1016/j.ijcard.2011.07.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 07/11/2011] [Accepted: 07/13/2011] [Indexed: 11/29/2022]
|
20
|
Aquilani R, La Rovere MT, Febo O, Boschi F, Iadarola P, Corbellini D, Viglio S, Bongiorno AI, Pastoris O, Verri M. Preserved muscle protein metabolism in obese patients with chronic heart failure. Int J Cardiol 2012; 160:102-8. [DOI: 10.1016/j.ijcard.2011.03.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 02/16/2011] [Accepted: 03/19/2011] [Indexed: 11/29/2022]
|
21
|
Wong AKF, Symon R, AlZadjali MA, Ang DSC, Ogston S, Choy A, Petrie JR, Struthers AD, Lang CC. The effect of metformin on insulin resistance and exercise parameters in patients with heart failure. Eur J Heart Fail 2012; 14:1303-10. [PMID: 22740509 DOI: 10.1093/eurjhf/hfs106] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIMS Chronic heart failure (CHF) is an insulin-resistant state. The degree of insulin resistance (IR) correlates with disease severity and is associated with reduced exercise capacity. In this proof of concept study, we have examined the effect of metformin on IR and exercise capacity in non-diabetic CHF patients identified to have IR. METHODS AND RESULTS In a double-blind, placebo-controlled study, 62 non-diabetic IR CHF patients (mean age, 65.2 ± 8.0 years; male, 90%; left ventricular ejection fraction, 32.6 ± 8.3%; New York Heart Association class I/II/III/IV, 11/45/6/0) were randomized to receive either 4 months of metformin (n = 39, 2 g/day) or matching placebo (n = 23). IR was defined by a fasting insulin resistance index (FIRI) ≥2.7. Cardiopulmonary exercise testing and FIRI were assessed at baseline and after 4 months of intervention. Compared with placebo, metformin decreased FIRI (from 5.8 ± 3.8 to 4.0 ± 2.5, P < 0.001) and resulted in a weight loss of 1.9 kg (P < 0.001). The primary endpoint of the study, peak oxygen uptake (VO(2)), did not differ between treatment groups. However, metformin improved the secondary endpoint of the slope of the ratio of minute ventilation to carbon dioxide production (VE/VCO(2) slope), from 32.9 ± 15.9 to 28.1 ± 8.8 (P = 0.034). In the metformin-treated group, FIRI was significantly related to the reduction of the VE/VCO(2) slope (R = 0.41, P = 0.036). CONCLUSION Metformin treatment significantly improved IR but had no effect on peak VO(2), the primary endpoint of our study. However, metformin treatment did result in a significant improvement in VE/VCO(2) slope. TRIAL REGISTRATION NCT00473876.
Collapse
Affiliation(s)
- Aaron K F Wong
- Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, University of Dundee, Ninewells Hospital & Medical School, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Schulze PC, Biolo A, Gopal D, Shahzad K, Balog J, Fish M, Siwik D, Colucci WS. Dynamics in insulin resistance and plasma levels of adipokines in patients with acute decompensated and chronic stable heart failure. J Card Fail 2011; 17:1004-11. [PMID: 22123363 PMCID: PMC3226951 DOI: 10.1016/j.cardfail.2011.08.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 08/17/2011] [Accepted: 08/18/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patients with heart failure (HF) develop metabolic derangements including increased adipokine levels, insulin resistance, inflammation and progressive catabolism. It is not known whether metabolic dysfunction and adipocyte activation worsen in the setting of acute clinical decompensation, or conversely, improve with clinical recovery. METHODS AND RESULTS We assessed insulin resistance using homeostasis model assessment of insulin resistance (HOMA-IR), and measured plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), adiponectin, visfatin, resistin, leptin, and tumor necrosis factor (TNF) α in 44 patients with acute decompensated HF (ADHF) due to left ventricular (LV) systolic dysfunction and again early (<1 wk) and late (> 6 mo) after clinical recovery, in 26 patients with chronic stable HF, and in 21 patients without HF. NT-proBNP was not increased in control subjects, mildly elevated in patients with stable HF, markedly elevated in patients with ADHF, and decreased progressively early and late after treatment. Compared to control subjects, plasma adiponectin, visfatin, leptin, resistin, and TNF-α were elevated in patients with chronic stable HF and increased further in patients with ADHF. Likewise, HOMA-IR was increased in chronic stable HF and increased further during ADHF. Adiponectin, visfatin, and HOMA-IR remained elevated at the time of discharge from the hospital, but returned to chronic stable HF levels. Adipokine levels were not related to body mass index in HF patients. HOMA-IR correlated positively with adipokines and TNF-α in HF patients. CONCLUSIONS ADHF is associated with worsening of insulin resistance and elevations of adipokines and TNF-α, indicative of adipocyte activation. These metabolic abnormalities are reversible, but they temporally lag behind the clinical resolution of decompensated HF.
Collapse
Affiliation(s)
- P Christian Schulze
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York 10032, USA.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Fudim M, Wagman G, Altschul R, Yucel E, Bloom M, Vittorio TJ. Pathophysiology and treatment options for cardiac anorexia. Curr Heart Fail Rep 2011; 8:147-53. [PMID: 21327573 DOI: 10.1007/s11897-011-0049-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The anorexia-cachexia syndrome (ACS) occurs in many chronic illnesses, such as cancer, AIDS, and chronic obstructive pulmonary disease in addition to chronic congestive heart failure (CHF). Comparable to other chronic states, the ACS complicates CHF and impacts its prognosis; however, the available treatment options for this syndrome remain unsatisfactory. This review article focuses on the complex pathophysiology of cardiac anorexia. We focus on the recent data demonstrating the relationships between central appetite-regulating structures, inflammatory processes, and neurohormonal activation, and their respective roles in the development of anorexia. We then describe the different treatment options and discuss some future prospects for the management for cardiac anorexia.
Collapse
Affiliation(s)
- Marat Fudim
- Heinrich-Heine-Universität, Düsseldorf, Germany
| | | | | | | | | | | |
Collapse
|
24
|
Abd El-Aziz TA, Mohamed RH, Mohamed RH, Pasha HF. Leptin, leptin gene and leptin receptor gene polymorphism in heart failure with preserved ejection fraction. Heart Vessels 2011; 27:271-9. [PMID: 21584748 DOI: 10.1007/s00380-011-0152-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/15/2011] [Indexed: 12/25/2022]
Abstract
Heart failure with a normal ejection fraction (HFNEF) is common in obesity and coronary artery disease (CAD). Both ischemia and reperfusion induce leptin (LEP) and leptin receptor (LEPR) gene expression. We aimed to investigate the possible associations of serum leptin, leptin gene and leptin receptor gene polymorphism with HFNEF in patients with CAD. 100 Egyptian CAD patients with HFNEF and 100 healthy subjects (the control group) were genotyped for LEP and LEPR polymorphism. Leptin levels were measured. Serum leptin levels were significantly increased in patients compared to the control group. There was a significant increase in the leptin gene (AA genotype) and the leptin receptor gene (RR genotype) in HFNEF patients compared to the control group. Leptin levels, leptin gene (AA genotype) and LEPR (RR genotype) were more associated with NYHA III than with NYHA I and II. We thus concluded that HFNEF is associated with increased serum leptin levels, and the LEP AA genotype or LEPR RR genotype carries at least a threefold increased risk of developing HFNEF.
Collapse
Affiliation(s)
- Tarek A Abd El-Aziz
- Cardiology Department, Faculty of Medicine, Zagazig University, 28-El-Galaa Street, Zagazig, Egypt.
| | | | | | | |
Collapse
|
25
|
Abstract
Obesity is reaching epidemic proportions in the United States. Obesity adversely affects the circulatory system with resultant endothelial dysfunction, which promotes systemic hypertension, coronary artery disease, and vascular calcification. It is believed that the release of adipokines is responsible for this effect. In addition, obesity causes intrinsic changes in the heart including an increase in left ventricular (LV) mass, LV hypertrophy, LV dilatation, left atrial dilatation, and diastolic, as well as systolic dysfunction in some cases. The combination of increased adipose cells and an increase lean muscle mass in obese patients results in high cardiac output and an accompanying increased circulating volume leading to these adaptive changes. Weight loss by means of caloric restriction or surgery results in favorable hemodynamic changes referred to as "reverse remodeling." Regression of LV mass and chamber size has been shown universally. However, some studies have failed to reveal improvement in diastolic function possibly because of confounders such as nutritional deficiency that may occur after weight loss surgery. Some evidence seems to suggest that the greatest regression of LV mass and LV hypertrophy may occur when weight loss is combined with beta-adrenergic blocker therapy (in those who have an indication for the drug) when compared with other antihypertensive drugs versus weight loss alone.
Collapse
Affiliation(s)
- Mohan Lakhani
- Division of Cardiology, Albany Medical Center, Albany, NY 12204, USA.
| | | |
Collapse
|
26
|
Protein catabolism and impairment of skeletal muscle insulin signalling in heart failure. Clin Sci (Lond) 2010; 119:465-6. [PMID: 20629636 DOI: 10.1042/cs20100363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Derangements in systemic and local metabolism develop in patients with CHF [chronic HF (heart failure)] and contribute to the progression of the disease. Impaired skeletal muscle metabolism, morphology and function leading to exercise intolerance are hallmarks of the syndrome of CHF. These changes result in abnormal glucose and lipid metabolism, and the associated insulin resistance, which contribute to progression of skeletal muscle catabolism and development of muscle atrophy in patients with advanced HF. In the present issue of Clinical Science, Toth and co-workers demonstrate the impairment of skeletal muscle protein metabolism in patients with HF, and specifically show an impaired anabolic response in the skeletal muscle of these patients following a period of nutritional deficiency.
Collapse
|
27
|
Bobbert P, Weithäuser A, Andres J, Bobbert T, Kühl U, Schultheiss HP, Rauch U, Skurk C. Increased plasma retinol binding protein 4 levels in patients with inflammatory cardiomyopathy. Eur J Heart Fail 2010; 11:1163-8. [PMID: 19926600 DOI: 10.1093/eurjhf/hfp153] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Chronic heart failure (CHF) is associated with a higher risk for diabetes mellitus. Retinol binding protein 4 (RBP 4) is an adipose tissue-derived protein with pro-diabetogenic effects. A complete understanding of the association of CHF and insulin resistance remains elusive. The purpose of this study was to examine the relationship between CHF and diabetes mellitus. METHODS AND RESULTS Plasma levels of RBP 4, insulin, and interleukins (IL) 2, 8, and 10, were assessed in patients with dilated cardiomyopathy (DCM, n = 53), dilated inflammatory cardiomyopathy (DCMi, n = 54), and controls (n = 20). In addition, a possible mechanism of RBP 4 regulation was examined in adipocytes in vitro. Plasma levels of RBP 4 and insulin were measured by a specific ELISA. Interleukin concentrations were obtained by multiplex ELISA. Cell culture with 3T3-L1 adipocytes was performed to measure RBP 4 mRNA expression after stimulation with IL-8. RBP 4 levels were significantly increased in patients with DCMi (52.95 +/- 20.42 microg/mL) compared with DCM (35.54 +/- 23.08 microg/mL) and the control group (27.3 +/- 18.51 microg/mL). RBP 4 was positively correlated with IL-8 (r=0.416, P < 0.05) in human plasma in patients with DCMi. Moreover, increased insulin resistance was observed in patients with DCMi compared with the control and DCM groups. In vitro, IL-8 induced a significant upregulation of RBP 4 mRNA expression in adipocytes. CONCLUSION Elevated RBP 4 plasma concentrations, induced by IL-8, might be one mechanism leading to a higher incidence of diabetes in patients with DCMi.
Collapse
Affiliation(s)
- Peter Bobbert
- Department of Cardiology and Pneumology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Doehner W, Gathercole D, Cicoira M, Krack A, Coats AJS, Camici PG, Anker SD. Reduced glucose transporter GLUT4 in skeletal muscle predicts insulin resistance in non-diabetic chronic heart failure patients independently of body composition. Int J Cardiol 2010; 138:19-24. [PMID: 18778861 DOI: 10.1016/j.ijcard.2008.07.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 07/27/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND In chronic heart failure (CHF) skeletal muscle insulin resistance occurs independently of etiology and contributes to impaired energy metabolism. GLUT4, the predominant glucose transporter in the skeletal muscle promotes the rate-limiting step of glucose utilization in skeletal muscle. The significance of skeletal muscle GLUT4 in patients with CHF has not been studied in detail. METHODS In patients with CHF and free of diabetes mellitus (n=29; mean NYHA class 2.3+/-0.1, peak VO(2) 18.8+/-1.1 mL/kg/min) and healthy control subjects of similar age (n=7), GLUT4 protein was assessed from percutaneous skeletal muscle biopsies. Skeletal muscle insulin sensitivity was assessed by intravenous glucose tolerance testing using a minimal modeling technique. Body composition was analyzed by dual energy X-ray absorptiometry (DEXA) scanning. RESULTS Skeletal muscle GLUT4 was lower in CHF patients than in controls (0.75+/-0.07 vs 1.24+/-0.19 density units, P<0.01) and decreased in parallel to severity of CHF, being lowest in NYHA III/IV (0.596+/-0.08, ANOVA P<0.01 vs controls). GLUT4 was lower in patients with an ischemic etiology compared to dilated cardiomyopathy and controls (ANOVA P<0.01). Patients and controls were similar for global parameters of body composition (weight: 78+/-4 vs 76+/-4 kg, BMI 25.5+/-0.8 vs 25.8+/-1.5 kg/m(2)), and total tissue amount and regional distribution of fat and lean tissue (all P>0.2). Low GLUT4 predicted impaired insulin sensitivity, i.e. insulin resistance (r=0.55, P<0.01). In multivariate analysis, GLUT4 levels predicted insulin sensitivity independently of age and parameters of body composition (including weight, BMI, and total and regional fat and lean tissue distribution). CONCLUSION In non-diabetic patients with CHF, skeletal muscle GLUT4 transport protein is reduced in parallel to disease severity, independently of body composition. Low skeletal muscle GLUT4 contributes to insulin resistance in CHF.
Collapse
Affiliation(s)
- Wolfram Doehner
- Division of Applied Cachexia Research, Department of Cardiology, Charité, Campus Virchow-Klinikum, Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|
29
|
Sainani GS, Karatela RA. Plasma leptin in insulin-resistant and insulin-nonresistant coronary artery disease and its association with cardio-metabolic risk factors among Asian Indians. Metab Syndr Relat Disord 2009; 7:335-40. [PMID: 19450159 DOI: 10.1089/met.2008.0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The relationship between plasma leptin and insulin resistance among coronary artery disease (CAD) subjects remains poorly understood. We determined plasma leptin levels in insulin-resistant and insulin-nonresistant CAD patients. We also examined the association of plasma leptin with several cardiometabolic risk factors in all of the study group subjects from an Asian Indian population. METHODS We evaluated 130 subjects among the Asian Indian population. Out of these, 65 were CAD subjects and 65 were age- and sex-matched, healthy, non-CAD controls. Fasting plasma levels of leptin, insulin, glucose, homocysteine, fibrinogen, and lipid parameters were estimated for all the subjects. Body mass index (BMI) and waist circumference (WC) were also determined. RESULTS We observed raised levels of leptin as well as homocysteine, BMI, and WC among the insulin-resistant CAD subjects compared to the insulin-nonresistant CAD subjects. Similarly, a significant elevation in plasma leptin, homocysteine, BMI, and WC was observed among the insulin-resistant controls compared to the insulin-nonresistant controls. Plasma leptin in CAD patients was correlated significantly with overall and abdominal obesity, insulin resistance, and insulin levels. However, it was nonsignificantly correlated with plasma homocysteine, fibrinogen, mean arterial pressure, and dyslipidemia in CAD subjects. On multiple regression analysis, we observed that raised plasma leptin in CAD was significantly associated with insulin resistance independent of obesity. CONCLUSIONS Our data showed a signifcant association of plasma leptin levels with insulin resistance in CAD that was independent of obesity.
Collapse
|
30
|
Abstract
The pathophysiology of heart failure is complex, and the list of biomarkers representing distinct pathophysiologic pathways is growing rapidly. This article focuses on some promising newer biomarkers that have contributed to a better understanding of pathophysiologic mechanisms involved in heart failure but for which less data are currently available: osteoprotegerin, galectin-3, cystatin C, chromogranin A, and the adipokines adiponectin, leptin, and resistin. Despite the intriguing early information from these newer markers, none is ready for routine clinical use. Much additional study is needed to determine how these biomarkers will fit into diagnostic and treatment algorithms for patients who have heart failure.
Collapse
Affiliation(s)
- Sachin Gupta
- The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | | |
Collapse
|
31
|
von Haehling S, Schefold JC, Jankowska E, Doehner W, Springer J, Strohschein K, Genth-Zotz S, Volk HD, Poole-Wilson P, Anker SD. Leukocyte redistribution: effects of beta blockers in patients with chronic heart failure. PLoS One 2009; 4:e6411. [PMID: 19641622 PMCID: PMC2713422 DOI: 10.1371/journal.pone.0006411] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 06/24/2009] [Indexed: 11/18/2022] Open
Abstract
Background Overproduction of pro-inflammatory cytokines is a well established factor in the progression of chronic heart failure (CHF). Changes in cellular immunity have not been widely studied, and the impact of standard medication is uncertain. Here we investigate whether a leukocyte redistribution occurs in CHF and whether this effect is influenced by beta-blocker therapy. Methodology We prospectively studied 75 patients with systolic CHF (age: 68±11 years, left ventricular ejection fraction 32±11%, New York Heart Association class 2.5±0.7) and 20 age-matched healthy control subjects (age: 63±10 years). We measured the response of cells to endotoxin exposure in vitro, analysed subsets of lymphocytes using flow cytometry, and assessed plasma levels of the pro-inflammatory markers interleukin 1, 6, tumor necrosis factor-α, and soluble tumor necrosis factor receptors 1 and 2. Principal findings While no differences in the number of leukocytes were noted between patients with CHF and healthy controls, we detected relative lymphopenia in patients with CHF (p<0.001 vs. control), mostly driven by reductions in T helper cells and B cells (both p<0.05). The number of neutrophils was increased (p<0.01). These effects were pronounced in patients who were beta-blocker naïve (32% of all patients with CHF). Increased plasma levels of soluble tumor necrosis receptor-1 correlated with the relative number of lymphocyte subsets. Conclusions In patients with CHF, we detected a redistribution of leukocyte subsets, i.e. an increase in neutrophils with relative lymphopenia. These effects were pronounced in patients who were beta-blocker naïve. The underlying mechanism remains to be elucidated.
Collapse
Affiliation(s)
- Stephan von Haehling
- Applied Cachexia Research, Dept. of Cardiology, Charité Medical School, Campus Virchow-Clinic, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Insulin Resistance Is Highly Prevalent and Is Associated With Reduced Exercise Tolerance in Nondiabetic Patients With Heart Failure. J Am Coll Cardiol 2009; 53:747-53. [DOI: 10.1016/j.jacc.2008.08.081] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 08/14/2008] [Accepted: 08/18/2008] [Indexed: 11/19/2022]
|
33
|
von Haehling S, Lainscak M, Springer J, Anker SD. Cardiac cachexia: a systematic overview. Pharmacol Ther 2008; 121:227-52. [PMID: 19061914 DOI: 10.1016/j.pharmthera.2008.09.009] [Citation(s) in RCA: 261] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Accepted: 09/03/2008] [Indexed: 01/10/2023]
Abstract
Cardiac cachexia as a terminal stage of chronic heart failure carries a poor prognosis. The definition of this clinical syndrome has been a matter of debate in recent years. This review describes the ongoing discussion about this issue and the complex pathophysiology of cardiac cachexia and chronic heart failure with particular focus on immunological, metabolic, and hormonal aspects at the intracellular and extracellular level. These include regulators such as neuropeptide Y, leptin, melanocortins, ghrelin, growth hormone, and insulin. The regulation of feeding is discussed as are nutritional aspects in the treatment of the disease. The mechanisms of wasting in different body compartments are described. Moreover, we discuss several therapeutic approaches. These include appetite stimulants like megestrol acetate, medroxyprogesterone acetate, and cannabinoids. Other drug classes of interest comprise angiotensin-converting enzyme inhibitors, beta-blockers, anabolic steroids, beta-adrenergic agonists, anti-inflammatory substances, statins, thalidomide, proteasome inhibitors, and pentoxifylline.
Collapse
Affiliation(s)
- Stephan von Haehling
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
| | | | | | | |
Collapse
|
34
|
Affiliation(s)
- Hutan Ashrafian
- Department of Biosurgery and Surgical Technology, Imperial College London at St Mary's Hospital Campus, London, UK.
| | | | | | | |
Collapse
|
35
|
Amasyali B, Kose S, Kursaklioglu H, Kilic A, Isik E. Leptin in acute coronary syndromes: Has the time come for its use in risk stratification? Int J Cardiol 2008; 130:264-5. [PMID: 17669522 DOI: 10.1016/j.ijcard.2007.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Accepted: 07/01/2007] [Indexed: 11/26/2022]
Abstract
Leptin, a recently discovered obesity gene product, is primarily involved in the regulation of food intake and energy expenditure. Recent observations suggest that leptin has a much broader biological role other than regulation of body weight and energy metabolism. It has been shown that leptin increases sympathetic nerve activity, stimulates generation of reactive oxygen species, induces platelet aggregation and promotes arterial thrombosis, and is an independent risk factor for coronary heart disease. In this paper, we discussed the role of leptin in the pathogenesis of acute coronary syndromes and its usefulness as a biomarker for risk stratification in acute coronary syndromes.
Collapse
|
36
|
Wong AK, ALZadjali MA, Choy AMJ, Lang CC. Insulin Resistance: A Potential New Target for Therapy in Patients with Heart Failure. Cardiovasc Ther 2008; 26:203-13. [DOI: 10.1111/j.1755-5922.2008.00053.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
|
37
|
Sandek A, Rauchhaus M, Anker SD, von Haehling S. The emerging role of the gut in chronic heart failure. Curr Opin Clin Nutr Metab Care 2008; 11:632-9. [PMID: 18685461 DOI: 10.1097/mco.0b013e32830a4c6e] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Chronic heart failure is a multisystem disease with increased sympathetic tone, an anabolic/catabolic dysbalance, and chronic inflammation. Recent studies suggest an altered morphology, permeability, and absorption of the digestive tract in chronic heart failure. Due to nonocclusive mesenterial ischaemia and disturbed intestinal microcirculation, bacterial endotoxin is thought to enter the bloodstream through the hypoperfused, oedematous gut wall, thereby triggering an inflammatory response. Circulating cytokines act as cardiosuppressors. Their plasma levels predict increased mortality in chronic heart failure. RECENT FINDINGS The present article focuses on specific alterations of the gastric, small intestinal, and large intestinal region in chronic heart failure. It describes the leaky intestinal barrier with an augmented bacterial biofilm that may contribute to chronic inflammation and malnutrition. Furthermore, we review methods for bowel perfusion measurement and potential therapeutic approaches. SUMMARY It remains unclear whether increased adherent bacteria in patients with chronic heart failure are a primary or secondary event and whether they contribute to systemic inflammation. Both lack of mucosal integrity with consecutive local and systemic inflammation and dysfunction of transport proteins may worsen the clinical symptoms of chronic heart failure. Therefore, future studies need to address the pathophysiology of the intestinal barrier whose reactivity seems to be crucial for heart function.
Collapse
Affiliation(s)
- Anja Sandek
- Applied Cachexia Research, Department of Cardiology, Campus Virchow-Klinikum, Charité, Berlin, Germany
| | | | | | | |
Collapse
|
38
|
|
39
|
Sierra-Johnson J, Romero-Corral A, Somers VK, Olson LJ, Johnson BD. Leptin, a novel predictor of lung function in heart failure. Chest 2008; 134:346-350. [PMID: 18403666 DOI: 10.1378/chest.07-2751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Leptin is a protein hormone produced by adipose tissue. Leptin has proinflammatory properties and is usually elevated in patients with chronic heart failure. We assessed if serum leptin relates to the loss in lung function in noncachectic patients with chronic heart failure. MATERIALS AND METHODS One hundred thirty-five consecutively eligible non-Hispanic white subjects (age, 24 to 79 years; 85 men and 50 women) with a diagnosis of stable systolic heart failure were recruited prospectively, along with 106 matched control subjects. FVC, FEV(1), and single-breath diffusing capacity of the lung for carbon monoxide (DLco) were measured by spirometry. Plasma leptin was measured by radioimmunoassay. Multiple linear regression was applied. RESULTS The relationships of FEV(1), FVC, and DLco with leptin differed significantly between heart failure and control subjects after controlling for age, sex, percentage of body fat, and ejection fraction. In heart failure, leptin was as an independent predictor of FVC values (additional R(2) = 0.05, p < 0.0001), FEV(1) values (additional R(2) = 0.05, p < 0.0001), and DLco values (additional R(2) = 0.14, p < 0.0001). In a final multiple regression model predicting lung function in heart failure, the independent effect of leptin was significant after further adjustments. CONCLUSIONS The predictive information provided by leptin is additive to that provided by measures of body fat in heart failure patients, especially for DLco. Leptin may play a role in the impairment of lung function in subjects with heart failure.
Collapse
Affiliation(s)
- Justo Sierra-Johnson
- Atherosclerosis Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Abel Romero-Corral
- Division of Cardiovascular Diseases, Department of Internal Medicine, and the Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester MN
| | - Virend K Somers
- Division of Cardiovascular Diseases, Department of Internal Medicine, and the Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester MN
| | - Lyle J Olson
- Division of Cardiovascular Diseases, Department of Internal Medicine, and the Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester MN
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Department of Internal Medicine, and the Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester MN.
| |
Collapse
|
40
|
Fernandes F, Dantas S, Ianni BM, Ramires FJA, Buck P, Salemi VMC, Lopes HF, Mady C. Leptin levels in different forms of Chagas' disease. Braz J Med Biol Res 2007; 40:1631-6. [PMID: 17713658 DOI: 10.1590/s0100-879x2006005000152] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 07/02/2007] [Indexed: 11/21/2022] Open
Abstract
Leptin is produced primarily by adipocytes. Although originally associated with the central regulation of satiety and energy metabolism, increasing evidence indicates that leptin may be an important mediator in cardiovascular pathophysiology. The aim of the present study was to investigate plasma leptin levels in patient with Chagas' heart disease and their relation to different forms of the disease. We studied 52 chagasic patients and 30 controls matched for age and body mass index. All subjects underwent anthropometric, leptin and N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements and were evaluated by echocardiography, 12-lead electrocardiogram (ECG), and chest X-ray. All patients had fasting blood samples taken between 8:00 and 9:00 am. Chagasic patients were divided into 3 groups: group I (indeterminate form, IF group) consisted of 24 subjects with 2 positive serologic reactions for Chagas' disease and no cardiac involvement as evaluated by chest X-rays, ECG and two-dimensional echocardiography; group II (showing ECG abnormalities and normal left ventricular systolic function, ECG group) consisted of 14 patients; group III consisted of 14 patients with congestive heart failure (CHF group) and left ventricular dysfunction. Serum leptin levels were significantly lower (P < 0.001) in the CHF group (1.4 +/- 0.8 ng/mL) when compared to the IF group (5.3 +/- 5.3 ng/mL), ECG group (9.7 +/- 10.7 ng/mL), and control group (8.1 +/- 7.8 ng/mL). NT-proBNP levels were significantly higher (P < 0.001) in the CHF group (831.8 +/- 800.1 pg/mL) when compared to the IF group (53.2 +/- 33.3 pg/mL), ECG group (83.3 +/- 57.4 pg/mL), and control group (32 +/- 22.7 pg/mL). Patients with Chagas' disease and an advanced stage of CHF have high levels of NT-ProBNP andlow plasma levels of leptin. One or more leptin-suppressing mechanisms may operate in chagasic patients.
Collapse
Affiliation(s)
- F Fernandes
- Unidade de Miocardiopatias, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Patel JV, Sosin M, Lim HS, Chung I, Panja N, Davis RC, Hughes EA, Lip GYH. Raised leptin concentrations among South Asian patients with chronic heart failure. Int J Cardiol 2007; 122:34-40. [PMID: 17187880 DOI: 10.1016/j.ijcard.2006.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2006] [Revised: 09/25/2006] [Accepted: 11/02/2006] [Indexed: 01/06/2023]
Abstract
BACKGROUND The disease presentation of chronic heart failure (CHF) is considered to progress with metabolic deterioration, underlined by changes in adipose associated hormones (adipocytokines). However, little is known about ethnic variations of adipocytokines amongst CHF patients, in particular South Asians, who are at an increased risk of CHF. METHODS Using a cross-sectional study, South Asians (n=106) and Caucasians (n=105) living in the UK were compared by CHF status. We investigated ethnic differences in adipocytokines (leptin, adiponectin, tumor necrosis factor (TNF)alpha), and their association with CHF. Patients with mild to moderate CHF were recruited from heart failure clinics (47 Caucasian, 54 South Asian), and compared to healthy controls. Metabolic parameters (including insulin resistance using HOMA modelling), echocardiography and brain natriuretic peptide (BNP) were measured amongst patients and healthy controls, and compared across and within ethnic groups. RESULTS Mean (log transformed) plasma leptin concentrations were highest amongst South Asian patients, being 5.25% (95%CI: 1.50-9.02) higher than Caucasian patients (P=0.007), and similarly raised with respect to controls (P< or =0.04). Indices of insulin resistance were higher amongst CHF patients compared with controls, with no ethnic variation. In addition to age, female gender and body-mass index, levels of leptin were also associated with South Asian ethnicity (P<0.001), insulin resistance (P=0.02), smoking habit (P=0.01) and HDL cholesterol (P=0.004). Levels of adiponectin showed no ethnic variation, but were associated with CHF and a previous history of myocardial infarction (P<0.001). On multivariate regression analysis of patients and healthy controls, CHF was independently associated with smoking habit, adiponectin and insulin resistance (all P<0.01). CONCLUSION Metabolic abnormalities are present in CHF, which in turn, are influenced by ethnicity. The role of adipocytokines in CHF pathophysiology and prognosis merits further study.
Collapse
Affiliation(s)
- Jeetesh V Patel
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Although neurohumoral antagonism has successfully reduced heart failure morbidity and mortality, the residual disability and death rate remains unacceptably high. Though abnormalities of myocardial metabolism are associated with heart failure, recent data suggest that heart failure may itself promote metabolic changes such as insulin resistance, in part through neurohumoral activation. A detrimental self-perpetuating cycle (heart failure --> altered metabolism --> heart failure) that promotes the progression of heart failure may thus be postulated. Accordingly, we review the cellular mechanisms and pathophysiology of altered metabolism and insulin resistance in heart failure. It is hypothesized that the ensuing detrimental myocardial energetic perturbations result from neurohumoral activation, increased adverse free fatty acid metabolism, decreased protective glucose metabolism, and in some cases insulin resistance. The result is depletion of myocardial ATP, phosphocreatine, and creatine kinase with decreased efficiency of mechanical work. On the basis of the mechanisms outlined, appropriate therapies to mitigate aberrant metabolism include intense neurohumoral antagonism, limitation of diuretics, correction of hypokalemia, exercise, and diet. We also discuss more novel mechanistic-based therapies to ameliorate metabolism and insulin resistance in heart failure. For example, metabolic modulators may optimize myocardial substrate utilization to improve cardiac function and exercise performance beyond standard care. The ultimate success of metabolic-based therapy will be manifest by its capacity further to lessen the residual mortality in heart failure.
Collapse
Affiliation(s)
- Houman Ashrafian
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.
| | | | | |
Collapse
|
43
|
Nishiyama Y, Minohara M, Ohe M, Hirai Y, Katoh A, Miyamoto T, Iwami G, Nakata M, Koga Y. Effect of Physical Training on Insulin Resistance in Patients With Chronic Heart Failure. Circ J 2006; 70:864-7. [PMID: 16799239 DOI: 10.1253/circj.70.864] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of physical training on insulin resistance (IR) in chronic heart failure (CHF) remains unclear. METHODS AND RESULTS Fourteen patients with CHF performed physical training using a bicycle ergometer; 9 patients (64%) were hyperinsulinemic and insulin resistant (HOMA IR > 1.97). Exercise tolerance increased (5.1 +/- 1.7 to 6.9 +/- 2.7 METs, p < 0.05) and heart rate at rest decreased (82 +/- 15 to 72 +/- 6, p < 0.05) in the IR group after physical training. Physical training also decreased the insulin level (15.1 +/- 5.6 to 9.8 +/- 2.6 microU/ml, p < 0.05) and HOMA IR (3.7 +/- 1.4 to 2.3 +/- 0.6, p < 0.05) in the IR group, but not in the 5 patients (36%) without IR or in 6 control patients. CONCLUSION Physical training can improve hyperinsulinemia and IR in patients with CHF.
Collapse
|
44
|
Schulze PC, Kratzsch J. Leptin as a new diagnostic tool in chronic heart failure. Clin Chim Acta 2005; 362:1-11. [PMID: 16005450 DOI: 10.1016/j.cccn.2005.05.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Revised: 05/16/2005] [Accepted: 05/17/2005] [Indexed: 01/21/2023]
Abstract
Leptin, the product of the ob-gene, regulates cellular homeostasis and glycemic control. While initially described as an adipocyte-derived protein with expression and secretion restricted to adipose tissue, recent reports have shown local expression of leptin in several tissues including the skeletal muscle, heart, vessels and brain. Leptin acts through the different isoforms of its receptor which are ubiquitously expressed and can be detected in endothelium, vascular smooth muscle and myocardium. In addition to its metabolic effects, leptin has distinct effects in the cardiovascular system leading to increased production of proinflammatory cytokines and oxidative stress, vascular remodeling and neointima formation as well as cardiomyocyte hypertrophy. Notably, recent clinical studies have linked serum levels of leptin to the occurrence of cardiovascular events such as myocardial infarction and stroke suggesting that leptin promotes pro-atherogenic vascular mechanisms. In contrast, less is known about the role and effects of leptin in the setting of chronic heart failure. We here review the current knowledge on cardiovascular effects of leptin and discuss its potential as a new therapeutic tool in chronic heart failure.
Collapse
Affiliation(s)
- P Christian Schulze
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA.
| | | |
Collapse
|
45
|
Wisniacki N, Taylor W, Lye M, Wilding JPH. Insulin resistance and inflammatory activation in older patients with systolic and diastolic heart failure. Heart 2005; 91:32-7. [PMID: 15604330 PMCID: PMC1768659 DOI: 10.1136/hrt.2003.029652] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate insulin resistance and systemic inflammation in older patients with systolic (SHF) or diastolic heart failure (DHF). PATIENTS 52 non-diabetic patients (> 70 and < 90 years old) with chronic heart failure (CHF) and hospitalised within the previous six months for heart failure were studied, together with a control group of older healthy volunteers (n = 26). On the basis of Doppler echocardiographic criteria patients were classed as having SHF (n = 27) or DHF (n = 25). MAIN OUTCOME MEASURES Fasting glucose, insulin, C reactive protein, interleukin 6, and tumour necrosis factor alpha soluble receptor II (TNF-alphaSRII) concentrations were determined. Insulin resistance was estimated by the homeostasis model assessment (HOMA). RESULTS HOMA index (median, interquartile range) was higher in patients with DHF (1.77, 1.06-2.26) than in patients with SHF (0.97, 0.81-1.85) or healthy volunteers (1.04, 0.76-1.44; p = 0.01). After adjustment for body mass index, age, and use of angiotensin converting enzyme inhibitors, both groups of patients with CHF were more insulin resistant than were healthy volunteers (p = 0.02). C reactive protein, interleukin 6, and TNF-alphaSRII were all significantly (p < 0.001) higher in patients with DHF and SHF than in healthy volunteers. All markers of systemic inflammation were independently associated with the presence of clinical CHF. CONCLUSION Insulin resistance and inflammatory activation are present in older patients with SHF and DHF.
Collapse
Affiliation(s)
- N Wisniacki
- Diabetes and Endocrinology Research Group, Department of Medicine, University of Liverpool, Liverpool, UK.
| | | | | | | |
Collapse
|
46
|
Tenenbaum A, Fisman EZ. Impaired glucose metabolism in patients with heart failure: pathophysiology and possible treatment strategies. Am J Cardiovasc Drugs 2004; 4:269-80. [PMID: 15449970 DOI: 10.2165/00129784-200404050-00001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The firm association of diabetes mellitus with congestive heart failure (CHF) has been undoubtedly established. Recent reports support the presence of the reciprocal interrelationships between CHF and glucose abnormalities. The present review provides an overview of some aspects of the multifactorial interrelationships between heart failure and diabetes mellitus. Patients with heart failure are generally at higher risk of developing type 2 diabetes mellitus. Several factors may be involved, such as a lack of physical activity, hypermetabolic state, intracellular metabolic defects, poor muscle perfusion, and poor nutrition. Serum levels of inflammatory cytokines and leptin are elevated in patients with heart failure. Activation of the sympathetic system in CHF not only increases insulin resistance but also decreases the release of insulin from the pancreatic beta cells, increases hepatic glucose production by stimulating both gluconeogenesis and glycogenolysis, and increases glucagon production and lipolysis. People who develop type 2 diabetes mellitus usually pass through the phases of nuclear peroxisome proliferator-activated receptor modulation, insulin resistance, hyperinsulinemia, pancreatic beta-cell stress and damage leading to progressively decreasing insulin secretion, and impaired fasting and postprandial blood glucose levels. Once hyperglycemia ensues, the risk of metabolic and cardiovascular complications also increases. It is possible that the cornerstone of diabetes mellitus prevention in patients with CHF could be controlled by increased physical activity in a cardiac rehabilitation framework. Pharmacologic interventions by some medications (metformin, orlistat, ramipril and acarbose) can also effectively delay progression to type 2 diabetes mellitus in general high risk populations, but the magnitude of the benefit in patients with CHF is unknown. In patients with CHF and overt diabetes mellitus, ACE inhibitors may provide a special advantage and should be the first-line agent. Recent reports have suggested that angiotensin receptor antagonists (angiotensin receptor blockers), similar to ACE inhibitors, provide beneficial effects in patients with diabetes mellitus and should be the second-line agent if ACE inhibitors are contraindicated. Treatment with HMG-CoA reductase inhibitors should probably now be considered routinely for all diabetic patients with CHF, irrespective of their initial serum cholesterol levels, unless there is a contraindication.
Collapse
Affiliation(s)
- Alexander Tenenbaum
- Cardiac Rehabilitation Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | | |
Collapse
|
47
|
Sabelis LWE, Senden PJ, Zonderland ML, van de Wiel A, Wielders JPM, Huisveld IA, van Haeften TW, Mosterd WL. Determinants of insulin sensitivity in chronic heart failure. Eur J Heart Fail 2004; 5:759-65. [PMID: 14675854 DOI: 10.1016/s1388-9842(03)00156-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To describe the determinants of insulin sensitivity (IS) in chronic heart failure (CHF), we created a model in which the influence of lifestyle factors and etiology of heart failure on IS were incorporated concomitantly with age, left ventricular ejection fraction (LVEF) and parameters of body composition. DESIGN Observational cohort study. SETTING Outpatient clinic for chronic heart failure. PATIENTS Fifty-seven male CHF patients [NYHA class II-III, age 61+/-9 years, body mass index (BMI) 26.9+/-3.3 kg/m2 (mean+/-S.D.)]. INTERVENTIONS Euglycemic hyperinsulinemic clamp, cycle ergometry, anthropometric measurements, LVEF and a physical activity questionnaire. MAIN OUTCOME MEASURES A model explaining the variance of IS in CHF. RESULTS IS was 18.2+/-8.6 microg.kg(-1).min(-1).mU(-1).l(-1), fasting insulin level was 15.9+/-11.0 mU/l and fasting glucose level was 5.5+/-0.6 mmol/l. Peak VO2 was 19.1+/-4.9 ml.kg(-1).min(-1) and LVEF 26.2+/-7.1%. IS was inversely associated with fasting insulin concentration (r=-0.50, P<0.001) and BMI (r=-0.54, P<0.001). After controlling for BMI, IS also revealed a correlation with age (r=-0.36, P<0.01). The model explained 60% of variance in IS: BMI contributed 20%, smoking 17%, age 17% and physical activity in daily life (DPA) 16% (all P<0.05) to the variance of IS, whereas LVEF (9%) and etiology of heart failure (8%) contributed moderately. CONCLUSIONS In CHF patients, IS is for a major part predicted by BMI, smoking, age, daily physical activity, LVEF and etiology of heart failure.
Collapse
Affiliation(s)
- L W E Sabelis
- Department of Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Anemia can be the cause of heart failure, but also its consequence. The pathogenesis of anemia in chronic heart failure (CHF) has yet to be fully elucidated, but is likely to be complex. Epidemiologic studies suggest that kidney dysfunction (by reducing the erythropoietic response to anemia), inflammation (by inducing erythropoietin resistance), decreased body mass index, old age, female gender, and poor clinical status may be important factors in the development of anemia in CHF. Intestinal malabsorption, chronic aspirin use, and proteinuria predisposes to iron deficiency. Proinflammatory cytokines are likely to play a significant role in anemia in CHF by generating the "anemia of chronic illness" that is a hallmark of inflammatory conditions. Few studies have investigated the mechanisms of anemia in CHF. There is a need for such studies.
Collapse
Affiliation(s)
- Darlington O Okonko
- Imperial College, NHLI, Department of Clinical Cardiology, London, United Kingdom
| | | |
Collapse
|
49
|
Abstract
Diabetes is a risk factor for coronary atherosclerosis, myocardial infarction, and ischemic cardiomyopathy. Insulin resistance is associated with left ventricular (LV) hypertrophy and hypertensive cardiomyopathy. Even in the absence of coronary artery disease or hypertension, "diabetic cardiomyopathy" can develop because of myocardial autonomic dysfunction or impaired coronary flow reserve. The relationship between insulin resistance and cardiomyopathy is bidirectional. Systemic and myocardial glucose uptake is compromised in heart failure independent of etiology. These abnormalities are associated with cellular deficits of insulin signaling. Insulin resistance in heart failure can be detrimental, because transcriptional shifts in metabolic gene expression favor glucose over fat as a substrate for high-energy phosphate production. Although preexisting diabetes accelerates this process of "metabolic death," insulin resistance can also develop secondary to cardiomyopathy-associated overabundance of neurohormones and cytokines. Insulin resistance and fatty acid excess are potential therapeutic targets in heart failure, striving for efficient myocardial substrate utilization. Peroxisome proliferator activator receptor gamma (PPARgamma) agonists are antidiabetic agents with antilipemic and insulin-sensitizing activity. Experimental studies suggest salutary effects in limiting infarct size, attenuating myocardial reperfusion injury, inhibiting hypertrophic signaling and vascular antiinflammatory actions through cytokine inhibition. However, clinical applicability in diabetic patients experiencing heart failure has been hampered because of increased edema and even fewer reports of exacerbation associated with these compounds. Evidence to date argues for peripheral mechanisms of edema unrelated to central hemodynamics. Nevertheless, they are currently contraindicated in New York Heart Association (NYHA) III-IV patients, particularly in combination with insulin. Investigations are underway to decipher mechanisms, risks, and benefits of PPARgamma agonists, as well as the role of the structurally related PPARalpha receptor on cardiovascular metabolism and function.
Collapse
Affiliation(s)
- Lazaros A Nikolaidis
- Division of Cardiology, Department of Medicine, Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA
| | | |
Collapse
|
50
|
Piatti P, Di Mario C, Monti LD, Fragasso G, Sgura F, Caumo A, Setola E, Lucotti P, Galluccio E, Ronchi C, Origgi A, Zavaroni I, Margonato A, Colombo A. Association of insulin resistance, hyperleptinemia, and impaired nitric oxide release with in-stent restenosis in patients undergoing coronary stenting. Circulation 2003; 108:2074-81. [PMID: 14530196 DOI: 10.1161/01.cir.0000095272.67948.17] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Previously undiagnosed diabetes, impaired glucose tolerance, and insulin resistance are common in patients with acute myocardial infarction and coronary heart disease (CHD) and might be involved in early restenosis after stent implantation. To evaluate whether markers of insulin resistance syndrome, including leptin, and endothelial dysfunction are related to increased rate of early restenosis, we studied nondiabetic patients with CHD after successful coronary stenting. METHODS AND RESULTS Both patients with CHD undergoing coronary stenting (120 patients) and control subjects (58 patients) were submitted to an oral glucose tolerance test (OGTT). Fasting leptin levels and fasting and postglucose load insulin sensitivity were assessed. Endothelial function was measured by nitrite and nitrate release (NOx) during OGTT. More than 50% of patients treated with stent implantation presented impaired glucose tolerance or type 2 diabetes, which was previously undiagnosed. These patients also had higher glucose, insulin, and leptin levels than control subjects. Among the stented patients, insulin and leptin levels were higher in patients with restenosis than in patients without restenosis. A significant increase in NOx levels was found during OGTT both in patients without restenosis and in control subjects. On the contrary, NOx profiles were blunted in patients with restenosis. At multiple regression analysis, only DeltaAUC-NOx areas and insulin sensitivity index showed an independent correlation with the minimal lumen diameter at follow-up. CONCLUSIONS We demonstrated that insulin resistance and endothelial dysfunction are independent predictors of early restenosis after coronary stenting.
Collapse
Affiliation(s)
- PierMarco Piatti
- Cardiovascular and Metabolic Rehabilitation Unit, Rehabilitation and Functional Reeducation Division, IRCCS H. San Raffaele, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|