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Serum miR-122 levels correlate with diabetic retinopathy. Clin Exp Med 2019; 19:255-260. [PMID: 30673918 DOI: 10.1007/s10238-019-00546-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/16/2019] [Indexed: 12/15/2022]
Abstract
Diabetic retinopathy is the most severe ocular complication of diabetes and may lead to visual disability and blindness. Proliferative diabetic retinopathy (PDR) is characterized by ischemia-induced neovascularization with associated complications. An association was established between the presence of PDR, cardiovascular disease, and mortality among patients with type 1 diabetes mellitus and type 2 diabetes mellitus in epidemiological studies. However, the mechanism underlying increased cardiovascular risk in patients with PDR is still unknown. In recent years, a group of miRNAs has been linked to the pathology of diabetes mellitus. Besides, miRNAs in biofluids such as serum have been suggested as potential minimally invasive biomarkers of diabetes and vascular complications. This was a prospective study that recruited 40 human subjects: 10 healthy subjects, 10 with diabetes but without retinopathy (NDR), 10 with diabetic non-proliferative retinopathy (NPDR), and 10 with proliferative diabetic retinopathy (PDR). To examine whether serum miRNAs show altered levels at different stages of diabetic retinopathy, seven specific miRNA candidates (miR-126-3p, miR-130a-3p, miR-21-1, let-7f-5p, miR-122, miR-30c and miR-451a) were measured by qRT-PCR in RNA isolated from sera of all subjects. miR-122 levels increased in parallel with retinopathy severity: from healthy controls to NDR and from NDR to NPDR. However, when the disease progressed to PDR a marked decrease in miR-122 level was noted. This decrease was significant both compared to NPDR samples (p = 0.016) and to all non-PDR samples (p = 0.0002). Additionally, a positive trend was observed comparing miR-122 levels and the number of endothelial progenitor cells in the sera of all subjects. A significant increase in miR-122 was found in patients with diabetic retinopathy that may be related to its role in preventing angiogenesis and proliferation. The dramatic decline in patients with PDR may represent an inhibition or exhaustion of the anti-angiogenic anti-proliferative defense system. Further studies are needed to understand whether miRNA-122 has a role in the pathogenesis of diabetic retinopathy.
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McCarthy NS, Vangjeli C, Surendran P, Treumann A, Rooney C, Ho E, Sever P, Thom S, Hughes AD, Munroe PB, Howard P, Johnson T, Caulfield M, Shields DC, O'Brien E, Fitzgerald DJ, Stanton AV. Genetic variants in PPARGC1B and CNTN4 are associated with thromboxane A 2 formation and with cardiovascular event free survival in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). Atherosclerosis 2018; 269:42-49. [PMID: 29258006 PMCID: PMC5813793 DOI: 10.1016/j.atherosclerosis.2017.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/17/2017] [Accepted: 12/07/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Elevated urinary 11-dehydro thromboxane B2 (TxB2), a measure of thromboxane A2 formation in vivo, predicts future atherothrombotic events. To further understand this relationship, the genetic determinants of 11-dehydro TxB2 and their associations with cardiovascular morbidity were investigated in this study. METHODS Genome-wide and targeted genetic association studies of urinary 11-dehydro TxB2 were conducted in 806 Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) participants. RESULTS The strongest associations were in PPARGC1B (rs4235745, rs32582, rs10515638) and CNTN4 (rs10510230, rs4684343), these 5 single nucleotide polymorphisms (SNPs) were independently associated with 11-dehydro TxB2 formation. Haplotypes of 11-dehydro TxB2 increasing alleles for both PPARGC1B and CNTN4 were significantly associated with 11-dehydro TxB2, explaining 5.2% and 4.5% of the variation in the whole cohort, and 8.8% and 7.9% in participants not taking aspirin, respectively. In a second ASCOT population (n = 6199), addition of these 5 SNPs significantly improved the covariate-only Cox proportional hazards model for cardiovascular events (chisq = 14.7, p=0.01). Two of the risk alleles associated with increased urinary 11-dehydro TxB2 were individually associated with greater incidences of cardiovascular events - rs10515638 (HR = 1.31, p=0.01) and rs10510230 (HR = 1.25, p=0.007); effect sizes were larger in those not taking aspirin. CONCLUSIONS PPARGC1B and CNTN4 genotypes are associated with elevated thromboxane A2 formation and with an excess of cardiovascular events. Aspirin appears to blunt these associations. If specific protection of PPARGC1B and CNTN4 variant carriers by aspirin is confirmed by additional studies, PPARGC1B and CNTN4 genotyping could potentially assist in clinical decision making regarding the use of aspirin in primary prevention.
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Affiliation(s)
- Nina S McCarthy
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, RCSI, Dublin, Ireland; Centre for the Genetic Origins of Health and Disease, University of Western Australia, Perth, Australia.
| | - Ciara Vangjeli
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, RCSI, Dublin, Ireland
| | - Praveen Surendran
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, RCSI, Dublin, Ireland; School of Medicine, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Achim Treumann
- Newcastle University Protein and Proteome Analysis (NUPPA), University of Newcastle, Newcastle upon Tyne, UK
| | - Cathy Rooney
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, RCSI, Dublin, Ireland
| | - Emily Ho
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, RCSI, Dublin, Ireland
| | - Peter Sever
- International Centre for Circulatory Health, Imperial College London, London, UK
| | - Simon Thom
- International Centre for Circulatory Health, Imperial College London, London, UK
| | - Alun D Hughes
- International Centre for Circulatory Health, Imperial College London, London, UK
| | - Patricia B Munroe
- Clinical Pharmacology, William Harvey Research Institute, Barts and the London Medical School, Queen Mary University of London and NIHR Barts Cardiovascular Biomedical Research Unit, London, UK
| | - Philip Howard
- Clinical Pharmacology, William Harvey Research Institute, Barts and the London Medical School, Queen Mary University of London and NIHR Barts Cardiovascular Biomedical Research Unit, London, UK
| | - Toby Johnson
- Clinical Pharmacology, William Harvey Research Institute, Barts and the London Medical School, Queen Mary University of London and NIHR Barts Cardiovascular Biomedical Research Unit, London, UK; GlaxoSmithKline, Gunnels Wood Road, Stevenage SG1 2NY, UK
| | - Mark Caulfield
- Clinical Pharmacology, William Harvey Research Institute, Barts and the London Medical School, Queen Mary University of London and NIHR Barts Cardiovascular Biomedical Research Unit, London, UK
| | - Denis C Shields
- School of Medicine, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Eoin O'Brien
- School of Medicine, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Desmond J Fitzgerald
- School of Medicine, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Alice V Stanton
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, RCSI, Dublin, Ireland
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Willeit P, Skroblin P, Moschen AR, Yin X, Kaudewitz D, Zampetaki A, Barwari T, Whitehead M, Ramírez CM, Goedeke L, Rotllan N, Bonora E, Hughes AD, Santer P, Fernández-Hernando C, Tilg H, Willeit J, Kiechl S, Mayr M. Circulating MicroRNA-122 Is Associated With the Risk of New-Onset Metabolic Syndrome and Type 2 Diabetes. Diabetes 2017; 66:347-357. [PMID: 27899485 PMCID: PMC5248985 DOI: 10.2337/db16-0731] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/18/2016] [Indexed: 12/12/2022]
Abstract
MicroRNA-122 (miR-122) is abundant in the liver and involved in lipid homeostasis, but its relevance to the long-term risk of developing metabolic disorders is unknown. We therefore measured circulating miR-122 in the prospective population-based Bruneck Study (n = 810; survey year 1995). Circulating miR-122 was associated with prevalent insulin resistance, obesity, metabolic syndrome, type 2 diabetes, and an adverse lipid profile. Among 92 plasma proteins and 135 lipid subspecies quantified with mass spectrometry, it correlated inversely with zinc-α-2-glycoprotein and positively with afamin, complement factor H, VLDL-associated apolipoproteins, and lipid subspecies containing monounsaturated and saturated fatty acids. Proteomics analysis of livers from antagomiR-122-treated mice revealed novel regulators of hepatic lipid metabolism that are responsive to miR-122 inhibition. In the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT, n = 155), 12-month atorvastatin reduced circulating miR-122. A similar response to atorvastatin was observed in mice and cultured murine hepatocytes. Over up to 15 years of follow-up in the Bruneck Study, multivariable adjusted risk ratios per one-SD higher log miR-122 were 1.60 (95% CI 1.30-1.96; P < 0.001) for metabolic syndrome and 1.37 (1.03-1.82; P = 0.021) for type 2 diabetes. In conclusion, circulating miR-122 is strongly associated with the risk of developing metabolic syndrome and type 2 diabetes in the general population.
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Affiliation(s)
- Peter Willeit
- King's British Heart Foundation Centre, King's College London, London, U.K.
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K
| | - Philipp Skroblin
- King's British Heart Foundation Centre, King's College London, London, U.K
| | - Alexander R Moschen
- Department of Internal Medicine I (Endocrinology, Gastroenterology and Metabolic Diseases), Medical University of Innsbruck, Innsbruck, Austria
| | - Xiaoke Yin
- King's British Heart Foundation Centre, King's College London, London, U.K
| | - Dorothee Kaudewitz
- King's British Heart Foundation Centre, King's College London, London, U.K
| | - Anna Zampetaki
- King's British Heart Foundation Centre, King's College London, London, U.K
| | - Temo Barwari
- King's British Heart Foundation Centre, King's College London, London, U.K
| | - Meredith Whitehead
- King's British Heart Foundation Centre, King's College London, London, U.K
| | - Cristina M Ramírez
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT
| | - Leigh Goedeke
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT
| | - Noemi Rotllan
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT
| | - Enzo Bonora
- Division of Endocrinology, Diabetes, and Metabolic Diseases, University and Hospital Trust of Verona, Verona, Italy
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, London, U.K
| | - Peter Santer
- Department of Laboratory Medicine, Bruneck Hospital, Bruneck, Italy
| | | | - Herbert Tilg
- Department of Internal Medicine I (Endocrinology, Gastroenterology and Metabolic Diseases), Medical University of Innsbruck, Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Manuel Mayr
- King's British Heart Foundation Centre, King's College London, London, U.K.
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4
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Urinary proteomic biomarkers to predict cardiovascular events. Proteomics Clin Appl 2015; 9:610-7. [DOI: 10.1002/prca.201400195] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/21/2015] [Accepted: 03/16/2015] [Indexed: 12/29/2022]
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Davies JE, Lacy P, Tillin T, Collier D, Cruickshank JK, Francis DP, Malaweera A, Mayet J, Stanton A, Williams B, Parker KH, McG Thom SA, Hughes AD. Excess pressure integral predicts cardiovascular events independent of other risk factors in the conduit artery functional evaluation substudy of Anglo-Scandinavian Cardiac Outcomes Trial. Hypertension 2014; 64:60-8. [PMID: 24821941 DOI: 10.1161/hypertensionaha.113.02838] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Excess pressure integral (XSPI), a new index of surplus work performed by the left ventricle, can be calculated from blood pressure waveforms and may indicate circulatory dysfunction. We investigated whether XSPI predicted future cardiovascular events and target organ damage in treated hypertensive individuals. Radial blood pressure waveforms were acquired by tonometry in 2069 individuals (aged, 63±8 years) in the Conduit Artery Functional Evaluation (CAFE) substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). Measurements of left ventricular mass index (n=862) and common carotid artery intima media thickness (n=923) were also performed. XSPI and the integral of reservoir pressure were lower in people treated with amlodipine±perindopril than in those treated with atenolol±bendroflumethiazide, although brachial systolic blood pressure was similar. A total of 134 cardiovascular events accrued during a median 3.4 years of follow-up; XSPI was a significant predictor of cardiovascular events after adjustment for age and sex, and this relationship was unaffected by adjustment for conventional cardiovascular risk factors or Framingham risk score. XSPI, central systolic blood pressure, central augmentation pressure, central pulse pressure, and integral of reservoir pressure were correlated with left ventricular mass index, but only XSPI, augmentation pressure, and central pulse pressure were associated positively with carotid artery intima media thickness. Associations between left ventricular mass index, XSPI, and integral of reservoir pressure and carotid artery intima media thickness and XSPI were unaffected by multivariable adjustment for other covariates. XSPI is a novel indicator of cardiovascular dysfunction and independently predicts cardiovascular events and targets organ damage in a prospective clinical trial.
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Affiliation(s)
- Justin E Davies
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - Peter Lacy
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - Therese Tillin
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - David Collier
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - J Kennedy Cruickshank
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - Darrel P Francis
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - Anura Malaweera
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - Jamil Mayet
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - Alice Stanton
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - Bryan Williams
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - Kim H Parker
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - Simon A McG Thom
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.)
| | - Alun D Hughes
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College Healthcare NHS Trust (J.E.D., D.P.F., A.M., J.M., S.A.M.T.) and Department of Bioengineering (K.H.P.), Imperial College London, London, United Kingdom; Institute of Cardiovascular Science and National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom (P.L., T.T., B.W., A.D.H.); Department of Clinical Pharmacology, William Harvey Research Institute, Bart's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom (D.C.); Cardiovascular Medicine and Nutrition at King's College London, London, United Kingdom (J.K.C.); and Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland (A.S.).
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Barron AJ, Hughes AD, Sharp A, Baksi AJ, Surendran P, Jabbour RJ, Stanton A, Poulter N, Fitzgerald D, Sever P, O'Brien E, Thom S, Mayet J. Long-term antihypertensive treatment fails to improve E/e' despite regression of left ventricular mass: an Anglo-Scandinavian cardiac outcomes trial substudy. Hypertension 2013; 63:252-8. [PMID: 24218432 DOI: 10.1161/hypertensionaha.113.01360] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antihypertensive treatment can improve tissue Doppler indices of left ventricular diastolic function in the short term, but little is known about the longer-term effect of different antihypertensive treatments on progression of left ventricular diastolic function and left ventricular hypertrophy. We hypothesized that long-term treatment of hypertension will lead to improvements in left ventricular hypertrophy and diastolic function. We collected detailed cardiovascular phenotypic data on 1006 participants from a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial. Patients randomized to either an amlodipine±perindopril-based or an atenolol±bendroflumethiazide-based regimen underwent conventional and tissue Doppler echocardiography at time of control of blood pressure after randomization (≈1.5 years; phase 1) and after a further 2 years of antihypertensive treatment (phase 2). There were no prerandomization data. Five hundred thirty-six patients had complete data collection at both phases. Left ventricular mass index regressed from phase 1 to 2 with no significant difference between treatment groups (amlodipine: 119.5-116.8; atenolol: 122.9-117.5; P<0.001 for both). Conversely, tissue Doppler diastolic indices did not change in the amlodipine±perindopril-based regimen (E/e', 7.5-7.6 cm/s; P=not significant), but deteriorated in the atenolol±bendroflumethiazide-based regimen (E/e', 8.0-8.5 cm/s; P<0.01). Despite regression of left ventricular hypertrophy, there was no associated improvement in diastolic function. In fact, long-term treatment with atenolol±bendroflumethiazide resulted in a progressive deterioration in E/e'. This may be a factor contributing to the previously described worse clinical outcome in patients treated with atenolol±bendroflumethiazide compared with amlodipine±perindopril.
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Affiliation(s)
- Anthony J Barron
- Imperial College London, 59 North Wharf Rd, London W2 1LA, United Kingdom.
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7
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Tapp RJ, Sharp A, Stanton AV, O'Brien E, Chaturvedi N, Poulter NR, Sever PS, Thom SAM, Hughes AD, Mayet J. Differential effects of antihypertensive treatment on left ventricular diastolic function: an ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) substudy. J Am Coll Cardiol 2010; 55:1875-81. [PMID: 20413040 DOI: 10.1016/j.jacc.2009.11.084] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 11/09/2009] [Accepted: 11/18/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We hypothesized that an amlodipine-based regimen would have more favorable effects on left ventricular (LV) diastolic function. BACKGROUND Different antihypertensive therapies may vary in their effect on LV diastolic function. METHODS The HACVD (Hypertension Associated Cardiovascular Disease) substudy of ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) collected detailed cardiovascular phenotypic data on a subset of 1,006 participants recruited from 2 centers (St. Mary's Hospital, London, and Beaumont Hospital, Dublin). Conventional and tissue Doppler echocardiography and measurement of plasma B-type natriuretic peptide (BNP) were performed approximately 1 year after randomization to atenolol-based or amlodipine-based antihypertensive treatment to assess LV diastolic function. RESULTS On-treatment blood pressure (BP) (mean +/- SD) was similar in both groups: atenolol-based regimen, systolic BP of 137 +/- 17 mm Hg, diastolic BP of 82 +/- 9 mm Hg; amlodipine-based regimen, systolic BP of 136 +/- 15 mm Hg, diastolic BP of 80 +/- 9 mm Hg. Ejection fraction did not differ between groups, but early diastolic mitral annular velocity (E'), a measure of diastolic relaxation, was lower in patients on the atenolol-based regimen: atenolol-based regimen, 7.9 +/- 1.8; amlodipine-based regimen, 8.8 +/- 2.0. A measure of left ventricular filling pressure, E/E', and BNP were significantly higher in patients on the atenolol-based regimen. Differences in E', E/E', and BNP remained significant after adjustment for age and sex. Further adjustment for systolic BP, LV mass index, and heart rate had no impact on differences in mean E' or BNP. The difference in E/E' was attenuated. CONCLUSIONS Patients receiving treatment with an amlodipine-based regimen had better diastolic function than patients treated with the atenolol-based regimen. Treatment-related differences in diastolic function were independent of BP reduction and other factors that are known to affect diastolic function.
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Affiliation(s)
- Robyn J Tapp
- International Centre for Circulatory Health, NHLI, St. Mary's Hospital and Imperial College London, St. Mary'sCampus, London, United Kingdom.
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Sharp AS, Tapp RJ, Thom SAM, Francis DP, Hughes AD, Stanton AV, Zambanini A, O'Brien E, Chaturvedi N, Lyons S, Byrd S, Poulter NR, Sever PS, Mayet J. Tissue Doppler E/E' ratio is a powerful predictor of primary cardiac events in a hypertensive population: an ASCOT substudy. Eur Heart J 2009; 31:747-52. [DOI: 10.1093/eurheartj/ehp498] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Thom S, Stettler C, Stanton A, Witt N, Tapp R, Chaturvedi N, Allemann S, Mayet J, Sever P, Poulter N, O'Brien E, Hughes A. Differential Effects of Antihypertensive Treatment on the Retinal Microcirculation. Hypertension 2009; 54:405-8. [DOI: 10.1161/hypertensionaha.109.133819] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Simon Thom
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Christoph Stettler
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Alice Stanton
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Nicholas Witt
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Robyn Tapp
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Nish Chaturvedi
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Sabin Allemann
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Jamil Mayet
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Peter Sever
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Neil Poulter
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Eoin O'Brien
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
| | - Alun Hughes
- From the International Centre for Circulatory Health (S.T., C.S., N.W., R.T., N.C., J.M., P.S., N.P., A.H.), National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, London, United Kingdom; Division of Endocrinology, Diabetes, and Clinical Nutrition (C.S., S.A.), University Hospital and University of Bern, Bern, Switzerland; Molecular and Cellular Therapeutics (A.S.), RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Epidemiology
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Stettler C, Witt N, Tapp RJ, Thom S, Allemann S, Tillin T, Stanton A, O'Brien E, Poulter N, Gallimore JR, Hughes AD, Chaturvedi N. Serum amyloid A, C-reactive protein, and retinal microvascular changes in hypertensive diabetic and nondiabetic individuals: an Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) substudy. Diabetes Care 2009; 32:1098-100. [PMID: 19244088 PMCID: PMC2681044 DOI: 10.2337/dc08-2137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study the association of the inflammatory markers serum amyloid A (SAA) and C-reactive protein (CRP) with retinal microvascular parameters in hypertensive individuals with and without type 2 diabetes. RESEARCH DESIGN AND METHODS This cross-sectional analysis was a substudy in 711 patients (159 with and 552 without diabetes) of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) based on digital 30-degree images of superior and inferior temporal retinal fields. RESULTS SAA was associated with arteriolar length-to-diameter ratio positively in nondiabetic patients (P(trend)= 0.028) but negatively in diabetic patients (P(trend)= 0.005). The difference was unlikely to be a chance finding (P = 0.007 for interaction). Similar results were found for the association of SAA with arteriolar tortuosity (P = 0.05 for interaction). Associations were less pronounced for CRP and retinal parameters. CONCLUSIONS Inflammatory processes are differentially involved in retinal microvascular disease in diabetic compared with nondiabetic hypertensive individuals.
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Affiliation(s)
- Christoph Stettler
- Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital and University of Bern, Bern, Switzerland.
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Stojanovic MM, O'Brien E, Lyons S, Stanton AV. Silent myocardial ischaemia in treated hypertensives with and without left ventricular hypertrophy. Blood Press Monit 2003; 8:45-51. [PMID: 12604937 DOI: 10.1097/00126097-200302000-00010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Silent ischaemia has been reported to be associated with an increased risk of myocardial infarction and sudden death in a wide range of patient groups. The aim of this study was to examine the prevalence of silent ischaemia in hypertensive patients with and without left ventricular hypertrophy (LVH). METHODS Twenty hypertensive patients participating in the Anglo-Scandinavian Cardiac Outcomes Trial with echocardiographic LVH (11 males, nine females), and 20 age, sex, blood pressure, and drug treatment-matched hypertensive patients without LVH underwent 24-h combined ambulatory blood pressure and electrocardiographic (ECG) monitoring. Ischaemic events were defined by the 'rule of 3 x 1'-asymptomatic ST-depression >/= 1 mm (0.1 mV), lasting at least 1 min, and with a duration of at least 1 min between two events. RESULTS Thirteen patients with LVH had ischaemic events, whilst only four without LVH demonstrated ischaemia. Median numbers of events (seven versus zero; P < 0.01) and median total ischaemic area (0.25 versus 0 mV*min/day; P < 0.01) were significantly increased amongst hypertensive patients with LVH by comparison to those without LVH. CONCLUSION Despite similar levels of established risk factors for atherosclerotic coronary artery disease, the prevalence of silent ischaemia was markedly increased amongst hypertensive patients with LVH by comparison to those with normal left ventricular dimensions. Ambulatory ECG monitoring may have a use in the identification of those at greatest risk of cardiovascular complications and sudden death, amongst hypertensive patients with persistent cardiac hypertrophy despite anti-hypertensive therapy.
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Affiliation(s)
- Milos M Stojanovic
- Blood Pressure Unit and ADAPT Centre, Beaumont Hospital, Dublin 9, Ireland
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