1
|
Zhou Y, Zhao L, Zhang Z, Meng X, Cai QJ, Zhao XL, Wang LP, Hu AH, Zhou XL. Sex difference in nocturnal blood pressure dipping in adolescents with varying degrees of adiposity. BMC Pediatr 2024; 24:353. [PMID: 38778302 PMCID: PMC11110230 DOI: 10.1186/s12887-024-04804-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND For adolescents, abnormal dipping patterns in blood pressure (BP) are associated with early-onset organ damage and a higher risk of cardiovascular disorders in adulthood. Obesity is one of the most common reasons for abnormal BP dipping in young people. However, it is unknown whether the severity of obesity is associated with BP dipping status and whether this association is sex-dependent. METHODS 499 participants between 12 and 17 years old with overweight or obesity underwent ambulatory blood pressure monitoring (ABPM) between April 2018 and January 2019 in Beijing and Baoding. Participants were grouped by body mass index (BMI) into overweight (BMI 85th-95th percentile), obese (BMI ≥ 95th percentile) and severely obese (BMI ≥ 120% of 95th percentile or ≥ 35 kg/m2) groups. Non-dipping was defined as a < 10% reduction in BP from day to night. The interaction effect between sex and obesity degree was also analyzed. RESULTS 326 boys and 173 girls were included, of whom 130 were overweight, 189 were obese, and 180 were severely obese. Girls with severe obesity had a higher prevalence of non-dipping, but boys showed no significant differences in BP dipping status between obesity categories. In addition, as obesity severity went up, a more evident increase in night-time SBP was observed in girls than in boys. CONCLUSIONS Severely obese is associated with a higher prevalence of non-BP dipping patterns in girls than in boys, which suggests that the relationship between the severity of obesity and BP dipping status might be sex-specific.
Collapse
Affiliation(s)
- Yi Zhou
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Lin Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Zenglei Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Qiu-Jing Cai
- Department of Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiao-Lei Zhao
- Department of Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Lin-Ping Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | - Ai-Hua Hu
- Department of Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| |
Collapse
|
2
|
Li GA, Huang J, Wang J, Fan L. Association between the triglyceride-glucose index and subclinical left ventricular systolic dysfunction in obese patients. Cardiovasc Diabetol 2024; 23:161. [PMID: 38715070 PMCID: PMC11077869 DOI: 10.1186/s12933-024-02253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The association between the triglyceride-glucose (TyG) index and subclinical left ventricular (LV) systolic dysfunction in obese patients remains unclear. This study aimed to investigate the relationship between the TyG index and LV global longitudinal strain (GLS) in obese patients. METHODS A total of 1028 obese patients from January 2019 to January 2024 were included in the present study. Clinical parameters and biochemical and echocardiographic data were obtained from the participants. LV GLS was obtained from the GE EchoPAC workstation for evaluating subclinical LV function. The TyG index was calculated as Ln (fasting TG [mg/dL] × fasting glucose [mg/dL]/2). LV GLS was compared between obese patients with a high TyG index and those with a low TyG index. RESULTS Obese patients with a high TyG index had greater incidences of hypertension, diabetes mellitus and hyperlipidaemia. The LV GLS was significantly lower in the high TyG index group than in the low TyG index group (P = 0.01). After adjusting for sex, age, body mass index, heart rate, hypertension, diabetes mellitus, dyslipidaemia, blood urea nitrogen, serum creatinine, LV mass and LV hypertrophy, the TyG index remained an independent risk indicator related to an LV GLS < 20% (OR: 1.520, 95% CI: 1.040 to 2.221; P = 0.031). CONCLUSIONS We concluded that an increase in the TyG index is independently associated with subclinical LV systolic dysfunction in obese patients.
Collapse
Affiliation(s)
- Guang-An Li
- Department of Echocardiography, The Affiliated Changzhou Second People's Hospital with Nanjing Medical University, 213003, Changzhou, China
| | - Jun Huang
- Department of Echocardiography, The Affiliated Changzhou Second People's Hospital with Nanjing Medical University, 213003, Changzhou, China.
| | - Jing Wang
- Department of Weight Loss Metabolic Surgery, The Affiliated Changzhou Second People's Hospital with Nanjing Medical University, 213003, Changzhou, China
| | - Li Fan
- Department of Echocardiography, The Affiliated Changzhou Second People's Hospital with Nanjing Medical University, 213003, Changzhou, China
| |
Collapse
|
3
|
Zhang X, Li G, Zhang D, Sun Y. Influence of hypertension and global or abdominal obesity on left ventricular hypertrophy: A cross-sectional study. J Clin Hypertens (Greenwich) 2023. [PMID: 37794691 DOI: 10.1111/jch.14716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 10/06/2023]
Abstract
Although hypertension and obesity are both risk factors for left ventricular hypertrophy (LVH), the extent of their impact on LVH in the general population is still unclear, and the predictive value of obesity indicators for LVH remains to be elucidated. In this study, obesity-related indicators, including waist circumference (WC), waist-height ratio (WHTR), and waist-hip ratio (WHR), were used to define abdominal obesity (AO), whereas body mass index (BMI) was used to measure general obesity (GO). The effects of hypertension and obesity on LVH were estimated using logistic regression analysis, as was the relative risk of LVH based on the presence of obesity, hypertension, or both. Subgroup analyses were performed based on sex and age. Of the 9134 participants (≥35 years old), 915 (10.0%) developed LVH. After adjusting for covariates, the odds ratios (95% confidence intervals) for LVH were 3.94 (3.27-4.75) in patients with hypertension, 1.90 (1.60-2.26) in those with GO, and 1.45 (1.25-1.69), 1.69 (1.43-2.00), and 1.54 (1.33-4.75) in individuals with AO defined based on WC, WHTR, and WHR, respectively. Analysis by sex showed similar values in women, but AO based on WC and WHR were not significantly associated with LVH in men. Further, after adjusting for potential confounding factors, concomitant hypertension and obesity had an increased risk of developing LVH in all age ranges, particularly in patients aged 35-45 years (risk increased 14.14-fold, 10.84-fold, 7.97-fold, and 9.95-fold for BMI-based GO and WC-, WHTR-, and WHR-based AO, respectively), and in both men and women but particularly in men (risk increased 7.71-fold, 4.67-fold, 5.83-fold, and 5.58-fold, respectively). In summary, all obesity indicators (BMI, WC, WHTR, and WHR) had predictive value for LVH in women; however, only BMI and WHTR should be considered for men. Furthermore, monitoring for the occurrence and progression of LVH is imperative for rural Chinese patients with concomitant hypertension and obesity, especially men and those aged 35-45 years.
Collapse
Affiliation(s)
- Xueyao Zhang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Guangxiao Li
- Department of Medical Record Management, First Hospital of China Medical University, Shenyang, China
| | - Dongyuan Zhang
- NHC Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS), Comparative Medicine Center, Peking, Union Medical College (PUMC), Beijing, China
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
4
|
Schulz A, Lange T, Evertz R, Kowallick JT, Hasenfuß G, Backhaus SJ, Schuster A. Sex-Specific Impairment of Cardiac Functional Reserve in HFpEF: Insights From the HFpEF Stress Trial. JACC. ADVANCES 2023; 2:100327. [PMID: 38938247 PMCID: PMC11198589 DOI: 10.1016/j.jacadv.2023.100327] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 06/29/2024]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) has been observed to have a twice as high prevalence in women compared to men with similar predisposing risk factors between both sexes. Objectives This study aimed to identify sex-specific pathophysiological features in HFpEF using rest and exercise stress right heart catheterization (RHC), echocardiography and cardiovascular magnetic resonance imaging (CMR). Methods Seventy-five patients with exertional dyspnea, preserved ejection fraction (EF) (≥50%), and signs of diastolic dysfunction on echocardiography were prospectively recruited in the HFpEF Stress Trial. Patients underwent RHC, echocardiography and CMR at rest and during exercise stress. Patients were diagnosed with HFpEF and noncardiac dyspnea according to RHC measurements. Results After exclusion, the final study cohort comprised 68 patients (females n = 44, males n = 24) with a mean age of 66.9 ± 9.7 years. Compared to men, women with HFpEF revealed lower right ventricular stroke volumes during exercise stress (females 38.1 vs males 50.4 mL/m2 BSA; P = 0.011). This was accompanied by a decreasing left atrial EF in women but not men comparing resting to exercise conditions (females -2.7% vs males 2.5%, P = 0.020) and impaired left ventricular filling (females 35.5 vs males 44.2 mL/m2 BSA, P = 0.017) in women with HFpEF during exercise stress. These sex-specific differences were not present in noncardiac dyspnea. Conclusions Women with HFpEF demonstrate sex-specific functional alterations of right ventricular, left atrial, and left ventricular function during exercise stress. This unique pathophysiology represents a sex-specific diagnostic target, which may allow early identification of women with HFpEF for future individualized therapeutic approaches.
Collapse
Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| |
Collapse
|
5
|
Ságová I, Dragula M, Mokáň M, Vaňuga P. Filling the gap between the heart and the body in acromegaly: a case-control study. Endocrine 2023; 79:365-375. [PMID: 36309947 PMCID: PMC9892104 DOI: 10.1007/s12020-022-03232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/12/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Cardiovascul diseases are the most common comorbidities in acromegaly. Potential parameters in pathology of cardiovascular comorbidities are changes in levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) as well as body composition parameters. PURPOSE The aim of this study was to examine morphological and functional parameters of the cardiovascular system by echocardiography and to assess its relationship with disease activity and body composition parameters. METHODS We prospectively enroled 129 acromegalic patients (82 females, 47 males) and 80 healthy controls (53 females, 27 males) matched for age, gender, and BMI. All patients underwent two-dimensional echocardiography. Body composition parameters were assessed by dual-energy X-ray absorptiometry. RESULTS Acromegaly patients presented with higher left ventricle mass (LVM) compared to controls (LVMI: 123 ± 45 g/m2 vs 83 ± 16 g/m2, P < 0.001). Prevalence of left ventricle hypertrophy in acromegaly patients was 67% (78% concentric, 22% eccentric). IGF -1 levels, BMI, and lean mass positively correlated with LVM in all acromegaly patients (P < 0.001). Fat mass positively correlated with LVM in females (R = 0.306, P = 0.005), but this correlation was not found in males. We did not find any difference in size of the left and right ventricle between acromegaly patients and controls. Acromegaly patients presented with left atrium enlargement, diastolic dysfunction and low incidence of systolic dysfunction. Valvopathy was found in 43% of patients with predominant (31%) prevalence of mitral regurgitation. CONCLUSION Our study demonstrates higher prevalence of cardiovascular comorbidities in acromegaly patients and the impact of IGF-1 levels and body composition parameters in pathology in some of these comorbidities.
Collapse
Affiliation(s)
- Ivana Ságová
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia.
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia.
| | - Milan Dragula
- Cardiology clinic University Hospital Martin, Martin, Slovakia
| | - Marián Mokáň
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia
| | - Peter Vaňuga
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
| |
Collapse
|
6
|
Szadkowska I, Guligowska A, Jegier A, Pawlikowski M, Pisarek H, Winczyk K, Kostka T. Serum testosterone level correlates with left ventricular hypertrophy in older women. Front Endocrinol (Lausanne) 2023; 13:1079043. [PMID: 36686418 PMCID: PMC9853043 DOI: 10.3389/fendo.2022.1079043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Sex hormones may play an important role in age-related cardiac remodeling. However, their impact on cardiac structure and function in females of advanced age still remains unclear. The aim of this study is to evaluate the relationship between sex hormones level and echocardiographic parameters in older women with concomitant cardiovascular diseases. Materials and Methods The study group included 52 community-dwelling women with mean age 79.5 ± 2.8 years, consecutive patients of an outpatient geriatric clinic. In all the subjects, a transthoracic echocardiogram was performed and serum testosterone, estradiol, follicle-stimulating hormone, luteinising hormone, dehydroepiandrosterone sulphate, and cortisol levels were determined. Results Testosterone level correlated positively with interventricular septum diastolic dimension (IVSd) (rS=0.293, p<0.05), left ventricular mass index (rS=0.285, p<0.05), E/E' ratio (rS=0.301, p<0.05), and negatively with E' (rS=-0.301, p<0.05). Estradiol level showed a positive correlation with the posterior wall dimension (rS=0.28, p<0.05). Besides, no significant correlations between clinical or echocardiographic parameters and other hormones were observed. Female subjects with diagnosed left ventricular hypertrophy (LVH) (n=34) were characterized by a significantly higher rate of hypertension (p=0.011), higher waist-to-height ratio (p=0.009), higher testosterone level (0.82 vs. 0.48 nmol/L, p=0.024), higher testosterone/estradiol ratio (16.4 vs. 9.9, p=0.021), and received more anti-hypertensive drugs (p=0.030). In a multiple stepwise logistic regression, the best determinants of LVH were the presence of hypertension (OR=6.51; 95% CI 1.62-26.1), and testosterone level (OR= 6.6; 95% CI 1.19-36.6). Conclusions Higher serum testosterone levels may contribute to pathological cardiac remodeling, especially in hypertensive women. Estradiol, gonadotropins, DHEAS, and cortisol were not related to echocardiographic parameters.
Collapse
Affiliation(s)
- Iwona Szadkowska
- Department of Sports Medicine, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Guligowska
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Lodz, Poland
| | - Anna Jegier
- Department of Sports Medicine, Medical University of Lodz, Lodz, Poland
| | - Marek Pawlikowski
- Department of Immunoendocrinology, Medical University of Lodz, Lodz, Poland
| | - Hanna Pisarek
- Department of Neuroendocrinology, Chair of Laboratory and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland
| | - Katarzyna Winczyk
- Department of Neuroendocrinology, Chair of Laboratory and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
7
|
Bao Q, Li Y, Ma S, Qiu J, Sun J, Su Y, Zhang A, Cai S, Cheng B, Li M, Zhang Y, Wang S, Zhu P. Hypertriglyceridemic waist phenotype is associated with left ventricular hypertrophy in Chinese hypertension patients. J Clin Hypertens (Greenwich) 2023; 25:191-198. [PMID: 36591647 PMCID: PMC9903198 DOI: 10.1111/jch.14604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 01/03/2023]
Abstract
Left ventricular hypertrophy (LVH), the most common target organ damage in patients with hypertension, is closely related to excessive visceral adipose tissue (VAT) accumulation in the body. The hypertriglyceridemic waist (HTHW) phenotype can act as a surrogate marker of excessive VAT. However, the relationship between the HTHW phenotype and LVH in patients with hypertension remains unknown. The present study aimed to investigate whether the HTHW phenotype is associated with LVH, using echocardiography in a cross-sectional study involving 4470 middle-aged and older Chinese patients with hypertension. Logistic regression analysis revealed that patients with the HTHW phenotype were 1.52-fold more likely to experience LVH than those with normal triglyceride levels and normal waist circumference. This association was independent of age, sex, and other potentially confounding factors. In the stratified analysis, a stronger correlation was found among women, people of at least 70 years of age, and people with hyperuricemia. These results suggest that distinguishing the HTHW phenotype in patients with hypertension could serve as a simple and effective screening strategy for identifying people with a higher risk of developing LVH.
Collapse
Affiliation(s)
- Qiligeer Bao
- Medical School of Chinese PLABeijingChina,Department of GeriatricsThe Second Medical Center & National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Yun Li
- Medical School of Chinese PLABeijingChina,The 305 Hospital of PLABeijingChina
| | - Shouyuan Ma
- Department of Geriatric CardiologyThe Second Medical CenterChinese PLA General HospitalBeijingChina
| | - Jiaojiao Qiu
- Department of GeriatricsThe Second Medical Center & National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Jin Sun
- Medical School of Chinese PLABeijingChina,Department of GeriatricsThe Second Medical Center & National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Yongkang Su
- Medical School of Chinese PLABeijingChina,Department of GeriatricsThe Second Medical Center & National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Anhang Zhang
- Medical School of Chinese PLABeijingChina,Department of GeriatricsThe Second Medical Center & National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Shuang Cai
- Medical School of Chinese PLABeijingChina,Department of GeriatricsThe Second Medical Center & National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Bokai Cheng
- Medical School of Chinese PLABeijingChina,Department of GeriatricsThe Second Medical Center & National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Man Li
- Department of GeriatricsThe Second Medical Center & National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Yan Zhang
- Department of OutpatientThe First Medical CenterChinese PLA General HospitalBeijingChina
| | - Shuxia Wang
- Department of GeriatricsThe Second Medical Center & National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Ping Zhu
- Department of GeriatricsThe Second Medical Center & National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| |
Collapse
|
8
|
Li K, Cardoso C, Moctezuma-Ramirez A, Elgalad A, Perin E. Evaluation of large animal models for preclinical studies of heart failure with preserved ejection fraction using clinical score systems. Front Cardiovasc Med 2023; 10:1099453. [PMID: 37034319 PMCID: PMC10076838 DOI: 10.3389/fcvm.2023.1099453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is characterized by a complex, heterogeneous spectrum of pathologic features combined with average left ventricular volume and diastolic dysfunction. HFpEF is a significant public health problem associated with high morbidity and mortality rates. Currently, effective treatments for HFpEF represent the greatest unmet need in cardiovascular medicine. A lack of an efficient preclinical model has hampered the development of new devices and medications for HFpEF. Because large animal models have similar physiologic traits as humans and appropriate organ sizes, they are the best option for limiting practical constraints. HFpEF is a highly integrated, multiorgan, systemic disorder requiring a multipronged investigative approach. Here, we review the large animal models of HFpEF reported to date and describe the methods that have been used to create HFpEF, including surgery-induced pressure overloading, medicine-induced pressure overloading, and diet-induced metabolic syndrome. In addition, for the first time to our knowledge, we use two established clinical HFpEF algorithms (HFA-PEFF and H2FPEF scores) to evaluate the currently available large animal models. We also discuss new technologies, such as continuous remote pressure monitors and inflatable aortic cuffs, as well as how the models could be improved. Based on current progress and our own experience, we believe an efficient large animal model of HFpEF should simultaneously encompass multiple pathophysiologic factors, along with multiorgan dysfunction. This could be fully evaluated through available methods (imaging, blood work). Although many models have been studied, only a few studies completely meet clinical score standards. Therefore, it is critical to address the deficiencies of each model and incorporate novel techniques to establish a more reliable model, which will help facilitate the understanding of HFpEF mechanisms and the development of a treatment.
Collapse
Affiliation(s)
- Ke Li
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX, United States
| | - Cristiano Cardoso
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX, United States
| | - Angel Moctezuma-Ramirez
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX, United States
| | - Abdelmotagaly Elgalad
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX, United States
- Correspondence: Abdelmotagaly Elgalad
| | - Emerson Perin
- Center for Clinical Research, The Texas Heart Institute, Houston, TX, United States
| |
Collapse
|
9
|
Gerdts E, Sudano I, Brouwers S, Borghi C, Bruno RM, Ceconi C, Cornelissen V, Diévart F, Ferrini M, Kahan T, Løchen ML, Maas AHEM, Mahfoud F, Mihailidou AS, Moholdt T, Parati G, de Simone G. Sex differences in arterial hypertension. Eur Heart J 2022; 43:4777-4788. [PMID: 36136303 PMCID: PMC9726450 DOI: 10.1093/eurheartj/ehac470] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/17/2022] [Accepted: 08/11/2022] [Indexed: 01/12/2023] Open
Abstract
There is strong evidence that sex chromosomes and sex hormones influence blood pressure (BP) regulation, distribution of cardiovascular (CV) risk factors and co-morbidities differentially in females and males with essential arterial hypertension. The risk for CV disease increases at a lower BP level in females than in males, suggesting that sex-specific thresholds for diagnosis of hypertension may be reasonable. However, due to paucity of data, in particularly from specifically designed clinical trials, it is not yet known whether hypertension should be differently managed in females and males, including treatment goals and choice and dosages of antihypertensive drugs. Accordingly, this consensus document was conceived to provide a comprehensive overview of current knowledge on sex differences in essential hypertension including BP development over the life course, development of hypertension, pathophysiologic mechanisms regulating BP, interaction of BP with CV risk factors and co-morbidities, hypertension-mediated organ damage in the heart and the arteries, impact on incident CV disease, and differences in the effect of antihypertensive treatment. The consensus document also highlights areas where focused research is needed to advance sex-specific prevention and management of hypertension.
Collapse
Affiliation(s)
| | - Isabella Sudano
- University Hospital Zurich University Heart Center, Cardiology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium,Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Rosa Maria Bruno
- Université de Paris Cité, Inserm, PARCC, Paris, France,Service de Pharamcologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Claudio Ceconi
- University of Cardiologia, ASST Garda, Desenzano del Garda, Italy
| | | | | | - Marc Ferrini
- Department of Cardiology and Vascular Pathology, CH Saint Joseph and Saint Luc, Lyon, France
| | - Thomas Kahan
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards, UK,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gianfranco Parati
- Department of Cardiac, Neural and Metabolic Sciences, Instituto Auxologico Italiano, IRCCS, Milan, Italy,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | |
Collapse
|
10
|
de Oliveira Silva T, Lino CA, Miranda JB, Balbino-Silva CS, Lunardon G, Lima VM, Jensen L, Donato J, Irigoyen MC, Barreto-Chaves MLM, Diniz GP. miRNA-143-3p-Sox6-Myh7 pathway is altered in obesogenic diet-induced cardiac hypertrophy. Exp Physiol 2022; 107:892-905. [PMID: 35765992 DOI: 10.1113/ep090315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? To investigate the effect of an obesogenic diet on the expression of microRNAs (miRNAs) involved in cardiac hypertrophy in female mice. What is the main finding and its importance? Female mice fed an obesogenic diet exhibited cardiac hypertrophy associated with increased levels of miRNA-143-3p, decreased levels of Sox6 and increased expression of Myh7. Inhibition of miRNA-143-3p increased Sox6 mRNA levels and reduced Myh7 expression in cardiomyocytes, and prevented angiotensin II-induced cardiomyocyte hypertrophy. Our results indicate that the miRNA-143-3p-Sox6-Myh7 pathway may play a key role in obesity-induced cardiac hypertrophy. ABSTRACT Obesity induces cardiometabolic disorders associated with a high risk of mortality. We have previously shown that the microRNA (miRNA) expression profile is changed in obesity-induced cardiac hypertrophy in male mice. Here, we investigated the effect of an obesogenic diet on the expression of microRNAs (miRNAs) involved in cardiac hypertrophy in female mice. Female mice fed an obesogenic diet displayed an increased body weight gain, glucose intolerance, insulin resistance, and dyslipidemia. In addition, obese female mice exhibited cardiac hypertrophy associated with increased levels of several miRNAs, including miR-143-3p. Bioinformatic analysis identified Sox6, a regulator of Myh7 transcription, as a predicted target of the miR-143-3p. Female mice fed an obesogenic diet exhibited decreased levels of Sox6 and increased expression of Myh7 in the heart. Loss-of-function studies in cardiomyocytes revealed that inhibition of miR-143-3p increased Sox6 mRNA levels and reduced Myh7 expression. Collectively, our results indicate that obesity-associated cardiac hypertrophy in female mice is accompanied by alterations in diverse miRNAs, and suggest that the miR-143-3p-Sox6-Myh7 pathway may play a key role in obesity-induced cardiac hypertrophy. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Caroline A Lino
- Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Juliane B Miranda
- Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Camila S Balbino-Silva
- Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Guilherme Lunardon
- Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Vanessa M Lima
- Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Leonardo Jensen
- Hypertension Unit, Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Jose Donato
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Gabriela P Diniz
- Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
11
|
Zhang X, Li G, Shi C, Zhang D, Sun Y. Combined superposition effect of hypertension and dyslipidemia on left ventricular hypertrophy. Animal Model Exp Med 2022; 5:227-238. [PMID: 35746831 PMCID: PMC9240736 DOI: 10.1002/ame2.12249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hypertension and dyslipidemia are considered reversible risk factors for cardiovascular disease. The purpose of this study was to explore the impact of traditional and nontraditional blood lipid profiles on the risk of left ventricular hypertrophy (LVH) and to explore the superposition effect of dyslipidemia combined with hypertension. METHODS Data on 9134 participants (53.5 ± 10.3 years old) from the Northeast China Rural Cardiovascular Health Study (NCRCHS) were statistically analyzed. The blood lipid profile was measured by total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total glyceride (TG), and calculated nontraditional blood lipid indices including non-HDL-C, atherosclerosis index (AI), TC/HDL-C, and residual cholesterol (RC). RESULTS After the adjustment of age and gender, the odds ratios (ORs) of LVH in patients with hypertension, high LDL-C, high non-HDL-C, high AI, and high TC/HDL-C were 3.97 (3.31-4.76), 1.27 (1.02-1.59), 1.21 (1.04-1.39), 1.33 (1.15-1.53), and 1.42 (1.22-1.65), respectively. After full adjustment of potential confounding factors, high AI and TC/HDL-C were associated with LVH rather than traditional blood lipid indices. The combination of hypertension and nontraditional dyslipidemia (defined by high AI and TC/HDL-C) was associated with the highest risk of LVH, especially in participants under 45 years of age. The risk was more significant in men, 5.09-fold and 6.24-fold, respectively, compared with 3.66-fold and 4.01-fold in women. CONCLUSIONS People with dyslipidemia defined by nontraditional blood lipid indices (high AI and high TC/HDL-C) and hypertension were more likely to develop LVH.
Collapse
Affiliation(s)
- Xueyao Zhang
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
| | - Guangxiao Li
- Department of Medical Record ManagementFirst Hospital of China Medical UniversityShenyangChina
| | - Chuning Shi
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
| | - Dongyuan Zhang
- NHC Key Laboratory of Human Disease Comparative MedicineInstitute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS), Comparative Medicine Center, Peking Union Medical College (PUMC)BeijingChina
| | - Yingxian Sun
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
| |
Collapse
|
12
|
Rossi A, Mikail N, Bengs S, Haider A, Treyer V, Buechel RR, Wegener S, Rauen K, Tawakol A, Bairey Merz CN, Regitz-Zagrosek V, Gebhard C. Heart-brain interactions in cardiac and brain diseases: why sex matters. Eur Heart J 2022; 43:3971-3980. [PMID: 35194633 PMCID: PMC9794190 DOI: 10.1093/eurheartj/ehac061] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/24/2022] [Accepted: 01/30/2022] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular disease and brain disorders, such as depression and cognitive dysfunction, are highly prevalent conditions and are among the leading causes limiting patient's quality of life. A growing body of evidence has shown an intimate crosstalk between the heart and the brain, resulting from a complex network of several physiological and neurohumoral circuits. From a pathophysiological perspective, both organs share common risk factors, such as hypertension, diabetes, smoking or dyslipidaemia, and are similarly affected by systemic inflammation, atherosclerosis, and dysfunction of the neuroendocrine system. In addition, there is an increasing awareness that physiological interactions between the two organs play important roles in potentiating disease and that sex- and gender-related differences modify those interactions between the heart and the brain over the entire lifespan. The present review summarizes contemporary evidence of the effect of sex on heart-brain interactions and how these influence pathogenesis, clinical manifestation, and treatment responses of specific heart and brain diseases.
Collapse
Affiliation(s)
- Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland,Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Ronny Ralf Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric Hospital, Zurich, Switzerland,Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Vera Regitz-Zagrosek
- Charité, Universitätsmedizin Berlin, Berlin, Germany,University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
13
|
Impact of Sex and Obesity on Echocardiographic Parameters in Children and Adolescents. Pediatr Cardiol 2022; 43:1502-1516. [PMID: 35394150 PMCID: PMC9489563 DOI: 10.1007/s00246-022-02876-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/15/2022] [Indexed: 12/04/2022]
Abstract
Subclinical alterations in left ventricular structure and function are detectable in adolescents with hypertension or obesity. However, data on early echocardiographic abnormalities in seemingly healthy children are lacking. Sex differences in cardiac structure and function have been previously reported, but sex-specific reference values are not available. Specifically, the potential interaction of sex and overweight has not been addressed at all. Anthropometric data, blood pressure and exercise tests were obtained in 356 healthy children. Echocardiographic parameters comprised peak early (E) and late (A) mitral inflow Doppler velocities, E/A ratio, tissue Doppler peak velocities of early (e') and late diastolic (a') excursion of mitral/septal annulus and isovolumetric relaxation time (IVRT). Left ventricular mass index (LVMI) and LVMI z-score were calculated. Interaction terms between BMI and sex and stratification by sex were used for analysis. We provide values for echocardiographic parameters for children of two age groups separated by BMI. Overweight/obese children had a significant higher LVMI, lower E/A ratio, higher E/e' ratios and a longer IVRT. For a given BMI in the upper ranges we demonstrated a higher LVMI in girls than in boys, the IVRT extended significantly more in girls than in boys with increasing BMI. There are sex differences in structural and functional echocardiographic parameters in children and adolescents. Our data not only confirms the importance of overweight and obesity, but demonstrates important interactions between sex and overweight. The greater susceptibility of overweight girls toward echocardiographic changes associated with potential long-term functional impairment needs further exploration and follow-up.Trial registration number DRKS00012371; Date 18.08.2017.
Collapse
|
14
|
Thomas YT, Newman CB, Faynshtayn NG, McGregor AJ. Exploring Obesity as a Gendered Contagion: Impact on Lifestyle Interventions to Improve Cardiovascular Health. Clin Ther 2021; 44:23-32. [PMID: 34937663 DOI: 10.1016/j.clinthera.2021.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Obesity increases the risk of cardiovascular disease. Lifestyle interventions such as physical activity and diet are important components for reducing the risk of obesity. Data suggest that lifestyle choices differ between men and women, as well as in groups. The purpose of this review was to explore whether obesity can be considered as a gendered social contagion, associated with differences in lifestyle and response to lifestyle interventions in men and women. FINDINGS There are important sex-based differences of obesity to consider. There is evidence that peers have an influence on lifestyle preferences such as physical activity level and dietary habits, but the evidence is inconclusive if the differences exist between men and women. Similarly, data from lifestyle intervention studies are not conclusive whether there are differences between men and women. There is not enough evidence for the notion that obesity is a gendered social contagion. IMPLICATIONS More research is needed to understand differences in lifestyle and lifestyle interventions between men and women, especially across the life span, which could have profound public health implications.
Collapse
Affiliation(s)
- Ynhi T Thomas
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Connie B Newman
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, New York University School of Medicine, New York, NY, USA
| | | | - Alyson J McGregor
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| |
Collapse
|
15
|
Denfeld QE, Habecker BA, Camacho SA, Roberts Davis M, Gupta N, Hiatt SO, Medysky ME, Purnell JQ, Winters-Stone K, Lee CS. Characterizing Sex Differences in Physical Frailty Phenotypes in Heart Failure. Circ Heart Fail 2021; 14:e008076. [PMID: 34428925 DOI: 10.1161/circheartfailure.120.008076] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although women with heart failure (HF) are potentially more likely to be physically frail compared with men with HF, the underlying contributors to this sex difference are poorly understood. The purpose of this study was to characterize sex differences in physical frailty phenotypes in HF. METHODS We prospectively enrolled adults with class I-IV HF. Physical frailty was measured with the frailty phenotype criteria. Symptoms of dyspnea, sleep-related impairment, pain interference, depression, and anxiety were assessed. Body composition was measured using dual-energy x-ray absorptiometry. Simple comparative statistics and stepwise regression modeling were used. RESULTS The average age of the sample (n=115) was 63.6±15.7 years, 49% were women, and 73% had nonischemic cause. Forty-three percent of the sample was physically frail. Women had a 4.6 times greater odds of being physically frail compared with men, adjusting for covariates (odds ratio=4.63 [95% CI, 1.81-11.84], P=0.001). Both physically frail men and women were characterized by more type 2 diabetes, higher comorbidity burden, and worse dyspnea symptoms. Physically frail women had significantly worse symptoms compared with non-physically frail women but no difference in body composition characteristics. Physically frail men had significantly lower appendicular muscle mass, higher percent fat, lower hemoglobin, and more depressive symptoms compared with non-physically frail men. CONCLUSIONS Women are significantly more likely to be physically frail compared with men in HF. Physical frailty in both women and men is characterized by comorbidities and worse symptoms; physical frailty in men is characterized by worse physiological characteristics.
Collapse
Affiliation(s)
- Quin E Denfeld
- School of Nursing (Q.E.D., M.R.D., S.O.H., M.E.M., K.W.-S.), Oregon Health and Science University, Portland.,Knight Cardiovascular Institute (Q.E.D., B.A.H., S.A.C., N.G., J.Q.P.), Oregon Health and Science University, Portland
| | - Beth A Habecker
- Knight Cardiovascular Institute (Q.E.D., B.A.H., S.A.C., N.G., J.Q.P.), Oregon Health and Science University, Portland.,Department of Chemical Physiology and Biochemistry (B.A.H.), Oregon Health and Science University, Portland
| | - S Albert Camacho
- Knight Cardiovascular Institute (Q.E.D., B.A.H., S.A.C., N.G., J.Q.P.), Oregon Health and Science University, Portland
| | - Mary Roberts Davis
- School of Nursing (Q.E.D., M.R.D., S.O.H., M.E.M., K.W.-S.), Oregon Health and Science University, Portland
| | - Nandita Gupta
- Knight Cardiovascular Institute (Q.E.D., B.A.H., S.A.C., N.G., J.Q.P.), Oregon Health and Science University, Portland
| | - Shirin O Hiatt
- School of Nursing (Q.E.D., M.R.D., S.O.H., M.E.M., K.W.-S.), Oregon Health and Science University, Portland
| | - Mary E Medysky
- School of Nursing (Q.E.D., M.R.D., S.O.H., M.E.M., K.W.-S.), Oregon Health and Science University, Portland
| | - Jonathan Q Purnell
- Knight Cardiovascular Institute (Q.E.D., B.A.H., S.A.C., N.G., J.Q.P.), Oregon Health and Science University, Portland
| | - Kerri Winters-Stone
- School of Nursing (Q.E.D., M.R.D., S.O.H., M.E.M., K.W.-S.), Oregon Health and Science University, Portland.,Knight Cancer Institute (K.W.-S.), Oregon Health and Science University, Portland
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA (C.S.L.)
| |
Collapse
|
16
|
Withaar C, Lam CSP, Schiattarella GG, de Boer RA, Meems LMG. Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models. Eur Heart J 2021; 42:4420-4430. [PMID: 34414416 PMCID: PMC8599003 DOI: 10.1093/eurheartj/ehab389] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/15/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a multifactorial disease accounting for a large and increasing proportion of all clinical HF presentations. As a clinical syndrome, HFpEF is characterized by typical signs and symptoms of HF, a distinct cardiac phenotype and raised natriuretic peptides. Non-cardiac comorbidities frequently co-exist and contribute to the pathophysiology of HFpEF. To date, no therapy has proven to improve outcomes in HFpEF, with drug development hampered, at least partly, by lack of consensus on appropriate standards for pre-clinical HFpEF models. Recently, two clinical algorithms (HFA-PEFF and H2FPEF scores) have been developed to improve and standardize the diagnosis of HFpEF. In this review, we evaluate the translational utility of HFpEF mouse models in the context of these HFpEF scores. We systematically recorded evidence of symptoms and signs of HF or clinical HFpEF features and included several cardiac and extra-cardiac parameters as well as age and sex for each HFpEF mouse model. We found that most of the pre-clinical HFpEF models do not meet the HFpEF clinical criteria, although some multifactorial models resemble human HFpEF to a reasonable extent. We therefore conclude that to optimize the translational value of mouse models to human HFpEF, a novel approach for the development of pre-clinical HFpEF models is needed, taking into account the complex HFpEF pathophysiology in humans.
Collapse
Affiliation(s)
- Coenraad Withaar
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Carolyn S P Lam
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.,National University Heart Centre, Singapore and Duke-National University of Singapore
| | - Gabriele G Schiattarella
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Department of Cardiology, Center for Cardiovascular Research (CCR), Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Department of Internal Medicine (Cardiology), University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Laura M G Meems
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| |
Collapse
|
17
|
Gebhard C, Maredziak M, Messerli M, Buechel RR, Lin F, Gransar H, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kim YJ, Leipsic J, Maffei E, Marques H, Gonçalves PDA, Pontone G, Raff GL, Rubinshtein R, Shaw LJ, Villines TC, Lu Y, Jones EC, Peña JM, Min JK, Kaufmann PA. Increased long-term mortality in women with high left ventricular ejection fraction: data from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) long-term registry. Eur Heart J Cardiovasc Imaging 2021; 21:363-374. [PMID: 31985803 DOI: 10.1093/ehjci/jez321] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/15/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS There are significant sex-specific differences in left ventricular ejection fraction (LVEF), with a higher LVEF being observed in women. We sought to assess the clinical relevance of an increased LVEF in women and men. METHODS AND RESULTS A total of 4632 patients from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry (44.8% women; mean age 58.7 ± 13.2 years in men and 59.5 ± 13.3 years in women, P = 0.05), in whom LVEF was measured by cardiac computed tomography, were categorized according to LVEF (low <55%, normal 55-65%, and high >65%). The prevalence of high LVEF was similar in both sexes (33.5% in women and 32.5% in men, P = 0.46). After 6 years of follow-up, no difference in mortality was observed in patients with high LVEF in the overall cohort (P = 0.41). When data were stratified by sex, women with high LVEF died more often from any cause as compared to women with normal LVEF (8.6% vs. 7.1%, log rank P = 0.032), while an opposite trend was observed in men (5.8% vs. 6.8% in normal LVEF, log rank P = 0.89). Accordingly, a first order interaction term of male sex and high LVEF was significant (hazard ratios 0.63, 95% confidence intervals 0.41-0.98, P = 0.043) in a Cox regression model of all-cause mortality adjusted for age, cardiovascular risk factors, and severity of coronary artery disease (CAD). CONCLUSION Increased LVEF is highly prevalent in patients referred for evaluation of CAD and is associated with an increased risk of death in women, but not in men. Differentiating between normal and hyperdynamic left ventricles might improve risk stratification in women with CAD. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT01443637.
Collapse
Affiliation(s)
- Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Monika Maredziak
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Fay Lin
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, 8705 Gracie Allen Dr, Los Angeles, CA 90048, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Maximiliansplatz 2, 91054 Erlangen, Germany
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, The Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, 8705 Gracie Allen Dr, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, 1124 W Carson St, Torrance, CA 90502, USA
| | - Filippo Cademartiri
- Cardiovascular Imaging Center, SDN IRCCS, via Gianturco 113, 80143 Naples, Italy
| | - Tracy Q Callister
- Tennessee Heart and Vascular Institute, 353 New Shackle Island Rd, Hendersonville, TN 37075, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, South Korea
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, 8900 N Kendall Dr, Miami, FL 33176, USA
| | - Augustin DeLago
- Capitol Cardiology Associates, Corporate Woods 7 Southwoods Blvd., Albany, NY 12211, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020 Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Yong-Jin Kim
- Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Viale Federico Comandino, 70, 61029 Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Avenida Lusíada, 100, 1500-650 Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Avenida Lusíada, 100, 1500-650 Lisboa, Portugal
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa 34362, Israel
| | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA
| | - Todd C Villines
- Cardiology Service, Walter Reed National Military Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, 402 E. 67th Street, New York, NY 10065, USA
| | - Erica C Jones
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA
| | - Jessica M Peña
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| |
Collapse
|
18
|
Grymyr LMD, Nadirpour S, Gerdts E, Nedrebø BG, Hjertaas JJ, Matre K, Cramariuc D. Left ventricular myocardial oxygen demand and subclinical dysfunction in patients with severe obesity referred for bariatric surgery. Nutr Metab Cardiovasc Dis 2021; 31:666-674. [PMID: 33257189 DOI: 10.1016/j.numecd.2020.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/02/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Increased myocardial oxygen (O2) demand carries higher cardiovascular risk in hypertension. We hypothesized that myocardial O2 demand is increased in severe obesity and linked to early left ventricular (LV) dysfunction. METHODS AND RESULTS Baseline data from 106 severely obese subjects referred for gastric bypass surgery (42 ± 11 years, 74% women, body mass index [BMI] 41.9 ± 4.8 kg/m2, 32% with hypertension) in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study was used. LV systolic function was assessed by biplane ejection fraction (EF), midwall shortening (MWS) and endocardial global longitudinal strain (GLS), and LV diastolic function by mitral annular early diastolic velocity (e'). Myocardial O2 demand was estimated from the LV mass-wall stress-heart rate product (high if > 1.62 × 106/2.29 × 106 g kdyne/cm2 bpm in women/men). High myocardial O2 demand was found in 33% and associated with higher BMI and high prevalence of low GLS (65%) and low MWS (63%) despite normal EF. In ROC analyses, higher myocardial O2 demand discriminated between patients with low vs. normal MWS and GLS (area under curve 0.71 and 0.63, p < 0.05). In successive multiple regression analyses, higher myocardial O2 demand was associated with lower LV MWS, GLS and average e', respectively, independent of age, gender, BMI, pulse pressure, diabetes mellitus, and EF (all p < 0.05). CONCLUSION In obese patients without known heart disease and with normal EF referred for bariatric surgery, high myocardial O2 demand is associated with lower myocardial function whether assessed by GLS or MWS independent of confounders. CLINICALTRIALS. GOV IDENTIFIER NCT01533142.
Collapse
Affiliation(s)
- Lisa M D Grymyr
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| | | | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn G Nedrebø
- Department of Medicine, Haugesund Hospital, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Knut Matre
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Dana Cramariuc
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
19
|
Jung MH, Ihm SH, Lee DH, Han S, Jung HO, Youn HJ, Ryu KH. Sex-specific associations of obesity with exercise capacity and diastolic function in Koreans. Nutr Metab Cardiovasc Dis 2021; 31:254-262. [PMID: 33097412 DOI: 10.1016/j.numecd.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/21/2020] [Accepted: 08/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Women with obesity are highly predominant among patients with heart failure with preserved ejection fraction (HFpEF). We aimed to elucidate sex-specific associations of obesity with exercise capacity and diastolic function. METHODS AND RESULTS Healthy individuals without known cardiovascular diseases undergoing cardiopulmonary exercise test and echocardiography (n = 736) were included and categorized into 4 groups according to their sex and obesity. Exercise capacity was lower in women than men. Obesity was associated with a lower exercise capacity in women (23.5 ± 7.3 vs. 21.3 ± 5.4 ml/kg/min, p < 0.05) but not in men (28.2 ± 7.8 vs. 28.0 ± 6.6 ml/kg/min, p > 0.10). Overall, women had a higher E/e' than men. Women without obesity had a similar E/e' to men with obesity (8.2 ± 1.8 vs. 8.4 ± 2.1, p > 0.10), and women with obesity had the highest E/e'. Among 5 risk factors (aging, obesity, elevated blood pressure, elevated heart rate, and elevated fasting glucose), obesity was a significant determinant of exercise intolerance in women but not men. Furthermore, obesity was associated with a greater risk of diastolic dysfunction in women than men (women, adjusted odds ratio 4.35 [95% confidence interval 2.44-7.74]; men, adjusted odds ratio 2.91 [95% confidence interval 1.42-5.95]). CONCLUSION Obesity had a more deleterious effect on exercise capacity and diastolic function in women than men, even in a healthy cohort. These subclinical changes might contribute to the development of a female predominance among HFpEF patients, particularly among individuals with obesity.
Collapse
Affiliation(s)
- Mi-Hyang Jung
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaweong, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Dong-Hyeon Lee
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seongwoo Han
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaweong, Republic of Korea
| | - Hae Ok Jung
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho-Joong Youn
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu-Hyung Ryu
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaweong, Republic of Korea
| |
Collapse
|
20
|
Paiman EHM, de Mutsert R, Widya RL, Rosendaal FR, Jukema JW, Lamb HJ. The role of insulin resistance in the relation of visceral, abdominal subcutaneous and total body fat to cardiovascular function. Nutr Metab Cardiovasc Dis 2020; 30:2230-2241. [PMID: 32912791 DOI: 10.1016/j.numecd.2020.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The separate cardiovascular effects of type 2 diabetes and adiposity remain to be examined. This study aimed to investigate the role of insulin resistance in the relations of visceral (VAT), abdominal subcutaneous (aSAT) adipose tissue and total body fat (TBF) to cardiovascular remodeling. METHODS AND RESULTS In this cross-sectional analysis of the population-based Netherlands Epidemiology of Obesity study, 914 middle-aged individuals (46% men) were included. Participants underwent magnetic resonance imaging. Standardized linear regression coefficients (95%CI) were calculated, adjusted for potential confounding factors. All fat depots and insulin resistance (HOMA-IR), separate from VAT and TBF, were associated with lower mitral early and late peak filling rate ratios (E/A): -0.04 (-0.09;0.01) per SD (54 cm2) VAT; -0.05 (-0.10;0.00) per SD (94 cm2) aSAT; -0.09 (-0.16;-0.02) per SD (8%) TBF; -0.11 (-0.17;-0.05) per 10-fold increase in HOMA-IR, whereas VAT and TBF were differently associated with left ventricular (LV) end-diastolic volume: -8.9 (-11.7;-6.1) mL per SD VAT; +5.4 (1.1;9.7) mL per SD TBF. After adding HOMA-IR to the model to evaluate the mediating role of insulin resistance, change in E/A was -0.02 (-0.07;0.04) per SD VAT; -0.03 (-0.08;0.02) per SD aSAT; -0.06 (-0.13;0.01) per SD TBF, and change in LV end-diastolic volume was -7.0 (-9.7;-4.3) mL per SD VAT. In women, adiposity but not HOMA-IR was related to higher aortic arch pulse wave velocity. CONCLUSION Insulin resistance was associated with reduced diastolic function, separately from VAT and TBF, and partly mediated the associations between adiposity depots and lower diastolic function.
Collapse
Affiliation(s)
- Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ralph L Widya
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
21
|
Chen X, Wu M, Xu K, Huang M, Xu H. Effects of body mass index and gender on left atrial size in Chinese hypertensive patients. Clin Exp Hypertens 2020; 42:714-721. [PMID: 32546064 DOI: 10.1080/10641963.2020.1779285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Left atrial enlargement (LAE) is a common cardiac structural change in patients with hypertension, and obesity could further promote LAE. However, little is known about the effect of overweight on left atrial size, and if there is a gender difference of the effect. The aim of this study was to analyze the effects of different body mass index (BMI) grades (normal weight, overweight, and obesity) on left atrial size in both male and female patients with hypertension. METHODS A total of 710 patients with hypertension were divided into 3 study groups: normal weight group (BMI < 24 g/m2, n = 302), overweight group (24 kg/m2 ≤ BMI < 28 kg2, n = 318), and obesity group (BMI ≥28 kg/m2, n = 90). The clinical data, echocardiographic indexes and left atrial size were obtained from all the subjects. Pearson correlation analysis was used to analyze the correlation between clinical variables and left atrial diameter (LAD)/left atrial diameter index (LADI), and stepwise regression evaluation was used to study the relevant factors affecting LAD/LADI among all patients, male and female patients for possible gender difference. RESULTS The significant difference in LADI was noted in the three study groups with obesity group of 23.96 ± 2.90 mm/m, overweight group of 22.50 ± 3.02 mm/m and normal weight group of 21.08 ± 2.80 mm/m, respectively (P < . 05). After adjusting for age and gender, there was still significant difference in LADI among the three groups (P < . 05). The correlation between BMI and LADI was higher than that between systolic blood pressure (SBP) and diastolic blood pressure (DBP) (r = 0.348 vs 0.092 and -0.068, respectively, P < .05). After adjusting for other influencing factors, there was still a significant correlation between BMI and LADI (β = 0.326, P < .001), but no correlation was found between SBP and DBP (P > .05). For each additional unit of BMI, LAD increased by 0.034 mm and LADI increased by 0.305 mm/m. Multiple linear regression analysis showed that BMI, left ventricular mass index (LVMI), age and female gender were independently correlated with LADI (P < .05). And BMI was the most significant influencing factor of LADI in male patients (β = 0.350, P < .001), followed by LVMI (β = 0.343, P < .001). While in female patients, LVMI was the most significant (β = 0.353, P < .001), followed by BMI (β = 0.302, P < .001). CONCLUSION Overweight and obesity were significantly associated with LAE in hypertensive patients, with obesity more significant than overweight. While BMI had the greatest correlation with LAE in male, LVMI was the most important determinant of LAE in female. Therefore, in addition to weight loss, more attention should be paid to early inhibition of left ventricular remodeling in female with hypertension.
Collapse
Affiliation(s)
- Xi Chen
- Department of Cardiology, The Affiliated Hospital of Putian University , Putian, FJ, China
| | - Meifang Wu
- Department of Cardiology, The Affiliated Hospital of Putian University , Putian, FJ, China
| | - Kaizu Xu
- Department of Cardiology, The Affiliated Hospital of Putian University , Putian, FJ, China
| | - Meinv Huang
- Department of Cardiology, The Affiliated Hospital of Putian University , Putian, FJ, China
| | - Haishan Xu
- Department of Nephrology, The Affiliated Hospital of Putian University , Putian, FJ, China
| |
Collapse
|
22
|
Io H, Nakata J, Inoshita H, Ishizaka M, Tomino Y, Suzuki Y. Relationship among Left Ventricular Hypertrophy, Cardiovascular Events, and Preferred Blood Pressure Measurement Timing in Hemodialysis Patients. J Clin Med 2020; 9:E3512. [PMID: 33143005 PMCID: PMC7694059 DOI: 10.3390/jcm9113512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
This study aimed to identify the ideal timing and setting for measuring blood pressure (BP) and determine whether the left ventricular mass index (LVMI) is an independent risk factor associated with increased cardiovascular events in hemodialysis (HD) patients. BP and LVMI were measured at baseline and at 6 and 12 months after HD initiation. BP was monitored and recorded at nine different time points, including before and after HD over a one-week period (HDBP). The mean BP measurement was calculated as the weekly averaged BP (WABP). LVMI was significantly correlated with home BP, in-office BP, HDBP, and WABP. Receiver operating characteristic analysis indicated that the cutoff LVMI value for cardiovascular events was 156 g/m2. LVMI and diabetes mellitus were significant influencing factors for cardiovascular events (hazards ratio (95% confidence interval): diabetes mellitus, 2.84 (1.17,7.45); LVMI > 156 g/m2, 2.86 (1.22,6.99)). Pre-HDBP, post-HDBP, and WABP were independently associated with higher LVMI in the follow-up periods. Hemoglobin and human atrial natriuretic peptide (hANP) levels were associated with LVMI beyond 12 months after HD initiation. Treatment of hypertension, overhydration based on hANP, and anemia may reduce the progression of LVMI and help identify HD patients at high risk for cardiovascular events.
Collapse
Affiliation(s)
- Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan; (H.I.); (M.I.)
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| | - Junichiro Nakata
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| | - Hiroyuki Inoshita
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan; (H.I.); (M.I.)
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| | - Masanori Ishizaka
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan; (H.I.); (M.I.)
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| | - Yasuhiko Tomino
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| |
Collapse
|
23
|
Pristaj N, Saeed S, Midtbø H, Halland H, Matre K, Gerdts E. Covariables of Myocardial Function in Women and Men with Increased Body Mass Index. High Blood Press Cardiovasc Prev 2020; 27:579-586. [PMID: 33098553 PMCID: PMC7661414 DOI: 10.1007/s40292-020-00418-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/10/2020] [Indexed: 01/03/2023] Open
Abstract
Introduction Sex-difference in types of cardiac organ damage has been reported in subjects with increased body mass index (BMI). However less is known about sex-differences in left ventricular (LV) myocardial function assessed by global longitudinal strain (GLS) in these subjects. Methods 493 subjects (mean age 47 ± 9 years, 61% women) with BMI > 27.0 kg/m2 and without known cardiac disease underwent 24-hour (24h) ambulatory blood pressure (BP) recording, body composition analysis, carotid-femoral pulse wave velocity (PWV) measurement and echocardiography. LV peak systolic GLS was measured by two-dimensional speckle tracking echocardiography and LV ejection fraction (EF) by biplane Simpson’s method. Insulin sensitivity was assessed by homeostatic model of insulin resistance (HOMA-IR). Results Women had higher prevalence of increased waist circumference (99% vs. 82%), lower prevalence of hypertension (59 vs. 74%), and lower serum triglycerides (1.3 ± 0.7 vs. 1.7 ± 0.9 mmol/L) and carotid-femoral PWV (7.3 ± 1.6 vs. 7.7 ± 1.6 m/s) compared to men (all p < 0.05). Women also had higher (more negative) GLS compared to men (− 19.9 ± 3.0 vs. − 18.6 ± 3.0%, p < 0.001), while EF did not differ between sexes. In multivariable linear regression analyses, lower GLS in women was associated with higher waist circumference and PWV and with lower EF (all p < 0.05). In men, lower GLS was associated with higher waist circumference and HOMA-IR, and with lower EF (all p < 0.05). Conclusions Among subjects with increased BMI, GLS was higher in women than men. Lower GLS was associated with abdominal obesity in both sexes, and with impaired glucose metabolism in men, and with higher arterial stiffness in women. Trial registration https://www.clinicaltrials.gov NCT02805478, first registered 20.06.16.
Collapse
Affiliation(s)
- Nadia Pristaj
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Helga Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Hilde Halland
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Knut Matre
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway. .,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| |
Collapse
|
24
|
Wei FF, Xue R, Wu Y, Liang W, He X, Zhou Y, Owusu-Agyeman M, Wu Z, Zhu W, He J, Staessen JA, Dong Y, Liu C. Sex-Specific Associations of Risks and Cardiac Structure and Function With Microalbumin/Creatinine Ratio in Diastolic Heart Failure. Front Cardiovasc Med 2020; 7:579400. [PMID: 33134325 PMCID: PMC7577227 DOI: 10.3389/fcvm.2020.579400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) affects women more frequently than men. However, data on sex-specific associations of adverse health outcomes and left ventricular structure and function and with microalbuminuria in patients with HFpEF are scarce. Methods: In 1,334 participants enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial, we estimated the sex-specific multivariable-adjusted risk and LV traits with urine microalbumin/creatine ratio (ACR), using Cox or linear regression. Results: In total, 604 (45.3%) were women. In multivariable-adjusted analyses, a doubling of ACR in both men and women was associated with higher posterior (+0.014 cm, p = 0.012/+0.012 cm, p = 0.033) wall thickness and left ventricular mass index (+2.55 mg/m2, p = 0.004/+2.45 mg/m2, p = 0.009), whereas was also associated with higher septal (+0.018 cm, p = 0.002) and left atrial volume index (+1.44 mL/m2, p = 0.001) in men. ACR was a key predictor of all-cause (HR, 1.11; p = 0.006) and cardiovascular (HR, 1.17; p = 0.002) death in women, whereas in men ACR was associated with HF hospitalization (HR, 1.23; p < 0.001), any hospitalization (HR, 1.06; p = 0.006), and myocardial infarction (HR, 1.19; p = 0.017). The interactions of sex with ACR were significant for hospitalization for heart failure and any hospitalization (p ≤ 0.034). Conclusions: Outcomes and cardiac structure and function in patients with HFpEF appear to be influenced by ACR that vary according to sex. In men, ACR was significant associated with LV diastolic function, hospitalization, and myocardial infarction, whereas in women was associated with mortality.
Collapse
Affiliation(s)
- Fang-Fei Wei
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Ruicong Xue
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yuzhong Wu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Weihao Liang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xin He
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yuanyuan Zhou
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Marvin Owusu-Agyeman
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zexuan Wu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Jiangui He
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Non-profit Research Institute (NPA) Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
- National Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, Guangzhou, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
- National Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, Guangzhou, China
| |
Collapse
|
25
|
Packer M, Lam CS, Lund LH, Maurer MS, Borlaug BA. Characterization of the inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction: a hypothesis to explain influence of sex on the evolution and potential treatment of the disease. Eur J Heart Fail 2020; 22:1551-1567. [PMID: 32441863 PMCID: PMC7687188 DOI: 10.1002/ejhf.1902] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 12/11/2022] Open
Abstract
Accumulating evidence points to the existence of an inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction (HFpEF), which is characterized by biomarkers of inflammation, an expanded epicardial adipose tissue mass, microvascular endothelial dysfunction, normal-to-mildly increased left ventricular volumes and systolic blood pressures, and possibly, altered activity of adipocyte-associated inflammatory mediators. A broad range of adipogenic metabolic and systemic inflammatory disorders - e.g. obesity, diabetes and metabolic syndrome as well as rheumatoid arthritis and psoriasis - can cause this phenotype, independent of the presence of large vessel coronary artery disease. Interestingly, when compared with men, women are both at greater risk of and may suffer greater cardiac consequences from these systemic inflammatory and metabolic disorders. Women show disproportionate increases in left ventricular filling pressures following increases in central blood volume and have greater arterial stiffness than men. Additionally, they are particularly predisposed to epicardial and intramyocardial fat expansion and imbalances in adipocyte-associated proinflammatory mediators. The hormonal interrelationships seen in inflammatory-metabolic phenotype may explain why mineralocorticoid receptor antagonists and neprilysin inhibitors may be more effective in women than in men with HFpEF. Recognition of the inflammatory-metabolic phenotype may improve an understanding of the pathogenesis of HFpEF and enhance the ability to design clinical trials of interventions in this heterogeneous syndrome.
Collapse
Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular InstituteBaylor University Medical CenterDallasTXUSA
- Imperial College LondonLondonUK
| | - Carolyn S.P. Lam
- National Heart Centre Singapore and Duke‐National University of SingaporeSingapore
- University Medical Centre GroningenGroningenThe Netherlands
- The George Institute for Global HealthSydneyAustralia
| | - Lars H. Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
| | | | | |
Collapse
|
26
|
Brady TM, Roem J, Cox C, Schneider MF, Wilson AC, Furth SL, Warady BA, Mitsnefes M. Adiposity, Sex, and Cardiovascular Disease Risk in Children With CKD: A Longitudinal Study of Youth Enrolled in the Chronic Kidney Disease in Children (CKiD) Study. Am J Kidney Dis 2020; 76:166-173. [PMID: 32389356 PMCID: PMC7387195 DOI: 10.1053/j.ajkd.2020.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/17/2020] [Indexed: 12/18/2022]
Abstract
RATIONALE & OBJECTIVE Traditional and nontraditional cardiovascular disease risk factors are highly prevalent in children with chronic kidney disease (CKD). We examined the longitudinal association of adiposity with cardiac damage among children with CKD and explored whether this association was modified by sex. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Children with mild-to-moderate CKD enrolled in the Chronic Kidney Disease in Children (CKiD) Study at 49 pediatric nephrology centers across North America. EXPOSURE Age- and sex-specific body mass index (BMI) z score. OUTCOME Age- and sex-specific left ventricular mass index (LVMI) z score and left ventricular hypertrophy (LVH). ANALYTICAL APPROACH Longitudinal analyses using mixed-effects models to estimate sex-specific associations of BMI z scores with LVMI z score and with LVH, accounting for repeated measurements over time. RESULTS Among 725 children with 2,829 person-years of follow-up, median age was 11.0 years and median estimated glomerular filtration rate was 52.6mL/min/1.73m2. Nearly one-third of both boys and girls were overweight or obese, median LVMI z score was 0.18 (IQR: -0.67, 1.08), and 11% had LVH. Greater BMI z scores were independently associated with greater LVMI z scores and greater odds of LVH. For each 1-unit higher BMI z score, LVMI z score was 0.24 (95% CI, 0.17-0.31) higher in boys and 0.38 (95% CI, 0.29-0.47) higher in girls (Pinteraction = 0.01). For each 1-unit higher BMI z score, the odds of LVH was 1.5-fold (95% CI, 1.1-2.1) higher in boys and 3.1-fold (95% CI, 1.8-4.4) higher in girls (Pinteraction = 0.005). LIMITATIONS Not all children had repeated measurements. LVH is a surrogate and not a hard cardiac outcome. The observational design limits causal inference. CONCLUSIONS In children, adiposity is independently associated with the markers of cardiac damage, LVMI z score and LVH. This association is stronger among girls than boys. Pediatric overweight and obesity may therefore have a substantial impact on cardiovascular risk among children with CKD.
Collapse
Affiliation(s)
- Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jennifer Roem
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael F Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amy C Wilson
- J.W. Riley Hospital for Children, Indianapolis, IN
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bradley A Warady
- Division of Nephrology, Children's Mercy Hospital, Kansas City, MO
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
27
|
Weight Reduction for Obesity-Induced Heart Failure with Preserved Ejection Fraction. Curr Hypertens Rep 2020; 22:47. [DOI: 10.1007/s11906-020-01074-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
28
|
Sabbatini AR, Kararigas G. Estrogen-related mechanisms in sex differences of hypertension and target organ damage. Biol Sex Differ 2020; 11:31. [PMID: 32487164 PMCID: PMC7268741 DOI: 10.1186/s13293-020-00306-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/04/2020] [Indexed: 12/13/2022] Open
Abstract
Hypertension (HTN) is a primary risk factor for cardiovascular (CV) events, target organ damage (TOD), premature death and disability worldwide. The pathophysiology of HTN is complex and influenced by many factors including biological sex. Studies show that the prevalence of HTN is higher among adults aged 60 and over, highlighting the increase of HTN after menopause in women. Estrogen (E2) plays an important role in the development of systemic HTN and TOD, exerting several modulatory effects. The influence of E2 leads to alterations in mechanisms regulating the sympathetic nervous system, renin-angiotensin-aldosterone system, body mass, oxidative stress, endothelial function and salt sensitivity; all associated with a crucial inflammatory state and influenced by genetic factors, ultimately resulting in cardiac, vascular and renal damage in HTN. In the present article, we discuss the role of E2 in mechanisms accounting for the development of HTN and TOD in a sex-specific manner. The identification of targets with therapeutic potential would contribute to the development of more efficient treatments according to individual needs.
Collapse
Affiliation(s)
| | - Georgios Kararigas
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
| |
Collapse
|
29
|
Cardioprotective Effects of Dietary Phytochemicals on Oxidative Stress in Heart Failure by a Sex-Gender-Oriented Point of View. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:2176728. [PMID: 31998434 PMCID: PMC6975222 DOI: 10.1155/2020/2176728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/03/2019] [Accepted: 11/29/2019] [Indexed: 01/18/2023]
Abstract
Dietary phytochemicals are considered an innovative strategy that helps to reduce cardiovascular risk factors. Some phytochemicals have been shown to play a beneficial role in lipid metabolism, to improve endothelial function and to modify oxidative stress pathways in experimental and clinical models of cardiovascular impairment. Importantly, investigation on phytochemical effect on cardiac remodeling appears to be promising. Nowadays, drug therapy and implantation of devices have demonstrated to ameliorate survival. Of interest, sex-gender seems to influence the response to HF canonical therapies. In fact, starting by the evidence of the feminization of world population and the scarce efficacy and safety of the traditional drugs in women, the search of alternative therapeutic tools has become mandatory. The aim of this review is to summarize the possible role of dietary phytochemicals in HF therapy and the evidence of a different sex-gender-oriented response.
Collapse
|
30
|
Brandhorst S, Longo VD. Dietary Restrictions and Nutrition in the Prevention and Treatment of Cardiovascular Disease. Circ Res 2019; 124:952-965. [PMID: 30870119 DOI: 10.1161/circresaha.118.313352] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in many developed countries and remains one of the major diseases strongly affected by the diet. Nutrition can affect CVD directly by contributing to the accumulation of vascular plaques and also indirectly by regulating the rate of aging. This review summarizes research on nutrition and CVD incidence based on a multipillar system that includes basic research focused on aging, epidemiological studies, clinical studies, and studies of centenarians. The relevant research linking nutrition and CVD with focus on macronutrients and aging will be highlighted. We will review some of the most relevant studies on nutrition and CVD treatment, also focusing on interventions known to delay aging. We will discuss both everyday dietary compositions, as well as intermittent and periodic fasting interventions with the potential to prevent and treat CVD.
Collapse
Affiliation(s)
- Sebastian Brandhorst
- From the Longevity Institute, Davis School of Gerontology, University of Southern California, Los Angeles (S.B., V.D.L.)
| | - Valter D Longo
- From the Longevity Institute, Davis School of Gerontology, University of Southern California, Los Angeles (S.B., V.D.L.).,Institute of Molecular Oncology, Italian Foundation for Cancer Research, Milan (V.D.L.)
| |
Collapse
|
31
|
Gerdts E, Regitz-Zagrosek V. Sex differences in cardiometabolic disorders. Nat Med 2019; 25:1657-1666. [PMID: 31700185 DOI: 10.1038/s41591-019-0643-8] [Citation(s) in RCA: 237] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023]
Abstract
The prevalence of cardiometabolic disorders in both women and men has increased worldwide and is linked to a rise in obesity and obesity-associated associated clustering of other cardiometabolic risk factors such as hypertension, impaired glucose regulation and dyslipidemia. However, the predominance of common types of cardiometabolic disorders such as heart failure, atrial fibrillation and ischemic heart disease is sex specific, and our identification of these and the underlying mechanisms is only just emerging. New evidence suggests that sex hormones, sex-specific molecular mechanisms and gender influence glucose and lipid metabolisms, as well as cardiac energy metabolism, and function. Here we review sex differences in cardiometabolic risk factors, associated preclinical and clinical cardiac disorders and potential therapeutic avenues.
Collapse
Affiliation(s)
- Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Vera Regitz-Zagrosek
- Berlin Institute for Gender in Medicine, Charité Universitätsmedizin, Berlin, Germany.,DZHK, partner site Berlin, Berlin, Germany
| |
Collapse
|
32
|
Gronda E, Sacchi S, Benincasa G, Vanoli E, Napoli C. Unresolved issues in left ventricular postischemic remodeling and progression to heart failure. J Cardiovasc Med (Hagerstown) 2019; 20:640-649. [DOI: 10.2459/jcm.0000000000000834] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
33
|
Left ventricular myocardial dysfunction in young and middle-aged ischemic stroke patients. J Hypertens 2019; 37:538-545. [DOI: 10.1097/hjh.0000000000001925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
34
|
Cifkova R, Pitha J, Krajcoviechova A, Kralikova E. Is the impact of conventional risk factors the same in men and women? Plea for a more gender-specific approach. Int J Cardiol 2019; 286:214-219. [PMID: 30685102 DOI: 10.1016/j.ijcard.2019.01.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/28/2018] [Accepted: 01/10/2019] [Indexed: 01/06/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women in developed countries. The traditional modifiable risk factors are able to explain the majority of CVD mortality. The aim of this review is to analyze gender-specific aspects of major conventional cardiovascular risk factors and to assess whether they have the same impact on CVD in women. Cigarette smoking remains the single largest preventable cause of cardiovascular morbidity and premature death worldwide. Women smoke less than men; however, smoking seems to be more harmful in women, particularly in oral contraceptive users. Obesity in the general population is more prevalent in women. Visceral adiposity is associated with insulin resistance and a higher risk of developing cardiovascular disease. Life expectancy in female diabetic patients is shorter than in men with diabetes; women with diabetes are also at higher risk of developing cardiovascular events. Changes of main lipid parameters in women are frequently associated with their hormonal status and/or hormonal treatment. Hypertension is highly prevalent in post-menopausal women and carries a higher risk of developing left ventricular hypertrophy, which, together with a greater increase in vascular and myocardial stiffness, results in a higher incidence of heart failure with preserved ejection fraction and a higher risk of developing stroke. The risk of abdominal aortic rupture is substantially higher in women. In conclusion, smoking, diabetes and hypertension seem to be more harmful in women. Therefore, the question is whether there should not be lower thresholds for initiating drug treatment in women with diabetes and hypertension.
Collapse
Affiliation(s)
- Renata Cifkova
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic; Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic.
| | - Jan Pitha
- Department of Internal Medicine, Charles University in Prague, Second Faculty of Medicine, Prague, Czech Republic; Laboratory for Atherosclerosis Research, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Alena Krajcoviechova
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic
| | - Eva Kralikova
- Center for Tobacco Dependence, Third Medical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| |
Collapse
|
35
|
Foulds HJA, Bredin SSD, Warburton DER. Cardiovascular dynamics of Canadian Indigenous peoples. Int J Circumpolar Health 2018; 77:1421351. [PMID: 29405888 PMCID: PMC5804726 DOI: 10.1080/22423982.2017.1421351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022] Open
Abstract
Limited understanding of Indigenous adults' cardiovascular structure and function exists despite high rates of cardiovascular disease. This investigation characterised cardiovascular structure and function among young Indigenous adults and compared to age- and sex-matched European descendants. Echocardiographic assessments included apical two- and four-chamber images, parasternal short-axis images and Doppler. Analyses included cardiac volumes, dimensions, velocities and strains. Cardiovascular structure and function were similar between Indigenous (n=10, 25 ± 3 years, 4 women) and European-descendant (n=10, 24 ± 4 years, 4 women,) adults, though European descendants demonstrated greater systemic vascular resistance (18.19 ± 3.94 mmHg∙min-1∙L-1 vs. 15.36 ± 2.97 mmHg∙min-1∙L-1, p=0.03). Among Indigenous adults, women demonstrated greater arterial elastance (0.80 ± 0.15 mmHg·mL-1·m-2 vs. 0.55 ± 0.17 mmHg·mL-1·m-2, p=0.02) and possibly greater systemic vascular resistance (17.51 ± 2.20 mmHg∙min-1∙L-1 vs. 13.93 ± 2.61 mmHg∙min-1∙L-1, p=0.07). Indigenous men had greater cardiac size, dimensions and output, though body size differences accounted for cardiac size differences. Similar cardiac rotation and strains were observed across sexes. Arterial elastance and cardiac size were different between Indigenous men and women while cardiovascular structure and function may be similar between Indigenous and European descendants.
Collapse
Affiliation(s)
- Heather J. A. Foulds
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Physical Activity Promotion and Chronic Disease Prevention Unit, Vancouver, BC, Canada
| | - Shannon S. D. Bredin
- Physical Activity Promotion and Chronic Disease Prevention Unit, Vancouver, BC, Canada
| | - Darren E. R. Warburton
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Physical Activity Promotion and Chronic Disease Prevention Unit, Vancouver, BC, Canada
| |
Collapse
|
36
|
Gerdts E, Izzo R, Mancusi C, Losi MA, Manzi MV, Canciello G, De Luca N, Trimarco B, de Simone G. Left ventricular hypertrophy offsets the sex difference in cardiovascular risk (the Campania Salute Network). Int J Cardiol 2018; 258:257-261. [PMID: 29544940 DOI: 10.1016/j.ijcard.2017.12.086] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In general, women have lower risk for cardiovascular disease. We tested whether this sex-specific protection persists also in the presence of hypertensive left ventricular hypertrophy (LVH). METHODS 12,329 women and men with hypertension and free from prevalent cardiovascular disease enrolled in the prospective Campania Salute Network registry were followed over a median of 4.1years. Subjects were grouped according to the absence or the presence of LVH identified by echocardiography using validated sex-specific cut-off values of LV mass index (>47g/m2.7 in women and >50g/m2.7 in men). Main outcome was major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation). RESULTS The cardiovascular risk profile accompanying LVH did not differ between sexes, but presence of obesity and diabetes carried higher probability for LVH in women, and LVH was more prevalent in women than men (43.4 vs. 32.1%, p<0.001). Among patients without LVH (n=7764), women had a 35% lower hazard rate (HR) for MACE (n=179) than men (95% confidence interval [CI] 0.44-0.96, p=0.031) in Cox regression analysis adjusting for cardiovascular risk factors and antihypertensive treatment during follow up. In contrast, among patients with LVH (n=4565), women had a similar HR for MACE as men (HR 0.94 [95% CI 0.69-1.30], p=0.720). CONCLUSION This study demonstrates that presence of LVH in hypertension offsets the female sex-protection in cardiovascular risk. Thus among hypertensive subjects with LVH, women and men have comparable cardiovascular risk.
Collapse
Affiliation(s)
- Eva Gerdts
- Department of Clinical Science, University of Bergen, Norway; Hypertension Research Center, Federico II University Hospital, Naples, Italy.
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maria Virginia Manzi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Grazia Canciello
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Nicola De Luca
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| |
Collapse
|
37
|
Halland H, Lønnebakken MT, Pristaj N, Saeed S, Midtbø H, Einarsen E, Gerdts E. Sex differences in subclinical cardiac disease in overweight and obesity (the FATCOR study). Nutr Metab Cardiovasc Dis 2018; 28:1054-1060. [PMID: 30177273 DOI: 10.1016/j.numecd.2018.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Subclinical cardiac disease, like abnormal left ventricular (LV) geometry or left atrial (LA) dilatation, is common in obesity. Less is known about sex differences in the prevalence and type of subclinical cardiac disease in obesity. METHODS AND RESULTS Clinical and echocardiographic data from 581 women and men without established cardiovascular disease and body mass index (BMI) > 27.0 kg/m2 participating in the FAT associated CardiOvasculaR dysfunction (FATCOR) study was analyzed. LA dilatation was recognized as LA volume indexed for height2 ≥16.5 ml/m2 in women and ≥18.5 ml/m2 in men, and abnormal LV geometry as LV hypertrophy and/or increased relative wall thickness. On average, the participants were 48 years old, 60% women and mean BMI was 32.1 kg/m2. Overall, the prevalence of subclinical cardiac disease was higher in women than men (77% vs. 62%, p < 0.001). Women had a higher prevalence of LA dilatation than men (74% vs. 56%, p < 0.001), while men had a higher prevalence of abnormal LV geometry (30% vs. 21%, p = 0.011). After adjusting for confounders in multivariable logistic regression analysis, female sex was associated with a 2-fold higher risk of subclinical cardiac disease, in particular LA dilatation (confidence interval [CI] 1.67-3.49, p < 0.001), while male sex was associated with a 2-fold higher risk of abnormal LV geometry (CI 1.30-3.01, p = 0.001). CONCLUSION The majority of overweight and obese participants in the FATCOR study had subclinical cardiac disease, which may contribute to the impaired prognosis observed in obesity. Women had a higher prevalence of subclinical cardiac disease than men. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.govNCT02805478.
Collapse
Affiliation(s)
- H Halland
- Department of Clinical Science, University of Bergen, Bergen, Norway; Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.
| | - M T Lønnebakken
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - N Pristaj
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - S Saeed
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - H Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - E Einarsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - E Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
38
|
Aroor AR, Manrique-Acevedo C, DeMarco VG. The role of dipeptidylpeptidase-4 inhibitors in management of cardiovascular disease in diabetes; focus on linagliptin. Cardiovasc Diabetol 2018; 17:59. [PMID: 29669555 PMCID: PMC5907287 DOI: 10.1186/s12933-018-0704-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/12/2018] [Indexed: 12/15/2022] Open
Abstract
Multiple population based analyses have demonstrated a high incidence of cardiovascular disease (CVD) and cardiovascular (CV) mortality in subjects with T2DM that reduces life expectancy by as much as 15 years. Importantly, the CV system is particularly sensitive to the metabolic and immune derangements present in obese pre-diabetic and diabetic individuals; consequently, CV dysfunction is often the initial CV derangement to occur and promotes the progression to end organ/tissue damage in T2DM. Specifically, diabetic CVD can manifest as microvascular complications, such as nephropathy, retinopathy, and neuropathy, as well as, macrovascular impairments, including ischemic heart disease, peripheral vascular disease, and cerebrovascular disease. Despite some progress in prevention and treatment of CVD, mainly via blood pressure and dyslipidemia control strategies, the impact of metabolic disease on CV outcomes is still a major challenge and persists in proportion to the epidemics of obesity and diabetes. There is abundant pre-clinical and clinical evidence implicating the DPP-4-incretin axis in CVD. In this regard, linagliptin is a unique DPP-4 inhibitor with both CV and renal safety profiles. Moreover, it exerts beneficial CV effects beyond glycemic control and beyond class effects. Linagliptin is protective for both macrovascular and microvascular complications of diabetes in preclinical models, as well as clinical models. Given the role of endothelial-immune cell interactions as one of the key events in the initiation and progression of CVD, linagliptin modulates these cell–cell interactions by affecting two important pathways involving stimulation of NO signaling and potent inhibition of a key immunoregulatory molecule.
Collapse
Affiliation(s)
- Annayya R Aroor
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO, USA.,Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Camila Manrique-Acevedo
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO, USA.,Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA.,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - Vincent G DeMarco
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO, USA. .,Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA. .,Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA. .,Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA.
| |
Collapse
|
39
|
Wang H, Sun Y, Li Z, Guo X, Chen S, Ye N, Tian Y, Zhang L. Gender-specific contribution of cardiometabolic index and lipid accumulation product to left ventricular geometry change in general population of rural China. BMC Cardiovasc Disord 2018; 18:62. [PMID: 29631555 PMCID: PMC5891949 DOI: 10.1186/s12872-018-0798-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/04/2018] [Indexed: 12/17/2022] Open
Abstract
Background Despite current interest in the unfavorable impact of cardiometabolic index (CMI) and lipid accumulation product (LAP) on diabetes and cardiovascular risk, information regarding the relation of CMI and LAP to left ventricular (LV) geometry has not been specifically addressed. We aimed to examine the hypothesis: (1) CMI and LAP represent an independent determinant of LV remodeling in general population of rural China; (2) there are gender differences in obesity-related alterations in terms of LV morphology. Methods The sample for this cross-sectional analysis included 11,258 participants (mean age 53.9 years; 54.0% females) who underwent assessment of basic metabolic and anthropometric parameters in rural areas of northeast China. Comprehensive echocardiography-defined LV geometric pattern was determined according to left ventricular mass index and relative wall thickness. Results The prevalence rate of eccentric and concentric LV hypertrophy (LVH) presented a proportional increase with elevated quartiles of CMI and LAP in a dose-response manner (all P < 0.005). When CMI and LAP were entered as a continuous variable in multivariable adjusted model, we observed the independent effect of 1 SD increment in CMI and LAP with the probability of eccentric and concentric LVH, while this relationship was more pronounced in females than in males. Likewise, the odds ratio comparing the top versus bottom quartiles of CMI were 2.105 (95%CI:1.600–2.768) for eccentric LVH and 2.236 (95%CI:1.419–3.522) for concentric LVH in females. Males in the highest CMI quartile exhibited a nearly doubled (OR:1.724, 95%CI:1.287–2.311) and 1.523-fold (95%CI:1.003–2.313) greater risk of eccentric and concentric LVH, respectively. Increasing LAP entailed a higher possibility of eccentric LVH by a factor of 3.552 and 1.768 in females and males, respectively. In contrast to females, where LAP fourth quartile and concentric LVH were positively associated (OR:2.544, 95%CI:1.537–4.209), higher LAP did not correlate with concentric LVH in males (OR:1.234, 95%CI:0.824–1.849). Conclusions CMI and LAP give rise to a new paradigm of accounting for gender difference in obesity-related abnormal LV geometry, an effect that was substantially greater in females. These two indices, acting in concert, may also be advantageous prognostically for refining cardiovascular risk stratification in individuals with LV remodeling. Electronic supplementary material The online version of this article (10.1186/s12872-018-0798-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Haoyu Wang
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Zhao Li
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Shuang Chen
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Ning Ye
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yichen Tian
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Lijun Zhang
- Department of Hematology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China.
| |
Collapse
|
40
|
Ojji DB, Libhaber E, Alfa J, Murtala N, Abdullahi B, Nwankwo A, Nnamonu A, Karen S. Left ventricular mass estimation by different partition values in a large population of black hypertensive subjects. Health Sci Rep 2018; 1:e25. [PMID: 30623057 PMCID: PMC6266419 DOI: 10.1002/hsr2.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 01/19/2023] Open
Abstract
AIMS Our aim is to compare the impact of the 2 most widely used methods of indexing left ventricular mass (LVM) on the distribution of abnormal left ventricular (LV) geometric patterns, in a large sample of untreated asymptomatic black hypertensive subjects. METHODS AND RESULTS All patients with hypertension referred to the Cardiology unit of University of Abuja Teaching Hospital, Abuja, Nigeria from 2006 to 2013, who gave informed consent, and underwent physical examination and echocardiography. LVM indexation was classified into 4 geometric patterns after echocardiography: normal geometry, concentric hypertrophy, concentric remodeling, and eccentric hypertrophy. Concentric hypertrophy was the commonest geometric pattern and was detected in 33.6% to 39.5% of the patients. LVM/height2.7 was a better method to detect abnormal geometric pattern than LVM/BSA (P < 0.0001). CONCLUSION In a large cohort of hypertensive subjects with no clinical evidence of cardiovascular disease, abnormal LV geometry was found in greater than four-fifths of the population. In addition, LVM indexed for height 2.7 was found to be a better method for detecting LVH than LVM indexed for BSA, as the highest prevalence of abnormal geometry was diagnosed when LVM was indexed for height2.7.
Collapse
Affiliation(s)
- Dike B. Ojji
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
- South Africa Cardiovascular Research Unit, School of Clinical MedicineUniversity of WitwatersrandSouth Africa
| | - Elena Libhaber
- South Africa Cardiovascular Research Unit, School of Clinical MedicineUniversity of WitwatersrandSouth Africa
| | - Jacob Alfa
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Ngabea Murtala
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Bolaji Abdullahi
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Ada Nwankwo
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Anita Nnamonu
- From Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
| | - Sliwa Karen
- South Africa Cardiovascular Research Unit, School of Clinical MedicineUniversity of WitwatersrandSouth Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health SciencesUniversity of Cape TownSouth Africa
| |
Collapse
|
41
|
Duca F, Zotter-Tufaro C, Kammerlander AA, Aschauer S, Binder C, Mascherbauer J, Bonderman D. Gender-related differences in heart failure with preserved ejection fraction. Sci Rep 2018; 8:1080. [PMID: 29348420 PMCID: PMC5773700 DOI: 10.1038/s41598-018-19507-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/03/2018] [Indexed: 01/15/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) affects more women than men, suggesting gender to play a major role in disease evolution. However, studies investigating gender differences in HFpEF are limited. In the present study we aimed to describe gender differences in a well-characterized HFpEF cohort. Consecutive HFpEF patients underwent invasive hemodynamic assessment, cardiac magnetic resonance imaging and exercise testing. Study endpoints were: cardiac death, a combined endpoint of HF hospitalization or cardiac death and all-cause death. 260 HFpEF patients were prospectively enrolled. Men were more compromised with regard to exercise capacity and had significantly more co-morbidities. Men had more pronounced pulmonary vascular disease with higher diastolic pressure gradients and a lower right ventricular EF. During follow-up, 9.2% experienced cardiac death, 33.5% the combined endpoint and 17.3% all-cause death. Male gender was independently associated with cardiac death, but neither with the combined endpoint nor with all-cause mortality. We detected clear gender differences in HFpEF patients. Cardiac death was more common among men, but not all-cause death. While men are more prone to develop a right heart phenotype and die from HFpEF, women are more likely to die with HFpEF.
Collapse
Affiliation(s)
- Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Caroline Zotter-Tufaro
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas A Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Stefan Aschauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Diana Bonderman
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
42
|
Florijn BW, Bijkerk R, van der Veer EP, van Zonneveld AJ. Gender and cardiovascular disease: are sex-biased microRNA networks a driving force behind heart failure with preserved ejection fraction in women? Cardiovasc Res 2017; 114:210-225. [DOI: 10.1093/cvr/cvx223] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/23/2017] [Indexed: 01/08/2023] Open
Abstract
AbstractCardiovascular disease (CVD) is the primary cause of death among men and women worldwide. Nevertheless, our comprehension of how CVD progresses in women and elicits clinical outcomes is lacking, leading CVD to be under-diagnosed and under-treated in women. A clear example of this differential presentation of CVD pathophysiologies in females is the strikingly higher prevalence of heart failure with preserved ejection fraction (HFpEF). Women with a history of pre-eclampsia or those who present with co-morbidities such as obesity, hypertension, and diabetes mellitus are at increased risk of developing HFpEF. Long understood to be a critical CVD risk factor, our understanding of how gender differentially affects the development of CVD has been greatly expanded by extensive genomic and transcriptomic studies. These studies uncovered a pivotal role for differential microRNA (miRNA) expression in response to systemic inflammation, where their co-ordinated expression forms a post-transcriptional regulatory network that instigates microcirculation defects. Importantly, the potential sex-biased expression of the given miRNAs may explain sex-specific cardiovascular pathophysiologies in women, such as HFpEF. Sex-biased miRNAs are regulated by oestrogen (E2) in their transcription and processing or are expressed from loci on the X-chromosome due to incomplete X-chromosome inactivation. Interestingly, while E2-induced miRNAs predominantly appear to serve protective functions, it could be argued that many X-linked miRNAs have been found to challenge microvascular and myocardial integrity. Therefore, menopausal E2 deficiency, resulting in protective miRNA loss, and the augmentation of X-linked miRNA expression, may well contribute to the molecular mechanisms that underlie the female-specific cardiovascular aetiology in HFpEF.
Collapse
Affiliation(s)
- Barend W Florijn
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Roel Bijkerk
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Eric P van der Veer
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Anton Jan van Zonneveld
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| |
Collapse
|
43
|
Magnussen C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njølstad I, Vartiainen E, Sans S, Pasterkamp G, Hughes M, Costanzo S, Donati MB, Jousilahti P, Linneberg A, Palosaari T, de Gaetano G, Bobak M, den Ruijter HM, Mathiesen E, Jørgensen T, Söderberg S, Kuulasmaa K, Zeller T, Iacoviello L, Salomaa V, Schnabel RB. Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation 2017; 136:1588-1597. [PMID: 29038167 DOI: 10.1161/circulationaha.117.028981] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common cardiac disease in aging populations with high comorbidity and mortality. Sex differences in AF epidemiology are insufficiently understood. METHODS In N=79 793 individuals without AF diagnosis at baseline (median age, 49.6 years; age range, 24.1-97.6 years; 51.7% women) from 4 community-based European studies (FINRISK, DanMONICA, Moli-sani Northern Sweden) of the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), we examined AF incidence, its association with mortality, common risk factors, biomarkers, and prevalent cardiovascular disease, and their attributable risk by sex. Median follow-up time was 12.6 (to a maximum of 28.2) years. RESULTS Fewer AF cases were observed in women (N=1796; 4.4%), than in men (N=2465; 6.4%). Cardiovascular risk factor distribution and lipid profile at baseline were less beneficial in men than in women, and cardiovascular disease was more prevalent in men. Cumulative incidence increased markedly after the age of 50 years in men and after 60 years in women. The lifetime risk was similar (>30%) for both sexes. Subjects with incident AF had a 3.5-fold risk of death in comparison with those without AF. Multivariable-adjusted models showed sex differences for the association of body mass index and AF (hazard ratio per standard deviation increase, 1.18; 95% confidence interval [CI], 1.12-1.23 in women versus 1.31; 95% CI 1.25-1.38 in men; interaction P value of 0.001). Total cholesterol was inversely associated with incident AF with a greater risk reduction in women (hazard ratio per SD, 0.86; 95% CI, 0.81-0.90 versus 0.92; 95% CI, 0.88-0.97 in men; interaction P value of 0.023). No sex differences were seen for C-reactive protein and N-terminal pro B-type natriuretic peptide. The population-attributable risk of all risk factors combined was 41.9% in women and 46.0% in men. About 20% of the risk was observed for body mass index. CONCLUSIONS Lifetime risk of AF was high, and AF was strongly associated with increased mortality both in women and men. Body mass index explained the largest proportion of AF risk. Observed sex differences in the association of body mass index and total cholesterol with AF need to be evaluated for underlying pathophysiology and relevance to sex-specific prevention strategies.
Collapse
Affiliation(s)
- Christina Magnussen
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Teemu J Niiranen
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Francisco M Ojeda
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Francesco Gianfagna
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Stefan Blankenberg
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Inger Njølstad
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Erkki Vartiainen
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Susana Sans
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Gerard Pasterkamp
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Maria Hughes
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Simona Costanzo
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Maria Benedetta Donati
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Pekka Jousilahti
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Allan Linneberg
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Tarja Palosaari
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Giovanni de Gaetano
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Martin Bobak
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Hester M den Ruijter
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Ellisiv Mathiesen
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Torben Jørgensen
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Stefan Söderberg
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Kari Kuulasmaa
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Tanja Zeller
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Licia Iacoviello
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Veikko Salomaa
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.)
| | - Renate B Schnabel
- From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.).
| | | |
Collapse
|
44
|
Aroor AR, Habibi J, Kandikattu HK, Garro-Kacher M, Barron B, Chen D, Hayden MR, Whaley-Connell A, Bender SB, Klein T, Padilla J, Sowers JR, Chandrasekar B, DeMarco VG. Dipeptidyl peptidase-4 (DPP-4) inhibition with linagliptin reduces western diet-induced myocardial TRAF3IP2 expression, inflammation and fibrosis in female mice. Cardiovasc Diabetol 2017; 16:61. [PMID: 28476142 PMCID: PMC5420102 DOI: 10.1186/s12933-017-0544-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/29/2017] [Indexed: 12/12/2022] Open
Abstract
Background Diastolic dysfunction (DD), a hallmark of obesity and primary defect in heart failure with preserved ejection fraction, is a predictor of future cardiovascular events. We previously reported that linagliptin, a dipeptidyl peptidase-4 inhibitor, improved DD in Zucker Obese rats, a genetic model of obesity and hypertension. Here we investigated the cardioprotective effects of linagliptin on development of DD in western diet (WD)-fed mice, a clinically relevant model of overnutrition and activation of the renin-angiotensin-aldosterone system. Methods Female C56Bl/6 J mice were fed an obesogenic WD high in fat and simple sugars, and supplemented or not with linagliptin for 16 weeks. Results WD induced oxidative stress, inflammation, upregulation of Angiotensin II type 1 receptor and mineralocorticoid receptor (MR) expression, interstitial fibrosis, ultrastructural abnormalities and DD. Linagliptin inhibited cardiac DPP-4 activity and prevented molecular impairments and associated functional and structural abnormalities. Further, WD upregulated the expression of TRAF3IP2, a cytoplasmic adapter molecule and a regulator of multiple inflammatory mediators. Linagliptin inhibited its expression, activation of its downstream signaling intermediates NF-κB, AP-1 and p38-MAPK, and induction of multiple inflammatory mediators and growth factors that are known to contribute to development and progression of hypertrophy, fibrosis and contractile dysfunction. Linagliptin also inhibited WD-induced collagens I and III expression. Supporting these in vivo observations, linagliptin inhibited aldosterone-mediated MR-dependent oxidative stress, upregulation of TRAF3IP2, proinflammatory cytokine, and growth factor expression, and collagen induction in cultured primary cardiac fibroblasts. More importantly, linagliptin inhibited aldosterone-induced fibroblast activation and migration. Conclusions Together, these in vivo and in vitro results suggest that inhibition of DPP-4 activity by linagliptin reverses WD-induced DD, possibly by targeting TRAF3IP2 expression and its downstream inflammatory signaling.
Collapse
Affiliation(s)
- Annayya R Aroor
- Diabetes and Cardiovascular Center, Department of Medicine, University of Missouri, Columbia, MO, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | - Javad Habibi
- Diabetes and Cardiovascular Center, Department of Medicine, University of Missouri, Columbia, MO, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | - Hemanth Kumar Kandikattu
- Diabetes and Cardiovascular Center, Department of Medicine, University of Missouri, Columbia, MO, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | - Mona Garro-Kacher
- Diabetes and Cardiovascular Center, Department of Medicine, University of Missouri, Columbia, MO, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | - Brady Barron
- Diabetes and Cardiovascular Center, Department of Medicine, University of Missouri, Columbia, MO, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | - Dongqing Chen
- Diabetes and Cardiovascular Center, Department of Medicine, University of Missouri, Columbia, MO, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | - Melvin R Hayden
- Diabetes and Cardiovascular Center, Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Adam Whaley-Connell
- Division of Nephrology, Department of Medicine, University of Missouri, Columbia, MO, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | - Shawn B Bender
- Biomedical Sciences, University of Missouri, Columbia, MO, USA.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | | | - Jaume Padilla
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA.,Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA.,Department of Child Health, University of Missouri, Columbia, MO, USA
| | - James R Sowers
- Diabetes and Cardiovascular Center, Department of Medicine, University of Missouri, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | - Bysani Chandrasekar
- Division of Cardiovascular Medicine, Department of Medicine, University of Missouri, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA
| | - Vincent G DeMarco
- Diabetes and Cardiovascular Center, Department of Medicine, University of Missouri, Columbia, MO, USA. .,Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA. .,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA. .,Department of Medicine, Division of Endocrinology, University of Missouri School of Medicine, Columbia, MO, 65212, USA.
| |
Collapse
|
45
|
Schutte AE, Botha S, Fourie CMT, Gafane-Matemane LF, Kruger R, Lammertyn L, Malan L, Mels CMC, Schutte R, Smith W, van Rooyen JM, Ware LJ, Huisman HW. Recent advances in understanding hypertension development in sub-Saharan Africa. J Hum Hypertens 2017; 31:491-500. [PMID: 28332510 DOI: 10.1038/jhh.2017.18] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/16/2017] [Accepted: 02/03/2017] [Indexed: 12/13/2022]
Abstract
Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the human immunodeficiency virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies and
Collapse
Affiliation(s)
- A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - S Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M T Fourie
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Lammertyn
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,Department of Medicine and Healthcare Science, Anglia Ruskin University, Chelmsford, UK
| | - W Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - J M van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - H W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| |
Collapse
|
46
|
Izzo R, Losi MA, Stabile E, Lönnebakken MT, Canciello G, Esposito G, Barbato E, De Luca N, Trimarco B, de Simone G. Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients: The Campania Salute Network. Hypertension 2016; 69:136-142. [PMID: 27895192 DOI: 10.1161/hypertensionaha.116.08158] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/25/2016] [Accepted: 10/17/2016] [Indexed: 01/27/2023]
Abstract
There is little information on left ventricular (LV) hypertrophy (LVH) development during antihypertensive treatment. We evaluate incident LVH in a treated hypertensive cohort, the Campania Salute Network registry. We analyzed prospectively 4290 hypertensives (aged 50.3±11.1 years, 40% women) with at least 1-year follow-up, without LVH at baseline. Incident LVH was defined as the first detection of echocardiographic LV mass index ≥47 in women or ≥50 g/m2.7 in men. During a median 48-month follow-up, 915 patients (21.3%) developed LVH. They were older, more frequently women, and obese (P<0.0001), with initial higher fasting glucose, diastolic and systolic blood pressure, LV mass index, lower heart rate and glomerular filtration rate, longer hypertension history and follow-up, and higher average systolic blood pressure during follow-up (all P<0.05), despite a more frequent treatment with Ca++-channel blockers and diuretics (both P<0.02). At multivariable Cox regression, incident LVH was independently associated with older age, female sex, obesity, higher average systolic blood pressure during follow-up, and initial greater LV mass index (all P<0.02). By categorizing patients according to obesity and sex, obesity independently increased the risk for incident LVH in both sexes (obese versus nonobese men: hazard ratio, 1.34; confidence interval, 1.05-1.72; P=0.019; and obese versus nonobese women: hazard ratio, 1.34; confidence interval, 1.08-1.66; P=0.007). Despite more aggressive antihypertensive therapy, 21% of hypertensive patients develop clear-cut LVH. After adjusting for confounders, risk of incident LVH is particular relevant among women and is further increased by the presence of obesity. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02211365.
Collapse
Affiliation(s)
- Raffaele Izzo
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Maria-Angela Losi
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Eugenio Stabile
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Mai Tone Lönnebakken
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Grazia Canciello
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Giovanni Esposito
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Emanuele Barbato
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Nicola De Luca
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Bruno Trimarco
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.).
| | - Giovanni de Simone
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| |
Collapse
|
47
|
Paulin FV, Zagatto AM, Chiappa GR, Müller PDT. Addition of vitamin B12 to exercise training improves cycle ergometer endurance in advanced COPD patients: A randomized and controlled study. Respir Med 2016; 122:23-29. [PMID: 27993287 DOI: 10.1016/j.rmed.2016.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/16/2016] [Accepted: 11/20/2016] [Indexed: 01/08/2023]
Abstract
Vitamin B12 is essential in the homocysteine, mitochondrial, muscle and hematopoietic metabolisms, and its effects on exercise tolerance and kinetics adjustments of oxygen consumption (V'O2p) in rest-to-exercise transition in COPD patients are unknown. This randomized, double-blind, controlled study aimed to verify a possible interaction between vitamin B12 supplementation and these outcomes. After recruiting 69 patients, 35 subjects with moderate-to-severe COPD were eligible and 32 patients concluded the study, divided into four groups (n = 8 for each group): 1. rehabilitation group; 2. rehabilitation plus B12 group; 3. B12 group; and 4. placebo group. The primary endpoint was cycle ergometry endurance before and after 8 weeks and the secondary endpoints were oxygen uptake kinetics parameters (time constant). The prevalence of vitamin B12 deficiency was high (34.4%) and there was a statistically significant interaction (p < 0.05), favoring a global effect of supplementation on exercise tolerance in the supplemented groups compared to the non-supplemented groups, even after adjusting for confounding variables (p < 0.05). The same was not found for the kinetics adjustment variables (τV'O2p and MRTV'O2p, p > 0.05 for both). Supplementation with vitamin B12 appears to lead to discrete positive effects on exercise tolerance in groups of subjects with more advanced COPD and further studies are needed to establish indications for long-term supplementation.
Collapse
Affiliation(s)
- Fernanda Viana Paulin
- Laboratory of Respiratory Pathophysiology (LAFIR), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, MS, Brazil.
| | - Alessandro Moura Zagatto
- Laboratory of Respiratory Pathophysiology (LAFIR), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, MS, Brazil; Department of Physical Education, UNESP - Universidade Estadual Paulista, Bauru, São Paulo, Brazil.
| | - Gaspar R Chiappa
- Department of Physical Therapy, University of Brasilia (UnB), Brasilia, Brazil.
| | - Paulo de Tarso Müller
- Laboratory of Respiratory Pathophysiology (LAFIR), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, MS, Brazil.
| |
Collapse
|
48
|
de Simone G, Mancusi C, Izzo R, Losi MA, Aldo Ferrara L. Obesity and hypertensive heart disease: focus on body composition and sex differences. Diabetol Metab Syndr 2016; 8:79. [PMID: 27956942 PMCID: PMC5129668 DOI: 10.1186/s13098-016-0193-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/22/2016] [Indexed: 12/15/2022] Open
Abstract
There is evidence that hypertension is frequently associated with overweight/obesity even in kids and adolescents. Either conditions influence development of left ventricular (LV) hypertrophy (LVH), through different biological and hemodynamic mechanisms: obesity is conventionally thought to elicit a coherent growth of LV chamber dimensions and myocardial wall thickness (eccentric LV geometry), whereas a more accentuated increase in wall-thickness (concentric LV geometry) is attributed to hypertension. While during youth these differences are visible, proportion of LV concentric geometry, the most harmful LV geometric pattern, sharply raises in obese individuals during middle age, and becomes the most frequent geometric patterns among obese-hypertensive individuals. Two conditions with elevated hemodynamic impact, severe obstructive sleep apnea and masked hypertension contribute to the development of such a geometric pattern, but non-hemodynamic factors, and specifically body composition, also influence prevalence of concentric LV geometry. Contrasting a general belief, it has been observed that adipose mass strongly influences LV mass, particularly in women, especially when fat-free mass is relatively deficient. Thus, though blood pressure control is mandatory for prevention and reduction of LVH in obese hypertensive patients, without reduction of visceral adiposity regression of LVH is difficult. Future researches should be addressed on (1) assessing whether LVH resulting from alteration of body composition carries the same prognosis as pressure overload LVH; (2) defining tissue characterization of the hypertrophic heart in obese-hypertensive patients; (3) evaluating whether assessment of hemodynamic loading conditions and biological markers can help defining management of the association of obesity with hypertension.
Collapse
Affiliation(s)
- Giovanni de Simone
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, Building 1, 80131 Naples, Italy
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, Building 1, 80131 Naples, Italy
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, Building 1, 80131 Naples, Italy
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, Building 1, 80131 Naples, Italy
- Department of Advanced Medical Bioscience, Federico II University Hospital, Naples, Italy
| | - L. Aldo Ferrara
- Hypertension Research Center, Federico II University Hospital, Via S. Pansini 5, Building 1, 80131 Naples, Italy
| |
Collapse
|
49
|
Paoletti E, De Nicola L, Gabbai FB, Chiodini P, Ravera M, Pieracci L, Marre S, Cassottana P, Lucà S, Vettoretti S, Borrelli S, Conte G, Minutolo R. Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension. Clin J Am Soc Nephrol 2015; 11:271-9. [PMID: 26668021 DOI: 10.2215/cjn.06980615] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/30/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Left ventricular hypertrophy (LVH) and abnormal left ventricular (LV) geometry predict adverse outcomes in the general and hypertensive populations, but findings in CKD are still inconclusive. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We enrolled 445 patients with hypertension and CKD stages 2-5 in two academic nephrology clinics in 1999-2003 who underwent both echocardiography and ambulatory BP monitoring. LVH (LV mass >100 g/m(2) [women] and >131 g/m(2) [men]) and relative wall thickness (RWT) were used to define LV geometry: no LVH and RWT≤0.45 (normal), no LVH and RWT>0.45 (remodeling), LVH and RWT≤0.45 (eccentric), and LVH and RWT>0.45 (concentric). We evaluated the prognostic role of LVH and LV geometry on cardiovascular (CV; composite of fatal and nonfatal events) and renal outcomes (composite of ESRD and all-cause death). RESULTS Age was 64.1±13.8 years old; 19% had diabetes, and 22% had CV disease. eGFR was 39.9±20.2 ml/min per 1.73 m(2). LVH was detected in 249 patients (56.0%); of these, 125 had concentric LVH, and 124 had eccentric pattern, whereas 71 patients had concentric remodeling. Age, women, anemia, and nocturnal hypertension were independently associated with both concentric and eccentric LVH, whereas diabetes and history of CV disease associated with eccentric LVH only, and CKD stages 4 and 5 associated with concentric LVH only. During follow-up (median, 5.9 years; range, 0.04-15.3), 188 renal deaths (112 ESRD) and 103 CV events (61 fatal) occurred. Using multivariable Cox analysis, concentric and eccentric LVH was associated with higher risk of CV outcomes (hazard ratio [HR], 2.59; 95% confidence interval [95% CI], 1.39 to 4.84 and HR, 2.79; 95% CI, 1.47 to 5.26, respectively). Similarly, greater risk of renal end point was detected in concentric (HR, 2.33; 95% CI, 1.44 to 3.80) and eccentric (HR, 2.30; 95% CI, 1.42 to 3.74) LVH. Sensitivity analysis using LVH and RWT separately showed that LVH but not RWT was associated with higher cardiorenal risk. CONCLUSIONS In patients with CKD, LVH is a strong predictor of the risk of poor CV and renal outcomes independent from LV geometry.
Collapse
Affiliation(s)
- Ernesto Paoletti
- Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy
| | | | - Francis B Gabbai
- Department of Medicine, Veterans Affairs San Diego Healthcare System and University of California at San Diego Medical School, San Diego, California
| | - Paolo Chiodini
- Department of Medicine and Public Health, Second University of Naples, Naples, Italy
| | - Maura Ravera
- Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy
| | - Laura Pieracci
- Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy
| | - Sonia Marre
- Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy
| | - Paolo Cassottana
- Division of Cardiology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - Sergio Lucà
- Division of Cardiology, Santa Maria del Popolo degli Incurabili Hospital (PO SMdP Incurabili), Local Healthcare Unit Napoli1 Centro, Naples, Italy; and
| | - Simone Vettoretti
- Unit of Nephrology-Dialysis, Urology and Renal Transplantation, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | |
Collapse
|
50
|
Zsilinszka R, Shrader P, DeVore AD, Hardy NC, Mentz RJ, Pang PS, Peacock WF, Fonarow GC, Hernandez AF. Sex Differences in the Management and Outcomes of Heart Failure With Preserved Ejection Fraction in Patients Presenting to the Emergency Department With Acute Heart Failure. J Card Fail 2015; 22:781-8. [PMID: 26687985 DOI: 10.1016/j.cardfail.2015.12.008] [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: 06/29/2015] [Revised: 11/30/2015] [Accepted: 12/04/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart failure (HF) with preserved ejection fraction (HFpEF) is more common in women than in men; data characterizing sex differences in the management and outcomes of HFpEF patients presenting to the emergency department (ED) are limited. METHODS AND RESULTS Using Acute Decompensated Heart Failure National Registry Emergency Module data linked to Medicare claims, we conducted a retrospective analysis of acute HF patients in the ED, identifying HFpEF (ejection fraction [EF] ≥40%) patients and stratifying by sex to compare baseline characteristics, ED therapies, hospital length of stay (LOS), in-hospital mortality, and post-discharge outcomes. Of 4161 HFpEF patients, 2808 (67%) were women, who were more likely to be older and hypertensive, but less likely to be diabetic or smokers (all P < .01). Women more often presented with systolic blood pressure >140 mm Hg (62.5% vs 56.4%; P = .0001) and higher EF. There were no sex differences in ED therapies, adjusted 30- and 180-day all-cause mortality, in-hospital mortality, or 30- and 180-day readmissions. After adjustment, women had longer LOS (0.40 days, 95% confidence interval [CI] 0.10-0.70; P = .008). CONCLUSIONS Women with HFpEF presenting to the ED were more likely to have elevated systolic blood pressure, but overall ED management strategies were similar to those in men. We observed adjusted differences in hospital LOS, but no differences in 30- and 180-day outcomes.
Collapse
Affiliation(s)
| | - Peter Shrader
- Duke Clinical Research Institute, Durham, North Carolina
| | - Adam D DeVore
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina; Department of Emergency Medicine and the Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Robert J Mentz
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Peter S Pang
- Department of Emergency Medicine and the Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California
| | - Adrian F Hernandez
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina.
| |
Collapse
|