Age-related alterations in cardiac and arterial structure and function in hypertensive women and men

Influence of Echocardiographic Criteria on the Prevalence and Prognostic Implication of Left Ventricular Hypertrophy: A Nationwide Population-Based Study

BACKGROUND

Echocardiographic criteria of left ventricular hypertrophy (LVH) recommended in the international guidelines are derived from a White population, which could be less accurate in estimating LVH burden in other ethnic groups. Given that LVH is an important prognostic factor, assessing its burden using ethnically specific criteria has important implications. We sought to evaluate the prevalence and prognostic implications of LVH based on the EMINCA (Echocardiographic Measurements in Normal Chinese Adults) study criteria and the international guidelines.

METHODS AND RESULTS

Nationally representative populations aged ≥35 years (n=20 210; mean age, 56.0 years; 53.3% women) were enrolled from the China Hypertension Survey 2012 to 2015. The EMINCA study criteria for LVH were left ventricular mass index >109 g/m2 for men and >105 g/m2 for women; and the international guidelines criteria were left ventricular mass index >115 g/m2 for men and >95 g/m2 for women. Prevalence of LVH defined by the EMINCA study and international guidelines was 8.3% (≈56.8 million) and 11.7% (≈80.1 million), respectively. LVH defined by the EMINCA study was associated with adjusted hazard ratio (HR) of 1.55 (95% CI, 1.19-2.01; P<0.001) for cardiovascular death and 1.14 (95% CI, 0.95-1.37; P=0.16) for all-cause death. LVH defined by the international guidelines was associated with adjusted HR of 1.31 (95% CI, 1.00-1.72; P=0.047) for cardiovascular death and 1.12 (95% CI, 0.94-1.34; P=0.22) for all-cause death.

CONCLUSIONS

LVH diagnosis based on both criteria was independently associated with cardiovascular death. However, the prevalence of LVH in a general Chinese population varies significantly by the echocardiographic criteria.

Metabolic syndrome, left ventricular diastolic dysfunction and heart failure with preserved ejective fraction

Metabolic syndrome (MetS) encompasses a cluster of interrelated conditions, including obesity, hyperglycemia, hyperlipidemia, and hypertension, and has been established as a significant risk factor for cardiovascular events and heightened mortality. At its core, insulin resistance serves as the primary underlying mechanism driving the development of MetS. The prevalence of MetS is rising at an alarming rate, posing a significant public health challenge worldwide. Even in the absence of overt obstructive coronary artery disease or valvular heart disease, patients with MetS often exhibit adverse cardiac remodeling and myocardial dysfunction. Left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD) are the leading manifestations of heart failure with preserved ejection fraction (HFpEF). Abnormal myocardial substrate utilization, neurohormonal activation, interstitial fibrosis, coronary microvascular dysfunction, and metabolic inflammation have all been implicated in the development and progression of adverse cardiac remodeling associated with MetS. However, despite the tremendous research produced on this subject, HFpEF remains highly prevalent in such a population. The early diagnosis of abnormal cardiac remodeling would enable optimal effective therapies to prevent the progression of the disease to the symptomatic phase. HFpEF encompasses a diverse range of pathological processes. In these patients, LVDD and elevated left ventricular filling pressure are the primary manifestations. Echocardiography remains the popular imaging modality for the assessment of LVDD and LV filling pressure. The article aims to review recent articles covering the association between MetS components or MetS and LVDD in HFpEF.

Positive additive interaction effects of age, sex, obesity, and metabolic syndrome on left ventricular dysfunction

OBJECTIVE

This study aims to explore the association between metabolic syndrome (MetS) and left ventricular diastolic dysfunction (LVDD) and systolic dysfunction (LVSD), defined by impaired global longitudinal strain (GLS), and assess additive and multiplicative interactions among age, sex, obesity, and MetS regarding LVDD and LVSD.

METHODS

We prospectively recruited 5503 participants from the China PEACE (Patient-Centered Evaluative Assessment of Cardiac Events) Million Persons Project with complete echocardiography exam. Multivariable logistic models were used to calculate adjusted odds ratios to evaluate both additive and multiplicative interactions.

RESULTS

The mean age was 56.59 years; 59.4% were women, 46.7% had MetS, 26.6% had left ventricular hypertrophy, 46.3% had LVDD, and 12.50% had impaired GLS. Compared to the non-MetS, the odds ratio (OR) of LVDD and impaired GLS in MetS were 1.40 (1.20-1.64) and 1.26 (1.03-1.54), respectively. For LVDD, relative excess risk due to additive interaction (RERI) for women and MetS, elderly and MetS, obesity and MetS were 0.76 (0.02-1.50), 35.65 (17.51-53.79), and 2.14 (0.66-3.62), respectively, thus suggesting additive interactions. For impaired GLS, RERI for obesity and MetS was 3.37 (0.50-6.24), thus suggesting additive interactions.

CONCLUSIONS

The MetS is independently associated with LVDD and impaired GLS. From the public health implications, prevention of MetS in women, elderly, and obese individuals might result in a greater reduction of LVDD and LVSD risk in cardiovascular high-risk population.

The Safety and Antiaging Effects of Nicotinamide Mononucleotide in Human Clinical Trials: an Update

The importance of nicotinamide adenine dinucleotide (NAD+) in human physiology is well recognized. As the NAD+ concentration in human skin, blood, liver, muscle, and brain are thought to decrease with age, finding ways to increase NAD+ status could possibly influence the aging process and associated metabolic sequelae. Nicotinamide mononucleotide (NMN) is a precursor for NAD+ biosynthesis, and in vitro/in vivo studies have demonstrated that NMN supplementation increases NAD+ concentration and could mitigate aging-related disorders such as oxidative stress, DNA damage, neurodegeneration, and inflammatory responses. The promotion of NMN as an antiaging health supplement has gained popularity due to such findings; however, since most studies evaluating the effects of NMN have been conducted in cell or animal models, a concern remains regarding the safety and physiological effects of NMN supplementation in the human population. Nonetheless, a dozen human clinical trials with NMN supplementation are currently underway. This review summarizes the current progress of these trials and NMN/NAD+ biology to clarify the potential effects of NMN supplementation and to shed light on future study directions.

Sex, gender, and subclinical hypertensiveorgan damage-heart

Hypertension-mediated organ damage (HMOD) at cardiac level include a variety of abnormal phenotypes of recognized adverse prognostic value. Although the risk of cardiac HMOD is related with the severity of BP elevation, the interaction of numerous non-hemodynamic factors plays a relevant role in this unfavorable dynamic process. In particular, sex-related differences in cardiovascular (CV) risk factors and HMOD have been increasingly described. The objective of the present review is to provide comprehensive, updated information on sex-related differences in cardiac HMOD, focusing on the most important manifestations of subclinical hypertensive heart disease such as left ventricular hypertrophy (LVH), LV systolic and diastolic dysfunction, left atrial and aortic dilatation. Current evidence, based on cross-sectional and longitudinal observational studies as well as real-world registries and randomized controlled trials, suggests that women are more at risk of developing (and maintaining) LVH, concentric remodeling and subclinical LV dysfunction, namely the morpho-functional features of heart failure with preserved ejection fraction. It should be pointed out, however, that further studies are needed to fill the gap in defining gender-based optimal therapeutic strategies in order to protect women's hearts.

Prevalence and prognosis of left ventricular diastolic dysfunction in community hypertension patients

Left ventricular diastolic dysfunction (LVDD) is common in hypertension and is a predictor of increased cardiovascular risk, however the effect of LVDD, detected by new guideline, on major adverse cardiac events (MACE) is unknown in hypertensive patients without known cardiovascular disease. The present study aims to evaluate LVDD in a community hypertension cohort study and assess the effect of LVDD on MACE. we studied 283 asymptomatic nonischemic patients with hypertension who had baseline echocardiogram between 2012 and 2014. Patients were followed for MACE (myocardial infarction, coronary revascularization procedures, heart failure, stroke, all-cause mortality) with mean follow-up of 5.4 years. A Cox proportional hazards model was used to assess the association of LVDD with MACE. At baseline, 35 of the 283 hypertensions were diagnosed with LVDD (12.3%) and 25 patients were women (15.5%). Women had higher frequency of LVDD than men (8%). During follow-up, there were 26.6% patients occurring MACE in the LVDD group at baseline, 9.9% patients occurring MACE in the group with normal diastolic function. In multivariable Cox regression analyses, LVDD was a stronger predictor of MACE (HR: 2.5; 95% CI: 1.20 to 5.25; c- statistics 0.805) than E/e' ratio (HR: 1.13; 95% CI: 1.04 to 1.22). LVDD was strongly associated with MACE in hypertension patients.

Association of Office and Ambulatory Blood Pressure with Left Ventricular Structure and Function in Hypertensive Patients

Objective

Methods

Results

Conclusion

Influences of achieved SBP on age and sex-related left ventricular structural alteration in community hypertensive populations

OBJECTIVE

To evaluate age and sex-related left ventricular (LV) structural alteration in community hypertensive populations, and to explore whether achieved systolic blood pressure (SBP) (<120, < 130 and <140 mmHg) would modify the association between age and sex with LV structural alteration.

METHOD

A total of 1419 community hypertensive people (mean age 61 years, women 50.5%) without cardiovascular disease and left ventricular hypertrophy (LVH) at baseline were included. LV structural measures were assessed using transthoracic echocardiography at baseline and at follow-up. Age and sex-related LV structural alteration was evaluated using linear and Cox regression analysis as appropriate.

RESULTS

Per 10 years increase in age was associated with positive alteration of LV mass (LVM) index (coefficient-β: 2.63) and LV mass-to-volume (LVMV) ratio (coefficient-β: 0.04). Female sex was associated with positive alteration of LVM index (coefficient-β: 4.87) and LVMV ratio (coefficient-β: 0.05). After a median follow-up of 4 years, compared to men, women had a higher rate of LVH (36.8% vs. 11.5%, P < 0.001). The association between age and incident LVH was nonsignificant when achieved SBP <120 mmHg. The association between female sex and LVM index alteration was nonsignificant when achieved SBP <120 mmHg and <130 mmHg.

CONCLUSION

Age and female sex were associated with a phenotype of LV remodeling which was featured by increased LVM index and concentric remodeling. Women had a higher risk of developing LVH. A lower achieved SBP conferred greater effects on mitigating age and sex-related LV structural alteration.

VIDEO ABSTRACT

http://links.lww.com/HJH/B907.

Sex-Specific Age-Related Changes in Methylation of Certain Genes

The aim of the study was to conduct a functional analysis of sex-specific age-related changes in DNA methylation.