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Chandramohan D, Simhadri PK, Jena N, Palleti SK. Strategies for the Management of Cardiorenal Syndrome in the Acute Hospital Setting. HEARTS 2024; 5:329-348. [DOI: 10.3390/hearts5030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
Cardiorenal syndrome (CRS) is a life-threatening disorder that involves a complex interplay between the two organs. Managing this multifaceted syndrome is challenging in the hospital and requires a multidisciplinary approach to tackle the many manifestations and complications. There is no universally accepted algorithm to treat patients, and therapeutic options vary from one patient to another. The mainstays of therapy involve the stabilization of hemodynamics, decongestion using diuretics or renal replacement therapy, improvement of cardiac output with inotropes, and goal-directed medical treatment with renin–angiotensin–aldosterone system inhibitors, beta-blockers, and other medications. Mechanical circulatory support is another viable option in the armamentarium of agents that improve symptoms in select patients.
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Affiliation(s)
- Deepak Chandramohan
- Department of Internal Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Prathap Kumar Simhadri
- Department of Nephrology, Advent Health/FSU College of Medicine, Daytona Beach, FL 32117, USA
| | - Nihar Jena
- Department of Internal Medicine/Cardiovascular Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, USA
| | - Sujith Kumar Palleti
- Department of Internal Medicine/Nephrology, LSU Health Shreveport, Shreveport, LA 71103, USA
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Sveklina TS, Shustov SB, Kolyubaeva SN, Kuchmin AN, Kozlov VA, Oktysyuk PD, Konyaev VV. Inflammatory Biomarkers in Patients With Type 2 Diabetes Mellitus and Heart Failure With Preserved Ejection Faction. KARDIOLOGIIA 2024; 64:40-47. [PMID: 39102572 DOI: 10.18087/cardio.2024.7.n2562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 08/07/2024]
Abstract
AIM To verify the relationship between gene polymorphisms of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) with inflammation markers and codependent metabolic variables in patients with type 2 diabetes mellitus and chronic heart failure (CHF). MATERIAL AND METHODS This study included 154 patients (mean age, 69.1±3.2 years). The control group consisted of 47 patients with metabolic syndrome (MS) without CHF; the 2nd group included 56 patients with CHF with preserved ejection fraction (CHFpEF); and the 3rd group consisted of 51 patients with CHF with reduced ejection fraction (CHFrEF). The rs1800629 polymorphism of the TNF-α gene (TNF-α: G308A) was studied in real time by the polymerase chain reaction (PCR) method and the rs1800795 polymorphism of the IL-6 gene (IL-6: 174 G>C) was studied by PCR with the electrophoretic detection. The frequencies of polymorphic alleles were compared with the clinical blood test results, plasma concentrations of C-reactive protein (CRP), TNF-α, leptin, and fibrinogen. Differences between the groups were determined using the F test. Relationships between individual studied parameters were identified using the regression analysis. RESULTS In most patients, the occurrence of gene polymorphisms was eident as increased plasma concentrations of biomarkers. An association was found between the TNF-α gene polymorphism (G308A) and an increase in plasma TNF-α and between the IL-6 gene polymorphism (174 C>G) and an increase in plasma CRP. In the CHFpEF group, the rs1800629 gene polymorphism was observed in 55% of patients, among whom 93% had increased TNF-α. The rs1800795 gene polymorphism was observed in 82% of CHFpEF patients, among whom 21% had increased CRP. In the CHFrEF group, the G308A transition in the TNF-α gene was observed in 53% of patients; an increase in the respective cytokine was noted in 67% of patients; the IL-6 gene polymorphism 174 C>G was found in 78%, however, only 14% of patients with this polymorphism had also increased CRP. In the control group, the TNF-α G308A gene polymorphism was found in 30% of patients, while an increase in free TNF-α was associated with this polymorphism in 50% of patients; the IL-6 174 C>G gene polymorphism was detected in 78%, while no increase in the CRP level was observed in this group. This demonstrates a high probability of the TNF-α G308A gene polymorphism occurrence in patients with CHF. CONCLUSION Inflammatory markers are important predictors of CHF. The most significant predictor was the TNF-α G308A gene polymorphism, which was observed in more than 50% of patients, the majority of whom had an increase in plasma TNF-α.
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Affiliation(s)
| | - S B Shustov
- Kirov Military Medical Academy, St. Petersburg
| | | | - A N Kuchmin
- Kirov Military Medical Academy, St. Petersburg
| | - V A Kozlov
- Iljya Uljyanov Chuvash State University, Cheboksary
| | | | - V V Konyaev
- Kirov Military Medical Academy, St. Petersburg
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de Oliveira LB, de Figueiredo Martins Siqueira MA, de Macedo Gadêlha RB, Garcia J, Bandeira F. Vitamin D Deficiency in Patients Hospitalized for Heart Failure Living in the Tropics. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:84-90. [PMID: 38694929 PMCID: PMC11058433 DOI: 10.36628/ijhf.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 05/04/2024]
Abstract
Background and Objectives Vitamin D, as a steroid hormone, has multiple effects on human body and its deficiency has been associated with an increased risk of heart failure (HF) and unfavorable outcomes. The present study investigated the prevalence of vitamin D deficiency (VDD) and its relationship with cardiometabolic parameters in patients hospitalized for HF living in the city of Recife (latitude 8° South). Methods Analytical cross-sectional study, with men and women aged 40-64 years. The HF group was recruited during hospitalization due to decompensation. A matched control group was recruited from the general endocrine clinics. Vitamin D status was assessed by measuring serum 25-hydroxyvitamin D (25OHD), considering deficiency when 25OHD <20 ng/mL (<50 nmol/L). Results A total of 243 patients were evaluated (HF group: 161, control group: 82). Lower serum 25OHD levels were observed in the HF group (25.2±9.4 vs. 30.0±7.7ng/mL; p<0.001), as well as a higher prevalence of VDD (27.3% vs. 9.8%; prevalence ratio, 2.80; 95% confidence interval, 1.38-5.67; p=0.002). In patients with HF, VDD was associated with diabetes mellitus (65.9% vs. 41.0%; p=0.005) and female sex (65.9% vs. 44.4%; p=0.015). In the subgroup with VDD, higher values of hemoglobin A1c (7.9% [6.0-8.9] vs. 6.2% [5.7-7.9]; p=0.006) and dyslipidemia were also observed. Conclusions We found higher rates of VDD in patients hospitalized for HF and this was associated with deleterious laboratory metabolic parameters.
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Affiliation(s)
- Lucian Batista de Oliveira
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco (UPE), Faculty of Medical Sciences, Recife, PE, Brazil
| | | | - Rafael Buarque de Macedo Gadêlha
- Division of Cardiology, Agamenon Magalhães Hospital, University of Pernambuco (UPE), Faculty of Medical Sciences, Recife, PE, Brazil
| | - Jessica Garcia
- Division of Cardiology, Agamenon Magalhães Hospital, University of Pernambuco (UPE), Faculty of Medical Sciences, Recife, PE, Brazil
| | - Francisco Bandeira
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco (UPE), Faculty of Medical Sciences, Recife, PE, Brazil
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Canteri AL, Gusmon LB, Boguszewski CL, Borba VZC. Bone quality, mineral density, and fractures in heart failure. PLoS One 2023; 18:e0293903. [PMID: 37922295 PMCID: PMC10624280 DOI: 10.1371/journal.pone.0293903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/20/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND The trabecular bone score (TBS) indirectly estimates bone quality and predicts low-impact fractures independently of bone mineral density (BMD). However, there is still a paucity of data linking bone and heart diseases, mainly with gaps in the TBS analysis. METHODS In this cross-sectional study, we evaluated TBS, BMD, and fractures in patients with heart failure with reduced ejection fraction (HFrEF) and in sex-, BMI- and age-matched controls, and we assessed the fracture probability using the FRAX tool, considering active search for fractures by vertebral fracture assessment (VFA) and the adjustment for the TBS. RESULTS TBS values were 1.296 ± 0.14 in 85 patients (43.5% women; age 65 ± 13 years) and 1.320 ± 0.11 in 142 controls (P = 0.07), being reduced (< 1.31) in 51.8% and 46.1% of them, respectively (P = 0.12). TBS was lower in patients than in the controls when BMD was normal (P = 0.04) and when the BMI was 15-37 kg/m2 (P = 0.03). Age (odds ratio [OR] 1.05; P = 0.026), albumin (OR 0.12; P = 0.046), statin use (OR 0.27; P = 0.03), and energy intake (OR 1.03; P = 0.014) were associated with reduced TBS. Fractures on VFA occurred in 42.4% of the patients, and VFA and TBS adjustment increased the fracture risk by 16%-23%. CONCLUSION Patients with HFrEF had poor bone quality, with a better discriminating impact of the TBS assessment when BMD was normal, and BMI was suitable for densitometric analysis. Variables related to the prognosis, severity, and treatment of HFrEF were associated with reduced TBS. VFA and TBS adjustment increased fracture risk.
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Affiliation(s)
- Andre Luiz Canteri
- Division of Cardiology, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná State, Brazil
- Health Sciences and Internal Medicine Postgraduation Department, Federal University of Paraná, Curitiba, Paraná State, Brazil
| | - Luana Bassan Gusmon
- Division of Cardiology, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná State, Brazil
| | - Cesar Luiz Boguszewski
- Health Sciences and Internal Medicine Postgraduation Department, Federal University of Paraná, Curitiba, Paraná State, Brazil
- Endocrine Division (SEMPR), Department of Internal Medicine, Federal University of Paraná, Curitiba, Paraná State, Brazil
| | - Victoria Zeghbi Cochenski Borba
- Health Sciences and Internal Medicine Postgraduation Department, Federal University of Paraná, Curitiba, Paraná State, Brazil
- Endocrine Division (SEMPR), Department of Internal Medicine, Federal University of Paraná, Curitiba, Paraná State, Brazil
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Yang Y, Huang Y. Association between bone mineral density and cardiovascular disease in older adults. Front Public Health 2023; 11:1103403. [PMID: 37427263 PMCID: PMC10328748 DOI: 10.3389/fpubh.2023.1103403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/12/2023] [Indexed: 07/11/2023] Open
Abstract
Background and aims Cardiovascular disease and osteoporosis are common diseases in older adults with high morbidity. The study on the interaction between the two in pathogenic mechanisms has been paid much attention by the majority of researchers. This study aimed to explore the relationship between bone mineral density and cardiovascular disease in older adults. Methods The primary data was downloaded from the National Health and Nutrition Examination Survey database of the United States. Multivariate logistic regression model, generalized additive model, and smooth curve fitting were used to explore the relationship between bone mineral density and cardiovascular events risk. When a curve relationship was found, a two-piecewise linear model was used to calculate the inflection point. In addition, subgroup analysis was also performed. Results A total of 2097 subjects were included in this study. After adjusting for potential confounders, no significant association was found between lumbar bone mineral density and cardiovascular disease, while femur bone mineral density had a non-linear relationship with cardiovascular disease, with an inflection point of 0.741 gm/cm2. When bone mineral density was <0.741 gm/cm2, the risk of cardiovascular disease decreased speedily. Once bone mineral density exceeded this value, the risk of cardiovascular disease continued to decrease, but the trend became significantly slower. Compared with patients with normal bone mass, osteoporosis was associated with a 2.05-fold increased risk of cardiovascular disease (95% CI 1.68-5.52). There were no significant differences in interaction tests of all subgroups (p for interaction >0.05) except race. Conclusion Our results indicated that bone mineral density was closely associated with the prevalence of cardiovascular disease in older adults over 60 years old, especially the femur bone mineral density was negatively non-linear associated with cardiovascular disease risk, with an inflection point of 0.741 gm/cm2.
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Guan Z, Yuan W, Jia J, Zhang C, Zhu J, Huang J, Zhang W, Fan D, Leng H, Li Z, Xu Y, Song C. Bone mass loss in chronic heart failure is associated with sympathetic nerve activation. Bone 2023; 166:116596. [PMID: 36307018 DOI: 10.1016/j.bone.2022.116596] [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: 07/30/2022] [Revised: 10/02/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Chronic heart failure causes osteoporosis, but the mechanism remains unclear. The sympathetic nerve plays an important role in both bone metabolism and cardiovascular function. METHODS Thirty-six adult male SD rats were randomly divided into the following four groups: sham surgery (Sham) group, guanethidine (GD) group, abdominal transverse aorta coarctation-induced heart failure + normal saline (TAC) group, and TAC + guanethidine (TAC + GD) group. Normal saline (0.9 % NaCl) or guanethidine (40 mg/kg/ml) was intraperitoneally injected daily for 5 weeks. Then, DXA, micro-CT, ELISA and RT-PCR analyses were performed 12 weeks after treatment. RESULTS The bone loss in rats subjected to TAC-induced chronic heart failure and chemical sympathectomy with guanethidine was increased. Serum norepinephrine levels were increased in rats with TAC-induced heart failure but were decreased in TAC-induced heart failure rats treated with guanethidine. The expression of α2A adrenergic receptor, α2C adrenergic receptor, osteoprotegerin (OPG), and osteocalcin in the tibia decreased in the TAC-induced heart failure group, and the expression of β1 adrenergic receptor, β2 adrenergic receptor, receptor activator of nuclear factor-κ B ligand (RANKL), and RANKL/OPG in the tibia increased in the heart failure group. In addition, these changes in gene expression levels were rescued by chemical sympathectomy with guanethidine. CONCLUSIONS TAC-induced chronic heart failure is associated with bone mass loss, and the sympathetic nerve plays a significant role in heart failure-related bone mass loss. MINI ABSTRACT The present study supports the hypothesis that heart failure is related to bone loss, and the excessive activation of sympathetic nerves participates in this pathophysiological process. The present study suggests a potential pathological mechanism of osteoporosis associated with heart failure and new perspectives for developing strategies for heart failure-related bone loss.
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Affiliation(s)
- Zhiyuan Guan
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Wanqiong Yuan
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Jialin Jia
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Chenggui Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Junxiong Zhu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Jie Huang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Wang Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Dongwei Fan
- Department of Orthopedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Diseases, Beijing, China
| | - Huijie Leng
- Department of Orthopedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Diseases, Beijing, China
| | - Zijian Li
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Yingsheng Xu
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
| | - Chunli Song
- Department of Orthopedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Diseases, Beijing, China.
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Jadzic J, Tomanovic N, Djukic D, Zivkovic V, Nikolic S, Djuric M, Milovanovic P, Djonic D. Micro-scale assessment of bone quality changes in adult cadaveric men with congestive hepatopathy. Histochem Cell Biol 2022; 158:583-593. [PMID: 35849203 DOI: 10.1007/s00418-022-02128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 12/13/2022]
Abstract
Congestive hepatopathy (CH) is a chronic liver disease (CLD) caused by impaired hepatic venous blood outflow, most frequently resulting from congestive heart failure. Although it is known that heart failure and CLDs contribute to increased risk for age-related fractures, an assessment of CH-induced skeletal alterations has not been made to date. The aim of our study was to characterize changes in bone quality in adult male cadavers with pathohistologically confirmed CH compared with controls without liver disease. The anterior mid-transverse part of the fifth lumbar vertebral body was collected from 33 adult male cadavers (age range 43-89 years), divided into the CH group (n = 15) and the control group (n = 18). We evaluated trabecular and cortical micro-architecture and bone mineral content (using micro-computed tomography), bone mechanical competence (using Vickers micro-hardness tester), vertebral cellular indices (osteocyte lacunar network and bone marrow adiposity), and osteocytic sclerostin and connexin 43 expression levels (using immunohistochemistry staining and analysis). Deterioration in trabecular micro-architecture, reduced trabecular and cortical mineral content, and decreased Vickers microhardness were noted in the CH group (p < 0.05). Reduced total number of osteocytes and declined connexin 43 expression levels (p < 0.05) implied that harmed mechanotransduction throughout the osteocyte network might be present in CH. Moreover, elevated expression levels of sclerostin by osteocytes could indicate the role of sclerostin in mediating low bone formation in individuals with CH. Taken together, these micro-scale bone alterations suggest that vertebral strength could be compromised in men with CH, implying that vertebral fracture risk assessment and subsequent therapy may need to be considered in these patients. However, further research is required to confirm the clinical relevance of our findings.
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Affiliation(s)
- Jelena Jadzic
- Center of Bone Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/II, 11000, Belgrade, Serbia
| | - Nada Tomanovic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 1, Belgrade, Serbia
| | - Danica Djukic
- Institute of Forensic Medicine, Faculty of Medicine , University of Belgrade, Deligradska no. 31a, Belgrade, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine , University of Belgrade, Deligradska no. 31a, Belgrade, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine , University of Belgrade, Deligradska no. 31a, Belgrade, Serbia
| | - Marija Djuric
- Center of Bone Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/II, 11000, Belgrade, Serbia
| | - Petar Milovanovic
- Center of Bone Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/II, 11000, Belgrade, Serbia
| | - Danijela Djonic
- Center of Bone Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/II, 11000, Belgrade, Serbia.
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Chen H, Ye R, Guo X. Lack of causal association between heart failure and osteoporosis: a Mendelian randomization study. BMC Med Genomics 2022; 15:232. [PMID: 36333784 PMCID: PMC9636651 DOI: 10.1186/s12920-022-01385-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Heart failure (HF) has been implicated in osteoporosis. However, causality remains unestablished. Here, we sought to assess causal associations of genetic liability to HF with osteoporosis using Mendelian randomization (MR) analyses. Methods Independent single nucleotide polymorphisms associated with HF at genome-wide significance were derived from a large genome-wide association study (GWAS) (including up to 977,323 individuals). We obtained summary statistics for forearm (FA) bone mineral density (BMD) (n = 8,143), femoral neck (FN) BMD (n = 32,735), lumbar spine (LS) BMD (n = 28,498), heel (HE) BMD (n = 426,824), and fracture (n = 1,214,434) from other GWAS meta-analyses. Inverse variance weighted (IVW) and several supplementary methods were performed to calculate the MR estimates. Results Genetically determined HF has no causal effect on FA-BMD (odds ratio (OR) 1.17; 95% confidence interval (CI) 0.82, 1.66; P = 0.389), FN-BMD (OR 1.01; 95% CI 0.85, 1.19; P = 0.936), LS-BMD (OR 0.96; 95% CI 0.80, 1.17; P = 0.705), HE-BMD (OR 1.01; 95% CI 0.90, 1.13; P = 0.884), and fracture risk (OR 1.00; 95% CI 0.92, 1.10; P = 0.927). Complementary analyses returned broadly consistent results. Conclusion This MR study provides genetic evidence that HF may not lead to an increased risk of reduced BMDs or fracture. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01385-8.
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Skripnikova IA, Yaralieva EK, Drapkina OM. Heart failure and osteoporosis: common pathogenetic components. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This literature review reflects modern ideas about the combination of heart failure (HF) and osteoporosis, common risk factors for these diseases, and pathophysiological mechanisms of metabolic bone diseases in HF. Despite a growing number of studies on the combined cardiovascular and skeletal system pathology, the relationship between a decrease in bone mineral density and HF risk remains poorly understood. Both conditions are common causes of disability, death, prolonged hospitalizations and a significant reduction in quality of life, while its combination exacerbates their course and increases the incidence of adverse outcomes, which is a heavy burden for a patient and health care in general. Keywords: heart failure, osteoporosis, bone mineral density, bone metabolism.
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Affiliation(s)
- I. A. Skripnikova
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. K. Yaralieva
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Bandeira F, de Oliveira LB, Caldeira RB, Toscano LS. Skeletal consequences of heart failure. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221135501. [PMID: 36321835 PMCID: PMC9634191 DOI: 10.1177/17455057221135501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023]
Abstract
Heart failure (HF) is a prevalent clinical syndrome that causes significant physical limitations. Osteoporosis is also an important cause of loss of functionality, and it mainly affects women. There are several reports linking HF and osteoporosis, and both share risk factors. Most of the data available so far point to bone fragility as a consequence of HF, and several mechanisms have been identified to explain this relationship. Among the proposed pathophysiological mechanisms are the hyperactivation of the renin-angiotensin-aldosterone system and the increase in parathyroid hormone, functional limitation, production of inflammatory mediators and the use of drugs for HF. The role of osteoprotegerin has gained attention owing to its cardiovascular and skeletal effects, its observed deficiency during the postmenopausal period along with its compensatory increases in HF and severe osteoporosis. The objective of this review was to perform a literature search for the main evidence on skeletal impairment in HF, with emphasis on women. As for epidemiological studies, we selected data from 3 meta-analyses and 20 individual observational studies, which together showed the interrelationship between the two clinical conditions in terms of both decreased bone density and increased fracture risk. In conclusion, HF and osteoporosis are interrelated conditions mediated by complex pathophysiological mechanisms which may be more relevant for postmenopausal women, considered to be a vulnerable population for both cardiovascular diseases and bone fragility.
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Affiliation(s)
- Francisco Bandeira
- Division of Endocrinology and Diabetes, Agamenon
Magalhães Hospital, Faculty of Medical Sciences, University of Pernambuco (UPE),
Recife, Brazil
| | - Lucian Batista de Oliveira
- Division of Endocrinology and Diabetes, Agamenon
Magalhães Hospital, Faculty of Medical Sciences, University of Pernambuco (UPE),
Recife, Brazil
| | - Rodrigo Botelho Caldeira
- Division of Endocrinology and Diabetes, Agamenon
Magalhães Hospital, Faculty of Medical Sciences, University of Pernambuco (UPE),
Recife, Brazil
| | - Leticia Saldanha Toscano
- Division of Endocrinology and Diabetes, Agamenon
Magalhães Hospital, Faculty of Medical Sciences, University of Pernambuco (UPE),
Recife, Brazil
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Bone mineral density and risk of cardiovascular disease in men and women: the HUNT study. Eur J Epidemiol 2021; 36:1169-1177. [PMID: 34515906 PMCID: PMC8629874 DOI: 10.1007/s10654-021-00803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/30/2021] [Indexed: 11/17/2022]
Abstract
The association between bone mineral density (BMD) and cardiovascular disease (CVD) is not fully understood. We evaluated BMD as a risk factor for cardiovascular disease and specifically atrial fibrillation (AF), acute myocardial infarction (AMI), ischemic (IS) and hemorrhagic stroke (HS) and heart failure (HF) in men and women. This prospective population cohort utilized data on 22 857 adults from the second and third surveys of the HUNT Study in Norway free from CVD at baseline. BMD was measured using single and dual-energy X-ray absorptiometry in the non-dominant distal forearm and T-score was calculated. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from adjusted cox proportional hazards models. The analyses were sex-stratified, and models were adjusted for age, age-squared, BMI, physical activity, smoking status, alcohol use, and education level. Additionally, in women, we adjusted for estrogen use and postmenopause. During a mean follow-up of 13.6 ± 5.7 years, 2 928 individuals (12.8%) developed fatal or non-fatal CVD, 1 020 AF (4.5%), 1 172 AMI (5.1%), 1 389 IS (6.1%), 264 HS (1.1%), and 464 HF (2.0%). For every 1 unit decrease in BMD T-score the HR for any CVD was 1.01 (95% CI 0.98 to 1.04) in women and 0.99 (95% CI 0.94 to 1.03) in men. Point estimates for the four cardiovascular outcomes ranged from slightly protective (HR 0.95 for AF in men) to slightly deleterious (HR 1.12 for HS in men). We found no evidence of association of lower distal forearm BMD with CVD, AF, AMI, IS, HS, and HF.
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Kono Y, Izawa H, Aoyagi Y, Yamada R, Ishiguro T, Yoshinaga M, Okumura S, Fujiwara W, Hayashi M, Otaka Y. Impact of heart failure severity on bone mineral density among older patients with heart failure. Heart Vessels 2021; 36:1856-1860. [PMID: 34085103 DOI: 10.1007/s00380-021-01884-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/28/2021] [Indexed: 11/25/2022]
Abstract
The study aimed to identify factors related to bone mineral density (BMD) among older patients with heart failure (HF). A total of 70 consecutive patients with HF aged 65 years or older who were admitted to an acute hospital due to worsening condition were enrolled before discharge. BMD of the femoral neck was evaluated using the DEXA method. Physical function, as well as echocardiographic and laboratory findings including biomarker of HF severity were collected. Bivariate and multiple regression analyses were employed to determine the association between BMD and the clinical variables. Bivariate analysis determined that age, grip strength, walking speed, serum albumin, and N-terminal pro B-type natriuretic peptide (NT-proBNP) were significantly correlated with BMD (P < 0.01), whereas other clinical parameters were not. The multiple regression analysis identified NT-proBNP as an independent related factor for BMD after adjusting with confounding clinical variables. NT-proBNP was independently related to BMD among older patients with HF. Our results suggest the inclusion of bone fracture prevention strategies in disease management programs, especially for older patients with HF.
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Affiliation(s)
- Yuji Kono
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hideo Izawa
- Department of Cardiology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Japan.
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Ryo Yamada
- Department of Cardiology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Japan
| | - Tomoya Ishiguro
- Department of Cardiology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Japan
| | - Masataka Yoshinaga
- Department of Cardiology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Japan
| | - Satoshi Okumura
- Department of Cardiology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Japan
| | - Wakaya Fujiwara
- Department of Cardiology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Japan
| | - Mutsuharu Hayashi
- Department of Cardiology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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13
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Vitamin D status and predictors of 25-hydroxyvitamin D levels in patients with heart failure living in a sunny region. NUTR HOSP 2021; 38:349-357. [PMID: 33615819 DOI: 10.20960/nh.03291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Aims: hypovitaminosis D has frequently been identified in patients with heart failure (HF). However, few studies have been conducted in regions with high solar incidence. Therefore, this study aimed to evaluate vitamin D status and predictors of 25-hydroxyvitamin D (25(OH)D) levels in patients with HF living in a sunny region (5 °- 6 °S). Methods: this cross-sectional study enrolled 70 patients with HF. Biodemographic, clinical, biochemical, dietary, and sun exposure data were collected, and 25(OH)D levels were measured. Results: the mean 25(OH)D level was 40.1 (12.4) ng/mL, and 24.3 % (95 % CI: 14.2-33.8) of patients with HF had hypovitaminosis D (25(OH)D < 30 ng/mL). Female patients (p = 0.001), those with ischemic etiology (p = 0.03) and those with high parathyroid hormone levels (> 67 pg/mL) (p = 0.034) were more likely to present hypovitaminosis D. Higher 25(OH)D levels were observed in men than in women (β = 7.78, p = 0.005) and in patients with HF in New York Heart Association (NHYA) functional class I when compared to those in class III/IV (β = 8.23, p = 0.032). Conclusions: the majority of patients with HF had sufficient 25(OH)D levels. Sex and functional classification were identified as independent predictors of 25(OH)D levels. These results highlight the need for increased monitoring of vitamin D status among female patients with heart failure and those with more severe symptoms.
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14
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Tomita Y, Arima K, Mizukami S, Tsujimoto R, Kawashiri SY, Nishimura T, Okabe T, Tanaka N, Honda Y, Nakahara K, Yamamoto N, Ohmachi I, Goto H, Hasegawa M, Sou Y, Horiguchi I, Kanagae M, Abe Y, Nonaka F, Tamai M, Yamanashi H, Nagata Y, Kawakami A, Maeda T, Aoyagi K. Association between self-reported walking speed and calcaneal stiffness index in postmenopausal Japanese women. BMC Geriatr 2020; 20:466. [PMID: 33176711 PMCID: PMC7661156 DOI: 10.1186/s12877-020-01858-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoporosis and related fractures, a worldwide public health issue of growing concern, is characterized by compromised bone strength and an increased risk of fracture. Here we show an association between self-reported walking speed and bone mass among community-dwelling postmenopausal Japanese women aged 50 years and older. DESIGN; CROSS-SECTIONAL STUDY: Setting and Participants; The survey population included 1008 postmenopausal women 50-92 years of age residing in rural communities. METHODS Self-reported walking speed was ascertained by asking the participants: "Is your walking speed faster than others of the same age and sex?" to which participants responded "yes (faster)" or "no (moderate/slower)." Calcaneal stiffness index was measured. RESULTS Women with a faster self-reported walking speed were younger and had a lower BMI, higher stiffness index, and higher grip strength than women with a slower walking speed. Multiple linear regression analysis adjusted for age, BMI, grip strength, comorbidity, current smoking, and alcohol drinking status showed a significant association between faster self-reported walking speed and higher calcaneal stiffness index (p < 0.001). CONCLUSIONS Our findings suggest that questionnaires of walking speed may be useful for predicting bone mass and that a fast self-reported walking may benefit bone health in postmenopausal women.
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Affiliation(s)
- Yoshihito Tomita
- School of Rehabilitation, Department of Physical Therapy, Tokyo Professional University of Health Sciences, Tokyo, Japan.,Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Kazuhiko Arima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - Satoshi Mizukami
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Ritsu Tsujimoto
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shin-Ya Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Nishimura
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Human Science, Faculty of Design, Kyushu University, Fukuoka, Japan
| | - Takuhiro Okabe
- Department of Rehabilitation, Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Natsumi Tanaka
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Yuzo Honda
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Kazumi Nakahara
- Faculty of Health Science, Kumamoto Health Science University, Kumamoto, Japan
| | - Naoko Yamamoto
- Department of Health Science, Faculty of Medicine Kagoshima University, Kagoshima, Japan
| | - Izumi Ohmachi
- Department of Health Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Maiko Hasegawa
- Medical Policy Division, Nagasaki Prefectural Government, Nagasaki, Japan
| | - Youko Sou
- Ken-Nan Health Care Office, Nagasaki, Japan
| | - Itsuko Horiguchi
- Center for Public Relations Strategy, Nagasaki University, Nagasaki, Japan
| | - Mitsuo Kanagae
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Yasuyo Abe
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Fumiaki Nonaka
- Department of island and rural medical research, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mami Tamai
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirotomo Yamanashi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasuhiro Nagata
- Center for Comprehensive Community Care Education, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takahiro Maeda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyoshi Aoyagi
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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15
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Cellini M, Piccini S, Ferrante G, Carrone F, Olivetti R, Cicorella N, Aroldi M, Pini D, Centanni M, Lania AG, Mazziotti G. Secondary hyperparathyroidism and thoracic vertebral fractures in heart failure middle-aged patients: a 3-year prospective study. J Endocrinol Invest 2020; 43:1561-1569. [PMID: 32240522 DOI: 10.1007/s40618-020-01237-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/23/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Vertebral fractures (VFs) were described in elderly patients with heart failure (HF) whereas their prevalence and determinants in younger HF patients are still unknown. This study aimed at assessing whether secondary hyperparathyroidism (SHPT) may influence the risk of VFs in middle-aged patients with HF. METHODS 84 patients (44 males, median age 48.5 years, range 43-65) with HF were prospectively evaluated at the baseline and after 36-month follow-up for bone mineral density (BMD) and VFs by quantitative morphometry on chest X-rays. Serum PTH, calcium, 25-hydroxyvitamin D and 24-h-urinary calcium were evaluated at the baseline and every 6-12 months during the study period. RESULTS At baseline, SHPT, hypovitaminosis D and VFs were found in 43 patients (51.2%), 73 patients (86.9%) and 29 patients (34.5%), respectively. SHPT was associated with VFs at baseline [inverse probability-weighted (ipw) odds ratio (OR) 12.2, p < 0.001]. Patients were treated with vitamin D3 alone (56%), vitamin D3 plus calcium carbonate (21.4%), calcitriol alone (4.8%), bisphosphonates plus vitamin D3 (8.3%) or a combination of bisphosphonates, vitamin D3 and calcium carbonate (9.5%). At the end of follow-up, hypovitaminosis D was corrected in all patients, whereas 19/84 patients (22.6%) had persistent SHPT. During the follow-up, 16 patients developed incident VFs which resulted to be associated with baseline SHPT (ipw OR 55.7, p < 0.001), even after adjusting from BMD change from baseline to follow-up (ipw OR 46.4, p < 0.001). CONCLUSIONS This study provides a first evidence that SHPT may be a risk factor for VFs in middle-aged patients with HF.
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Affiliation(s)
- M Cellini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - S Piccini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - G Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - F Carrone
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - R Olivetti
- Endocrinology Unit, ASST Carlo Poma, Mantova, Italy
| | - N Cicorella
- Cardiology Unit, ASST Carlo Poma, Mantova, Italy
| | - M Aroldi
- Cardiology Unit, ASST Carlo Poma, Mantova, Italy
| | - D Pini
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - M Centanni
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - A G Lania
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - G Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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16
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Katano S, Yano T, Tsukada T, Kouzu H, Honma S, Inoue T, Takamura Y, Nagaoka R, Ishigo T, Watanabe A, Ohori K, Koyama M, Nagano N, Fujito T, Nishikawa R, Takashima H, Hashimoto A, Katayose M, Miura T. Clinical Risk Factors and Prognostic Impact of Osteoporosis in Patients With Chronic Heart Failure. Circ J 2020; 84:2224-2234. [PMID: 33116003 DOI: 10.1253/circj.cj-20-0593] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical significance of osteoporosis in chronic heart failure (CHF) remains unclear.Methods and Results:A total of 303 CHF patients (75 years, [interquartile range (IQR) 66-82 years]; 41% female) were retrospectively examined. Bone mineral densities (BMDs) at the lumbar spine, femoral neck, and total femur were measured by using dual-energy X-ray absorptiometry (DEXA), and osteoporosis was diagnosed when the BMD at any of the 3 sites was <70% of the Young Adult Mean percentage (%YAM). The prevalence of osteoporosis in CHF patients was 40%. Patients with osteoporosis were older (79 [IQR, 74-86] vs. 72 [IQR, 62-80] years), included a large percentage of females, had slower gait speed and had a lower body mass index. Multivariate logistic regression analysis indicated that sex, BMI, gait speed, loop diuretics use and no use of direct oral anticoagulants (DOACs) were independently associated with osteoporosis. Kaplan-Meier survival curves showed that the rate of death and heart failure hospitalization was higher in patients with osteoporotic BMD at 2 or 3 sites than in patients without osteoporosis (hazard ratio 3.45, P<0.01). In multivariate Cox regression analyses, osteoporotic BMD at 2 or 3 sites was an independent predictor of adverse events after adjustment for prognostic markers. CONCLUSIONS Loop diuretics use and no DOACs use are independently associated with osteoporosis in CHF patients. Osteoporosis is a novel predictor of worse outcome in patients with CHF.
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Affiliation(s)
- Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Takanori Tsukada
- Cardiac Rehabilitation Center, Social Welfare Corporation, Hokkaido Social Work Association Obihiro Hospital
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Suguru Honma
- Department of Rehabilitation, Sapporo Cardiovascular Hospital
| | - Takuya Inoue
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Yuhei Takamura
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Ryohei Nagaoka
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Tomoyuki Ishigo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Ayako Watanabe
- Division of Nursing, Sapporo Medical University Hospital
| | - Katsuhiko Ohori
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.,Department of Cardiology, Hokkaido Cardiovascular Hospital
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.,Division of Health Care Administration and Management, Sapporo Medical University School of Medicine
| | - Masaki Katayose
- Department of Public Health, Sapporo Medical University School of Medicine.,Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
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17
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Larina VN, Bart BY, Karpenko DG, Starostin IV, Larin VG, Kulbachinskaya OM. [Polymorbidity and its association with the unfavorable course of chronic heart failure in outpatients aged 60 years and older]. ACTA ACUST UNITED AC 2019; 59:25-36. [PMID: 31995723 DOI: 10.18087/cardio.n431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/26/2019] [Indexed: 11/18/2022]
Abstract
AIM This study was carried out to evaluate polymorbidity taking into account geriatric syndromes and their relationship with the course of chronic heart failure (CHF) in outpatients aged 60 years and older. Methods. We conducted an open, prospective, non-randomized study. The main group included 80 patients with CHF, the comparison group - 40 patients without CHF. Conducted clinical examination, ECG, echocardiography, two-photon X-ray absorptiometry. The scale of assessment of clinical status in CHF,Charlson comorbidity index were used. The criteria for frailty were the presence of at least 3 signs due FRAIL scale. Mean follow-up was 24.1±13.0 months. Results. All patients with CHF (100%) and 92.5% of the comparison group had a concomitant pathology. A combination of 3 or more of any diseases was more common in CHF compared to control group (p=0.008), CKD (66%) and obesity (35%) were the most common pathology. Combinations of osteoporosis and CKD (28%), obesity and CKD (23%) were the most frequent in the CHF patients, a combination of obesity and CKD (28%), obesity and diabetes (18%) - without CHF patients. The same incidence of osteoporosis (p=0.768), falls (p=0.980), fractures (p=0.549) and frailty (p=0.828) was observed in CHF patients and different EFLV, but prevalence of frailty was observed at the age of 75 years and older. During the observation period, 24% CHF patients and 5% patients without CHF (p=0.022) died. The worst survival of patients with ischemic genesis of CHF and osteoporosis was noted. The factors associated with an increased risk of death in CHF patients were the ischemic etiology of CHF (OR 8.33; 95% CI 1.11-62.4; p=0.039), male gender (OR 7.91; 95% CI 2.3-27.2; p=0.001), LV EF <45% (OR 2.52; 95% CI 1.01-6,27; p=0.047), low bone mineral density in femoral neck region (р=0.016, ОR 4.3, 95% CI 1.3-17.2), comorbidity score (OR 1.19; 95% CI 1.04-1.37; p=0.012), a total score on the scale of assessment of clinical status in CHF (OR 1.13; 95% CI 1.03-1.24; p=0.008). Conclusion. All СHF patients had concomitant diseases, CKD and obesity were the most common pathologies. The ischemic etiology of CHF, along with the male gender, LV EF less than 45%, severe clinical statusand high score on the Charlson comorbidity index turned out to be risk factors for death in outpatients aged 60 years and older with CHF.
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Affiliation(s)
- V N Larina
- The Russian National Research Medical University named after N. I. Pirogov
| | - B Ya Bart
- The Russian National Research Medical University named after N. I. Pirogov
| | - D G Karpenko
- The Russian National Research Medical University named after N. I. Pirogov
| | | | - V G Larin
- The Russian National Research Medical University named after N. I. Pirogov
| | - O M Kulbachinskaya
- The Russian National Research Medical University named after N. I. Pirogov; Diagnostic Clinical Center #1, Department of Health of Moscow
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18
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Itagaki A, Kakizaki A, Funahashi M, Sato K, Yasuhara K, Ishikawa A. Impact of heart failure on functional recovery after hip fracture. J Phys Ther Sci 2019; 31:277-281. [PMID: 30936645 PMCID: PMC6428653 DOI: 10.1589/jpts.31.277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/19/2018] [Indexed: 01/18/2023] Open
Abstract
[Purpose] Heart failure has been identified as a risk factor for reduced physical
function and falls; however, the impact of heart failure on functional recovery after a
hip fracture is unclear. This study aimed to examine how heart failure and pre-fracture
physical function affect recovery after a hip fracture. [Participants and Methods] The
study population consisted of 122 patients with sub-acute hip fracture (mean age 81.7 ±
9.7 years, 18.9% male) who were divided into two groups: heart failure and non-heart
failure. The outcome measurement was the functional independence measure effectiveness. A
two-way analysis of variance was performed to investigate how heart failure and ambulatory
ability prior to hip fracture were related to the functional independence measure
effectiveness. [Results] Seventeen patients (13.9%) had a history of heart failure. The
two-way analysis of variance showed the two independent variables (heart failure and
ambulatory ability before fracture) had significant main effects; however, their
interaction effect was not significant. [Conclusion] Heart failure affects functional
recovery after hip fracture independent of the pre-fracture physical function, and vice
versa. Further research on rehabilitation in hip fracture patients with heart failure is
required to develop strategies to overcome poor functional recovery in such patients.
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Affiliation(s)
- Atsunori Itagaki
- Department of Cardiac Rehabilitation, The Cardiovascular Institute: 3-2-19 Nishiazabu, Minato-ku, Tokyo, Japan.,Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Japan
| | - Ayaka Kakizaki
- Department of Rehabilitation, Fuyoukai Murakami Hospital, Japan
| | | | - Kaori Sato
- Department of Rehabilitation, Fuyoukai Murakami Hospital, Japan
| | - Kyoko Yasuhara
- Department of Rehabilitation, Fuyoukai Murakami Hospital, Japan
| | - Akira Ishikawa
- Graduate School of Health Sciences, Hirosaki University, Japan
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