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Peikert A, Claggett BL, Udell JA, Joseph J, Hegde SM, Kim K, Mao L, Wang T, Havighurst TC, Farkouh ME, Bhatt DL, Tattersall MC, Cooper LS, Solomon SD, Vardeny O. Influenza Vaccine Immune Response in Patients With High-Risk Cardiovascular Disease: A Secondary Analysis of the INVESTED Randomized Clinical Trial. JAMA Cardiol 2024:2817470. [PMID: 38583091 PMCID: PMC11000133 DOI: 10.1001/jamacardio.2024.0468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/13/2024] [Indexed: 04/08/2024]
Abstract
Importance High-dose trivalent compared with standard-dose quadrivalent influenza vaccine did not significantly reduce all-cause mortality or cardiopulmonary hospitalizations in patients with high-risk cardiovascular disease in the INVESTED trial. Whether humoral immune response to influenza vaccine is associated with clinical outcomes is unknown. Objective To examine the antibody response to high-dose trivalent compared with standard-dose quadrivalent inactivated influenza vaccine and its associations with clinical outcomes. Design, Setting, and Participants This secondary analysis is a prespecified analysis of the immune response substudy of the randomized, double-blind, active-controlled INVESTED trial, which was conducted at 157 sites in the United States and Canada over 3 influenza seasons between September 2016 and January 2019. Antibody titers were determined by hemagglutination inhibition assays at randomization and 4 weeks during the 2017-2018 and 2018-2019 seasons. Eligibility criteria included recent acute myocardial infarction or heart failure hospitalization and at least 1 additional risk factor. Data were analyzed from February 2023 to June 2023. Main Outcomes and Measures Mean antibody titer change, seroprotection (antibody titer level ≥1:40) and seroconversion (≥4-fold increase in titer) at 4 weeks, and the association between seroconversion status and the risk for adverse clinical outcomes. Interventions High-dose trivalent or standard-dose quadrivalent inactivated influenza vaccine, with revaccination up to 3 seasons. Results Antibody data were available for 658 of 5260 randomized participants (12.5%; mean [SD] age, 66.2 [11.4] years; 507 male [77.1%], 151 female [22.9%]; 348 with heart failure [52.9%]). High-dose vaccine was associated with an increased magnitude in antibody titers for A/H1N1, A/H3N2, and B-type antigens compared with standard dose. More than 92% of all participants achieved seroprotection for each of the contained antigens, while seroconversion rates were higher in participants who received high-dose vaccine. Seroconversion for any antigen was not associated with the risk for cardiopulmonary hospitalizations or all-cause mortality (hazard ratio, 1.09; 95% CI, 0.79-1.53; P = .59), irrespective of randomized treatment (P = .38 for interaction). Conclusions and Relevance High-dose vaccine elicited a more robust humoral response in patients with heart failure or prior myocardial infarction enrolled in the INVESTED trial, with no association between seroconversion status and the risk for cardiopulmonary hospitalizations or all-cause mortality. Vaccination to prevent influenza remains critical in high-risk populations. Trial Registration ClinicalTrials.gov Identifier: NCT02787044.
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Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Brian L. Claggett
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacob A. Udell
- Peter Munk Cardiac Centre, University Health Network and Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jacob Joseph
- Department of Medicine, VA Providence Healthcare System and Brown University, Providence, Rhode Island
| | - Sheila M. Hegde
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison
| | - Tuo Wang
- Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison
| | - Thomas C. Havighurst
- Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison
| | | | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York
| | - Matthew C. Tattersall
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin–Madison, Madison
| | | | - Scott D. Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Orly Vardeny
- Department of Medicine, University of Minnesota, Minneapolis VA Health Care System, Minneapolis
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2
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Peikert A, Bart BA, Vaduganathan M, Claggett BL, Kulac IJ, Kosiborod MN, Desai AS, Jhund PS, Lam CSP, Inzucchi SE, Martinez FA, de Boer RA, Hernandez AF, Shah SJ, Petersson M, Langkilde AM, McMurray JJV, Solomon SD, Vardeny O. Contemporary Use and Implications of Beta-Blockers in Patients With HFmrEF or HFpEF: The DELIVER Trial. JACC Heart Fail 2024; 12:631-644. [PMID: 37767674 DOI: 10.1016/j.jchf.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Although beta-blockers are not recommended for the treatment of heart failure with preserved ejection fraction (HFpEF) according to the latest European Society of Cardiology and American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines, these therapies remain commonly used for comorbidity management. There has been concern that beta-blockers may adversely influence clinical outcomes by limiting chronotropic response in HFpEF. OBJECTIVES This study sought to examine the contemporary use and implications of beta-blockers in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or HFpEF. METHODS In the DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trial, a total of 6,263 patients with symptomatic heart failure (HF) with a left ventricular ejection fraction (LVEF) >40% were randomized to dapagliflozin or placebo across 20 countries. In this prespecified analysis, efficacy and safety outcomes were examined according to beta-blocker use at randomization. The primary outcome was cardiovascular death or worsening HF. RESULTS Overall, beta-blockers were used in 5,177 patients (83%), with wide variation by geographic region. Beta-blocker use was associated with a lower risk of the primary outcome in covariate-adjusted models (HR: 0.70; 95% CI: 0.60-0.83). Dapagliflozin consistently reduced the risk of the primary outcome in patients taking beta-blockers (HR: 0.82; 95% CI: 0.72-0.94) and in patients not taking beta-blockers (HR: 0.79; 95% CI: 0.61-1.03; Pinteraction = 0.85), with similar findings for key secondary endpoints. Adverse events were balanced between patients randomized to dapagliflozin and placebo, regardless of background beta-blocker use. CONCLUSIONS In patients with HFmrEF or HFpEF who were enrolled in DELIVER, 4 out of 5 participants were treated with a beta-blocker. Beta-blocker use was not associated with a higher risk of worsening HF or cardiovascular death. Dapagliflozin consistently and safely reduced clinical events, irrespective of background beta-blocker use. (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213).
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Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bradley A Bart
- Minneapolis VA Center for Care Delivery and Outcomes Research, Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian J Kulac
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, Minnesota, USA
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Schwegel N, Zach D, Peikert A, Santner V, Höller V, Gollmer J, Späth J, Riepl H, Rainer PP, Wallner M, Pilz S, Zirlik A, von Lewinski D, Ablasser K, Verheyen N, Kolesnik E. The Prognostic Value of Right Ventricular Function in Patients with Chronic Heart Failure-A Prospective Study. J Clin Med 2024; 13:1930. [PMID: 38610695 PMCID: PMC11012981 DOI: 10.3390/jcm13071930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: In patients with stable chronic heart failure with a reduced ejection fraction (HFrEF), left ventricular ejection fraction (LVEF) provides limited prognostic value, especially in patients with moderately to severely reduced LVEF. Echocardiographic parameters of right ventricular function may be associated with adverse clinical events in these patients. Therefore, we analyzed 164 patients with HFrEF in a prospective single-center cohort study to evaluate whether the parameters of right ventricular function are associated with worsening heart failure (WHF) hospitalizations, cardiovascular and all-cause deaths and combined endpoints. Methods: Echocardiographic cine loops were analyzed using vendor-independent post-processing software. Multivariate Cox regression analyses were performed, which were then adjusted for clinical characteristics and left ventricular functional parameters. Results: In these models, higher tricuspid annular plane systolic excursion (TAPSE) was significantly associated with lower rates of WHF hospitalizations (HR 0.880, 95%CI 0.800-0.968, p = 0.008), a composite endpoint of WHF hospitalizations and cardiovascular death (HR 0.878, 95%CI 0.800-0.964, p = 0.006), and a composite endpoint of WHF hospitalization and all-cause death (HR 0.918, 95%CI 0.853-0.988, p = 0.023). These associations were more pronounced in patients with LVEF ≤ 35%. Conclusions: In conclusion, in patients with HFrEF, TAPSE is an independent prognosticator for adverse clinical outcomes, warranting further studies to elucidate whether incorporating TAPSE into established risk scores improves their diagnostic accuracy.
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Affiliation(s)
- Nora Schwegel
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - David Zach
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Alexander Peikert
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Viktoria Santner
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Viktoria Höller
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Johannes Gollmer
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Johannes Späth
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Hermann Riepl
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Peter P. Rainer
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
- Department of Medicine, St. Johann in Tirol General Hospital, 6380 St. Johann in Tirol, Austria
- BioTechMed Graz, 8010 Graz, Austria
| | - Markus Wallner
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Andreas Zirlik
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Klemens Ablasser
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Nicolas Verheyen
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
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Peikert A, Vaduganathan M. Sodium Glucose Co-Transporter 2 Inhibition Following Acute Myocardial Infarction: The DAPA-MI and EMPACT-MI Trials. JACC Heart Fail 2024:S2213-1779(24)00158-6. [PMID: 38583168 DOI: 10.1016/j.jchf.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Peikert A, Goyal P, Vaduganathan M, Claggett BL, Kulac IJ, Miao ZM, Vardeny O, Kosiborod MN, Desai AS, Jhund PS, Lam CSP, Inzucchi SE, Martinez FA, de Boer RA, Hernandez AF, Shah SJ, Petersson M, Langkilde AM, McMurray JJV, Solomon SD. Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction According to Polypharmacy Status. JACC Heart Fail 2023; 11:1380-1393. [PMID: 37294244 DOI: 10.1016/j.jchf.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Patients with heart failure (HF) have a high burden of multimorbidity, often necessitating numerous medications. There may be clinical concern about introducing another medication, especially among individuals with polypharmacy. OBJECTIVES This study examined the efficacy and safety of addition of dapagliflozin according to the number of concomitant medications in HF with mildly reduced or preserved ejection fraction. METHODS In this post hoc analysis of the DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trial, 6,263 participants with symptomatic HF with left ventricular ejection fraction >40% were randomized to dapagliflozin or placebo. Baseline medication use (including vitamins and supplements) was collected. Efficacy and safety outcomes were assessed by medication use categories ("nonpolypharmacy": <5 medications; "polypharmacy": 5 to 9 medications; and "hyperpolypharmacy": ≥10 medications) and continuously. The primary outcome was worsening HF or cardiovascular death. RESULTS Overall, 3,795 (60.6%) patients met polypharmacy and 1,886 (30.1%) met hyperpolypharmacy criteria. Higher numbers of medications were strongly associated with higher comorbidity burden and increased rates of the primary outcome. Compared with placebo, dapagliflozin similarly reduced the risk of the primary outcome irrespective of polypharmacy status (nonpolypharmacy HR: 0.88 [95% CI: 0.58-1.34]; polypharmacy HR: 0.88 [95% CI: 0.75-1.03]; hyperpolypharmacy HR: 0.73 [95% CI: 0.60-0.88]; Pinteraction = 0.30). Similarly, benefits with dapagliflozin were consistent across the spectrum of total medication use (Pinteraction = 0.06). Although adverse events increased with higher number of medications, they were not more frequent with dapagliflozin, regardless of polypharmacy status. CONCLUSIONS In the DELIVER trial, dapagliflozin safely reduced worsening HF or cardiovascular death across a broad range of baseline medication use, including among individuals with polypharmacy (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213).
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Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Parag Goyal
- Division of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian J Kulac
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore; University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | | | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R and D, AstraZeneca, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R and D, AstraZeneca, Gothenburg, Sweden
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Hegde SM, Claggett BL, Udell JA, Kim K, Joseph J, Farkouh ME, Peikert A, Bhatt AS, Tattersall MC, Bhatt DL, Cooper LS, Solomon SD, Vardeny O. Temporal Association Among Influenza-Like Illness, Cardiovascular Events, and Vaccine Dose in Patients With High-Risk Cardiovascular Disease: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2331284. [PMID: 37707817 PMCID: PMC10502520 DOI: 10.1001/jamanetworkopen.2023.31284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/22/2023] [Indexed: 09/15/2023] Open
Abstract
Importance Influenza-like illness (ILI) activity has been associated with increased risk of cardiopulmonary (CP) events during the influenza season. High-dose trivalent influenza vaccine was not superior to standard-dose quadrivalent vaccine for reducing these events in patients with high-risk cardiovascular (CV) disease in the Influenza Vaccine to Effectively Stop Cardio Thoracic Events and Decompensated Heart Failure (INVESTED) trial. Objective To evaluate whether high-dose trivalent influenza vaccination is associated with benefit over standard-dose quadrivalent vaccination in reducing CP events during periods of high, local influenza activity. Design, Setting, and Participants This study was a prespecified secondary analysis of INVESTED, a multicenter, double-blind, active comparator randomized clinical trial conducted over 3 consecutive influenza seasons from September 2016 to July 2019. Follow-up was completed in July 2019, and data were analyzed from September 21, 2016, to July 31, 2019. Weekly Centers for Disease Control and Prevention (CDC)-reported, state-level ILI activity was ascertained to assess the weekly odds of the primary outcome. The study population included 3094 patients with high-risk CV disease from participating centers in the US. Intervention Participants were randomized to high-dose trivalent or standard-dose quadrivalent influenza vaccine and revaccinated for up to 3 seasons. Main Outcomes and Measures The primary outcome was the time to composite of all-cause death or CP hospitalization within each season. Additional measures included weekly CDC-reported ILI activity data by state. Results Among 3094 participants (mean [SD] age, 65 [12] years; 2309 male [75%]), we analyzed 129 285 person-weeks of enrollment, including 1396 composite primary outcome events (1278 CP hospitalization, 118 deaths). A 1% ILI increase in the prior week was associated with an increased risk in the primary outcome (odds ratio [OR], 1.14; 95% CI, 1.07-1.21; P < .001), CP hospitalization (OR, 1.13; 95% CI, 1.06-1.21; P < .001), and CV hospitalization (OR, 1.12; 95% CI, 1.04-1.19; P = .001), after adjusting for state, demographic characteristics, enrollment strata, and CV risk factors. Increased ILI activity was not associated with all-cause death (OR, 1.00; 95% CI, 0.88-1.13; P > .99). High-dose compared with standard-dose vaccine did not significantly reduce the primary outcome, even when the analysis was restricted to weeks of high ILI activity (OR, 0.88; 95% CI, 0.65-1.20; P = .43). Traditionally warmer months in the US were associated with lower CV risk independent of local ILI activity. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, ILI activity was temporally associated with increased CP events in patients with high-risk CV disease, and a higher influenza vaccine dose did not significantly reduce temporal CV risk. Other seasonal factors may play a role in the coincident high rates of ILI and CV events. Trial Registration ClinicalTrials.gov Identifier: NCT02787044.
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Affiliation(s)
- Sheila M. Hegde
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian L. Claggett
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacob A. Udell
- Women’s College Hospital and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison
| | - Jacob Joseph
- Brown University, The Warren Alpert Medical School, Providence, Rhode Island
| | - Michael E. Farkouh
- Women’s College Hospital and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Peikert
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ankeet S. Bhatt
- Kaiser Permanente Division of Research, Northern California, Oakland
| | | | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Lawton S. Cooper
- National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Scott D. Solomon
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Orly Vardeny
- Department of Medicine, University of Minnesota, Minneapolis
- VA Minneapolis Health Care System, US Department of Veterans Affairs, Minneapolis, Minnesota
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7
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Solomon SD, Lowenstein CJ, Bhatt AS, Peikert A, Vardeny O, Kosiborod MN, Berger JS, Reynolds HR, Mavromichalis S, Barytol A, Althouse AD, Luther JF, Leifer ES, Kindzelski AL, Cushman M, Gong MN, Kornblith LZ, Khatri P, Kim KS, Baumann Kreuziger L, Wahid L, Kirwan BA, Geraci MW, Neal MD, Hochman JS. Effect of the P-Selectin Inhibitor Crizanlizumab on Survival Free of Organ Support in Patients Hospitalized for COVID-19: A Randomized Controlled Trial. Circulation 2023; 148:381-390. [PMID: 37356038 PMCID: PMC10373640 DOI: 10.1161/circulationaha.123.065190] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/12/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND COVID-19 has been associated with endothelial injury, resultant microvascular inflammation and thrombosis. Activated endothelial cells release and express P-selectin and von Willebrand factor, both of which are elevated in severe COVID-19 and may be implicated in the disease pathophysiology. We hypothesized that crizanlizumab, a humanized monoclonal antibody to P-selectin, would reduce morbidity and death in patients hospitalized for COVID-19. METHODS An international, adaptive, randomized controlled platform trial, funded by the National Heart, Lung, and Blood Institute, randomly assigned 422 patients hospitalized with COVID-19 with moderate or severe illness to receive either a single infusion of the P-selectin inhibitor crizanlizumab (at a dose of 5 mg/kg) plus standard of care or standard of care alone in an open-label 1:1 ratio. The primary outcome was organ support-free days, evaluated on an ordinal scale consisting of the number of days alive free of organ support through the first 21 days after trial entry. RESULTS The study was stopped for futility by the data safety monitoring committee. Among 421 randomized patients with known 21-day outcomes, 163 patients (77%) randomized to the crizanlizumab plus standard-of-care arm did not require any respiratory or cardiovascular organ support compared with 169 (80%) in the standard-of-care-alone arm. The adjusted odds ratio for the effect of crizanlizumab on organ support-free days was 0.70 (95% CI, 0.43-1.16), where an odds ratio >1 indicates treatment benefit, yielding a posterior probability of futility (odds ratio <1.2) of 98% and a posterior probability of inferiority (odds ratio <1.0) of 91%. Overall, there were 37 deaths (17.5%) in the crizanlizumab arm and 27 deaths (12.8%) in the standard-of-care arm (hazard ratio, 1.33 [95% CrI, 0.85-2.21]; [probability of hazard ratio>1] = 0.879). CONCLUSIONS Crizanlizumab, a P-selectin inhibitor, did not result in improvement in organ support-free days in patients hospitalized with COVID-19. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04505774.
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Affiliation(s)
- Scott D. Solomon
- Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., A.S.B., A.P., A.B.)
| | | | - Ankeet S. Bhatt
- Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., A.S.B., A.P., A.B.)
- Kaiser Permanente San Francisco Medical Center, CA (A.S.B.)
| | - Alexander Peikert
- Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., A.S.B., A.P., A.B.)
| | - Orly Vardeny
- University of Minnesota and the Minneapolis VA Medical Center (O.V.)
| | - Mikhail N. Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri–Kansas City (M.N.K.)
| | - Jeffrey S. Berger
- Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, New York (J.S.B., H.R.R., S.M., J.S.H.)
| | - Harmony R. Reynolds
- Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, New York (J.S.B., H.R.R., S.M., J.S.H.)
| | - Stephanie Mavromichalis
- Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, New York (J.S.B., H.R.R., S.M., J.S.H.)
| | - Anya Barytol
- Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., A.S.B., A.P., A.B.)
| | | | - James F. Luther
- University of Pittsburgh, PA (A.D.A., J.F.L., M.W.G., M.D.N.)
| | - Eric S. Leifer
- National Heart, Lung, and Blood Institute, Bethesda, MD (E.S.L., A.L.K.)
| | | | - Mary Cushman
- Larner College of Medicine, University of Vermont, Burlington (M.C.)
| | | | | | - Pooja Khatri
- University of Cincinnati Medical Center, OH (P.K.)
| | | | | | | | | | - Mark W. Geraci
- University of Pittsburgh, PA (A.D.A., J.F.L., M.W.G., M.D.N.)
| | - Matthew D. Neal
- University of Pittsburgh, PA (A.D.A., J.F.L., M.W.G., M.D.N.)
| | - Judith S. Hochman
- Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, New York (J.S.B., H.R.R., S.M., J.S.H.)
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8
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Peikert A, Chandra A, Kosiborod MN, Claggett BL, Desai AS, Jhund PS, Lam CSP, Inzucchi SE, Martinez FA, de Boer RA, Hernandez AF, Shah SJ, Janssens SP, Belohlávek J, Borleffs CJW, Dobreanu D, Langkilde AM, Bengtsson O, Petersson M, McMurray JJV, Solomon SD, Vaduganathan M. Association of Dapagliflozin vs Placebo With Individual Kansas City Cardiomyopathy Questionnaire Components in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Secondary Analysis of the DELIVER Trial. JAMA Cardiol 2023:2805331. [PMID: 37208998 DOI: 10.1001/jamacardio.2023.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Importance Dapagliflozin has been shown to improve overall health status based on aggregate summary scores of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with heart failure (HF) with mildly reduced or preserved ejection fraction enrolled in the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial. A comprehensive understanding of the responsiveness of individual KCCQ items would allow clinicians to better inform patients on expected changes in daily living with treatment. Objective To examine the association of dapagliflozin treatment with changes in individual components of the KCCQ. Design, Setting, and Participants This is a post hoc exploratory analysis of DELIVER, a randomized double-blind placebo-controlled trial conducted at 353 centers in 20 countries from August 2018 to March 2022. KCCQ was administered at randomization and 1, 4, and 8 months. Scores of individual KCCQ components were scaled from 0 to 100. Eligibility criteria included symptomatic HF with left ventricular ejection fraction greater than 40%, elevated natriuretic peptide levels, and evidence of structural heart disease. Data were analyzed from November 2022 to February 2023. Main Outcomes and Measures Changes in the 23 individual KCCQ components at 8 months. Interventions Dapagliflozin, 10 mg, once daily or placebo. Results Baseline KCCQ data were available for 5795 of 6263 randomized patients (92.5%) (mean [SD] age, 71.5 [9.5] years; 3344 male [57.7%] and 2451 female [42.3%]). Dapagliflozin was associated with larger improvements in almost all KCCQ components at 8 months compared with placebo. The most significant improvements with dapagliflozin were observed in frequency of lower limb edema (difference, 3.2; 95% CI, 1.6-4.8; P < .001), sleep limitation by shortness of breath (difference, 3.0; 95% CI, 1.6-4.4; P < .001), and limitation in desired activities by shortness of breath (difference, 2.8; 95% CI, 1.3-4.3; P < .001). Similar treatment patterns were observed in longitudinal analyses integrating data from months 1, 4, and 8. Higher proportions of patients treated with dapagliflozin experienced improvements, and fewer had deteriorations across most individual components. Conclusions and Relevance In this study of patients with HF with mildly reduced or preserved ejection fraction, dapagliflozin was associated with improvement in a broad range of individual KCCQ components, with the greatest benefits in domains related to symptom frequency and physical limitations. Potential improvements in specific symptoms and activities of daily living might be more readily recognizable and easily communicated to patients. Trial Registration ClinicalTrials.gov Identifier: NCT03619213.
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Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alvin Chandra
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri - Kansas City
| | - Brian L Claggett
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Akshay S Desai
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pardeep S Jhund
- British Heart Foundation Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stefan P Janssens
- Cardiac Intensive Care, Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jan Belohlávek
- Department of Internal Medicine II, Cardiology and Angiology, General University Hospital, 1st Medical School, Charles University, Prague, Czech Republic
| | | | - Dan Dobreanu
- University of Medicine, Pharmacy, Science and Technology, George Emile Palade, Târgu Mureș, Romania
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Olof Bengtsson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - John J V McMurray
- British Heart Foundation Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Muthiah Vaduganathan
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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9
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Peikert A, Claggett BL, Kim K, Udell JA, Joseph J, Desai AS, Farkouh ME, Hegde SM, Hernandez AF, Bhatt DL, Gaziano JM, Talbot HK, Yancy C, Anand I, Mao L, Cooper LS, Solomon SD, Vardeny O. Association of post-vaccination adverse reactions after influenza vaccine with mortality and cardiopulmonary outcomes in patients with high-risk cardiovascular disease: the INVESTED trial. Eur J Heart Fail 2023; 25:299-310. [PMID: 36335639 DOI: 10.1002/ejhf.2716] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS Influenza vaccination is associated with reduced cardiopulmonary morbidity and mortality among patients with heart failure or recent myocardial infarction. The immune response to vaccination frequently results in mild adverse reactions (AR), which leads to vaccine hesitancy. This post hoc analysis explored the association between vaccine-related AR and morbidity and mortality in patients with high-risk cardiovascular disease. METHODS AND RESULTS The INVESTED trial randomized 5260 patients with recent heart failure hospitalization or acute myocardial infarction to high-dose trivalent or standard-dose quadrivalent inactivated influenza vaccine. We examined the association between vaccine-related AR and adverse clinical outcomes across both treatment groups in propensity-adjusted models. Among 5210 participants with available information on post-vaccination symptoms, 1968 participants (37.8%) experienced a vaccine-related AR. Compared to those without AR, post-vaccination AR, most commonly injection site pain (60.3%), were associated with lower risk for the composite of all-cause death or cardiopulmonary hospitalization (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.75-0.92, p < 0.001), cardiopulmonary hospitalizations (HR 0.85 [95% CI 0.76-0.95], p = 0.003), all-cause death (HR 0.77 [95% CI 0.62-0.96], p = 0.02), cardiovascular hospitalizations (HR 0.88 [95% CI 0.78-0.99], p = 0.03) and non-cardiopulmonary hospitalizations (HR 0.80 [95% CI 0.69-0.92], p = 0.003). While mild (76.4%) and moderate (20.6%) AR were most common and together associated with lower risk for the primary outcome (HR 0.81 [95% CI 0.74-0.90], p < 0.001), severe AR (2.9%) were related to increased risk (HR 1.68 [95% CI 1.17-2.42], p = 0.005). CONCLUSION Mild to moderate post-vaccination reactions after influenza vaccine were associated with reduced risk of cardiopulmonary hospitalizations and all-cause mortality in patients with high-risk cardiovascular disease, while severe reactions may indicate increased risk. Mild to moderate AR to influenza vaccination may be a marker of immune response and should not deter future vaccinations.
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Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Jacob A Udell
- Peter Munk Cardiac Centre, University Health Network and Women's College Hospital, University of Toronto, Toronto, ONT, Canada
| | - Jacob Joseph
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Boston, MA, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ONT, Canada
| | - Sheila M Hegde
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Deepak L Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Michael Gaziano
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Boston, MA, USA
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Clyde Yancy
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Inder Anand
- Department of Medicine, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Lawton S Cooper
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Orly Vardeny
- Department of Medicine, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, MN, USA
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10
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Peikert A, Cunningham JW. Amyloid-β and the Risk of Heart Failure: Cause or Only Association? JACC Heart Fail 2023; 11:103-105. [PMID: 36599537 DOI: 10.1016/j.jchf.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan W Cunningham
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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11
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Peikert A, Martinez FA, Vaduganathan M, Claggett BL, Kulac IJ, Desai AS, Jhund PS, de Boer RA, DeMets D, Hernandez AF, Inzucchi SE, Kosiborod MN, Lam CSP, Shah SJ, Katova T, Merkely B, Vardeny O, Wilderäng U, Lindholm D, Petersson M, Langkilde AM, McMurray JJV, Solomon SD. Efficacy and Safety of Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction According to Age: The DELIVER Trial. Circ Heart Fail 2022; 15:e010080. [PMID: 36029467 DOI: 10.1161/circheartfailure.122.010080] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The prevalence of heart failure (HF) with mildly reduced or preserved ejection fraction (EF) markedly increases with age, with older individuals disproportionately facing excess risk for mortality and hospitalization. Methods: The DELIVER trial (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure) randomized patients with New York Heart Association functional class II-IV and left ventricular EF >40% to either dapagliflozin or placebo for a median follow-up period of 2.3 years. We examined efficacy and safety outcomes by age categories (<55, 55-64, 65-74 and ≥75 years) and across age as a continuous measure. Results: Among 6,263 randomized patients (aged 40-99 years, mean age 71.7 ± 9.6 years), 338 (5.4%) were <55 years, 1,007 (16.1%) were 55-64 years, 2,326 (37.1%) were 65-74 years, and 2,592 (41.4%) were ≥75 years. Dapagliflozin reduced the risk of the primary composite outcome compared with placebo in all age categories (pinteraction=0.95) and across the age spectrum as a continuous function (pinteraction=0.76). Similar benefits were observed for the components of the primary outcome, with no significant interaction between randomized treatment and age category. Adverse events occurred more frequently with increasing age, but there were no significant differences in predefined safety outcomes between patients randomized to dapagliflozin and placebo across all age categories. Conclusions: In patients with HF and mildly reduced or preserved EF enrolled in DELIVER, Dapagliflozin reduced cardiovascular death or HF events across the spectrum of age, with a consistent safety profile, including among the traditionally under-treated older segment of patients ≥75 years. Clinical Trial Registration: URL: https://www.clinicaltrials.gov Unique identifier: NCT03619213.
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Affiliation(s)
| | | | | | | | | | | | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UNITED KINGDOM
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12
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Chatur S, Vaduganathan M, Peikert A, Claggett BL, McCausland FR, Skali H, Pfeffer MA, Beldhuis IE, Kober L, Seferovic P, Lefkowitz M, McMurray JJ, Solomon SD. Longitudinal Trajectories in Renal Function Before and After Heart Failure Hospitalization Among Patients with HFpEF in the PARAGON-HF Trial. Eur J Heart Fail 2022; 24:1906-1914. [PMID: 35895867 PMCID: PMC10086974 DOI: 10.1002/ejhf.2638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Worsening renal function may impact long-term outcomes in heart failure (HF). However, little is known about the longitudinal trajectories in renal function in relation to the HF hospitalization or how this high-risk clinical event impacts renal outcomes. METHODS AND RESULTS In PARAGON-HF, we evaluated the association between recency of prior HF hospitalization (occurring pre-randomization) and subsequent first renal composite outcome: (1) time to ≥50% decline in eGFR ; (2) development of end stage renal disease (ESRD); or (3) death attributable to renal causes. 2,306 (48.1%) patients had a history of prior HF hospitalization. Incident rates of the renal outcome were highest in those most recently hospitalized and decreased with longer time from last hospitalization. Treatment effect on the renal outcome of sacubitril/valsartan vs. valsartan was similar between patients with (HR 0.43; 95% CI: 0.26 to 0.75) and without (HR 0.63; 95% CI: 0.33 to 1.18; Pinteraction = 0.39) a prior history of HF hospitalization and appeared consistent regardless of timing of prior hospitalization for HF (Pinteraction =0.39). Serial eGFR measurements leading up to and after a HF hospitalization (occurring during the study period) and estimated eGFR trajectories using repeated measures regression models with restricted cubic splines were also examined. Patients experiencing a post-randomization HF hospitalization had a significant decline in eGFR prior to hospitalization while patients without HF hospitalization experienced a relatively stable eGFR trajectory (p<0.001). A change in the rate of decline of eGFR trajectory was observed 12-months preceding a HF hospitalization, and continued in the post-discharge window to 12 months following hospitalization. CONCLUSIONS HF hospitalization denotes increased risk for kidney disease progression which continues following recovery from HF decompensation in patients with HF with preserved ejection fraction.
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Affiliation(s)
- Safia Chatur
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Peikert
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Finnian R McCausland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hicham Skali
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Iris E Beldhuis
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Lars Kober
- Rigshospitalet Copenhagen University Hospital
| | - Petar Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia
| | - Martin Lefkowitz
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - John Jv McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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13
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Peikert A, Vaduganathan M, McCausland F, Claggett BL, Chatur S, Packer M, Pfeffer MA, Zannad F, Lefkowitz MP, Pieske B, Düngen HD, McMurray JJV, Solomon SD. Effects of Sacubitril/Valsartan Versus Valsartan on Renal Function in Patients with and without Diabetes and Heart Failure with Preserved Ejection Fraction: Insights From PARAGON-HF. Eur J Heart Fail 2022; 24:794-803. [PMID: 35119183 PMCID: PMC9305963 DOI: 10.1002/ejhf.2450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Diabetes is associated with a faster rate of renal function decline in patients with heart failure (HF). Sacubitril/valsartan attenuates the deterioration of renal function to a greater extent in patients with diabetes and HF with reduced ejection fraction compared with renin-angiotensin-system inhibitors alone. We assessed whether the same may be true in HF with preserved ejection fraction (HFpEF). METHODS AND RESULTS In the PARAGON-HF trial in patients with HF and LVEF of 45% or greater (n=4,796), we characterized the effects of sacubitril/valsartan on changes in estimated glomerular filtration rate (eGFR) over a period of 192 weeks, and on the prespecified renal composite outcome (eGFR reduction of ≥50%, end-stage renal disease, or death attributable to renal causes) in patients with (n=2,388) and without diabetes (n=2,408). The decline in eGFR was greater in patients with diabetes than in those without (-2.6 vs. -1.7 mL/min per 1·73 m2 per year, p<0.001), regardless of treatment assignment. Sacubitril/valsartan attenuated decline in eGFR similarly in patients with (-2.2 vs. -2.9 mL/min per 1·73 m2 per year, p=0.001) and without diabetes (-1.5 vs. -2.0 mL/min per 1·73 m2 per year, p=0.006) (Pinteraction for difference in eGFR slopes = 0.40). Compared with valsartan, sacubitril/valsartan reduced the renal composite outcome similarly in patients without diabetes (HR 0.42 (95% CI 0.19-0.91) and those with diabetes (HR 0.54 (95% CI 0.33-0.89); Pinteraction =0.59), as well as across a range of baseline HbA1c (Pinteraction =0.71). CONCLUSION Sacubitril/valsartan, compared with valsartan, attenuates the decline of eGFR and reduces clinically relevant kidney events similarly among patients with HFpEF with and without diabetes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alexander Peikert
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Finnian McCausland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Safia Chatur
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Milton Packer
- Baylor Heart and Vascular Hospital, Baylor University Medical Center, Dallas, TX, USA
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - John J V McMurray
- New British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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14
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Jäckel M, Kaier K, Rilinger J, Wolf D, Peikert A, Roth K, Oettinger V, Dawid Leander S, Zehender M, Bode C, Constantin VZM, Stachon P. Outcomes of female and male patients suffering from coronary artery disease: A nation-wide registry of patients admitted as emergency. Medicine (Baltimore) 2021; 100:e27298. [PMID: 34559142 PMCID: PMC8462577 DOI: 10.1097/md.0000000000027298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Presentation and mortality of coronary artery disease (CAD) substantially differs in both sexes. Most of the existing data analyzing sex differences is older than 10 years and mostly was retrieved in clinical trials, which are potentially structured with a bias against the inclusion of women, leading to a potential selection-bias. Meanwhile, with better diagnostic and therapeutic options, actual data analyzing sex differences in emergency CAD patients is rare.Data on all emergency case numbers with CAD diagnosis in Germany 2017 was retrieved from the German Institute for Medical Documentation and Information. DRG, OPS, and ICD codes were used to determine comorbidities, in-hospital course, and outcome. Competing risk regression analysis for in-hospital mortality was performed analyzing age, European System for Cardiac Operative Risk Evaluation (EuroSCORE), severity of CAD, clinical presentation type and sex.264,742 patients were included. Female patients were older and had more comorbidities. Three-vessel CAD was significantly less present in female patients (36.5% vs 47.5%; P < .001). After adjusting for age, EuroSCORE and severity of CAD, female sex was an independent predictor of lower in-hospital mortality (subdistribution hazard ratio [sHR] 0.94, 95% CI: 0.90-0.98, P = .002) in the whole cohort and in non-ST-segment elevation myocardial infarction (NSTEMI) patients (sHR 0.85, 95% CI: 0.79-0.92, P < .001), whereas in ST-segment elevation myocardial infarction (STEMI) patients, female sex was associated with a higher in-hospital mortality (sHR 1.07, 95% CI: 1.01-1.14, P = .029).In all patients admitted as emergency with CAD diagnosis and in all NSTEMI patients, female sex is protective, whereas in STEMI patients, females show a higher in-hospital mortality risk.
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Affiliation(s)
- Markus Jäckel
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology, Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dennis Wolf
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Alexander Peikert
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Katrin Roth
- Department of Obstetrics and Gynecology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vera Oettinger
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology, Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Staudacher Dawid Leander
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Manfred Zehender
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology, Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Von Zur Mühlen Constantin
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology, Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology, Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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15
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Merz J, Rofa K, Karnbrock L, Von Garlen S, Dimanski D, Koenig S, Bulatova K, Schaefer I, Peikert A, Albrecht P, Hoppe N, Bode C, Zirlik A, Stachon P. Knockout of purinergic receptor Y13 (P2Y13) results in an improved outcome of metabolic syndrome in mice. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Metabolic syndrome (MetS) clusters the main risk factors for cardiovascular diseases (CVDs) and endocrine dysfunction. The pathomechanism of MetS is described as local death of hypertrophic adipocytes releasing danger-associated molecular patterns (DAMPs) such as nucleotides (e.g. ADP). This promotes a long term inflammation of adipose tissue via activation of purinergic receptors with a gradual shift towards a pro-inflammatory environment. The ADP receptor P2Y13 is both described in metabolic and immunological processes. These combined characteristics make the P2Y13 an interesting candidate to investigate its role in MetS. Nevertheless, the role of P2Y13R in the pathogenesis of MetS is currently unknown and shall be analyzed in this study.
BMDM isolation and differentiation to Mϕ using M-CSF and subsequent stimulation with medium, LPS and IFNγ or IL4; Expression was quantified using Taqman. Male C57Bl6/J wild-type (WT) and P2Y13-deficient (KO) mice were fed a HFD for 20 weeks; body weight and food consumption were recorded weekly. GTT, ITT and metabolic cages were performed after 15 weeks with euthanization after 20 weeks. In order to distinguish the effect of hematopoetic or somatic cells, mice were lethally irradiated with 9.4Gy and reconstituted with donor bone-marrow (BM) via tail vein injection.
We observed a unique expression of P2Y13R on pro-inflammatory M1 Mϕ. After HFD feeding KO mice showed higher O2 consumption compared to WT mice (AUC of O2 consumption on 2nd day= KO:61620±2261mL/kg vs WT: 53830±916mL/kg, p<0.05). Although KO mice consumed more food compared to WT littermates (KO:5.7±0.5g/d vs WT:3.1±0.1g/d, p<0.0001), they showed significantly decelerated weight gain (e.g.week 15→KO:147,292±5,26% vs WT:180.8±15.9%, p<0.05). Obese KO animals outperformed obese WT littermates in a peritoneal glucose tolerance test (GTT) (2h post-injection (post-i.) →KO:273.7±46.3mg/dL vs WT: 555.0±40.8mg/dL, p<0.05). KO mice on HFD were protected from developing a fatty liver. HFD KO mice receiving WT BM show accelerated weight gain compared to KO mice receiving KO BM (e.g.week 10 WT in KO: 111.2±2.2% vs KO in KO: 102.2±1.2%, p<0.05). In the GTT irradiated KO mice either receiving KO or WT BM are protected from HFD induced impaired glucose homeostasis (45min post-i.; KO→KO:222.1±21.2mg/dL vs WT→KO:232.8±15.9mg/dL vs WT on chow diet:240.4±18.6mg/dL). Contrary, WT mice receiving KO or WT BM developed a glucose resistance comparable to non-irradiated WT mice (45min post-i.; WT→WT:423.8±61.7mg/dL vs KO→WT:434.3±51.1 vs WT on HFD:574.4±7.9).
P2Y13 KO improves the outcome of MetS in mice with improved glucose homeostasis, decelerated weight gain, no fatty liver development and better metabolic turnover. BM transplantation experiments suggest a somatic component as possible explanation of these observations. Given these beneficial metabolic effects, we hypothesize that antagonization of P2Y13R could be a promising therapeutic tool in the field of MetS.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Merz
- University of Freiburg, Cardiology, Freiburg, Germany
| | - K Rofa
- University of Freiburg, Cardiology, Freiburg, Germany
| | - L Karnbrock
- University of Freiburg, Cardiology, Freiburg, Germany
| | - S Von Garlen
- University of Freiburg, Cardiology, Freiburg, Germany
| | - D Dimanski
- University of Freiburg, Cardiology, Freiburg, Germany
| | - S Koenig
- University of Freiburg, Cardiology, Freiburg, Germany
| | - K Bulatova
- University of Freiburg, Cardiology, Freiburg, Germany
| | - I Schaefer
- University of Freiburg, Cardiology, Freiburg, Germany
| | - A Peikert
- University of Freiburg, Cardiology, Freiburg, Germany
| | - P Albrecht
- University of Freiburg, Cardiology, Freiburg, Germany
| | - N Hoppe
- University of Freiburg, Cardiology, Freiburg, Germany
| | - C Bode
- University of Freiburg, Cardiology, Freiburg, Germany
| | - A Zirlik
- Medical University of Graz, Internal medicine, cardiology, Graz, Austria
| | - P Stachon
- University of Freiburg, Cardiology, Freiburg, Germany
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16
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Koenig S, Peikert A, Merz J, Rofa K, Schaefer I, Dimanski D, Karnbrock L, Von Garlen S, Aleid R, Bulatova K, Hoppe N, Bode C, Zirlik A, Stachon P. Deficiency of the purinergic receptor P2X4 limits atherosclerosis in mice. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Extracellular nucleotides like ATP promote inflammation as danger signals in various chronic diseases via purinergic receptors. In our previous work we identified P2X4 expression in murine atherosclerotic lesions. Therefore, we hypothesized a contribution of the ATP-P2X4 axis to vascular inflammation in atherosclerosis.
Methods
To investigate the functional role of P2X4 in atherogenesis, wild-type LDL-receptor deficient mice (LDLR−/−) and P2X4-deficient LDLR−/− mice (P2X4−/−LDLR−/−) were fed a high cholesterol diet for 16 weeks. Plaque progression in aortic arches was monitored by echography at intervals of 4 weeks, and leukocyte subsets in blood samples were analysed by flow cytometry. Atherosclerotic lesions were then assessed histologically in aortic root, arch, and abdominal aorta. In order to assess leukocyte recruitment, intravital microscopy was performed after injection of ATP in P2X4−/− or wildtype mice (WT). Regarding transferability to human disease, atherosclerotic plaque from carotid endarterectomy has been stained immunohistochemically for P2X4-receptor expression.
Results
After 16 weeks, P2X4-deficient mice showed significantly reduced atherosclerotic lesions in the aortic root (n=40, LDLR−/−: 0.47 mm2, P2X4−/−LDLR−/−: 0.39 mm2, p=0.04). Ly6C- monocyte count in peripheral blood was higher in P2X4−/−LDLR−/− (n=32, LDLR−/−: 241/μl, P2X4−/−LDLR−/−: 542/μl, p=0.0088), shifting the balance to a more anti-inflammatory subset. Memory-cell generation of CD4-T-cells is significantly higher in knockout-mice, suggesting an involvement of T-helper cells (n=25, LDLR−/−: 27%, P2X4−/−LDLR−/−: 46%, p=0.0003). Peritoneally injected ATP induced leukocyte rolling in WT, but not in P2X4-deficient mice. In human carotid arteries, atherosclerotic plaque shows higher staining for P2X4−/− receptor than not diseased areas.
Conclusion
P2X4-deficiency enhances anti-inflammatory leukocytes in peripheral blood and reduces atherosclerosis. Therefore, blocking the ATP-P2X4 axis may prevent leukocyte recruitment to atherosclerotic lesions and could present a potential new target for anti-atherogenic therapy.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported by a research grant of the German Research Foundation (DFG) to Peter Stachon. Sebastian König was supported by a research grant of the German Cardiac Society (DGK)
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Affiliation(s)
- S Koenig
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - A Peikert
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - J Merz
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - K Rofa
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - I Schaefer
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - D Dimanski
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - L Karnbrock
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - S Von Garlen
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - R Aleid
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - K Bulatova
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - N Hoppe
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - C Bode
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
| | - A Zirlik
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - P Stachon
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, Freiburg, Germany
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17
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Peikert A, Kaier K, Merz J, Manhart L, Schäfer I, Hilgendorf I, Hehn P, Wolf D, Willecke F, Sheng X, Clemens A, Zehender M, von Zur Mühlen C, Bode C, Zirlik A, Stachon P. Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort. Clin Res Cardiol 2019; 109:315-323. [PMID: 31325043 PMCID: PMC7042185 DOI: 10.1007/s00392-019-01511-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/17/2019] [Indexed: 01/14/2023]
Abstract
Background Inflammation drives atherosclerosis and its complications. Anti-inflammatory therapy with interleukin 1 beta (IL-1β) antibody reduces cardiovascular events in patients with elevated high-sensitive C-reactive protein (hsCRP). This study aims to identify the share of patients with coronary heart disease (CHD) and residual inflammation who may benefit from anti-inflammatory therapy. Methods hsCRP and low-density lipoprotein (LDL) levels were determined in 2741 all-comers admitted to the cardiological ward of our tertiary referral hospital between June 2016 and June 2018. Patients without CHD, with acute coronary syndrome, chronic or recurrent systemic infection, use of immunosuppressant or anti-inflammatory agents, chronic inflammatory diseases, chemotherapy, terminal organ failure, traumatic injury and pregnancy were excluded. Results 856 patients with stable CHD were included. 42.7% of those had elevated hsCRP ≥ 2 mg/l. Within the group of patients with LDL-cholesterol < 70 mg/dl, 30.9% shared increased hsCRP indicating residual inflammation. After multivariate adjusted backward selection elevated Lipoprotein (a) (OR 1.61, p = 0.048), elevated proBNP (OR 2.57, p < 0.0001), smoking (OR 1.70, p = 0.022), and obesity (OR 2.28, p = 0.007) were associated with elevated hsCRP. In contrast, the use of ezetimibe was associated with normal hsCRP (OR 0.51, p = 0.014). In the subgroup of patients with on-target LDL-cholesterol < 70 mg/dl, backward selection identified elevated proBNP (OR 3.49, p = 0.007) as independent predictor of elevated hsCRP in patients with LDL-cholesterol < 70 mg/dl. Conclusion One-third of all-comers patients with CHD showed increased levels of hsCRP despite a LDL-cholesterol < 70 mg/dl potentially qualifying for an anti-inflammatory therapy. Elevated proBNP is an independent risk factor for hsCRP elevation. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-019-01511-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Peikert
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Julian Merz
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Lucas Manhart
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Ibrahim Schäfer
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Ingo Hilgendorf
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Philipp Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Dennis Wolf
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Florian Willecke
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Xia Sheng
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Andreas Clemens
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany.,Novartis Pharma AG, Basel, Switzerland
| | - Manfred Zehender
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Andreas Zirlik
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany. .,Department of Cardiology, Medical University of Graz, Graz, Austria.
| | - Peter Stachon
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
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18
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Peikert A, Kaier K, Manhart L, Merz J, Ahmed I, Wolf D, Hilgendorf I, Willecke F, Stachon P, Zirlik A. P2670Need of Treating Residual Inflammatory Activity in Coronary Heart Disease: the value of high sensitive CRP and LDL in a Real World Cohort. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Peikert
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - K Kaier
- University of Freiburg, Freiburg, Germany
| | - L Manhart
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - J Merz
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - I Ahmed
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - D Wolf
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - I Hilgendorf
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - F Willecke
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - P Stachon
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - A Zirlik
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
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19
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Stachon P, Geis S, Peikert A, Heidenreich A, Michel NA, Ünal F, Hoppe N, Dufner B, Schulte L, Marchini T, Cicko S, Ayata K, Zech A, Wolf D, Hilgendorf I, Willecke F, Reinöhl J, von Zur Mühlen C, Bode C, Idzko M, Zirlik A. Extracellular ATP Induces Vascular Inflammation and Atherosclerosis via Purinergic Receptor Y2 in Mice. Arterioscler Thromb Vasc Biol 2016; 36:1577-86. [PMID: 27339459 DOI: 10.1161/atvbaha.115.307397] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 06/02/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE A solid body of evidence supports a role of extracellular ATP and its P2 receptors in innate and adaptive immunity. It promotes inflammation as a danger signal in various chronic inflammatory diseases. Thus, we hypothesize contribution of extracellular ATP and its receptor P2Y2 in vascular inflammation and atherosclerosis. APPROACH AND RESULTS Extracellular ATP induced leukocyte rolling, adhesion, and migration in vivo as assessed by intravital microscopy and in sterile peritonitis. To test the role of extracellular ATP in atherosclerosis, ATP or saline as control was injected intraperitoneally 3× a week in low-density lipoprotein receptor(-/-) mice consuming high cholesterol diet. Atherosclerosis significantly increased after 16 weeks in ATP-treated mice (n=13; control group, 0.26 mm2; ATP group, 0.33 mm2; P=0.01). To gain into the role of ATP-receptor P2Y2 in ATP-induced leukocyte recruitment, ATP was administered systemically in P2Y2-deficient or P2Y2-competent mice. In P2Y2-deficient mice, the ATP-induced leukocyte adhesion was significantly reduced as assessed by intravital microscopy. P2Y2 expression in atherosclerosis was measured by real-time polymerase chain reaction and immunohistochemistry and demonstrates an increased expression mainly caused by influx of P2Y2-expressing macrophages. To investigate the functional role of P2Y2 in atherogenesis, P2Y2-deficient low-density lipoprotein receptor(-/-) mice consumed high cholesterol diet. After 16 weeks, P2Y2-deficient mice showed significantly reduced atherosclerotic lesions with decreased macrophages compared with P2Y2-competent mice (n=11; aortic arch: control group, 0.25 mm(2); P2Y2-deficient, 0.14 mm2; P=0.04). Mechanistically, atherosclerotic lesions from P2Y2-deficient mice expressed less vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 RNA. CONCLUSIONS We show that extracellular ATP induces vascular inflammation and atherosclerosis via activation of P2Y2.
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Affiliation(s)
- Peter Stachon
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Serjosha Geis
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Alexander Peikert
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Adrian Heidenreich
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Nathaly Anto Michel
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Fatih Ünal
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Natalie Hoppe
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Bianca Dufner
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Lisa Schulte
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Timoteo Marchini
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Sanja Cicko
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Korcan Ayata
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Andreas Zech
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Dennis Wolf
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Ingo Hilgendorf
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Florian Willecke
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Jochen Reinöhl
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Marco Idzko
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany
| | - Andreas Zirlik
- From the Atherogenesis Research Group, University Heart Center Freiburg, Department of Cardiology and Angiology I (P.S., S.G., A.P., A.H., N.A.M., F.Ü., N.H., B.D., L.S., T.M., D.W., I.H., F.W., J.R., C.v.z.M., C.B., A.Z.) and Department of Pneumology (S.C., K.A., A.Z., M.I.), University of Freiburg, Freiburg, Germany.
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Stachon P, Peikert A, Michel NA, Hergeth S, Marchini T, Wolf D, Dufner B, Hoppe N, Ayata CK, Grimm M, Cicko S, Schulte L, Reinöhl J, von zur Muhlen C, Bode C, Idzko M, Zirlik A. P2Y6 deficiency limits vascular inflammation and atherosclerosis in mice. Arterioscler Thromb Vasc Biol 2014; 34:2237-45. [PMID: 25104800 DOI: 10.1161/atvbaha.114.303585] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Nucleotides such as ATP, ADP, UTP, and UDP serve as proinflammatory danger signals via purinergic receptors on their release to the extracellular space by activated or dying cells. UDP binds to the purinergic receptor Y6 (P2Y6) and propagates vascular inflammation by inducing the expression of chemokines such as monocyte chemoattractant protein 1, interleukin-8, or its mouse homologsCCL1 (chemokine [C-C motif] ligand 1)/keratinocyte chemokine, CXCL2 (chemokine [C-X-C motif] ligand 2)/macrophage inflammatory protein 2, and CXCL5 (chemokine [C-X-C motif] ligand 5)/LIX, and adhesion molecules such as vascular cell adhesion molecule 1 and intercellular cell adhesion molecule 1. Thus, P2Y6 contributes to leukocyte recruitment and inflammation in conditions such as allergic asthma or sepsis. Because atherosclerosis is a chronic inflammatory disease driven by leukocyte recruitment to the vessel wall, we hypothesized a role of P2Y6 in atherogenesis. APPROACH AND RESULTS Intraperitoneal stimulation of wild-type mice with UDP induced rolling and adhesion of leukocytes to the vessel wall as assessed by intravital microscopy. This effect was not present in P2Y6-deficient mice. Atherosclerotic aortas of low-density lipoprotein receptor-deficient mice consuming high-cholesterol diet for 16 weeks expressed significantly more transcripts and protein of P2Y6 than respective controls. Finally, P2Y6 (-/-)/low-density lipoprotein receptor-deficient mice consuming high-cholesterol diet for 16 weeks developed significantly smaller atherosclerotic lesions compared with P2Y6 (+/+)/low-density lipoprotein receptor-deficient mice. Bone marrow transplantation identified a crucial role of P2Y6 on vascular resident cells, most likely endothelial cells, on leukocyte recruitment and atherogenesis. Atherosclerotic lesions of P2Y6-deficient mice contained fewer macrophages and fewer lipids as determined by immunohistochemistry. Mechanistically, RNA expression of vascular cell adhesion molecule 1 and interleukin-6 was decreased in these lesions and P2Y6-deficient macrophages took up less modified low-density lipoprotein cholesterol. CONCLUSIONS We show for the first time that P2Y6 deficiency limits atherosclerosis and plaque inflammation in mice.
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Affiliation(s)
- Peter Stachon
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Alexander Peikert
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Nathaly Anto Michel
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Sonja Hergeth
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Timoteo Marchini
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Dennis Wolf
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Bianca Dufner
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Natalie Hoppe
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Cemil Korcan Ayata
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Melanie Grimm
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Sanja Cicko
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Lisa Schulte
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Jochen Reinöhl
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Constantin von zur Muhlen
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Christoph Bode
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Marco Idzko
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.)
| | - Andreas Zirlik
- From the Atherogenesis Research Group, University Heart Center, Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (P.S., A.P., N.A.M., S.H., T.M., D.W., B.D., N.H., L.S., J.R., C.v.z.M., C.B., A.Z.); and Department of Pneumology, University of Freiburg, Freiburg, Germany (C.K.A., M.G., S.C., M.I.).
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Stachon P, Peikert A, Michel N, Wolf D, Dufner B, Hoppe N, Bode C, Idzko M, Zirlik A. P736P2Y6 deficiency limits vascular inflammation and atherosclerosis in mice. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stachon P, Peikert A, Michel A, Wolf D, Hoppe N, Dufner B, Bode C, Idzko M, Zirlik A. 530Extracellular ATP induces atherosclerosis and vascular inflammation via purinergic receptor 2 (P2Y2) in mice. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu093.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wissmann A, Feuersenger A, Gendolla A, Reuter U, Straube A, Evers S, May A, Peikert A, Pfaffenrath V, Staudenmayer H, Diener HC. Entwicklung eines Migräneprophylaxe-Screeninginstruments (MPS). Schmerz 2007; 21:430-8. [PMID: 17323045 DOI: 10.1007/s00482-007-0529-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to develop a screening tool to aid non-headache specialists, like general practitioners, in deciding whether migraine prophylaxis in the individual migraine patient is useful or not. The first step was the development of a questionnaire, consisting of 10 items, which was filled in by 132 migraineurs who called on neurologists or headache experts. Independently, the physicians filled in another questionnaire to answer the question of whether they decided to prescribe migraine prophylaxis and if they had, to give their reasons for doing so. Using logistic regression analysis, we identified the three questions which had the most influence on the decision regarding prophylaxis in the data set. As results, we identified the following three questions: 1. Do you suffer from migraine on more than 3 days/month? 2. Do you have to rest in bed while experiencing a migraine attack? 3. Do you have to take medication against migraine on more than 5 days/month? Validation of this reduced questionnaire is currently ongoing and involves 150 migraine patients of general practitioners.
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Affiliation(s)
- A Wissmann
- Klinik für Neurologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122 Essen
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Abstract
This multicentre, randomized, double-blind, placebo-controlled, parallel group dose-ranging study compared the efficacy and tolerability of four doses of sumatriptan nasal spray (2.5, 5, 10 and 20 mg) with a placebo, in the acute treatment of a single migraine attack. In total, 544 patients received the study medication as a single spray in one nostril, to treat a single migraine attack in the clinic. Efficacy assessments included the measurement of headache severity, clinical disability, and the presence/absence of associated symptoms. The incidence of headache recurrence was also assessed. The three highest doses of sumatriptan (5 mg 49%, 10 mg 46%, 20 mg 64%) were significantly better than the placebo (25%) at providing headache relief (moderate or severe headache improving to mild or none) 120 min after treatment (P </= 0. 01). Also, the 20 mg dose was significantly superior to both the 10 and 5 mg doses at this time point (P < 0.05). The proportion of patients who were headache-free 120 min after treatment, was also higher following 20 mg (42%) rather than following any other sumatriptan dose (14-24%, P < 0.005 20 vs 10 mg) or placebo (11%). Headache recurrence in patients who had responded to initial treatment was reported by 30-41% of patients who received sumatriptan, compared with 33% of patients in the placebo group. Sumatriptan nasal spray was well tolerated, the incidence of adverse events with each dose of sumatriptan being similar to the placebo (20-27 and 23%, respectively). Apart from bad/bitter taste, the events were comparable with those reported following sumatriptan treatment by other routes of administration.
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Affiliation(s)
- A Peikert
- Stadtirches Klinikum Sanatoriumsplatz 2, 81545 Munchen-Harlaching, Germany
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Peikert A, Wilimzig C, Köhne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996; 16:257-63. [PMID: 8792038 DOI: 10.1046/j.1468-2982.1996.1604257.x] [Citation(s) in RCA: 182] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In order to evaluate the prophylactic effect of oral magnesium, 81 patients aged 18-65 years with migraine according to the International Headache Society (IHS) criteria (mean attack frequency 3.6 per month) were examined. After a prospective baseline period of 4 weeks they received oral 600 mg (24 mmol) magnesium (trimagnesium dicitrate) daily for 12 weeks or placebo. In weeks 9-12 the attack frequency was reduced by 41.6% in the magnesium group and by 15.8% in the placebo group compared to the baseline (p < 0.05). The number of days with migraine and the drug consumption for symptomatic treatment per patient also decreased significantly in the magnesium group. Duration and intensity of the attacks and the drug consumption per attack also tended to decrease compared to placebo but failed to be significant. Adverse events were diarrhea (18.6%) and gastric irritation (4.7%). High-dose oral magnesium appears to be effective in migraine prophylaxis.
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Affiliation(s)
- A Peikert
- Department of Neurology and Clinical Neurophysiology, Munich-Harlaching Clinic, Germany
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Peikert A, Hentrich M, Ochs G. Topical 0.025% capsaicin in chronic post-herpetic neuralgia: efficacy, predictors of response and long-term course. J Neurol 1991; 238:452-6. [PMID: 1779253 DOI: 10.1007/bf00314653] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In order to evaluate the efficacy, time-course of action and predictors of response to topical capsaicin, 39 patients with chronic post-herpetic neuralgia (PHN), median duration 24 months, were treated with 0.025% capsaicin cream for 8 weeks. During therapy the patients rated their pain on a visual analogue scale (VAS) and a verbal outcome scale. A follow-up investigation was performed 10-12 months after study onset on the patients who had improved. Nineteen patients (48.7%) substantially improved after the 8-week trial; 5 (12.8%) discontinued therapy due to side-effects such as intolerable capsaicin-induced burning sensations (4) or mastitis (1); 15 (38.5%) reported no benefit. The decrease in VAS ratings was significant after 2 weeks of continuous application. Of the responders 72.2% were still improved at the follow-up; only one-third of them had continued application irregularly. Treatment effect was not dependent on patient's age, duration or localization of PHN (trigeminal involvement was excluded), sensory disturbance or pain character. Treatment response was not correlated with the incidence, time-course or severity of capsaicin-induced burning. If confirmed in controlled trials, the long-term results of this open, non-randomized study might indicate that the analgesic effect of capsaicin in PHN is mediated by both interference with neuropeptide metabolism and morphological changes (perhaps degeneration) of nociceptive afferents.
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Affiliation(s)
- A Peikert
- Neurologische Klinik und Poliklinik, Technischen Universität, München, Federal Republic of Germany
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Peikert A, Egbert R, Flock K, Hipp R, Rust M, Struppler A. [Systemic pharmacotherapy in backache. Indications and practical applications]. Fortschr Med 1989; 107:55-6, 59-60. [PMID: 2568972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The treatment of acute and chronic low back pain is a problem frequently encountered in the doctor's office. Selective drug therapy has a useful role to play within the framework of the overall therapeutic strategy. Indications and practical application of the major analgesic agents in various low back pain conditions are discussed.
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Tölle R, Peikert A, Rieke A. [Personality disorders in patients with melancholia]. Nervenarzt 1987; 58:227-36. [PMID: 3587456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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