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Mackenzie IS, Hawkey CJ, Ford I, Greenlaw N, Pigazzani F, Rogers A, Struthers AD, Begg AG, Wei L, Avery AJ, Taggar JS, Walker A, Duce SL, Barr RJ, Dumbleton JS, Rooke ED, Townend JN, Ritchie LD, MacDonald TM. Allopurinol and cardiovascular outcomes in patients with ischaemic heart disease: the ALL-HEART RCT and economic evaluation. Health Technol Assess 2024; 28:1-55. [PMID: 38551218 PMCID: PMC11017142 DOI: 10.3310/attm4092] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Background Allopurinol is a xanthine oxidase inhibitor that lowers serum uric acid and is used to prevent acute gout flares in patients with gout. Observational and small interventional studies have suggested beneficial cardiovascular effects of allopurinol. Objective To determine whether allopurinol improves major cardiovascular outcomes in patients with ischaemic heart disease. Design Prospective, randomised, open-label, blinded endpoint multicentre clinical trial. Setting Four hundred and twenty-four UK primary care practices. Participants Aged 60 years and over with ischaemic heart disease but no gout. Interventions Participants were randomised (1 : 1) using a central web-based randomisation system to receive allopurinol up to 600 mg daily that was added to usual care or to continue usual care. Main outcome measures The primary outcome was the composite of non-fatal myocardial infarction, non-fatal stroke or cardiovascular death. Secondary outcomes were non-fatal myocardial infarction, non-fatal stroke, cardiovascular death, all-cause mortality, hospitalisation for heart failure, hospitalisation for acute coronary syndrome, coronary revascularisation, hospitalisation for acute coronary syndrome or coronary revascularisation, all cardiovascular hospitalisations, quality of life and cost-effectiveness. The hazard ratio (allopurinol vs. usual care) in a Cox proportional hazards model was assessed for superiority in a modified intention-to-treat analysis. Results From 7 February 2014 to 2 October 2017, 5937 participants were enrolled and randomised to the allopurinol arm (n = 2979) or the usual care arm (n = 2958). A total of 5721 randomised participants (2853 allopurinol; 2868 usual care) were included in the modified intention-to-treat analysis population (mean age 72.0 years; 75.5% male). There was no difference between the allopurinol and usual care arms in the primary endpoint, 314 (11.0%) participants in the allopurinol arm (2.47 events per 100 patient-years) and 325 (11.3%) in the usual care arm (2.37 events per 100 patient-years), hazard ratio 1.04 (95% confidence interval 0.89 to 1.21); p = 0.65. Two hundred and eighty-eight (10.1%) participants in the allopurinol arm and 303 (10.6%) participants in the usual care arm died, hazard ratio 1.02 (95% confidence interval 0.87 to 1.20); p = 0.77. The pre-specified health economic analysis plan was to perform a 'within trial' cost-utility analysis if there was no statistically significant difference in the primary endpoint, so NHS costs and quality-adjusted life-years were estimated over a 5-year period. The difference in costs between treatment arms was +£115 higher for allopurinol (95% confidence interval £17 to £210) with no difference in quality-adjusted life-years (95% confidence interval -0.061 to +0.060). We conclude that there is no evidence that allopurinol used in line with the study protocol is cost-effective. Limitations The results may not be generalisable to younger populations, other ethnic groups or patients with more acute ischaemic heart disease. One thousand six hundred and thirty-seven participants (57.4%) in the allopurinol arm withdrew from randomised treatment, but an on-treatment analysis gave similar results to the main analysis. Conclusions The ALL-HEART study showed that treatment with allopurinol 600 mg daily did not improve cardiovascular outcomes compared to usual care in patients with ischaemic heart disease. We conclude that allopurinol should not be recommended for the secondary prevention of cardiovascular events in patients with ischaemic heart disease but no gout. Future work The effects of allopurinol on cardiovascular outcomes in patients with ischaemic heart disease and co-existing hyperuricaemia or clinical gout could be explored in future studies. Trial registration This trial is registered as EU Clinical Trials Register (EudraCT 2013-003559-39) and ISRCTN (ISRCTN 32017426). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 11/36/41) and is published in full in Health Technology Assessment; Vol. 28, No. 18. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Isla S Mackenzie
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | | | - Ian Ford
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Nicola Greenlaw
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Filippo Pigazzani
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Amy Rogers
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Allan D Struthers
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Alan G Begg
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Anthony J Avery
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jaspal S Taggar
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Suzanne L Duce
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Rebecca J Barr
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | | | - Evelien D Rooke
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Jonathan N Townend
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Thomas M MacDonald
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
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Bashir T, Achison M, Adamson S, Akpan A, Aspray T, Avenell A, Band MM, Burton LA, Cvoro V, Donnan PT, Duncan GW, George J, Gordon AL, Gregson CL, Hapca A, Hume C, Jackson TA, Kerr S, Kilgour A, Masud T, McKenzie A, McKenzie E, Patel H, Pilvinyte K, Roberts HC, Rossios C, Sayer AA, Smith KT, Soiza RL, Steves CJ, Struthers AD, Tiwari D, Whitney J, Witham MD, Kemp PR. Activin type I receptor polymorphisms and body composition in older individuals with sarcopenia-Analyses from the LACE randomised controlled trial. PLoS One 2023; 18:e0294330. [PMID: 37963137 PMCID: PMC10645316 DOI: 10.1371/journal.pone.0294330] [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] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Ageing is associated with changes in body composition including an overall reduction in muscle mass and a proportionate increase in fat mass. Sarcopenia is characterised by losses in both muscle mass and strength. Body composition and muscle strength are at least in part genetically determined, consequently polymorphisms in pathways important in muscle biology (e.g., the activin/myostatin signalling pathway) are hypothesised to contribute to the development of sarcopenia. METHODS We compared regional body composition measured by DXA with genotypes for two polymorphisms (rs10783486, minor allele frequency (MAF) = 0.26 and rs2854464, MAF = 0.26) in the activin 1B receptor (ACVR1B) determined by PCR in a cross-sectional analysis of DNA from 110 older individuals with sarcopenia from the LACE trial. RESULTS Neither muscle mass nor strength showed any significant associations with either genotype in this cohort. Initial analysis of rs10783486 showed that males with the AA/AG genotype were taller than GG males (174±7cm vs 170±5cm, p = 0.023) and had higher arm fat mass, (median higher by 15%, p = 0.008), and leg fat mass (median higher by 14%, p = 0.042). After correcting for height, arm fat mass remained significantly higher (median higher by 4% padj = 0.024). No associations (adjusted or unadjusted) were seen in females. Similar analysis of the rs2854464 allele showed a similar pattern with the presence of the minor allele (GG/AG) being associated with greater height (GG/AG = 174±7 cm vs AA = 170 ±5cm, p = 0.017) and greater arm fat mass (median higher by 16%, p = 0.023). Again, the difference in arm fat remained after correction for height. No similar associations were seen in females analysed alone. CONCLUSION These data suggest that polymorphic variation in the ACVR1B locus could be associated with body composition in older males. The activin/myostatin pathway might offer a novel potential target to prevent fat accumulation in older individuals.
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Affiliation(s)
- Tufail Bashir
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Marcus Achison
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - Simon Adamson
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - Asangaedem Akpan
- Liverpool University Hospitals NHS FT Trust, Clinical Research Network Northwest Coast, University of Liverpool, Liverpool, United Kingdom
| | - Terry Aspray
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle upon Tyne Hospitals NHS Trust, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Margaret M. Band
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - Louise A. Burton
- Medicine for the Elderly, NHS Tayside, Dundee, United Kingdom
- Ageing and Health, University of Dundee, Dundee, United Kingdom
| | - Vera Cvoro
- Victoria Hospital, Kirkcaldy, United Kingdom
- Centre for Clinical Brain Sciences University of Edinburgh, Edinburgh, United Kingdom
| | - Peter T. Donnan
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Gordon W. Duncan
- Centre for Clinical Brain Sciences University of Edinburgh, Edinburgh, United Kingdom
- Medicine for the Elderly, NHS Lothian, Edinburgh, United Kingdom
| | - Jacob George
- Division of Molecular & Clinical Medicine, Dept Clinical Pharmacology, Ninewells Hospital, University of Dundee Medical School, Dundee, United Kingdom
| | - Adam L. Gordon
- Unit of Injury, Inflammation and Recovery, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Department of Medicine for the Elderly, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Celia L. Gregson
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Older Person’s Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, United Kingdom
| | - Adrian Hapca
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - Cheryl Hume
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - Thomas A. Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Simon Kerr
- Department of Older People’s Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Alixe Kilgour
- Medicine for the Elderly, NHS Lothian, Edinburgh, United Kingdom
- Ageing and Health Research Group, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tahir Masud
- Clinical Gerontology Research Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, United Kingdom
| | - Andrew McKenzie
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - Emma McKenzie
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - Harnish Patel
- NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHSFT, Southampton, United Kingdom
| | - Kristina Pilvinyte
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - Helen C. Roberts
- Academic Geriatric Medicine, Mailpoint 807 Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Christos Rossios
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Avan A. Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle upon Tyne Hospitals NHS Trust, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Karen T. Smith
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - Roy L. Soiza
- Ageing & Clinical Experimental Research (ACER) Group, University of Aberdeen, Aberdeen, United Kingdom
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King’s College London, Department of Clinical Gerontology, King’s College Hospital, London, United Kingdom
| | - Allan D. Struthers
- Division of Molecular & Clinical Medicine, Dept Clinical Pharmacology, Ninewells Hospital, University of Dundee Medical School, Dundee, United Kingdom
| | - Divya Tiwari
- Bournemouth University and Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Julie Whitney
- School of Population Health & Environmental Sciences, King’s College London and King’s College Hospital, London, United Kingdom
| | - Miles D. Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle upon Tyne Hospitals NHS Trust, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul R. Kemp
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, United Kingdom
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Rossios C, Bashir T, Achison M, Adamson S, Akpan A, Aspray T, Avenell A, Band MM, Burton LA, Cvoro V, Donnan PT, Duncan GW, George J, Gordon AL, Gregson CL, Hapca A, Hume C, Jackson TA, Kerr S, Kilgour A, Masud T, McKenzie A, McKenzie E, Patel H, Pilvinyte K, Roberts HC, Sayer AA, Smith KT, Soiza RL, Steves CJ, Struthers AD, Tiwari D, Whitney J, Witham MD, Kemp PR. ACE I/D genotype associates with strength in sarcopenic men but not with response to ACE inhibitor therapy in older adults with sarcopenia: Results from the LACE trial. PLoS One 2023; 18:e0292402. [PMID: 37862321 PMCID: PMC10588903 DOI: 10.1371/journal.pone.0292402] [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] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/19/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Angiotensin II (AII), has been suggested to promote muscle loss. Reducing AII synthesis, by inhibiting angiotensin converting enzyme (ACE) activity has been proposed as a method to inhibit muscle loss. The LACE clinical trial was designed to determine whether ACE inhibition would reduce further muscle loss in individuals with sarcopenia but suffered from low recruitment and returned a negative result. Polymorphic variation in the ACE promoter (I/D alleles) has been associated with differences in ACE activity and muscle physiology in a range of clinical conditions. This aim of this analysis was to determine whether I/D polymorphic variation is associated with muscle mass, strength, in sarcopenia or contributed to the lack of response to treatment in the LACE study. METHODS Sarcopenic individuals were recruited into a 2x2 factorial multicentre double-blind study of the effects of perindopril and/or leucine versus placebo on physical performance and muscle mass. DNA extracted from blood samples (n = 130 72 women and 58 men) was genotyped by PCR for the ACE I/D polymorphism. Genotypes were then compared with body composition measured by DXA, hand grip and quadriceps strength before and after 12 months' treatment with leucine and/or perindopril in a cross-sectional analysis of the influence of genotype on these variables. RESULTS Allele frequencies for the normal UK population were extracted from 13 previous studies (I = 0.473, D = 0.527). In the LACE cohort the D allele was over-represented (I = 0.412, D = 0.588, p = 0.046). This over-representation was present in men (I = 0.353, D = 0.647, p = 0.010) but not women (I = 0.458, D = 0.532, p = 0.708). In men but not women, individuals with the I allele had greater leg strength (II/ID = 18.00 kg (14.50, 21.60) vs DD = 13.20 kg (10.50, 15.90), p = 0.028). Over the 12 months individuals with the DD genotype increased in quadriceps strength but those with the II or ID genotype did not. Perindopril did not increase muscle strength or mass in any polymorphism group relative to placebo. CONCLUSION Our results suggest that although ACE genotype was not associated with response to ACE inhibitor therapy in the LACE trial population, sarcopenic men with the ACE DD genotype may be weaker than those with the ACE I/D or II genotype.
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Affiliation(s)
- Christos Rossios
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Tufail Bashir
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Marcus Achison
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Simon Adamson
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Asangaedem Akpan
- University of Liverpool, Liverpool University Hospitals NHS FT Trust, Clinical Research Network Northwest Coast, Liverpool, United Kingdom
| | - Terry Aspray
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Newcastle University, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Margaret M. Band
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Louise A. Burton
- Medicine for the Elderly, NHS Tayside, Dundee, United Kingdom
- Ageing and Health, University of Dundee, Dundee, United Kingdom
| | - Vera Cvoro
- Victoria Hospital, Kirkcaldy, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter T. Donnan
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Gordon W. Duncan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Medicine for the Elderly, NHS Lothian, Edinburgh, United Kingdom
| | - Jacob George
- Dept Clinical Pharmacology, Division of Molecular & Clinical Medicine, University of Dundee Medical School, Ninewells Hospital, Dundee, United Kingdom
| | - Adam L. Gordon
- Unit of Injury, Inflammation and Recovery, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Department of Medicine for the Elderly, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Celia L. Gregson
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Older Person’s Unit, Royal United Hospital NHS Foundation Trust Bath, Bath, United Kingdom
| | - Adrian Hapca
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Cheryl Hume
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Thomas A. Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Simon Kerr
- Department of Older People’s Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Alixe Kilgour
- Medicine for the Elderly, NHS Lothian, Edinburgh, United Kingdom
- Ageing and Health Research Group, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tahir Masud
- Clinical Gerontology Research Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, United Kingdom
| | - Andrew McKenzie
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Emma McKenzie
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Harnish Patel
- NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHSFT, Southampton, Hampshire, United Kingdom
| | - Kristina Pilvinyte
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Helen C. Roberts
- Academic Geriatric Medicine, University of Southampton, Mailpoint 807 Southampton General Hospital, Southampton, United Kingdom
| | - Avan A. Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Newcastle University, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Karen T. Smith
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Roy L. Soiza
- Ageing & Clinical Experimental Research (ACER) Group, University of Aberdeen, Aberdeen, United Kingdom
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King’s College London & Department of Clinical Gerontology, King’s College Hospital, London, United Kingdom
| | - Allan D. Struthers
- Dept Clinical Pharmacology, Division of Molecular & Clinical Medicine, University of Dundee Medical School, Ninewells Hospital, Dundee, United Kingdom
| | - Divya Tiwari
- Bournemouth University and Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Julie Whitney
- School of Population Health & Environmental Sciences, King’s College London and King’s College Hospital, London, United Kingdom
| | - Miles D. Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Newcastle University, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Paul R. Kemp
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, United Kingdom
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Chen A, Ju C, Mackenzie IS, MacDonald TM, Struthers AD, Wei L, Man KK. Impact of beta-blockers on mortality and cardiovascular disease outcomes in patients with obstructive sleep apnoea: a population-based cohort study in target trial emulation framework. Lancet Reg Health Eur 2023; 33:100715. [PMID: 37601338 PMCID: PMC10432194 DOI: 10.1016/j.lanepe.2023.100715] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023]
Abstract
Background There is no real-world evidence regarding the association between beta-blocker use and mortality or cardiovascular outcomes in patients with obstructive sleep apnoea (OSA). We aimed to investigate the impact of beta-blocker use on all-cause mortality and cardiovascular diseases (CVDs) in patients with OSA. Methods We conducted a target trial emulation study of 37,581 patients with newly diagnosed OSA from 1st January 2000 to 30th November 2021 using the IMRD-UK database (formerly known as the THIN database). We compared the treatment strategies of initiating beta-blocker treatment within one year versus non-beta-blocker treatment through the method of clone-censor-weight. Covariates, including patients' demographics, lifestyle, comorbidities, and recent medications, were measured and controlled. Patients were followed up for all-cause mortality or composite CVD outcomes (angina, myocardial infarction, stroke/transient ischaemic attack, heart failure, or atrial fibrillation). We estimated the five-year absolute risks, risk differences and risk ratio with 95% confidence intervals (CIs) with standardised, weighted pooled logistic regression, which is a discrete-time hazard model for survival analysis. Several sensitivity analyses were performed, including multiple imputation addressing the missing data. Findings The median follow-up time was 4.1 (interquartile range, 1.9-7.8) years. The five-year absolute risk of all-cause mortality and CVD outcomes were 4.9% (95% CI, 3.8-6.0) and 13.0% (95% CI, 11.4-15.0) among beta-blocker users, and 4.0% (95% CI, 3.8-4.2) and 9.4% (95% CI, 9.1-9.7) among non-beta-blocker users, respectively. The five-year absolute risk difference and risk ratio between the two groups for all-cause mortality and CVD outcomes were 0.9% (95% CI, -0.2 to 2.1) and 1.22 (95% CI, 0.96-1.54), and 3.5% (95% CI, 2.1-5.5) and 1.37 (95% CI, 1.22-1.62), respectively. Findings were consistent across the sensitivity analyses. Interpretation Beta-blocker treatment was associated with an increased risk of CVD and a trend for an increased risk of mortality among patients with OSA. Further studies are needed to confirm our findings. Funding Innovation and Technology Commission of the Hong Kong Special Administration Region Government.
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Affiliation(s)
- Anthony Chen
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, England
- Faculty of Medicine & Health Sciences, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, England
| | - Chengsheng Ju
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, England
| | - Isla S. Mackenzie
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland
| | - Thomas M. MacDonald
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland
| | - Allan D. Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, England
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, China
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, England
| | - Kenneth K.C. Man
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, England
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, China
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, England
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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5
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Mackenzie IS, Rogers A, Poulter NR, Williams B, Brown MJ, Webb DJ, Ford I, Rorie DA, Guthrie G, Grieve JWK, Pigazzani F, Rothwell PM, Young R, McConnachie A, Struthers AD, Lang CC, MacDonald TM. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet 2022; 400:1417-1425. [PMID: 36240838 PMCID: PMC9631239 DOI: 10.1016/s0140-6736(22)01786-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Studies have suggested that evening dosing with antihypertensive therapy might have better outcomes than morning dosing. The Treatment in Morning versus Evening (TIME) study aimed to investigate whether evening dosing of usual antihypertensive medication improves major cardiovascular outcomes compared with morning dosing in patients with hypertension. METHODS The TIME study is a prospective, pragmatic, decentralised, parallel-group study in the UK, that recruited adults (aged ≥18 years) with hypertension and taking at least one antihypertensive medication. Eligible participants were randomly assigned (1:1), without restriction, stratification, or minimisation, to take all of their usual antihypertensive medications in either the morning (0600-1000 h) or in the evening (2000-0000 h). Participants were followed up for the composite primary endpoint of vascular death or hospitalisation for non-fatal myocardial infarction or non-fatal stroke. Endpoints were identified by participant report or record linkage to National Health Service datasets and were adjudicated by a committee masked to treatment allocation. The primary endpoint was assessed as the time to first occurrence of an event in the intention-to-treat population (ie, all participants randomly assigned to a treatment group). Safety was assessed in all participants who submitted at least one follow-up questionnaire. The study is registered with EudraCT (2011-001968-21) and ISRCTN (18157641), and is now complete. FINDINGS Between Dec 17, 2011, and June 5, 2018, 24 610 individuals were screened and 21 104 were randomly assigned to evening (n=10 503) or morning (n=10 601) dosing groups. Mean age at study entry was 65·1 years (SD 9·3); 12 136 (57·5%) participants were men; 8968 (42·5%) were women; 19 101 (90·5%) were White; 98 (0·5%) were Black, African, Caribbean, or Black British (ethnicity was not reported by 1637 [7·8%] participants); and 2725 (13·0%) had a previous cardiovascular disease. By the end of study follow-up (March 31, 2021), median follow-up was 5·2 years (IQR 4·9-5·7), and 529 (5·0%) of 10 503 participants assigned to evening treatment and 318 (3·0%) of 10 601 assigned to morning treatment had withdrawn from all follow-up. A primary endpoint event occurred in 362 (3·4%) participants assigned to evening treatment (0·69 events [95% CI 0·62-0·76] per 100 patient-years) and 390 (3·7%) assigned to morning treatment (0·72 events [95% CI 0·65-0·79] per 100 patient-years; unadjusted hazard ratio 0·95 [95% CI 0·83-1·10]; p=0·53). No safety concerns were identified. INTERPRETATION Evening dosing of usual antihypertensive medication was not different from morning dosing in terms of major cardiovascular outcomes. Patients can be advised that they can take their regular antihypertensive medications at a convenient time that minimises any undesirable effects. FUNDING British Heart Foundation.
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Affiliation(s)
- Isla S Mackenzie
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Amy Rogers
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Neil R Poulter
- School of Public Health, Imperial College London, London, UK
| | - Bryan Williams
- NIHR University College London Hospitals Biomedical Research Centre and University College London, London, UK
| | | | - David J Webb
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ian Ford
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - David A Rorie
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Greg Guthrie
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - J W Kerr Grieve
- Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Filippo Pigazzani
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Robin Young
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Thomas M MacDonald
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
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6
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Mackenzie IS, Hawkey CJ, Ford I, Greenlaw N, Pigazzani F, Rogers A, Struthers AD, Begg AG, Wei L, Avery AJ, Taggar JS, Walker A, Duce SL, Barr RJ, Dumbleton JS, Rooke ED, Townend JN, Ritchie LD, MacDonald TM. Allopurinol versus usual care in UK patients with ischaemic heart disease (ALL-HEART): a multicentre, prospective, randomised, open-label, blinded-endpoint trial. Lancet 2022; 400:1195-1205. [PMID: 36216006 DOI: 10.1016/s0140-6736(22)01657-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [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: 08/12/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Allopurinol is a urate-lowering therapy used to treat patients with gout. Previous studies have shown that allopurinol has positive effects on several cardiovascular parameters. The ALL-HEART study aimed to determine whether allopurinol therapy improves major cardiovascular outcomes in patients with ischaemic heart disease. METHODS ALL-HEART was a multicentre, prospective, randomised, open-label, blinded-endpoint trial done in 18 regional centres in England and Scotland, with patients recruited from 424 primary care practices. Eligible patients were aged 60 years or older, with ischaemic heart disease but no history of gout. Participants were randomly assigned (1:1), using a central web-based randomisation system accessed via a web-based application or an interactive voice response system, to receive oral allopurinol up-titrated to a dose of 600 mg daily (300 mg daily in participants with moderate renal impairment at baseline) or to continue usual care. The primary outcome was the composite cardiovascular endpoint of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death. The hazard ratio (allopurinol vs usual care) in a Cox proportional hazards model was assessed for superiority in a modified intention-to-treat analysis (excluding randomly assigned patients later found to have met one of the exclusion criteria). The safety analysis population included all patients in the modified intention-to-treat usual care group and those who took at least one dose of randomised medication in the allopurinol group. This study is registered with the EU Clinical Trials Register, EudraCT 2013-003559-39, and ISRCTN, ISRCTN32017426. FINDINGS Between Feb 7, 2014, and Oct 2, 2017, 5937 participants were enrolled and then randomly assigned to receive allopurinol or usual care. After exclusion of 216 patients after randomisation, 5721 participants (mean age 72·0 years [SD 6·8], 4321 [75·5%] males, and 5676 [99·2%] white) were included in the modified intention-to-treat population, with 2853 in the allopurinol group and 2868 in the usual care group. Mean follow-up time in the study was 4·8 years (1·5). There was no evidence of a difference between the randomised treatment groups in the rates of the primary endpoint. 314 (11·0%) participants in the allopurinol group (2·47 events per 100 patient-years) and 325 (11·3%) in the usual care group (2·37 events per 100 patient-years) had a primary endpoint (hazard ratio [HR] 1·04 [95% CI 0·89-1·21], p=0·65). 288 (10·1%) participants in the allopurinol group and 303 (10·6%) participants in the usual care group died from any cause (HR 1·02 [95% CI 0·87-1·20], p=0·77). INTERPRETATION In this large, randomised clinical trial in patients aged 60 years or older with ischaemic heart disease but no history of gout, there was no difference in the primary outcome of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death between participants randomised to allopurinol therapy and those randomised to usual care. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Isla S Mackenzie
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.
| | | | - Ian Ford
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Nicola Greenlaw
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Filippo Pigazzani
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Amy Rogers
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Allan D Struthers
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Alan G Begg
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Anthony J Avery
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jaspal S Taggar
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Suzanne L Duce
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Rebecca J Barr
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | | | - Evelien D Rooke
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Jonathan N Townend
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Thomas M MacDonald
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
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7
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Lee CEC, Subramani P, Ananth P, Bhalraam U, Victor C, Venkatesan R, Prathiba V, Anjana RM, Palmer CNA, Struthers AD, Singh JS, Mordi IR, Mohan V, Lang CC. High prevalence of asymptomatic left ventricular diastolic dysfunction and its detection among South Asian patients with Type 2 Diabetes Mellitus compared with White Europeans. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.821] [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: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is an important manifestation of Type 2 Diabetes (T2D). The development of HF in T2D may be preceded by Stage B HF. Asymptomatic left ventricular impairment, especially left ventricular diastolic dysfunction (LVDD), is a defining early feature of Stage B HF. Detection of Stage B HF is crucial as it provides an opportune target for intervention with cardio-protective therapy to prevent the development of symptomatic HF in T2D. The risk of T2DM is higher in South Asian populations resulting in increased risk of macrovascular and microvascular complications. The prevalence of Stage B HF in South Asian patients with T2DM is not known.
Purpose
(i) To compare the prevalence of Stage B HF in South Asians in India compared with White Europeans in Scotland; (ii) To test the role of NT-proBNP in identifying Stage B HF
Methods
This study involved the comparison between two independently conducted, cross-sectional studies. The patients were asymptomatic patients with T2DM with no prior history of cardiovascular disease from Chennai, India (n=246) and Tayside, Scotland (n=246). All patients underwent transthoracic echocardiogram (echo) examination to detect the presence of structural and functional echo features of Stage B HF: left atrial enlargement (LAE), left ventricular hypertrophy (LVH), LVDD and LV systolic dysfunction (LVSD). Receiver operating curves (ROC) were used to determine the predictive ability of NT-proBNP to predict LAE/LVDD/LVD/LVSD.
Results
The prevalence of Stage B HF was high in South-Asian patients with T2DM (median age of 55 [49, 62] with a high prevalence of LVDD (5% had LVH, 7.3% had LAE, 70% had LVDD and 0% had LVSD (Figure 1B). 10% of the South Asian patients had at least 2 factors contributing to Stage B HF and these patients had higher NT-proBNP titres (703.4 [500.0, 949.2] vs 423.7 [35.0, 754.2], p<0.001). ROC curves show that NT-proBNP can predict these participants with 2 or more echo features [Figure 2B, AUC: 0.7043 (0.6159, 0.7928) p<0.05]. The prevalence of Stage B HF among White Europeans (median age of 67 [61, 72].) was lower compared with South Asian patients: 15% had LVH, 13% had LAE, 19% had LVDD and 2% had LVSD (Figure 1A). 8% of White Europeans had at least 2 factors contributing to Stage B HF and these had higher NT-proBNP titres (368.9 [154.6, 1087.8] vs 186.8 [79.7, 411.5], p=0.02). ROC curves show that NT-proBNP can predict participants with 2 or more factors [Figure 2A, AUC: 0.6399 (0.5122, 0.7676) p<0.05].
Conclusion
Our study has shown that South Asian patients with T2DM have a high prevalence of Stage B HF compared with White Europeans and that the predominant Stage B HF feature is LVDD.
We also found that NTproBNP could potentially be used to detect Stage B HF and help identify at-risk patients for cardio-protective therapy such as SGLT2 inhibitor therapy that has been shown to prevent the development of future HF events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C E C Lee
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - P Subramani
- Madras Diabetes Research Foundation , Chennai , India
| | - P Ananth
- Madras Diabetes Research Foundation , Chennai , India
| | - U Bhalraam
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - C Victor
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - R Venkatesan
- Madras Diabetes Research Foundation , Chennai , India
| | - V Prathiba
- Madras Diabetes Research Foundation , Chennai , India
| | - R M Anjana
- Madras Diabetes Research Foundation , Chennai , India
| | - C N A Palmer
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - A D Struthers
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - J S Singh
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - I R Mordi
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - V Mohan
- Madras Diabetes Research Foundation , Chennai , India
| | - C C Lang
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
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8
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Achison M, Adamson S, Akpan A, Aspray T, Avenell A, Band MM, Bashir T, Burton LA, Cvoro V, Donnan PT, Duncan GW, George J, Gordon AL, Gregson CL, Hapca A, Henderson E, Hume C, Jackson TA, Kemp P, Kerr S, Kilgour A, Lyell V, Masud T, McKenzie A, McKenzie E, Patel H, Pilvinyte K, Roberts HC, Rossios C, Sayer AA, Smith KT, Soiza RL, Steves CJ, Struthers AD, Sumukadas D, Tiwari D, Whitney J, Witham MD. Effect of perindopril or leucine on physical performance in older people with sarcopenia: the LACE randomized controlled trial. J Cachexia Sarcopenia Muscle 2022; 13:858-871. [PMID: 35174663 PMCID: PMC8977979 DOI: 10.1002/jcsm.12934] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 07/16/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This trial aimed to determine the efficacy of leucine and/or perindopril in improving physical function in older people with sarcopenia. METHODS Placebo-controlled, parallel group, double-blind, randomized two-by-two factorial trial. We recruited adults aged ≥ 70 years with sarcopenia, defined as low gait speed (<0.8 m/s on 4 m walk) and/or low handgrip strength (women < 20 kg, men < 30 kg) plus low muscle mass (using sex and body mass index category-specific thresholds derived from normative UK BioBank data) from 14 UK centres. Eligible participants were randomized to perindopril 4 mg or placebo, and to oral leucine powder 2.5 g or placebo thrice daily. The primary outcome was the between-group difference in the short physical performance battery (SPPB) score over 12-month follow-up by repeated-measures mixed models. Results were combined with existing systematic reviews using random-effects meta-analysis to derive summary estimates of treatment efficacy. RESULTS We screened 320 people and randomized 145 participants compared with an original target of 440 participants. For perindopril [n = 73, mean age 79 (SD 6), female sex 39 (53%), mean SPPB 7.1 (SD 2.3)] versus no perindopril [n = 72, mean age 79 (SD 6), female sex 39 (54%), mean SPPB 6.9 (SD 2.4)], median adherence to perindopril was lower (76% vs. 96%; P < 0.001). Perindopril did not improve the primary outcome [adjusted treatment effect -0.1 points (95%CI -1.2 to 1.0), P = 0.89]. No significant treatment benefit was seen for any secondary outcome including muscle mass [adjusted treatment effect -0.4 kg (95%CI -1.1 to 0.3), P = 0.27]. More adverse events occurred in the perindopril group (218 vs. 165), but falls rates were similar. For leucine [n = 72, mean age 78 (SD 6), female sex 38 (53%), mean SPPB 7.0 (SD 2.1)] versus no leucine [n = 72, mean age 79 (SD 6), female sex 40 (55%), mean SPPB 7.0 (SD 2.5)], median adherence was the same in both groups (76% vs. 76%; P = 0.99). Leucine did not improve the primary outcome [adjusted treatment effect 0.1 point (95%CI -1.0 to 1.1), P = 0.90]. No significant treatment benefit was seen for any secondary outcome including muscle mass [adjusted treatment effect -0.3 kg (95%CI -1.0 to 0.4), P = 0.47]. Meta-analysis of angiotensin converting enzyme inhibitor/angiotensin receptor blocker trials showed no clinically important treatment effect for the SPPB [between-group difference -0.1 points (95%CI -0.4 to 0.2)]. CONCLUSIONS Neither perindopril nor leucine improved physical performance or muscle mass in this trial; meta-analysis did not find evidence of efficacy of either ACE inhibitors or leucine as treatments to improve physical performance.
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Affiliation(s)
| | - Marcus Achison
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Simon Adamson
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Asangaedem Akpan
- Clinical Research Network Northwest Coast, University of Liverpool, Liverpool University Hospitals NHS FT Trust, Liverpool, UK
| | - Terry Aspray
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Newcastle University and Newcastle-upon-Tyne NHS Trust, Newcastle upon Tyne, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Margaret M Band
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Tufail Bashir
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - Louise A Burton
- Medicine for the Elderly, NHS Tayside, Dundee, UK and Ageing and Health, University of Dundee, Dundee, UK
| | - Vera Cvoro
- Victoria Hospital, Kirkcaldy, UK.,Centre for Clinical Brain Sciences University of Edinburgh, Edinburgh, UK
| | - Peter T Donnan
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Gordon W Duncan
- Medicine for the Elderly, NHS Lothian, Edinburgh, UK and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jacob George
- Department of Clinical Pharmacology, Division of Molecular & Clinical Medicine, University of Dundee Medical School, Ninewells Hospital, Dundee, UK
| | - Adam L Gordon
- Unit of Injury, Inflammation and Recovery, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Department of Medicine for the Elderly, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK.,Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Bath, UK
| | - Adrian Hapca
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Emily Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Royal United Hospital Bath NHS Foundation Trust, Bath, UK
| | - Cheryl Hume
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Thomas A Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Paul Kemp
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - Simon Kerr
- Department of Older People's Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alixe Kilgour
- Medicine for the Elderly, NHS Lothian, Edinburgh, UK
| | - Veronica Lyell
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Tahir Masud
- Clinical Gerontology Research Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - Andrew McKenzie
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Emma McKenzie
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Harnish Patel
- NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHSFT, Southampton, UK
| | - Kristina Pilvinyte
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, University of Southampton, Mailpoint 807 Southampton General Hospital, Southampton, UK
| | - Christos Rossios
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - Avan A Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Newcastle University and Newcastle-upon-Tyne NHS Trust, Newcastle upon Tyne, UK
| | - Karen T Smith
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Roy L Soiza
- Ageing & Clinical Experimental Research (ACER) Group, University of Aberdeen, Aberdeen, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London & Department of Clinical Gerontology, King's College Hospital, London, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Deepa Sumukadas
- Department of Medicine for the Elderly, NHS Tayside, Dundee, UK
| | - Divya Tiwari
- Bournemouth University and Royal Bournemouth Hospital, Bournemouth, UK
| | - Julie Whitney
- School of Population Health & Environmental Sciences, King's College London and King's College Hospital, London, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Newcastle University and Newcastle-upon-Tyne NHS Trust, Newcastle upon Tyne, UK
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Witham MD, Adamson S, Avenell A, Band MM, Donnan PT, George J, Hapca A, Hume C, Kemp P, McKenzie E, Pilvinyte K, Smith K, Struthers AD, Sumukadas D. 667 EFFECT OF LEUCINE SUPPLEMENTATION ON PHYSICAL PERFORMANCE, MUSCLE MASS AND QUALITY OF LIFE IN OLDER PEOPLE WITH SARCOPENIA. Age Ageing 2022. [DOI: 10.1093/ageing/afac036.667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Leucine supplementation improves muscle protein synthesis in physiological studies and has been proposed as a treatment to improve muscle mass and physical performance. We tested the effects of leucine supplementation in a randomised controlled trial enrolling patients with sarcopenia.
Methods
We conducted a placebo-controlled, parallel group, double-blind, randomised two-by-two factorial trial. Participants aged 70 and over with low muscle mass by bioimpedance and either low grip strength or low walk speed, were recruited from 14 UK sites. Participants were randomised to receive one year of leucine powder 2.5 g three times a day or matching placebo, plus perindopril 4 mg once daily or matching placebo. The primary outcome was the between-group difference in the Short Physical Performance Battery, measured at baseline, 6 and 12 months, analysed using repeated-measures mixed models. Secondary outcomes included grip strength, quadriceps strength, six-minute walk distance, appendicular muscle mass measured by dual x-ray absorptiometry, quality of life measured using the EQ5D tool, falls rates and adverse events.
Results
We screened 320 people and randomised 145 participants, mean age 79 (SD 6) years; 78 (54%) were women and the mean SPPB was 7.0 (SD 2.4). 72 were randomised to leucine and 73 to placebo. Median adherence was the same in both groups (76% vs 76%; p < 0.001). Leucine had no significant effect on the primary outcome (adjusted treatment effect 0.1 points [95%CI -1.0 to 1.1]). No significant treatment effect was seen for any secondary outcome. There were similar numbers of adverse events in both groups (leucine 187, placebo 196) and falls rates were similar (leucine 1.9 [95%CI 0.9 to 2.9] per year; placebo 2.9 [95%CI 0.8 to 5.0] per year).
Conclusion
Leucine did not improve measures of physical performance, muscle mass or quality of life in older people with sarcopenia.
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Affiliation(s)
- M D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle-upon-Tyne Hospitals Trust
- Molecular and Clinical Medicine, University of Dundee
| | - S Adamson
- Tayside Clinical Trials Unit, University of Dundee
| | - A Avenell
- Health Services Research Unit, University of Aberdeen
| | - M M Band
- Tayside Clinical Trials Unit, University of Dundee
| | - P T Donnan
- Tayside Clinical Trials Unit, University of Dundee
| | - J George
- Molecular and Clinical Medicine, University of Dundee
| | - A Hapca
- Tayside Clinical Trials Unit, University of Dundee
| | - C Hume
- Tayside Clinical Trials Unit, University of Dundee
| | - P Kemp
- Cardiovascular and Respiratory Interface Section, Imperial College London
| | - E McKenzie
- Tayside Clinical Trials Unit, University of Dundee
| | - K Pilvinyte
- Tayside Clinical Trials Unit, University of Dundee
| | - K Smith
- Tayside Clinical Trials Unit, University of Dundee
| | - A D Struthers
- Molecular and Clinical Medicine, University of Dundee
| | - D Sumukadas
- Department of Medicine for the Elderly, NHS Tayside, Dundee
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Witham MD, Adamson S, Avenell A, Band MM, Donnan PT, George J, Hapca A, Hume C, Kemp P, McKenzie E, Pilvinyte K, Smith K, Struthers AD, Sumukadas D. 666 EFFECT OF PERINDOPRIL ON PHYSICAL PERFORMANCE, MUSCLE MASS AND QUALITY OF LIFE IN OLDER PEOPLE WITH SARCOPENIA: RESULTS: FROM THE. Age Ageing 2022. [DOI: 10.1093/ageing/afac036.666] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Angiotensin-converting enzyme inhibitors such as perindopril have been proposed as treatments to improve muscle mass and physical performance but have not been tested in randomised controlled trials enrolling patients with sarcopenia.
Methods
We conducted a placebo-controlled, parallel group, double-blind, randomised two-by-two factorial trial. Participants aged 70 and over with low muscle mass by bioimpedance and either low grip strength or low walk speed, were recruited from 14 UK sites. Participants were randomised to receive one year of perindopril 4 mg once daily or matching placebo, and to receive leucine powder 2.5 g three times a day or matching placebo. The primary outcome was the between-group difference in the Short Physical Performance Battery, measured at baseline, 6 and 12 months, analysed using repeated-measures mixed models. Secondary outcomes included grip strength, quadriceps strength, six-minute walk distance, appendicular muscle mass measured by dual x-ray absorptiometry, quality of life measured using the EQ5D tool, falls rates and adverse events.
Results
We screened 320 people and randomised 145 participants, mean age 79 (SD 6) years; 78 (54%) were women and the mean SPPB was 7.0 (SD 2.4). 73 were randomised to perindopril and 72 to placebo. Median adherence was lower for perindopril (76% vs 96%; p < 0.001). Perindopril had no significant effect on the primary outcome (adjusted treatment effect −0.1 points [95%CI -1.2 to 1.0]). No significant treatment effect was seen for any secondary outcome except for worse EQ5D thermometer scores in the perindopril group (treatment effect −12 points [95%CI -21 to −3]). More adverse events were seen in the perindopril group (218 vs 165) but falls rates were similar (perindopril 2.0 [95%CI 1.1 to 3.0] per year; placebo 2.8 [95%CI 0.6 to 5.1] per year).
Conclusion
Perindopril did not improve measures of physical performance, muscle mass or quality of life in older people with sarcopenia.
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Affiliation(s)
- M D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle-upon-Tyne Hospitals Trust
- Molecular and Clinical Medicine, University of Dundee
| | - S Adamson
- Tayside Clinical Trials Unit, University of Dundee
| | - A Avenell
- Health Services Research Unit, University of Aberdeen
| | - M M Band
- Tayside Clinical Trials Unit, University of Dundee
| | - P T Donnan
- Tayside Clinical Trials Unit, University of Dundee
| | - J George
- Molecular and Clinical Medicine, University of Dundee
| | - A Hapca
- Tayside Clinical Trials Unit, University of Dundee
| | - C Hume
- Tayside Clinical Trials Unit, University of Dundee
| | - P Kemp
- Cardiovascular and Respiratory Interface Section, Imperial College London
| | - E McKenzie
- Tayside Clinical Trials Unit, University of Dundee
| | - K Pilvinyte
- Tayside Clinical Trials Unit, University of Dundee
| | - K Smith
- Tayside Clinical Trials Unit, University of Dundee
| | - A D Struthers
- Molecular and Clinical Medicine, University of Dundee
| | - D Sumukadas
- Department of Medicine for the Elderly, NHS Tayside, Dundee
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11
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Singh JS, Struthers AD, Lang CC. Letter by Singh et al Regarding Article, "Effect of Empagliflozin on Left Ventricular Volumes in Patients With Type 2 Diabetes, or Prediabetes, and Heart Failure With Reduced Ejection Fraction (SUGAR-DM-HF)". Circulation 2021; 144:e38-e39. [PMID: 34279989 DOI: 10.1161/circulationaha.120.053057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jagdeep S Singh
- Division of Molecular and Clinical Medicine, University of Dundee Medical School, Scotland, United Kingdom
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, University of Dundee Medical School, Scotland, United Kingdom
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, University of Dundee Medical School, Scotland, United Kingdom
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12
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Brown AJM, Gandy S, McCrimmon R, Houston JG, Struthers AD, Lang CC. A randomized controlled trial of dapagliflozin on left ventricular hypertrophy in people with type two diabetes: the DAPA-LVH trial. Eur Heart J 2021; 41:3421-3432. [PMID: 32578850 PMCID: PMC8202417 DOI: 10.1093/eurheartj/ehaa419] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [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: 12/03/2019] [Revised: 02/11/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
AIM We tested the hypothesis that dapagliflozin may regress left ventricular hypertrophy (LVH) in people with type 2 diabetes (T2D). METHODS AND RESULTS We randomly assigned 66 people (mean age 67 ± 7 years, 38 males) with T2D, LVH, and controlled blood pressure (BP) to receive dapagliflozin 10 mg once daily or placebo for 12 months. Primary endpoint was change in absolute left ventricular mass (LVM), assessed by cardiac magnetic resonance imaging. In the intention-to-treat analysis, dapagliflozin significantly reduced LVM compared with placebo with an absolute mean change of -2.82g [95% confidence interval (CI): -5.13 to -0.51, P = 0.018]. Additional sensitivity analysis adjusting for baseline LVM, baseline BP, weight, and systolic BP change showed the LVM change to remain statistically significant (mean change -2.92g; 95% CI: -5.45 to -0.38, P = 0.025). Dapagliflozin significantly reduced pre-specified secondary endpoints including ambulatory 24-h systolic BP (P = 0.012), nocturnal systolic BP (P = 0.017), body weight (P < 0.001), visceral adipose tissue (VAT) (P < 0.001), subcutaneous adipose tissue (SCAT) (P = 0.001), insulin resistance, Homeostatic Model Assessment of Insulin Resistance (P = 0.017), and high-sensitivity C-reactive protein (hsCRP) (P = 0.049). CONCLUSION Dapagliflozin treatment significantly reduced LVM in people with T2D and LVH. This reduction in LVM was accompanied by reductions in systolic BP, body weight, visceral and SCAT, insulin resistance, and hsCRP. The regression of LVM suggests dapagliflozin can initiate reverse remodelling and changes in left ventricular structure that may partly contribute to the cardio-protective effects of dapagliflozin. CLINICALTRIALS.GOV IDENTIFIER NCT02956811.
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Affiliation(s)
- Alexander J M Brown
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Stephen Gandy
- Department of Medical Physics, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK
| | - Rory McCrimmon
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - John Graeme Houston
- Department of Radiology, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK
| | - Allan D Struthers
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Chim C Lang
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
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13
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Chungath RR, Witham MD, Clarke CL, Hutcheon A, Gandy S, Gingles C, Priba L, Nicholas SR, Cavin I, Sumukadas D, Struthers AD, George J. Association between mitochondrial function measured by 31P magnetic resonance spectroscopy and physical performance in older people with functional impairment. JCSM Clinical Reports 2021. [DOI: 10.1002/crt2.33] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Rebecca R. Chungath
- AGE Research Group, NIHR Newcastle Biomedical Research Centre Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
| | - Miles D. Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
- Division of Molecular and Clinical Medicine University of Dundee, Ninewells Hospital and Medical School Dundee UK
| | - Clare L. Clarke
- Division of Molecular and Clinical Medicine University of Dundee, Ninewells Hospital and Medical School Dundee UK
| | - Anita Hutcheon
- Division of Molecular and Clinical Medicine University of Dundee, Ninewells Hospital and Medical School Dundee UK
| | - Stephen Gandy
- Department of Medical Physics Ninewells Hospital, NHS Tayside Dundee UK
| | - Christopher Gingles
- Division of Molecular and Clinical Medicine University of Dundee, Ninewells Hospital and Medical School Dundee UK
| | - Lukasz Priba
- Department of Medical Physics Ninewells Hospital, NHS Tayside Dundee UK
| | | | - Ian Cavin
- Department of Medical Physics NHS Lothian Edinburgh UK
| | - Deepa Sumukadas
- Department of Medicine for the Elderly Ninewells Hospital, NHS Tayside Dundee UK
| | - Allan D. Struthers
- Division of Molecular and Clinical Medicine University of Dundee, Ninewells Hospital and Medical School Dundee UK
| | - Jacob George
- Division of Molecular and Clinical Medicine University of Dundee, Ninewells Hospital and Medical School Dundee UK
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14
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Chungath RR, Witham MD, Clarke CL, Hutcheon A, Gandy S, Gingles C, Priba L, Nicholas S, Cavin I, Sumukadas D, Struthers AD, George J. 42 Is Mitochondrial Function Measured by 31P Magnetic Resonance Spectroscopy Associated with Physical Performance in Older People with Functional Impairment? Age Ageing 2021. [DOI: 10.1093/ageing/afab030.03] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mitochondrial dysfunction has been proposed as a therapeutic target to improve muscle strength and endurance, but the contribution that mitochondrial dysfunction makes to impaired skeletal muscle performance in older people remains unclear. We studied the relationship between phosphocreatine recovery rate (a measure of skeletal muscle mitochondrial function) and physical performance in older people.
Methods
We analysed data from the Allopurinol in Functional Impairment (ALFIE) trial. Participants aged 65 and over, who were unable to walk 400 m in six minutes, underwent 31P magnetic resonance spectroscopy of the calf after exercise at baseline and at 20 weeks follow up. The phosphocreatine recovery half-life time (t-half) was derived as a measure of mitochondrial function. Participants also undertook the 6-minute walk distance, the Short Physical Performance Battery test (SPPB), and had muscle mass measured using bio-impedance analysis. Bivariate correlations and multivariable regression analyses were conducted to determine associations between t-half and baseline factors.
Results
One hundred and seventeen people underwent baseline 31P magnetic resonance spectroscopy, mean age 80.4 years (SD 6.0); 56 (48%) were female. Mean 6-minute walk was 291 m (SD 80) and mean SPPB score was 8.4 (SD 1.9). T-half was significantly correlated with SPPB score (r = 0.22, p = 0.02) but not with 6-minute walk distance (r = 0.10, p = 0.29). In multivariable linear regression, muscle mass and weight, but not t-half, were independently associated with SPPB score and with 6-minute walk distance. The change in t-half between baseline and 20 weeks was not significantly associated with the change in SPPB (r = 0.03, p = 0.79) or with the change in 6-minute walk distance (r = −0.11, p = 0.28).
Conclusion
Muscle mass, but not phosphocreatine recovery time, was associated with Short Physical Performance Battery score and 6-minute walk distance in this cohort of older people with functional impairment.
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Affiliation(s)
- R R Chungath
- Age Research Group, NIHR Newcastle Biomedical Research Centre
| | - M D Witham
- Age Research Group, NIHR Newcastle Biomedical Research Centre
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15
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Rutherford E, Ireland S, Mangion K, Stewart GA, MacGregor MS, Roditi G, Woodward R, Gandy SJ, Houston JG, Jardine AG, Rauchhaus P, Witham MD, Mark PB, Struthers AD. A Randomized, Controlled Trial of the Effect of Allopurinol on Left Ventricular Mass Index in Hemodialysis Patients. Kidney Int Rep 2020; 6:146-155. [PMID: 33426394 PMCID: PMC7783562 DOI: 10.1016/j.ekir.2020.10.025] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/01/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Increased left ventricular mass index (LVMI) is associated with mortality in end-stage renal disease. LVMI regression may improve outcomes. Allopurinol has reduced LVMI in randomized controlled trials in chronic kidney disease, diabetes, and ischemic heart disease. This study investigated whether allopurinol would regress LVMI in hemodialysis patients. Methods This was a randomized placebo-controlled double-blind multicenter trial funded by the British Heart Foundation (PG/12/72/29743). A total of 80 patients undergoing regular maintenance hemodialysis were recruited from NHS Tayside, NHS Greater Glasgow and Clyde and NHS Ayrshire and Arran in Scotland, UK. Participants were randomly assigned on a 1:1 ratio to 12 months of therapy with allopurinol 300 mg or placebo after each dialysis session. The primary outcome was change in LVMI, as assessed by cardiac magnetic resonance imaging (CMRI) at baseline and 12 months. Secondary outcomes were change in BP, flow-mediated dilation (FMD), augmentation indices (AIx), and pulse wave velocity (PWV). Results A total of 53 patients, with a mean age of 58 years, completed the study and had CMRI follow-up data for analysis. Allopurinol did not regress LVMI (change in LVMI: placebo +3.6 ± 10.4 g/m2; allopurinol: +1.6 ± 11 g/m2; P = 0.49). Allopurinol had no demonstrable effect on BP, FMD, AIx, or PWV. Conclusion Compared with placebo, treatment with allopurinol did not regress LVMI in this trial.
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Affiliation(s)
- Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK.,Renal & Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Sheila Ireland
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK
| | | | - Mark S MacGregor
- Renal Unit, Crosshouse Hospital, NHS Ayrshire & Arran, Kilmarnock, UK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK.,Department of Radiology, Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Rosemary Woodward
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK
| | - Stephen J Gandy
- Department of Radiology, Ninewells Hospital, NHS Tayside, Dundee, UK.,Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
| | | | - Alan G Jardine
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK.,Renal & Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Miles D Witham
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals Trust, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, BHF Clinical Research Centre, University of Glasgow, UK.,Renal & Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Allan D Struthers
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
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16
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Witham MD, Clarke CL, Hutcheon A, Gingles C, Gandy S, Priba L, Nicholas RS, Cavin I, Sumukadas D, Struthers AD, George J. Effect of allopurinol on phosphocreatine recovery and muscle function in older people with impaired physical function: a randomised controlled trial. Age Ageing 2020; 49:1003-1010. [PMID: 32318695 PMCID: PMC7583523 DOI: 10.1093/ageing/afaa061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/19/2020] [Indexed: 01/22/2023] Open
Abstract
Background Allopurinol has vascular antioxidant effects and participates in purinergic signalling within muscle. We tested whether allopurinol could improve skeletal muscle energetics and physical function in older people with impaired physical performance. Methods We conducted a randomised, double blind, parallel group, placebo-controlled trial, comparing 20 weeks of allopurinol 600 mg once daily versus placebo. We recruited community-dwelling participants aged 65 and over with baseline 6-min walk distance of <400 m and no contraindications to magnetic resonance imaging scanning. Outcomes were measured at baseline and 20 weeks. The primary outcome was post-exercise phosphocreatine (PCr) recovery rate measured using 31P magnetic resonance spectroscopy of the calf. Secondary outcomes included 6-min walk distance, short physical performance battery (SPPB), lean body mass measured by bioimpedance, endothelial function and quality of life. Results In total, 124 participants were randomised, mean age 80 (SD 6) years. A total of 59 (48%) were female, baseline 6-min walk distance was 293 m (SD 80 m) and baseline SPPB was 8.5 (SD 2.0). Allopurinol did not significantly improve PCr recovery rate (treatment effect 0.10 units [95% CI, −0.07 to 0.27], P = 0.25). No significant changes were seen in endothelial function, quality of life, lean body mass or SPPB. Allopurinol improved 6-min walk distance (treatment effect 25 m [95% 4–46, P = 0.02]). This was more pronounced in those with high baseline oxidative stress and urate. Conclusion Allopurinol improved 6-min walk distance but not PCr recovery rate in older people with impaired physical function. Antioxidant strategies to improve muscle function for older people may need to be targeted at subgroups with high baseline oxidative stress.
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Affiliation(s)
- Miles D Witham
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals Trust, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle, UK
| | - Clare L Clarke
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Anita Hutcheon
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Christopher Gingles
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Stephen Gandy
- Department of Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Lukasz Priba
- Department of Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Richard S Nicholas
- Department of Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Ian Cavin
- Department of Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Deepa Sumukadas
- Department of Medicine for the Elderly, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Jacob George
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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17
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Mohan M, Al-Talabany S, McKinnie A, Mordi IR, Singh JSS, Gandy SJ, Baig F, Hussain MS, Bhalraam U, Khan F, Choy AM, Matthew S, Houston JG, Struthers AD, George J, Lang CC. A randomized controlled trial of metformin on left ventricular hypertrophy in patients with coronary artery disease without diabetes: the MET-REMODEL trial. Eur Heart J 2020; 40:3409-3417. [PMID: 30993313 PMCID: PMC6823615 DOI: 10.1093/eurheartj/ehz203] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [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: 11/28/2018] [Revised: 02/01/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022] Open
Abstract
Aim We tested the hypothesis that metformin may regress left ventricular hypertrophy (LVH) in patients who have coronary artery disease (CAD), with insulin resistance (IR) and/or pre-diabetes. Methods and results We randomly assigned 68 patients (mean age 65 ± 8 years) without diabetes who have CAD with IR and/or pre-diabetes to receive either metformin XL (2000 mg daily dose) or placebo for 12 months. Primary endpoint was change in left ventricular mass indexed to height1.7 (LVMI), assessed by magnetic resonance imaging. In the modified intention-to-treat analysis (n = 63), metformin treatment significantly reduced LVMI compared with placebo group (absolute mean difference −1.37 (95% confidence interval: −2.63 to −0.12, P = 0.033). Metformin also significantly reduced other secondary study endpoints such as: LVM (P = 0.032), body weight (P = 0.001), subcutaneous adipose tissue (P = 0.024), office systolic blood pressure (BP, P = 0.022) and concentration of thiobarbituric acid reactive substances, a biomarker for oxidative stress (P = 0.04). The glycated haemoglobin A1C concentration and fasting IR index did not differ between study groups at the end of the study. Conclusion Metformin treatment significantly reduced LVMI, LVM, office systolic BP, body weight, and oxidative stress. Although LVH is a good surrogate marker of cardiovascular (CV) outcome, conclusive evidence for the cardio-protective role of metformin is required from large CV outcomes trials. ![]()
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Affiliation(s)
- Mohapradeep Mohan
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Shaween Al-Talabany
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Angela McKinnie
- NHS Tayside Clinical Radiology, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Jagdeep S S Singh
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Stephen J Gandy
- Department of Medical Physics, NHS Tayside, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Fatima Baig
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Muhammad S Hussain
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - U Bhalraam
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Faisel Khan
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Anna-Maria Choy
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Shona Matthew
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - John Graeme Houston
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Jacob George
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
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18
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Liu-Shiu-Cheong PSK, Lipworth BJ, Weir-McCall JR, Houston JG, Struthers AD. Allopurinol in Patients with Pulmonary Hypertension Associated with Chronic Lung Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:2015-2024. [PMID: 32904701 PMCID: PMC7457596 DOI: 10.2147/copd.s260917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Oxidative stress (OS) has been implicated in the development of pulmonary hypertension (PH) and ventricular hypertrophy. Xanthine oxidase is a well-recognised source of reactive oxygen species, which lead to OS. The aim of this proof of concept study was to assess whether allopurinol (xanthine oxidase inhibitor) would reduce right ventricular mass (RVM) in patients with PH-associated chronic lung disease (PH-CLD). Methods We conducted a randomised, double-blind, parallel-group, placebo-controlled trial in patients with PH-CLD (93% COPD, 7% IPF) who were randomly assigned to receive allopurinol or placebo for 12 months. The primary outcome was the mean change in RVM, as assessed by cardiac magnetic resonance imaging (CMRI). Secondary outcomes included quality of life (QOL), spirometry and six-minute walk test (6MWT). Results Seventy-one patients were recruited: mean age 71 years, mean pulmonary arterial pressure 30 mm Hg, FEV1 60% and resting SpO2 96%. After 12 months, there was no significant difference in the change in RVM from baseline (allopurinol 1.85g vs placebo 0.97g with mean difference 0.88g, CI −4.77 to 3.01, p =0.7). There were also no significant changes in other cardiac parameters measured on MRI, in QOL, spirometry and 6MWT. Subgroup analysis showed that allopurinol significantly reduced RVM compared to placebo with -6.16g vs 0.75g and mean difference 6.92g (CI 1.14 to 12.69, p = 0.02) in COPD patients with more severe airflow limitation. Conclusion Allopurinol had no overall impact on patients with PH-CLD but had potential benefit in COPD patients with more severe airflow limitation.
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Affiliation(s)
- Patrick S K Liu-Shiu-Cheong
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee DD1 9SY, UK.,Department of Respiratory Medicine, Victoria Hospital, NHS Fife, Kirkcaldy KY2 5AH, UK
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research, Medical Research Institute, University of Dundee, Dundee DD1 9SY, UK
| | - Jonathan R Weir-McCall
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee DD1 9SY, UK.,Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - J Graeme Houston
- Imaging Science and Technology, University of Dundee, Dundee DD1 9SY, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee DD1 9SY, UK
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Mordi NA, Mordi IR, Singh JS, McCrimmon RJ, Struthers AD, Lang CC. Renal and Cardiovascular Effects of SGLT2 Inhibition in Combination With Loop Diuretics in Patients With Type 2 Diabetes and Chronic Heart Failure: The RECEDE-CHF Trial. Circulation 2020; 142:1713-1724. [PMID: 32865004 PMCID: PMC7594536 DOI: 10.1161/circulationaha.120.048739] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [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] [Indexed: 01/10/2023]
Abstract
Supplemental Digital Content is available in the text. Background: SGLT2 (sodium-glucose cotransporter-2) inhibitors improve heart failure–associated outcomes in patients with type 2 diabetes. In patients with heart failure, SGLT2 inhibitors will likely be coprescribed with a loop diuretic, but this combined effect is not well-defined. Our aim was to assess the diuretic and natriuretic effect of empagliflozin in combination with loop diuretics. Methods: The RECEDE-CHF trial (SGLT2 Inhibition in Combination With Diuretics in Heart Failure) was a randomized, double-blind, placebo-controlled, crossover trial of patients with type 2 diabetes and heart failure with reduced ejection fraction taking regular loop diuretic who were randomized to empagliflozin 25 mg once daily or placebo for 6 weeks with a 2-week washout period. The primary outcome was change in 24-hour urinary volume from baseline to week 6. Results: Twenty-three participants (mean age, 69.8 years; 73.9% male; mean furosemide dose, 49.6±31.3 mg/d; mean HbA1c, 7.9±3.8%) were recruited. Compared with placebo, empagliflozin caused a significant increase in 24-hour urinary volume at both day 3 (mean difference, 535 mL [95% CI, 133–936]; P=0.005) and week 6 (mean difference, 545 mL [95% CI, 136–954]; P=0.005) after adjustment for treatment order, baseline 24-hour urine volume, and percentage change in loop diuretic dose. At 6 weeks, empagliflozin did not cause a significant change in 24-hour urinary sodium (mean difference, −7.85 mmol/L [95% CI, −2.43 to 6.73]; P=0.57). Empagliflozin caused a nonsignificant increase in fractional excretion of sodium at day 3, which was absent at week 6 (mean difference day 3, 0.30% [95% CI, −0.03 to 0.63]; P=0.09; week 6, 0.11% [95% CI, −0.22 to 0.44]; P>0.99), and a significant increase in electrolyte-free water clearance at week 6 (mean difference, 312 mL [95% CI, 26–598]; P=0.026) compared with placebo. Empagliflozin also caused significant reductions in body weight and serum urate at week 6. Conclusions: Empagliflozin caused a significant increase in 24-hour urine volume without an increase in urinary sodium when used in combination with loop diuretic. Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03226457.
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Affiliation(s)
- Natalie A Mordi
- Division of Molecular and Clinical Medicine, University of Dundee, Scotland, United Kingdom (N.A.M., I.R.M., R.J.M., A.D.S., C.C.L.)
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, University of Dundee, Scotland, United Kingdom (N.A.M., I.R.M., R.J.M., A.D.S., C.C.L.)
| | - Jagdeep S Singh
- Royal Infirmary of Edinburgh, Scotland, United Kingdom (J.D.S.)
| | - Rory J McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Scotland, United Kingdom (N.A.M., I.R.M., R.J.M., A.D.S., C.C.L.)
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Scotland, United Kingdom (N.A.M., I.R.M., R.J.M., A.D.S., C.C.L.)
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, University of Dundee, Scotland, United Kingdom (N.A.M., I.R.M., R.J.M., A.D.S., C.C.L.)
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Witham MD, Lees JS, White M, Band M, Bell S, Chantler DJ, Ford I, Fulton RL, Kennedy G, Littleford RC, McCrea IV, McGlynn D, Panarelli M, Ralston MR, Rutherford E, Severn A, Thomson N, Traynor JP, Struthers AD, Wetherall K, Mark PB. Vitamin K Supplementation to Improve Vascular Stiffness in CKD: The K4Kidneys Randomized Controlled Trial. J Am Soc Nephrol 2020; 31:2434-2445. [PMID: 32817311 DOI: 10.1681/asn.2020020225] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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: 02/27/2020] [Accepted: 07/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Vascular calcification, a risk factor for cardiovascular disease, is common among patients with CKD and is an independent contributor to increased vascular stiffness and vascular risk in this patient group. Vitamin K is a cofactor for proteins involved in prevention of vascular calcification. Whether or not vitamin K supplementation could improve arterial stiffness in patients with CKD is unknown. METHODS To determine if vitamin K supplementation might improve arterial stiffness in patients in CKD, we conducted a parallel-group, double-blind, randomized trial in participants aged 18 or older with CKD stage 3b or 4 (eGFR 15-45 ml/min per 1.73 m2). We randomly assigned participants to receive 400 μg oral vitamin K2 or matching placebo once daily for a year. The primary outcome was the adjusted between-group difference in carotid-femoral pulse wave velocity at 12 months. Secondary outcomes included augmentation index, abdominal aortic calcification, BP, physical function, and blood markers of mineral metabolism and vascular health. We also updated a recently published meta-analysis of trials to include the findings of this study. RESULTS We included 159 randomized participants in the modified intention-to-treat analysis, with 80 allocated to receive vitamin K and 79 to receive placebo. Mean age was 66 years, 62 (39%) were female, and 87 (55%) had CKD stage 4. We found no differences in pulse wave velocity at 12 months, augmentation index at 12 months, BP, B-type natriuretic peptide, or physical function. The updated meta-analysis showed no effect of vitamin K supplementation on vascular stiffness or vascular calcification measures. CONCLUSIONS Vitamin K2 supplementation did not improve vascular stiffness or other measures of vascular health in this trial involving individuals with CKD. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Vitamin K therapy to improve vascular health in patients with chronic kidney disease, ISRCTN21444964 (www.isrctn.com).
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Affiliation(s)
- Miles D Witham
- AGE Research Group, National Institute for Health Research Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle-upon-Tyne National Health Service Trust, Tyne, United Kingdom .,School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Jennifer S Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Myra White
- School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Margaret Band
- Tayside Clinical Trials Unit, Ninewells Hospital, Dundee, United Kingdom
| | - Samira Bell
- School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Donna J Chantler
- Department of Clinical Biochemistry, National Health Service Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Roberta L Fulton
- School of Nursing and Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Gwen Kennedy
- School of Medicine, University of Dundee, Dundee, United Kingdom
| | | | - Ian V McCrea
- Department of Radiology, National Health Service Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Deborah McGlynn
- Clinical Research Facility, National Health Service Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Maurizio Panarelli
- Department of Clinical Biochemistry, National Health Service Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Maximilian R Ralston
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Alison Severn
- Renal Unit, National Health Service Tayside, Ninewells Hospital, Dundee, United Kingdom
| | - Nicola Thomson
- Clinical Research Facility, National Health Service Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jamie P Traynor
- Clinical Research Facility, National Health Service Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Kirsty Wetherall
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
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21
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Affiliation(s)
- Elaine Rutherford
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital, Dundee, UK
| | - Allan D Struthers
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital, Dundee, UK
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22
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Singh JSS, Mordi IR, Vickneson K, Fathi A, Donnan PT, Mohan M, Choy AMJ, Gandy S, George J, Khan F, Pearson ER, Houston JG, Struthers AD, Lang CC. Dapagliflozin Versus Placebo on Left Ventricular Remodeling in Patients With Diabetes and Heart Failure: The REFORM Trial. Diabetes Care 2020; 43:1356-1359. [PMID: 32245746 PMCID: PMC7245350 DOI: 10.2337/dc19-2187] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/06/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the effects of dapagliflozin in patients with heart failure (HF) and type 2 diabetes mellitus (T2DM) on left ventricular (LV) remodeling using cardiac MRI. RESEARCH DESIGN AND METHODS We randomized 56 patients with T2DM and HF with LV systolic dysfunction to dapagliflozin 10 mg daily or placebo for 1 year, on top of usual therapy. The primary end point was difference in LV end-systolic volume (LVESV) using cardiac MRI. Key secondary end points included other measures of LV remodeling and clinical and biochemical parameters. RESULTS In our cohort, dapagliflozin had no effect on LVESV or any other parameter of LV remodeling. However, it reduced diastolic blood pressure and loop diuretic requirements while increasing hemoglobin, hematocrit, and ketone bodies. There was a trend toward lower weight. CONCLUSIONS We were unable to determine with certainty whether dapagliflozin in patients with T2DM and HF had any effect on LV remodeling. Whether the benefits of dapagliflozin in HF are due to remodeling or other mechanisms remains unknown.
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Affiliation(s)
- Jagdeep S S Singh
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Keeran Vickneson
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Amir Fathi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Peter T Donnan
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Mohapradeep Mohan
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Anna Maria J Choy
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Stephen Gandy
- Department of Medical Physics, NHS Tayside, Dundee, U.K
| | - Jacob George
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Faisel Khan
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Ewan R Pearson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - J Graeme Houston
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K.
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George J, Hussain M, Vadiveloo T, Ireland S, Hopkinson P, Struthers AD, Donnan PT, Khan F, Lang CC. Cardiovascular Effects of Switching From Tobacco Cigarettes to Electronic Cigarettes. J Am Coll Cardiol 2019; 74:3112-3120. [PMID: 31740017 PMCID: PMC6928567 DOI: 10.1016/j.jacc.2019.09.067] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [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: 06/22/2019] [Revised: 08/22/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022]
Abstract
Background E-cigarette (EC) use is increasing exponentially worldwide. The early cardiovascular effects of switching from tobacco cigarettes (TC) to EC in chronic smokers is unknown. Meta-analysis of flow-mediated dilation (FMD) studies indicate 13% lower pooled, adjusted relative risks of cardiovascular events with every 1% improvement in FMD. Objectives This study sought to determine the early vascular impact of switching from TC to EC in chronic smokers. Methods The authors conducted a prospective, randomized control trial with a parallel nonrandomized preference cohort and blinded endpoint of smokers ≥18 years of age who had smoked ≥15 cigarettes/day for ≥2 years and were free from established cardiovascular disease. Participants were randomized to EC with nicotine or EC without nicotine for 1 month. Those unwilling to quit continued with TC in a parallel preference arm. A propensity score analysis was done to adjust for differences between the randomized and preference arms. Vascular function was assessed by FMD and pulse wave velocity. Compliance with EC was measured by carbon monoxide levels. Results Within 1 month of switching from TC to EC, there was a significant improvement in endothelial function (linear trend β = 0.73%; 95% confidence interval [CI]: 0.41 to 1.05; p < 0.0001; TC vs. EC combined: 1.49%; 95% CI: 0.93 to 2.04; p < 0.0001) and vascular stiffness (−0.529 m/s; 95% CI: −0.946 to −0.112; p = 0.014). Females benefited from switching more than males did in every between-group comparison. Those who complied best with EC switch demonstrated the largest improvement. There was no difference in vascular effects between EC with and without nicotine within the study timeframe. Conclusions TC smokers, particularly females, demonstrate significant improvement in vascular health within 1 month of switching from TC to EC. Switching from TC to EC may be considered a harms reduction measure. (Vascular Effects of Regular Cigarettes Versus Electronic Cigarette Use [VESUVIUS]; NCT02878421; ISRCTN59133298)
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Affiliation(s)
- Jacob George
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom.
| | - Muhammad Hussain
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Thenmalar Vadiveloo
- Population Health and Genomics Division, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Sheila Ireland
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Pippa Hopkinson
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Peter T Donnan
- Population Health and Genomics Division, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Faisel Khan
- Division of Systems Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
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24
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George J, Clarke CL, Hutcheon A, Gandy S, Gingles C, Priba L, Nicholas S, Cavin I, Sumukadas D, McMurdo ME, Struthers AD, Witham MD. 49EFFECT OF ALLOPURINOL ON SKELETAL MUSCLE PHOSPHOCREATINE RECOVERY RATE AND PHYSICAL FUNCTION IN OLDER PEOPLE WITH IMPAIRED PHYSICAL FUNCTION: A RANDOMISED CONTROLLED TRIAL. Age Ageing 2019. [DOI: 10.1093/ageing/afz076.04] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - M D Witham
- NIHR Newcastle Biomedical Research Centre
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25
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Mohan M, Al-Talabany S, McKinnie A, Mordi I, Singh JSS, Gandy S, Khan F, Choy AM, Houston JG, George J, Struthers AD, Lang CC. 2358Metformin regresses left ventricular hypertrophy in normotensive patients with coronary artery disease without type 2 diabetes mellitus - The MET-REMODEL trialM. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2358] [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: 11/13/2022] Open
Affiliation(s)
- M Mohan
- University of Dundee, Division of Molecular & Clinical Medicine, Dundee, United Kingdom
| | - S Al-Talabany
- University of Dundee, Division of Molecular & Clinical Medicine, Dundee, United Kingdom
| | - A McKinnie
- NHS Tayside, Department of Radiology, Dundee, United Kingdom
| | - I Mordi
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - J S S Singh
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - S Gandy
- NHS Tayside, Department of Medical Physics, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - F Khan
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - A M Choy
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - J G Houston
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - J George
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - A D Struthers
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - C C Lang
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital, Dundee, United Kingdom
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26
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Singh JSS, Mordi I, Fathi A, Vickneson K, Donnan PT, Mohan M, Choy AM, Gandy SG, Pearson ER, Houston JG, Struthers AD, Lang CC. P905Research into the effect of sodium-glucose linked transporter inhibition in left ventricular remodelling in patients with heart failure and diabetes mellitus. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p905] [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: 11/13/2022] Open
Affiliation(s)
- J S S Singh
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - I Mordi
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - A Fathi
- University of Dundee, Medical School, Dundee, United Kingdom
| | - K Vickneson
- University of Dundee, Medical School, Dundee, United Kingdom
| | - P T Donnan
- University of Dundee, Dundee Epidemiology and Biostatistics Unit, Dundee, United Kingdom
| | - M Mohan
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - A M Choy
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - S G Gandy
- NHS Tayside, Department of Medical Physics, Dundee, United Kingdom
| | - E R Pearson
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - J G Houston
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - A D Struthers
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - C C Lang
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
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27
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Beveridge LA, Price RJG, Burton LA, Witham MD, Struthers AD, Sumukadas D. Acceptability and feasibility of magnetic femoral nerve stimulation in older, functionally impaired patients. BMC Res Notes 2018; 11:394. [PMID: 29907125 PMCID: PMC6003158 DOI: 10.1186/s13104-018-3493-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Magnetic femoral nerve stimulation to test muscle function has been largely unexplored in older people. We assessed acceptability, feasibility, along with reproducibility and correlation with other physical function measures. Results Study 1 recruited older people with sarcopenia. Stimulation was performed at baseline and 2 weeks along with six minute walk (6MW), maximum voluntary quadriceps contraction, short physical performance battery and grip strength. Acceptability was measured using visual analog scales. Study 2 used baseline data from a trial of older people. We correlated stimulation results with 6MW, maximal voluntary contraction and muscle mass. Maximum quadriceps twitch tension was measured in both studies, evoked using biphasic magnetic stimulation of the femoral nerve. In study 1 (n = 12), magnetic stimulation was well tolerated with mean discomfort rating of 9% (range 0–40%) on a visual analog scale. Reproducibility was poor (intraclass correlation coefficient 0.06; p = 0.44). Study 2 (n = 64) showed only weak to moderate correlations for maximum quadriceps twitch tension with other measures of physical function (6 minute walk test r = 0.24, p = 0.06; maximal voluntary contraction r = 0.26; p = 0.04). We conclude that magnetic femoral nerve stimulation is acceptable and feasible but poorly reproducible in older, functionally impaired people.
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Affiliation(s)
- Louise A Beveridge
- Department of Medicine for the Elderly, NHS Tayside, Dundee, Scotland, UK. .,Medicine for the Elderly, Perth Royal Infirmary, Perth, PH1 1NX, Scotland, UK.
| | - Rosemary J G Price
- Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland, UK
| | - Louise A Burton
- Department of Medicine for the Elderly, NHS Tayside, Dundee, Scotland, UK
| | - Miles D Witham
- Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland, UK
| | - Deepa Sumukadas
- Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland, UK
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28
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Lambert MA, Weir-McCall JR, Salsano M, Gandy SJ, Levin D, Cavin I, Littleford R, MacFarlane JA, Matthew SZ, Nicholas RS, Struthers AD, Sullivan F, Henderson SA, White RD, Belch JJF, Houston JG. Prevalence and Distribution of Atherosclerosis in a Low- to Intermediate-Risk Population: Assessment with Whole-Body MR Angiography. Radiology 2018; 287:795-804. [PMID: 29714681 PMCID: PMC5979784 DOI: 10.1148/radiol.2018171609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To quantify the burden and distribution of asymptomatic atherosclerosis in a population with a low to intermediate risk of cardiovascular disease. Materials and Methods Between June 2008 and February 2013, 1528 participants with 10-year risk of cardiovascular disease less than 20% were prospectively enrolled. They underwent whole-body magnetic resonance (MR) angiography at 3.0 T by using a two-injection, four-station acquisition technique. Thirty-one arterial segments were scored according to maximum stenosis. Scores were summed and normalized for the number of assessable arterial segments to provide a standardized atheroma score (SAS). Multiple linear regression was performed to assess effects of risk factors on atheroma burden. Results A total of 1513 participants (577 [37.9%] men; median age, 53.5 years; range, 40-83 years) completed the study protocol. Among 46 903 potentially analyzable segments, 46 601 (99.4%) were interpretable. Among these, 2468 segments (5%) demonstrated stenoses, of which 1649 (3.5%) showed stenosis less than 50% and 484 (1.0%) showed stenosis greater than or equal to 50%. Vascular stenoses were distributed throughout the body with no localized distribution. Seven hundred forty-seven (49.4%) participants had at least one stenotic vessel, and 408 (27.0%) participants had multiple stenotic vessels. At multivariable linear regression, SAS correlated with age (B = 3.4; 95% confidence interval: 2.61, 4.20), heart rate (B = 1.23; 95% confidence interval: 0.51, 1.95), systolic blood pressure (B = 0.02; 95% confidence interval: 0.01, 0.03), smoking status (B = 0.79; 95% confidence interval: 0.44, 1.15), and socioeconomic status (B = -0.06; 95% confidence interval: -0.10, -0.02) (P < .01 for all). Conclusion Whole-body MR angiography identifies early vascular disease at a population level. Although disease prevalence is low on a per-vessel level, vascular disease is common on a per-participant level, even in this low- to intermediate-risk cohort. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Marco Salsano
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Stephen J. Gandy
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Daniel Levin
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Ian Cavin
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Roberta Littleford
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Jennifer A. MacFarlane
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Shona Z. Matthew
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Richard S. Nicholas
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Allan D. Struthers
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Frank Sullivan
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Shelley A. Henderson
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Richard D. White
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Jill J. F. Belch
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - J. Graeme Houston
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
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Beveridge LA, Khan F, Struthers AD, Armitage J, Barchetta I, Bressendorff I, Cavallo MG, Clarke R, Dalan R, Dreyer G, Gepner AD, Forouhi NG, Harris RA, Hitman GA, Larsen T, Khadgawat R, Marckmann P, Mose FH, Pilz S, Scholze A, Shargorodsky M, Sokol SI, Stricker H, Zoccali C, Witham MD. Effect of Vitamin D Supplementation on Markers of Vascular Function: A Systematic Review and Individual Participant Meta-Analysis. J Am Heart Assoc 2018; 7:JAHA.117.008273. [PMID: 29848497 PMCID: PMC6015391 DOI: 10.1161/jaha.117.008273] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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] [Indexed: 02/07/2023]
Abstract
Background Low 25‐hydroxyvitamin D levels are associated with an increased risk of cardiovascular events, but the effect of vitamin D supplementation on markers of vascular function associated with major adverse cardiovascular events is unclear. Methods and Results We conducted a systematic review and individual participant meta‐analysis to examine the effect of vitamin D supplementation on flow‐mediated dilatation of the brachial artery, pulse wave velocity, augmentation index, central blood pressure, microvascular function, and reactive hyperemia index. MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and http://www.ClinicalTrials.gov were searched until the end of 2016 without language restrictions. Placebo‐controlled randomized trials of at least 4 weeks duration were included. Individual participant data were sought from investigators on included trials. Trial‐level meta‐analysis was performed using random‐effects models; individual participant meta‐analyses used a 2‐stage analytic strategy, examining effects in prespecified subgroups. 31 trials (2751 participants) were included; 29 trials (2641 participants) contributed data to trial‐level meta‐analysis, and 24 trials (2051 participants) contributed to individual‐participant analyses. Vitamin D3 daily dose equivalents ranged from 900 to 5000 IU; duration was 4 weeks to 12 months. Trial‐level meta‐analysis showed no significant effect of supplementation on macrovascular measures (flow‐mediated dilatation, 0.37% [95% confidence interval, −0.23 to 0.97]; carotid‐femoral pulse wave velocity, 0.00 m/s [95% confidence interval, −0.36 to 0.37]); similar results were obtained from individual participant data. Microvascular function showed a modest improvement in trial‐level data only. No consistent benefit was observed in subgroup analyses or between different vitamin D analogues. Conclusions Vitamin D supplementation had no significant effect on most markers of vascular function in this analysis.
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Affiliation(s)
- Louise A Beveridge
- Department of Medicine for the Elderly, NHS Tayside, Dundee, United Kingdom
| | - Faisel Khan
- School of Medicine, University of Dundee, United Kingdom
| | | | - Jane Armitage
- Clinical Trial Service Unit and MRC Population Health Research Unit, University of Oxford, United Kingdom
| | - Ilaria Barchetta
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Iain Bressendorff
- Department of Nephrology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - Robert Clarke
- Clinical Trial Service Unit and MRC Population Health Research Unit, University of Oxford, United Kingdom
| | - Rinkoo Dalan
- Tan Tock Seng Hospital, Lee Kong Chian School of Medicine Nanyang Technological University, Singapore
| | - Gavin Dreyer
- Department of Nephrology, Barts Health NHS Trust, London, United Kingdom
| | - Adam D Gepner
- University of Wisconsin School of Medicine and Public Health and William S. Middleton Veterans Affairs Hospital, Madison, WI
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Ryan A Harris
- Department of Population Health Science, Georgia Prevention Institute Augusta University, Augusta, Georgia, USA
| | - Graham A Hitman
- Blizard Institute, Queen Mary University of London, United Kingdom
| | - Thomas Larsen
- University Clinic in Nephrology and Hypertension, Department of Medical Research, Regional Hospital West Jutland and Aarhus University, Aarhus, Denmark
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Peter Marckmann
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Frank H Mose
- University Clinic in Nephrology and Hypertension, Department of Medical Research, Regional Hospital West Jutland and Aarhus University, Aarhus, Denmark
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| | - Alexandra Scholze
- Department of Nephrology, Odense University Hospital and Institute of Clinical Research University of Southern Denmark, Odense, Denmark
| | - Marina Shargorodsky
- Department of Endocrinology, Wolfson Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Seth I Sokol
- Division of Cardiology, Jacobi Medical Center, NY
| | - Hans Stricker
- Department of Angiology, Ospedale La Carita, Locarno, Switzerland
| | - Carmine Zoccali
- CNR-IFC Clinical Epidemiology and Pathphysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Miles D Witham
- School of Medicine, University of Dundee, United Kingdom
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30
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Weir-McCall JR, Liu-Shiu-Cheong PS, Struthers AD, Lipworth BJ, Houston JG. Disconnection of pulmonary and systemic arterial stiffness in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:1755-1765. [PMID: 29881265 PMCID: PMC5978466 DOI: 10.2147/copd.s160077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Both pulmonary arterial stiffening and systemic arterial stiffening have been described in COPD. The aim of the current study was to assess pulse wave velocity (PWV) within these two arterial beds to determine whether they are separate or linked processes. Materials and methods In total, 58 participants with COPD and 21 healthy volunteers (HVs) underwent cardiac magnetic resonance imaging (MRI) and were tested with a panel of relevant biomarkers. Cardiac MRI was used to quantify ventricular mass, volumes, and pulmonary (pulse wave velocity [pPWV] and systemic pulse wave velocity [sPWV]). Results Those with COPD had higher pPWV (COPD: 2.62 vs HV: 1.78 ms−1, p=0.006), higher right ventricular mass/volume ratio (RVMVR; COPD: 0.29 vs HV: 0.25 g/mL, p=0.012), higher left ventricular mass/volume ratio (LVMVR; COPD: 0.78 vs HV: 0.70 g/mL, p=0.009), and a trend toward a higher sPWV (COPD: 8.7 vs HV: 7.4 ms−1, p=0.06). Multiple biomarkers were elevated: interleukin-6 (COPD: 1.38 vs HV: 0.58 pg/mL, p=0.02), high-sensitivity C-reactive protein (COPD: 6.42 vs HV: 2.49 mg/L, p=0.002), surfactant protein D (COPD: 16.9 vs HV: 9.13 ng/mL, p=0.001), N-terminal pro-brain natriuretic peptide (COPD: 603 vs HV: 198 pg/mL, p=0.001), and high-sensitivity troponin I (COPD: 2.27 vs HV: 0.92 pg/mL, p<0.001). There was a significant relationship between sPWV and LVMVR (p=0.01) but not pPWV (p=0.97) nor between pPWV and RVMVR (p=0.27). Conclusion Pulmonary arterial stiffening and systemic arterial stiffening appear to be disconnected and should therefore be considered independent processes in COPD. Further work is warranted to determine whether both these cause an increased morbidity and mortality and whether both can be targeted by similar pharmacological therapy or whether different strategies are required for each.
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Affiliation(s)
- Jonathan R Weir-McCall
- Division of Molecular and Clinical Medicine, Medical Research Institute, University of Dundee, Dundee, UK
| | | | - Allan D Struthers
- Division of Molecular and Clinical Medicine, Medical Research Institute, University of Dundee, Dundee, UK
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research, Medical Research Institute, University of Dundee, Dundee, UK
| | - J Graeme Houston
- Division of Molecular and Clinical Medicine, Medical Research Institute, University of Dundee, Dundee, UK
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31
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Weir-McCall JR, Brown L, Summersgill J, Talarczyk P, Bonnici-Mallia M, Chin SC, Khan F, Struthers AD, Sullivan F, Colhoun HM, Shore AC, Aizawa K, Groop L, Nilsson J, Cockcroft JR, McEniery CM, Wilkinson IB, Ben-Shlomo Y, Houston JG. Development and Validation of a Path Length Calculation for Carotid-Femoral Pulse Wave Velocity Measurement: A TASCFORCE, SUMMIT, and Caerphilly Collaborative Venture. Hypertension 2018; 71:937-945. [PMID: 29555666 PMCID: PMC5902134 DOI: 10.1161/hypertensionaha.117.10620] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 12/28/2017] [Accepted: 01/30/2018] [Indexed: 11/19/2022]
Abstract
Supplemental Digital Content is available in the text. Current distance measurement techniques for pulse wave velocity (PWV) calculation are susceptible to intercenter variability. The aim of this study was to derive and validate a formula for this distance measurement. Based on carotid femoral distance in 1183 whole-body magnetic resonance angiograms, a formula was derived for calculating distance. This was compared with distance measurements in 128 whole-body magnetic resonance angiograms from a second study. The effects of recalculation of PWV using the new formula on association with risk factors, disease discrimination, and prediction of major adverse cardiovascular events were examined within 1242 participants from the multicenter SUMMIT study (Surrogate Markers of Micro- and Macrovascular Hard End-Points for Innovative Diabetes Tools) and 825 participants from the Caerphilly Prospective Study. The distance formula yielded a mean error of 7.8 mm (limits of agreement =−41.1 to 56.7 mm; P<0.001) compared with the second whole-body magnetic resonance angiogram group. Compared with an external distance measurement, the distance formula did not change associations between PWV and age, blood pressure, or creatinine (P<0.01) but did remove significant associations between PWV and body mass index (BMI). After accounting for differences in age, sex, and mean arterial pressure, intercenter differences in PWV persisted using the external distance measurement (F=4.6; P=0.004), whereas there was a loss of between center difference using the distance formula (F=1.4; P=0.24). PWV odds ratios for cardiovascular mortality remained the same using both the external distance measurement (1.14; 95% confidence interval, 1.06–1.24; P=0.001) and the distance formula (1.17; 95% confidence interval, 1.08–1.28; P<0.001). A population-derived automatic distance calculation for PWV obtained from routinely collected clinical information is accurate and removes intercenter measurement variability without impacting the diagnostic utility of carotid–femoral PWV.
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Affiliation(s)
- Jonathan R Weir-McCall
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Liam Brown
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Jennifer Summersgill
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Piotr Talarczyk
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Michael Bonnici-Mallia
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Sook C Chin
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Faisel Khan
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Allan D Struthers
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Frank Sullivan
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Helen M Colhoun
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Angela C Shore
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Kunihiko Aizawa
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Leif Groop
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Jan Nilsson
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - John R Cockcroft
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Carmel M McEniery
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Ian B Wilkinson
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - Yoav Ben-Shlomo
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.)
| | - J Graeme Houston
- From the Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, United Kingdom (J.R.W.-M., L.B., J.S., F.K., A.D.S., J.G.H.); NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom (P.T., M.B.-M., S.C.C.); Department of Research and Innovation, North York General Hospital, University of Toronto, Canada (F.S.); Centre for Genomic and Experimental Medicine, The University of Edinburgh, Western General Hospital, United Kingdom (H.M.C.); NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter Medical School, United Kingdom (A.C.S., K.A.); Lund University Diabetes Centre, Lund University, Malmö, Sweden (L.G.); Department of Clinical Sciences Malmö, Lund University, Sweden (J.N.); Department of Cardiology, Wales Heart Research Institute, Cardiff, United Kingdom (J.R.C.); Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W.); and Population Health Sciences, University of Bristol, United Kingdom (Y.B.-S.).
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Weir-McCall JR, Liu-Shiu-Cheong PS, Struthers AD, Lipworth BJ, Houston JG. Pulmonary arterial stiffening in COPD and its implications for right ventricular remodelling. Eur Radiol 2018; 28:3464-3472. [PMID: 29488084 PMCID: PMC6028842 DOI: 10.1007/s00330-018-5346-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 01/09/2023]
Abstract
Background Pulmonary pulse wave velocity (PWV) allows the non-invasive measurement of pulmonary arterial stiffening, but has not previously been assessed in COPD. The aim of the current study was to assess PWV in COPD and its association with right ventricular (RV) remodelling. Methods Fifty-eight participants with COPD underwent pulmonary function tests, 6-min walk test and cardiac MRI, while 21 healthy controls (HCs) underwent cardiac MRI. Thirty-two COPD patients underwent a follow-up MRI to assess for longitudinal changes in RV metrics. Cardiac MRI was used to quantify RV mass, volumes and PWV. Differences in continuous variables between the COPD and HC groups was tested using an independent t-test, and associations between PWV and right ventricular parameters was examined using Pearson’s correlation coefficient. Results Those with COPD had reduced pulsatility (COPD (mean±SD):24.88±8.84% vs. HC:30.55±11.28%, p=0.021), pulmonary acceleration time (COPD:104.0±22.9ms vs. HC: 128.1±32.2ms, p<0.001), higher PWV (COPD:2.62±1.29ms-1 vs. HC:1.78±0.72ms-1, p=0.001), lower RV end diastolic volume (COPD:53.6±11.1ml vs. HC:59.9±13.0ml, p=0.037) and RV stroke volume (COPD:31.9±6.9ml/m2 vs. HC:37.1±6.2ml/m2, p=0.003) with no difference in mass (p=0.53). PWV was not associated with right ventricular parameters. Conclusions While pulmonary vascular remodelling is present in COPD, cardiac remodelling favours reduced filling rather than increased afterload. Treatment of obstructive lung disease may have greater effect on cardiac function than treatment of pulmonary vascular disease in most COPD patients Key Points • Pulmonary pulse wave velocity (PWV) is elevated in COPD. • Pulmonary PWV is not associated with right ventricular remodelling. • Right ventricular remodelling is more in keeping with that of reduced filling. Electronic supplementary material The online version of this article (10.1007/s00330-018-5346-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan R Weir-McCall
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, UK
| | - Patrick Sk Liu-Shiu-Cheong
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, UK
| | - Allan D Struthers
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, UK
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research, Medical Research Institute, University of Dundee, Dundee, UK
| | - J Graeme Houston
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, UK.
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK.
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Weir-McCall JR, Lambert M, Gandy SJ, Belch JJF, Cavin I, Henderson SA, Littleford R, Macfarlane JA, Matthew SZ, Stephen Nicholas R, Struthers AD, Sullivan F, White RD, Graeme Houston J. Systemic arteriosclerosis is associated with left ventricular remodeling but not atherosclerosis: a TASCFORCE study. J Cardiovasc Magn Reson 2018; 20:7. [PMID: 29382349 PMCID: PMC5791244 DOI: 10.1186/s12968-018-0428-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/15/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Arteriosclerosis (arterial stiffening) is associated with future cardiovascular events, with this effect postulated to be due to its effect on cardiac afterload, atherosclerosis (plaque formation) progression or both, but with limited evidence examining these early in disease formation. The aim of the current study is to examine the association between arteriosclerosis, atherosclerosis and ventricular remodelling in a population at low-intermediate cardiovascular risk. METHODS One thousand six hundred fifty-one subjects free of clinical cardiovascular disease and with a < 20% 10 year cardiovascular risk score underwent a cardiovascular magnetic resonance (CMR) study and whole body CMR angiogram. Arteriosclerosis was measured using total arterial compliance (TAC) - calculated as the indexed stroke volume divided by the pulse pressure. Atherosclerosis was quantified using a standardised atheroma score (SAS) which was calculated by scoring 30 arterial segments within the body based on the degree of stenosis, summating these scores and normalising it to the number of assessable segments. Left ventricular remodelling was measured using left ventricular mass to volume ratio (LVMVR). RESULTS One thousand five hundred fifteen (38% male, 53.8 ± 8.2 years old) completed the study. On univariate analysis TAC was associated with SAS but this was lost after accounting for cardiovascular risk factors in both males (B = - 0.001 (- 0.004-0.002),p = 0.62) and females (B = 0.000(95%CI -0.002--0.002),p = 0.78). In contrast compliance correlated with LVMVR after accounting for cardiovascular risk factors (B = - 0.12(95%CI -0.16--0.091),p < 0.001 in males; B = - 0.12(95%CI -0.15--0.086),p < 0.001 in females). CONCLUSION Systemic arteriosclerosis is associated with left ventricular remodelling but not atherosclerosis. Future efforts in cardiovascular risk prevention should thus seek to address both arteriosclerosis and atherosclerosis individually.
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Affiliation(s)
- Jonathan R. Weir-McCall
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | - Matthew Lambert
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | | | - Jill J. F. Belch
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | - Ian Cavin
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | | | - Roberta Littleford
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | | | - Shona Z. Matthew
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | | | - Allan D. Struthers
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
| | - Frank Sullivan
- Department of Research and Innovation, North York General Hospital, University of Toronto, Toronto, Canada
| | - Richard D. White
- Department of Clinical Radiology, University Hospital of Wales, Cardiff, CF14 4XW UK
| | - J. Graeme Houston
- Division of Molecular and Clinical Medicine, College of Medicine, University of Dundee, Level 7, Dundee, DD1 9SY UK
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Fathi A, Weir-McCall JR, Struthers AD, Lipworth BJ, Houston G. Effects of contrast administration on cardiac MRI volumetric, flow and pulse wave velocity quantification using manual and software-based analysis. Br J Radiol 2018; 91:20170717. [PMID: 29271236 PMCID: PMC5965987 DOI: 10.1259/bjr.20170717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of the current study was to determine the effects of gadolinium contrast agent on right (RV) and left ventricular (LV) volumetric, aortic flow and pulse wave velocity (PWV) quantification using manual, semi-automatic and fully automatic analysis techniques. Methods: 61 participants free from known cardiovascular disease were recruited. Cardiac MR was performed on a 3 T scanner. A balanced steady-state free precession stack was acquired of the ventricles with phase contrast imaging of the aorta performed pre- and post-administration of 10 ml 0.5 mmol ml−1 gadoterate meglumine. The images were analysed manually, and using a semi-automated and a fully automated technique. Results: 54 completed the study. Gadolinium-based contrast administration significantly increase the signal-to-noise ratio (pre: 830 ± 398 vs post: 1028 ± 540, p = 0.003) with no significant change in contrast-to-noise ratio (pre: 583 ± 302 vs post: 559 ± 346, p = 0.54). On LV analysis, post-contrast analysis yielded significantly higher end systolic volume (54 ± 20 vs 57 ± 18 ml, p = 0.04), and lower ejection fraction (59 ± 9 vs 57 ± 8%, p = 0.023). On RV analysis, gadolinium contrast resulted in no significant differences. Similar results were seen using the semi-automated and fully-automated techniques but with a larger magnitude of difference. Conversely, using both manual and software analysis aortic flow and PWV quantification proved robust to the effects of contrast agent producing only small non-significant differences. Conclusion: Gadolinium contrast administration significantly alters LV endocardial contour detection with this effect amplified when using semi-automated analysis techniques. In comparison, RV and PWV analysis is robust to these effects. Advances in knowledge: Contrast administration alters LV quantification but not flow analysis. However, these differences are small.
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Affiliation(s)
- Amir Fathi
- 1 Division of Molecular and Clinical Medicine, Medical Research Institute, University of Dundee , Dundee , UK
| | - Jonathan R Weir-McCall
- 1 Division of Molecular and Clinical Medicine, Medical Research Institute, University of Dundee , Dundee , UK
| | - Allan D Struthers
- 1 Division of Molecular and Clinical Medicine, Medical Research Institute, University of Dundee , Dundee , UK
| | - Brian J Lipworth
- 2 Scottish Centre for Respiratory Research, Medical Research Institute, University of Dundee , Dundee , UK
| | - Graeme Houston
- 1 Division of Molecular and Clinical Medicine, Medical Research Institute, University of Dundee , Dundee , UK
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Lim TK, Noman A, Choy AMJ, Khan F, Struthers AD, Lang CC. The APEX trial: Effects of allopurinol on exercise capacity, coronary and peripheral endothelial function, and natriuretic peptides in patients with cardiac syndrome X. Cardiovasc Ther 2017; 36. [DOI: 10.1111/1755-5922.12311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Anna Maria J Choy
- Division of Molecular and Clinical Medicine; Ninewells Hospital and Medical School; University of Dundee; Dundee UK
| | - Faisel Khan
- Division of Molecular and Clinical Medicine; Ninewells Hospital and Medical School; University of Dundee; Dundee UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine; Ninewells Hospital and Medical School; University of Dundee; Dundee UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine; Ninewells Hospital and Medical School; University of Dundee; Dundee UK
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Mordi NA, Mordi IR, Singh JS, Baig F, Choy AM, McCrimmon RJ, Struthers AD, Lang CC. Renal and Cardiovascular Effects of sodium-glucose cotransporter 2 (SGLT2) inhibition in combination with loop Diuretics in diabetic patients with Chronic Heart Failure (RECEDE-CHF): protocol for a randomised controlled double-blind cross-over trial. BMJ Open 2017; 7:e018097. [PMID: 29042392 PMCID: PMC5652490 DOI: 10.1136/bmjopen-2017-018097] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) and heart failure (HF) are a frequent combination, where treatment options remain limited. There has been increasing interest around the sodium-glucose cotransporter 2 (SGLT2) inhibitors and their use in patients with HF. Data on the effect of SGLT2 inhibitor use with diuretics are limited. We hypothesise that SGLT2 inhibition may augment the effects of loop diuretics and the benefits of SGLT2 inhibitors may extend beyond those of their metabolic (glycaemic parameters and weight loss) and haemodynamic parameters. The effects of SGLT2 inhibitors as an osmotic diuretic and on natriuresis may underlie the cardiovascular and renal benefits demonstrated in the recent EMPA-REG study. METHODS AND ANALYSIS To assess the effect of SGLT2 inhibitors when used in combination with a loop diuretic, the RECEDE-CHF (Renal and Cardiovascular Effects of SGLT2 inhibition in combination with loop Diuretics in diabetic patients with Chronic Heart Failure) trial is a single-centre, randomised, double-blind, placebo-controlled, cross-over trial conducted in a secondary care setting within NHS Tayside, Scotland. 34 eligible participants, aged between 18 and 80 years, with stable T2D and CHF will be recruited. Renal physiological testing will be performed at two points (week 1 and week 6) on each arm to assess the effect of 25 mg empagliflozin, on the primary and secondary outcomes. Participants will be enrolled in the trial for a total period between 14 and 16 weeks. The primary outcome will assess the effect of empagliflozin versus placebo on urine output. The secondary outcomes are to assess the effect of empagliflozin on glomerular filtration rate, cystatin C, urinary sodium excretion, urinary protein/creatinine ratio and urinary albumin/creatinine ratio when compared with placebo. ETHICS AND DISSEMINATION Ethics approval was obtained by the East of Scotland Research Ethics Service. Results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03226457; Pre-results.
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Affiliation(s)
- Natalie A Mordi
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Ify R Mordi
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Jagdeep S Singh
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Fatima Baig
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Anna-Maria Choy
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Rory J McCrimmon
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Allan D Struthers
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Chim C Lang
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
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Barma M, Khan F, Price RJG, Donnan PT, Messow CM, Ford I, McConnachie A, Struthers AD, McMurdo MET, Witham MD. Association between GDF-15 levels and changes in vascular and physical function in older patients with hypertension. Aging Clin Exp Res 2017; 29:1055-1059. [PMID: 27734214 PMCID: PMC5589783 DOI: 10.1007/s40520-016-0636-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/29/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Growth differentiation factor-15 (GDF-15) may be a biomarker of disease, protective response and/or prognosis, in older people with hypertension. AIMS To correlate baseline GDF-15 levels with physical and vascular health data in this population. METHODS Baseline blood samples were analysed using a GDF-15 ELISA assay kit. Correlations with baseline and 12-month outcome data, including measures of physical and vascular function, were performed. RESULTS A total of 147 individuals, mean age 76.8 ± 4.7 years, were included. 77 (52 %) were male. Baseline log10GDF-15 showed significant correlations with age (r = 0.37, p < 0.001), total cholesterol (r = -0.33, p < 0.001) and 6-min walking distance (r = -0.37, p < 0.001). Age remained significantly associated with log10GDF-15 in multivariable analysis (beta = -0.29, p = 0.001). Baseline log10GDF-15 was significantly associated with decline in 6-min walk distance over 12 months (beta = -0.27, p = 0.01) in multivariable models. No significant correlations were seen with changes in vascular function over 12 months. CONCLUSION Baseline GDF-15 predicts declining physical, but not vascular, function in our population.
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Affiliation(s)
- Maryam Barma
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK.
- Ageing and Health, Ninewells Hospital, Dundee, UK.
| | - Faisel Khan
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Rosemary J G Price
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK
| | - C Martina Messow
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Allan D Struthers
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Marion E T McMurdo
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - Miles D Witham
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
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Tunstall-Pedoe H, Peters SAE, Woodward M, Struthers AD, Belch JJF. Twenty-Year Predictors of Peripheral Arterial Disease Compared With Coronary Heart Disease in the Scottish Heart Health Extended Cohort (SHHEC). J Am Heart Assoc 2017; 6:e005967. [PMID: 28923990 PMCID: PMC5634266 DOI: 10.1161/jaha.117.005967] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/23/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronary heart disease and peripheral arterial disease (PAD) affect different vascular territories. Supplementing baseline findings with assays from stored serum, we compared their 20-year predictors. METHODS AND RESULTS We randomly recruited 15 737 disease-free men and women aged 30 to 75 years across Scotland between 1984 and 1995 and followed them through 2009 for death and hospital diagnoses. Of these, 3098 developed coronary heart disease (19.7%), and 499 PAD (3.2%). Hazard ratios for 45 variables in the Cox model were adjusted for age and sex and for factors in the 2007 ASSIGN cardiovascular risk score. Forty-four of them were entered into parsimonious predictive models, tested by c-statistics and net reclassification improvements. Many hazard ratios diminished with adjustment and parsimonious modeling, leaving significant survivors. The hazard ratios were mostly higher in PAD. New parsimonious models increased the c-statistic and net reclassification improvements over ASSIGN variables alone but varied in their components and ranking. Coronary heart disease and PAD shared 7 of the 9 factors from ASSIGN: age, sex, family history, socioeconomic status, diabetes mellitus, tobacco smoking, and systolic blood pressure (but neither total nor high-density lipoprotein cholesterol); plus 4 new ones: NT-pro-BNP, cotinine, high-sensitivity C-reactive protein, and cystatin-C. The highest ranked hazard ratios for continuous factors in coronary heart disease were those for age, total cholesterol, high-sensitivity troponin, NT-pro-BNP, cotinine, apolipoprotein A, and waist circumference (plus 10 more); in PAD they were age, high-sensitivity C-reactive protein, systolic blood pressure, expired carbon monoxide, cotinine, socioeconomic status, and lipoprotein (a) (plus 5 more). CONCLUSIONS The mixture of shared with disparate determinants for arterial disease in the heart and the legs implies nonidentical pathogenesis: cholesterol dominant in the former, and inflammation (high-sensitivity C-reactive protein, diabetes mellitus, smoking) in the latter.
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Affiliation(s)
- Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, United Kingdom
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, United Kingdom
| | - Mark Woodward
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, United Kingdom
- The George Institute for Global Health, University of Oxford, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, United Kingdom
| | - Jill J F Belch
- Vascular Medicine, Institute of Cardiovascular Research, University of Dundee, United Kingdom
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Rutherford E, Stewart G, Houston JG, Jardine AG, Mark PB, Struthers AD. An Open-Label Dose-Finding Study of Allopurinol to Target Defined Reduction in Urate Levels in Hemodialysis Patients. J Clin Pharmacol 2017; 57:1409-1414. [PMID: 28597919 PMCID: PMC5655768 DOI: 10.1002/jcph.939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/14/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Elaine Rutherford
- Institute of Cardiovascular & Medical Sciences, BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Graham Stewart
- Renal Unit, Ninewells Hospital & Medical School, Dundee, UK
| | - J Graeme Houston
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Alan G Jardine
- Institute of Cardiovascular & Medical Sciences, BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular & Medical Sciences, BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Allan D Struthers
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
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Weir-McCall JR, Fitzgerald K, Papagiorcopulo CJ, Gandy SJ, Lambert M, Belch JJF, Cavin I, Littleford R, Macfarlane JA, Matthew SZ, Nicholas RS, Struthers AD, Sullivan FM, Waugh SA, White RD, Houston JG. Prevalence of unrecognized myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis. Eur Heart J Cardiovasc Imaging 2017; 18:657-662. [PMID: 27550660 PMCID: PMC5439404 DOI: 10.1093/ehjci/jew155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 01/04/2016] [Accepted: 06/29/2016] [Indexed: 12/18/2022] Open
Abstract
Aims Unrecognized myocardial infarctions (UMIs) have been described in 19–30% of the general population using late gadolinium enhancement (LGE) on cardiac magnetic resonance. However, these studies have focused on an unselected cohort including those with known cardiovascular disease (CVD). The aim of the current study was to ascertain the prevalence of UMIs in a non-high-risk population using magnetic resonance imaging (MRI). Methods and results A total of 5000 volunteers aged >40 years with no history of CVD and a 10-year risk of CVD of <20%, as assessed by the ATP-III risk score, were recruited to the Tayside Screening for Cardiac Events study. Those with a B-type natriuretic peptide (BNP) level greater than their gender-specific median were invited for a whole-body MR angiogram and cardiac MR including LGE assessment. LGE was classed as absent, UMI, or non-specific. A total of 1529 volunteers completed the imaging study; of these, 53 (3.6%) were excluded because of either missing data or inadequate LGE image quality. Ten of the remaining 1476 (0.67%) displayed LGE. Of these, three (0.2%) were consistent with UMI, whereas seven were non-specific occurring in the mid-myocardium (n = 4), epicardium (n = 1), or right ventricular insertion points (n = 2). Those with UMI had a significantly higher BNP [median 116 (range 31–133) vs. 22.6 (5–175) pg/mL, P = 0.015], lower ejection fraction [54.6 (36–62) vs. 68.9 (38–89)%, P = 0.007], and larger end-systolic volume [36.3 (27–61) vs. 21.7 (5–65) mL/m2, P = 0.014]. Those with non-specific LGE had lower diastolic blood pressure [68 (54–70) vs. 72 (46–98) mmHg, P = 0.013] but no differences in their cardiac function. Conclusion Despite previous reports describing high prevalence of UMI in older populations, in a predominantly middle-aged cohort, those who are of intermediate or low cardiovascular risk have a very low risk of having an unrecognized myocardial infarct.
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Affiliation(s)
- Jonathan R Weir-McCall
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Kerrie Fitzgerald
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Carla J Papagiorcopulo
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | | | - Matthew Lambert
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Jill J F Belch
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Ian Cavin
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | - Roberta Littleford
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | | | - Shona Z Matthew
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | | | - Allan D Struthers
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Frank M Sullivan
- Department of Research and Innovation, North York General Hospital, University of Toronto, Toronto, UK
| | | | - Richard D White
- Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK
| | - J Graeme Houston
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
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Weir-McCall JR, Yeap PM, Papagiorcopulo C, Fitzgerald K, Gandy SJ, Lambert M, Belch JJF, Cavin I, Littleford R, Macfarlane JA, Matthew SZ, Nicholas RS, Struthers AD, Sullivan F, Henderson SA, White RD, Houston JG. Reply: The Enigma of Left Ventricular Non-Compaction. J Am Coll Cardiol 2017; 69:2470-2471. [PMID: 28494989 DOI: 10.1016/j.jacc.2017.02.062] [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] [Received: 01/18/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
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Panaro L, Mangion K, Rutherford E, McComb C, Woodward R, Radjenovic A, Berry C, Struthers AD, Mark PB. SP538EXPLORATION OF RIGHT VENTRICULAR HAEMODYNAMICS IN HAEMODIALYSIS PATIENTS USING CARDIAC MAGNETIC RESONANCE IMAGING. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx152.sp538] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Weir-McCall J, Liu-Shiu-Cheong P, Struthers AD, Lipworth BJ, Houston JG. 025 Determinants of pulmonary arterial remodelling in copd and implications for right ventricular remodelling. Heart 2017. [DOI: 10.1136/heartjnl-2017-311399.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gandy SJ, Matthew S, Rekhraj S, Szwejkowski B, Crowe E, Struthers AD, Houston JG. MRI of the left atrium at 3T: evaluation of measurement reproducibility in healthy volunteers and patients with cardiovascular disease. Acta Radiol 2016; 57:1468-1475. [PMID: 26861203 DOI: 10.1177/0284185115627386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Left ventricular (LV) function has traditionally been the focus for cardiac magnetic resonance imaging (MRI) investigations, but similar methods can also be applied to the left atrium (LA). Previous studies elsewhere have almost entirely involved the use of 1.5T systems, but 3T MRI can provide faster data acquisition with thinner image slices, and may be more suitable for quantifying the structure and function of the LA. Purpose To evaluate 3T-MRI for LA volume assessments in: (i) healthy volunteers (HV); (ii) patients with LV-hypertrophy and ischemia (LVHI); and (iii) patients with LV-hypertrophy and diabetes (LVHD). Material and Methods Participants were imaged using a balanced steady-state free precession sequence. Healthy volunteers were scanned twice and patients were scanned on one occasion. Volumes were segmented by two observers, and coefficients of repeatability (CoR) were derived. Results For LA volumes (indexed to body surface area), CoRs were in the range of 1.3-4.6 mL/m2. The LVHI patients had enlarged LA volumes (diastolic, 46.4 mL/m2; systolic, 25.9 mL/m2) and reduced ejection fraction (EF) (44.9%) relative to the HV (diastolic, 39.0 mL/m2; systolic, 17.8 mL/m2; EF, 54.5%) and LVHD groups (diastolic, 41.4 mL/m2; systolic, 20.2 mL/m2; EF, 50.7%). LA volumes were moderately correlated with LV mass in the HV group (R2 = 0.59 for LA end-systolic volume), but became weaker (R2 ≤ 0.17) for patient groups. Conclusion 3T-MRI derived LA volume measurements are simple and repeatable, and can elicit clear differences between LVHI patients and HVs. These MRI endpoints provide scope for improved radiological interpretation of LA structure and function, and the high degree of repeatability validates their use for longitudinal investigations where precision work is essential.
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Affiliation(s)
- Stephen J Gandy
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
| | - Shona Matthew
- University of Dundee, Ninewells Hospital, Dundee, UK
| | | | | | - Elena Crowe
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
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Weir-McCall JR, Kamalasanan A, Cassidy DB, Struthers AD, Lipworth BJ, Houston JG. Assessment of proximal pulmonary arterial stiffness using magnetic resonance imaging: effects of technique, age and exercise. BMJ Open Respir Res 2016; 3:e000149. [PMID: 27843548 PMCID: PMC5073626 DOI: 10.1136/bmjresp-2016-000149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 09/16/2016] [Accepted: 09/19/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction To compare the reproducibility of pulmonary pulse wave velocity (PWV) techniques, and the effects of age and exercise on these. Methods 10 young healthy volunteers (YHV) and 20 older healthy volunteers (OHV) with no cardiac or lung condition were recruited. High temporal resolution phase contrast sequences were performed through the main pulmonary arteries (MPAs), right pulmonary arteries (RPAs) and left pulmonary arteries (LPAs), while high spatial resolution sequences were obtained through the MPA. YHV underwent 2 MRIs 6 months apart with the sequences repeated during exercise. OHV underwent an MRI scan with on-table repetition. PWV was calculated using the transit time (TT) and flow area techniques (QA). 3 methods for calculating QA PWV were compared. Results PWV did not differ between the two age groups (YHV 2.4±0.3/ms, OHV 2.9±0.2/ms, p=0.1). Using a high temporal resolution sequence through the RPA using the QA accounting for wave reflections yielded consistently better within-scan, interscan, intraobserver and interobserver reproducibility. Exercise did not result in a change in either TT PWV (mean (95% CI) of the differences: −0.42 (−1.2 to 0.4), p=0.24) or QA PWV (mean (95% CI) of the differences: 0.10 (−0.5 to 0.9), p=0.49) despite a significant rise in heart rate (65±2 to 87±3, p<0.0001), blood pressure (113/68 to 130/84, p<0.0001) and cardiac output (5.4±0.4 to 6.7±0.6 L/min, p=0.004). Conclusions QA PWV performed through the RPA using a high temporal resolution sequence accounting for wave reflections yields the most reproducible measurements of pulmonary PWV.
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Affiliation(s)
- Jonathan R Weir-McCall
- Division of Cardiovascular and Diabetes Medicine , Medical Research Institute, University of Dundee , Dundee , UK
| | - Anu Kamalasanan
- Department of Clinical Radiology , Ninewells Hospital and Medical School , Dundee , UK
| | - Deidre B Cassidy
- Division of Cardiovascular and Diabetes Medicine , Medical Research Institute, University of Dundee , Dundee , UK
| | - Allan D Struthers
- Division of Cardiovascular and Diabetes Medicine , Medical Research Institute, University of Dundee , Dundee , UK
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research, Medical Research Institute, University of Dundee , Dundee , UK
| | - J Graeme Houston
- Division of Cardiovascular and Diabetes Medicine , Medical Research Institute, University of Dundee , Dundee , UK
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Mackenzie IS, Ford I, Walker A, Hawkey C, Begg A, Avery A, Taggar J, Wei L, Struthers AD, MacDonald TM. Multicentre, prospective, randomised, open-label, blinded end point trial of the efficacy of allopurinol therapy in improving cardiovascular outcomes in patients with ischaemic heart disease: protocol of the ALL-HEART study. BMJ Open 2016; 6:e013774. [PMID: 27609859 PMCID: PMC5020706 DOI: 10.1136/bmjopen-2016-013774] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ischaemic heart disease (IHD) is one of the most common causes of death in the UK and treatment of patients with IHD costs the National Health System (NHS) billions of pounds each year. Allopurinol is a xanthine oxidase inhibitor used to prevent gout that also has several positive effects on the cardiovascular system. The ALL-HEART study aims to determine whether allopurinol improves cardiovascular outcomes in patients with IHD. METHODS AND ANALYSIS The ALL-HEART study is a multicentre, controlled, prospective, randomised, open-label blinded end point (PROBE) trial of allopurinol (up to 600 mg daily) versus no treatment in a 1:1 ratio, added to usual care, in 5215 patients aged 60 years and over with IHD. Patients are followed up by electronic record linkage and annual questionnaires for an average of 4 years. The primary outcome is the composite of non-fatal myocardial infarction, non-fatal stroke or cardiovascular death. Secondary outcomes include all-cause mortality, quality of life and cost-effectiveness of allopurinol. The study will end when 631 adjudicated primary outcomes have occurred. The study is powered at 80% to detect a 20% reduction in the primary end point for the intervention. Patient recruitment to the ALL-HEART study started in February 2014. ETHICS AND DISSEMINATION The study received ethical approval from the East of Scotland Research Ethics Service (EoSRES) REC 2 (13/ES/0104). The study is event-driven and results are expected after 2019. Results will be reported in peer-reviewed journals and at scientific meetings. Results will also be disseminated to guideline committees, NHS organisations and patient groups. TRIAL REGISTRATION NUMBER 32017426, pre-results.
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Affiliation(s)
- Isla S Mackenzie
- Medicines Monitoring Unit (MEMO) and Hypertension Research Centre, Division of Molecular and Clinical Medicine, University of Dundee and Ninewells Hospital, Dundee, UK
| | - Ian Ford
- Glasgow Clinical Trials Unit, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Andrew Walker
- Glasgow Clinical Trials Unit, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Chris Hawkey
- Nottingham Centre for Digestive Disorders, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alan Begg
- Townhead Medical Practice, Montrose, UK
| | - Anthony Avery
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Jaspal Taggar
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Li Wei
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, University of Dundee and Ninewells Hospital, Dundee, UK
| | - Thomas M MacDonald
- Medicines Monitoring Unit (MEMO) and Hypertension Research Centre, Division of Molecular and Clinical Medicine, University of Dundee and Ninewells Hospital, Dundee, UK
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Rutherford E, Talle MA, Mangion K, Bell E, Rauhalammi SM, Roditi G, McComb C, Radjenovic A, Welsh P, Woodward R, Struthers AD, Jardine AG, Patel RK, Berry C, Mark PB. Defining myocardial tissue abnormalities in end-stage renal failure with cardiac magnetic resonance imaging using native T1 mapping. Kidney Int 2016; 90:845-52. [PMID: 27503805 PMCID: PMC5035134 DOI: 10.1016/j.kint.2016.06.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/25/2016] [Accepted: 06/02/2016] [Indexed: 01/24/2023]
Abstract
Noninvasive quantification of myocardial fibrosis in end-stage renal disease is challenging. Gadolinium contrast agents previously used for cardiac magnetic resonance imaging (MRI) are contraindicated because of an association with nephrogenic systemic fibrosis. In other populations, increased myocardial native T1 times on cardiac MRI have been shown to be a surrogate marker of myocardial fibrosis. We applied this method to 33 incident hemodialysis patients and 28 age- and sex-matched healthy volunteers who underwent MRI at 3.0T. Native T1 relaxation times and feature tracking–derived global longitudinal strain as potential markers of fibrosis were compared and associated with cardiac biomarkers. Left ventricular mass indices were higher in the hemodialysis than the control group. Global, Septal and midseptal T1 times were all significantly higher in the hemodialysis group (global T1 hemodialysis 1171 ± 27 ms vs. 1154 ± 32 ms; septal T1 hemodialysis 1184 ± 29 ms vs. 1163 ± 30 ms; and midseptal T1 hemodialysis 1184 ± 34 ms vs. 1161 ± 29 ms). In the hemodialysis group, T1 times correlated with left ventricular mass indices. Septal T1 times correlated with troponin and electrocardiogram-corrected QT interval. The peak global longitudinal strain was significantly reduced in the hemodialysis group (hemodialysis -17.7±5.3% vs. -21.8±6.2%). For hemodialysis patients, the peak global longitudinal strain significantly correlated with left ventricular mass indices (R = 0.426), and a trend was seen for correlation with galectin-3, a biomarker of cardiac fibrosis. Thus, cardiac tissue properties of hemodialysis patients consistent with myocardial fibrosis can be determined noninvasively and associated with multiple structural and functional abnormalities.
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Affiliation(s)
- Elaine Rutherford
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK; University of Dundee, Division of Cardiovascular & Diabetes Medicine, Dundee, Scotland, UK.
| | - Mohammed A Talle
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Elizabeth Bell
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Samuli M Rauhalammi
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Christie McComb
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Aleksandra Radjenovic
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Rosemary Woodward
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Allan D Struthers
- University of Dundee, Division of Cardiovascular & Diabetes Medicine, Dundee, Scotland, UK
| | - Alan G Jardine
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Rajan K Patel
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
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Sim JS, Dick JBC, Struthers AD. Statin therapy increases vascular sensitivity to angiotensin II in hypercholesterolaemic patients. J Renin Angiotensin Aldosterone Syst 2016; 5:109-13. [PMID: 15526245 DOI: 10.3317/jraas.2004.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/01/2022] Open
Abstract
Introduction Cross-talk between various cardiovascular risk factors has been suggested by a number of studies. This study examines the interaction between hypercholesterolaemia and the renin-angiotensin system in vivo in man. Methods We performed a randomised, placebo-controlled, double-blind crossover study on 40 hypercholesterolaemic patients, comparing cholesterol-lowering therapy with a statin for six months versus placebo. Brachial artery function was assessed by bilateral venous occlusion plethysmography using intra-arterial infusions of the endothelial-dependent vasoconstrictors, angiotensin I (Ang I) and angiotensin II (Ang II), to measure vascular angiotensin-converting enzyme (ACE) and Ang II receptor response respectively. The endothelial-independent vasoconstrictor, noradrenaline, was used as a control vasoconstrictor. Results were analysed by multiple analysis of variance and statistical significance Cholesterol-lowering treatment with a statin was taken as a p value <0.05. Results Cholesterol-lowering treatment with alstatin significantly reduced the mean total cholesterol level to 5.71 mmol/L vs. 7.57 mmol/L on placebo (p<0.0001). Hypercholesterolaemia significantly increased the vasoconstriction response to noradrenaline (placebo versus statin treatment; p=0.046). In hypercholesterolaemia, there was a strong trend towards a reduction in the vasoconstriction response to Ang I (placebo versus statin treatment; p=0.089). In hypercholesterolaemia, the vasoconstriction response to Ang II was significantly reduced (placebo versus statin treatment; p=0.01). Conclusions Our in vivo results show that, unlike some other previous work, hypercholesterolaemia is associated with down-regulation of the vasoconstrictor response to Ang II and that statin therapy up-regulates the local vasoconstrictor response to Ang II. The possibility now arises that, in man, statins alter the balance between AT1-receptors and AT2-receptors.
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Affiliation(s)
- Justein Sn Sim
- Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
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Sim JSN, Farquharson C, Struthers AD. Tonic levels of angiotensin II reduce tonic levels of vascular nitric oxide even in salt-replete man. J Renin Angiotensin Aldosterone Syst 2016; 5:84-8. [PMID: 15295720 DOI: 10.3317/jraas.2004.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/01/2022] Open
Abstract
Introduction Losartan improves stimulated endothelial function in patients with cardiovascular disease, but there are no data to establish whether losartan has this effect in normal man. Furthermore, whether losartan improves basal nitric oxide (NO) activity is controversial. We therefore examined whether treatment with losartan improved basal NO activity in normal, salt-replete man. If so, this would imply that tonic levels of angiotensin II (Ang II) reduce tonic basal levels of NO, even in salt-replete normal man. Methods We performed a randomised, placebo-controlled, double-blind crossover study in 24 healthy volunteers, comparing losartan 50 mg daily for one month versus placebo. Brachial artery endothelial function was assessed by bilateral venous occlusion plethysmography, measuring the response to intra-arterial infusions of the endothelial-dependent and endothelial-independent vasodilators, acetylcholine and sodium nitroprusside respectively and the endothelial-dependent vasoconstrictor NG-monomethyl-L-arginine. Results were analysed by multiple analysis of variance and statistical significance was taken as a p value of ≤ 0.05. Results Losartan significantly increased the vasoconstriction in response to N G-monomethyl-L-arginine (-37 2% vs. -32+2%, losartan vs. placebo; p=0.05). Losartan improved the vasodilatation response to acetylcholine; however, this result did not reach significance (214+2 0% vs. 174+20%, losartan vs. placebo; p=0.15). Losartan did not affect the response to nitroprusside (172+15% vs. 176+16%, losartan vs. placebo; p=0.84). There was no significant difference in blood pressure between the two study days. Conclusions Losartan improves basal NO bioactivity in healthy salt-replete volunteers. Even in salt-replete man, basal Ang II levels exert a tonic effect, which reduces basal NO.
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Affiliation(s)
- Justein S N Sim
- Division of Medicine & Therapeutics, Ninewells Hospital & Medical School, Dundee, UK
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Singh JSS, Fathi A, Vickneson K, Mordi I, Mohan M, Houston JG, Pearson ER, Struthers AD, Lang CC. Research into the effect Of SGLT2 inhibition on left ventricular remodelling in patients with heart failure and diabetes mellitus (REFORM) trial rationale and design. Cardiovasc Diabetol 2016; 15:97. [PMID: 27422625 PMCID: PMC4946228 DOI: 10.1186/s12933-016-0419-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/04/2016] [Indexed: 01/05/2023] Open
Abstract
Background Heart failure (HF) and diabetes (DM) are a lethal combination. The current armamentarium of anti-diabetic agents has been shown to be less efficacious and sometimes even harmful in diabetic patients with concomitant cardiovascular disease, especially HF. Sodium glucose linked co-transporter type 2 (SGLT2) inhibitors are a new class of anti-diabetic agent that has shown potentially beneficial cardiovascular effects such as pre-load and after load reduction through osmotic diuresis, blood pressure reduction, reduced arterial stiffness and weight loss. This has been supported by the recently published EMPA-REG trial which showed a striking 38 and 35 % reduction in cardiovascular death and HF hospitalisation respectively. Methods The REFORM trial is a novel, phase IV randomised, double blind, placebo controlled clinical trial that has been ongoing since March 2015. It is designed specifically to test the safety and efficacy of the SLGT2 inhibitor, dapagliflozin, on diabetic patients with known HF. We utilise cardiac-MRI, cardio-pulmonary exercise testing, body composition analysis and other tests to quantify the cardiovascular and systemic effects of dapagliflozin 10 mg once daily against standard of care over a 1 year observation period. The primary outcome is to detect the change in left ventricular (LV) end systolic and LV end diastolic volumes. The secondary outcome measures include LV ejection fraction, LV mass index, exercise tolerance, fluid status, quality of life measures and others. Conclusions This trial will be able to determine if SGLT2 inhibitor therapy produces potentially beneficial effects in patients with DM and HF, thereby replacing current medications as the drug of choice when treating patients with both DM and HF. Trial registration Clinical Trials.gov: NCT02397421. Registered 12th March 2015
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Affiliation(s)
- Jagdeep S S Singh
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
| | - Amir Fathi
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Keeran Vickneson
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Ify Mordi
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Mohapradeep Mohan
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - J Graeme Houston
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Ewan R Pearson
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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