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Aceña A, Franco-Peláez JA, Gutierrez-Landaluce C, Pello AM, Cristóbal C, Tarín N, Huelmos A, Carda R, Martín-Mariscal ML, Alonso J, González-Parra E, González-Casaus ML, Lorenzo Ó, López Bescos L, Egido J, Tuñón J. Sun exposure influences the prognostic power of components of mineral metabolism in patients with coronary artery disease. Nutr Metab Cardiovasc Dis 2017; 27:762-767. [PMID: 28803689 DOI: 10.1016/j.numecd.2017.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/28/2017] [Accepted: 06/08/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Calcidiol (vitamin D metabolite) plasma levels vary with sun exposure (SE). However, it is not known if SE influences its prognostic ability. We have studied the effect of SE on plasma levels of the components of mineral metabolism (calcidiol, fibroblast growth factor-23 [FGF-23], parathormone [PTH], and phosphate [P]) and on their prognostic value in patients with coronary artery disease (CAD). METHODS AND RESULTS We studied prospectively 704 patients with stable CAD. Clinical variables and baseline calcidiol, FGF-23, PTH, and P plasma levels were assessed. We divided the population in two subgroups, according to the period of plasma extraction: High SE (HSE) (April-September) and low SE (LSE) (October-March). The outcome was the development of acute ischemic events (acute coronary syndrome, stroke, or transient ischemic attack), heart failure, or death. Mean follow-up was 2.15 ± 0.99 years. Calcidiol and P levels were higher in HSE group. In the whole population, calcidiol (HR = 0.84 for each 5 ng/ml increase, 95% CI = 0.71-0.99; p = 0.038) and FGF-23 (HR = 1.14 for each 100 RU/ml increase, 95% CI = 1.05-1.23; p = 0.009) were predictors of the outcome, along with age, hypertension, body-mass index, peripheral artery disease, and P levels. In the LSE subgroup, calcidiol (HR = 0.75; 95% CI = 0.57-0.99; p = 0.034) and FGF-23 (HR = 1.34; 95% CI = 1.13-1.58; p = 0.003) remained as predictors of the outcome. In the HSE group calcidiol and FGF-23 had not independent prognostic value. CONCLUSIONS In patients with stable CAD, low calcidiol and high FGF-23 plasma levels predict an adverse prognosis only when the sample is obtained during the months with LSE. SE should be taken into account in the clinical practice.
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Affiliation(s)
- A Aceña
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain
| | - J A Franco-Peláez
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain
| | | | - A M Pello
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain
| | - C Cristóbal
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain; Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - N Tarín
- Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain
| | - A Huelmos
- Department of Cardiology, Fundación Hospital de Alcorcón, Madrid, Spain
| | - R Carda
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain
| | | | - J Alonso
- Department of Cardiology, Hospital de Getafe, Madrid, Spain
| | - E González-Parra
- Autónoma University, Madrid, Spain; Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
| | - M L González-Casaus
- Laboratory of Nephrology and Mineral Metabolism, Hospital Gómez-Ulla, Madrid, Spain
| | - Ó Lorenzo
- Autónoma University, Madrid, Spain; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | | | - J Egido
- Autónoma University, Madrid, Spain; Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - J Tuñón
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain.
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Tuñón J, Fernández-Fernández B, Carda R, Pello AM, Cristóbal C, Tarín N, Aceña Á, González-Casaus ML, Huelmos A, Alonso J, Lorenzo Ó, González-Parra E, Hernández-González I, Mahíllo-Fernández I, López-Bescós L, Egido J. Circulating fibroblast growth factor-23 plasma levels predict adverse cardiovascular outcomes in patients with diabetes mellitus with coronary artery disease. Diabetes Metab Res Rev 2016; 32:685-693. [PMID: 26888181 DOI: 10.1002/dmrr.2787] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/16/2016] [Accepted: 02/09/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Abnormalities of fibroblast growth factor-23 (FGF-23) plasma levels predict adverse outcomes in patients with coronary artery disease. However, FGF-23 has a different behaviour in the presence of type 2 diabetes mellitus (T2D). We explored whether the presence of T2D affects the predictive power of FGF-23. METHODS In 704 patients with stable coronary artery disease, FGF-23, calcidiol, parathormone (PTH) and phosphate plasma levels were prospectively assessed. The primary outcome was the development of acute ischemic events (acute coronary syndrome, stroke or transient ischemic attack), heart failure or death. RESULTS One hundred seventy-three (24.6%) patients had T2D, without differences in age, sex or estimated glomerular filtration rate as compared with non-diabetic patients. Serum PTH was lower and phosphate higher in T2D than in non-diabetic patients, without differences in FGF-23 or calcidiol levels. During follow-up (2.15 ± 0.99 years), 26 (15.2%) T2D and 51 (9.6%) non-diabetic patients developed the outcome (p = 0.048). T2D patients who developed the outcome had higher FGF-23 [112.0 (59.9, 167.6) vs 68.9 (54.2, 93.0) RU/mL; p = 0.002], PTH [71.3 (47.3, 106.6) vs 51.9 (40.8, 66.2) pg/mL; p = 0.004) and phosphate (3.53 ± 0.71 vs 3.25 ± 0.50 mg/dL; p = 0.017) levels than T2D subjects who remained stable. These differences were not significant in non-diabetic patients. By multivariable Cox proportional hazard model, FGF-23 predicted independently the outcome in T2D patients [hazard ratio = 1.277; 95% CI (1.132, 1.442)] but not in those without T2D. CONCLUSIONS FGF-23 plasma levels predict adverse cardiovascular outcomes in coronary artery disease patients who have T2D but not in those without T2D. This finding should be confirmed in larger studies. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- José Tuñón
- IIS-Fundación Jiménez Díaz, Madrid, Spain.
- Autónoma University, Madrid, Spain.
| | | | | | | | - Carmen Cristóbal
- Hospital de Fuenlabrada, Fuenlabrada, Spain
- Rey Juan Carlos University, Alcorcón, Spain
| | - Nieves Tarín
- University Hospital of Móstoles, Móstoles, Spain
| | | | | | - Ana Huelmos
- University Hospital Fundación Alcorcón, Alcorcón, Spain
| | - Joaquín Alonso
- Rey Juan Carlos University, Alcorcón, Spain
- University Hospital of Getafe, Getafe, Spain
| | - Óscar Lorenzo
- IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
| | | | | | | | | | - Jesús Egido
- IIS-Fundación Jiménez Díaz, Madrid, Spain
- Autónoma University, Madrid, Spain
- CIBERDEM, Madrid, Spain
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Tuñón J, González-Hernández I, Llanos-Jiménez L, Alonso-Martín J, Escudier-Villa JM, Tarín N, Cristóbal C, Sanz P, Pello AM, Aceña Á, Carda R, Orejas M, Tomás M, Beltrán P, Calero Rueda M, Marcos E, Serrano-Antolín JM, Gutiérrez-Landaluce C, Jiménez R, Cabezudo J, Curcio A, Peces-Barba G, González-Parra E, Muñoz-Siscart R, González-Casaus ML, Lorenzo A, Huelmos A, Goicolea J, Ibáñez B, Hernández G, Alonso-Pulpón LM, Farré J, Lorenzo Ó, Mahíllo-Fernández I, Egido J. Design and rationale of a multicentre, randomised, double-blind, placebo-controlled clinical trial to evaluate the effect of vitamin D on ventricular remodelling in patients with anterior myocardial infarction: the VITamin D in Acute Myocardial Infarction (VITDAMI) trial. BMJ Open 2016; 6:e011287. [PMID: 27496232 PMCID: PMC4985833 DOI: 10.1136/bmjopen-2016-011287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Decreased plasma vitamin D (VD) levels are linked to cardiovascular damage. However, clinical trials have not demonstrated a benefit of VD supplements on left ventricular (LV) remodelling. Anterior ST-elevation acute myocardial infarction (STEMI) is the best human model to study the effect of treatments on LV remodelling. We present a proof-of-concept study that aims to investigate whether VD improves LV remodelling in patients with anterior STEMI. METHODS AND ANALYSIS The VITamin D in Acute Myocardial Infarction (VITDAMI) trial is a multicentre, randomised, double-blind, placebo-controlled trial. 144 patients with anterior STEMI will be assigned to receive calcifediol 0.266 mg capsules (Hidroferol SGC)/15 days or placebo on a 2:1 basis during 12 months. PRIMARY OBJECTIVE to evaluate the effect of calcifediol on LV remodelling defined as an increase in LV end-diastolic volume ≥10% (MRI). SECONDARY OBJECTIVES change in LV end-diastolic and end-systolic volumes, ejection fraction, LV mass, diastolic function, sphericity index and size of fibrotic area; endothelial function; plasma levels of aminoterminal fragment of B-type natriuretic peptide, galectin-3 and monocyte chemoattractant protein-1; levels of calcidiol (VD metabolite) and other components of mineral metabolism (fibroblast growth factor-23 (FGF-23), the soluble form of its receptor klotho, parathormone and phosphate). Differences in the effect of VD will be investigated according to the plasma levels of FGF-23 and klotho. Treatment safety and tolerability will be assessed. This is the first study to evaluate the effect of VD on cardiac remodelling in patients with STEMI. ETHICS AND DISSEMINATION This trial has been approved by the corresponding Institutional Review Board (IRB) and National Competent Authority (Agencia Española de Medicamentos y Productos Sanitarios (AEMPS)). It will be conducted in accordance with good clinical practice (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use - Good Clinical Practice (ICH-GCP)) requirements, ethical principles of the Declaration of Helsinki and national laws. The results will be submitted to indexed medical journals and national and international meetings. TRIAL REGISTRATION NUMBER NCT02548364; Pre-results.
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Affiliation(s)
- José Tuñón
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Joaquín Alonso-Martín
- Department of Cardiology, University Hospital of Getafe, Madrid, Spain
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | | | - Nieves Tarín
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | - Carmen Cristóbal
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Petra Sanz
- Department of Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Cardiology, Hospital Rey Juan Carlos, Madrid, Spain
| | - Ana M Pello
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Rocío Carda
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Miguel Orejas
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Marta Tomás
- Department of Radiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Paula Beltrán
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Esther Marcos
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | | | | | - Rosa Jiménez
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Jorge Cabezudo
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Alejandro Curcio
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | - Germán Peces-Barba
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Pneumology, Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio González-Parra
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Antonio Lorenzo
- Department of Cardiology, University Hospital of Móstoles, Móstoles, Spain
| | - Ana Huelmos
- Department of Cardiology, Fundación Hospital Alcorcón, Madrid, Spain
| | - Javier Goicolea
- Department of Cardiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Borja Ibáñez
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | - Luis M Alonso-Pulpón
- Department of Medicine, Autónoma University, Madrid, Spain
- Department of Cardiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Jerónimo Farré
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
- Department of Medicine, Autónoma University, Madrid, Spain
| | - Óscar Lorenzo
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Jesús Egido
- Department of Medicine, Autónoma University, Madrid, Spain
- Vascular Research Laboratory, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
- CIBERDEM, Madrid, Spain
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Aceña Á, Pello AM, Carda R, Lorenzo Ó, Gonzalez-Casaus ML, Blanco-Colio LM, Martín-Ventura JL, Palfy J, Orejas M, Rábago R, Gonzalez-Parra E, Mahíllo-Fernández I, Farré J, Egido J, Tuñón J. Parathormone Levels Are Independently Associated with the Presence of Left Ventricular Hypertrophy in Patients with Coronary Artery Disease. J Nutr Health Aging 2016; 20:659-64. [PMID: 27273357 DOI: 10.1007/s12603-015-0649-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Abnormalities of mineral metabolism and inflammation may affect the cardiovascular system. We have assessed the relationship of left ventricular hypertrophy (LVH) with inflammation and mineral metabolism. METHODS LVH was measured in 146 outpatients with stable coronary artery disease (SCAD) using echocardiography. Calcidiol (a vitamin D metabolite), parathyroid hormone (PTH), fibroblast growth factor-23, high-sensitivity C-reactive protein, MCP-1 (monocyte chemoattractant protein-1), galectin-3, NGAL (neutrophil gelatinase-associated lipocalin), and sTWEAK (soluble TNF-related weak inducer of apoptosis) plasma levels were studied. RESULTS LVH, defined as septal thickness ≥11 mm, was present in 19.9% of cases. These patients were older [75.0 (61.0-81.0) vs 64.0 (51.0-76.0) years; p=0.002], had higher prevalence of left ventricular ejection fraction (LVEF)>40%, and had higher PTH [84.7 (59.6-104.7) vs 63.2 (49.2-85.2) pg/ml; p=0.007], galectin-3 [9.6 (8.0-11.1) vs 8.3 (6.9-9.9) ng/ml; p=0.037], and NGAL (208.5±87.6 vs 173.9±73.4 ng/ml; p=0.031) plasma levels than those without LVH. Glomerular filtration rate was lower in patients with LVH than in those without it (65.1±20.0 vs 74.7±19.9 mL/min/1.73 m2; p=0.021). There were no significant differences in hypertension (79.3 vs 68.4%; p=0.363) or sex between both groups. Variables showing differences based on univariate analysis and hypertension were entered into a logistic regression analysis. Only age [odds ratio (OR) =1.052 (1.011-1.096); p=0.013], PTH plasma levels [OR=1.017 (1.003-1.031); p=0.021], and LVEF>40% [OR=7.595 (1.463-39.429); p=0.016] were independent predictors of LVH. CONCLUSIONS In patients with SCAD, elevated PTH levels are independently associated with the presence of LVH. Further studies are needed to elucidate the role of PTH in the development of myocardial hypertrophy.
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Affiliation(s)
- Á Aceña
- José Tuñón, Department of Cardiology, IIS-Fundación Jiménez Díaz-UAM, Avenida Reyes Católicos 2, 28040 Madrid, Spain, , Phone: 00-34-915504800 Ext-3701, Fax 00-34-915504904
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