1
|
Patras R, Georgiopoulos G, Petropoulos I, Theodorakakou F, Delialis D, Angelidakis L, Gavriatopoulou M, Dimopoulou MA, Sianis A, Maneta E, Neofytou O, Terpos E, Dimopoulos MA, Kastritis E, Stamatelopoulos K. Sustained vasodilation after cold pressor test is an independent predictor of poor survival in primary AL amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1790] [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: 11/14/2022] Open
Abstract
Abstract
Background
Primary AL amyloidosis is a rare yet lethal systemic disorder. Dysfunction of the autonomous nervous system due to disease-related nerve infiltration is a common manifestation of AL amyloidosis. Previously published own work indicated that AL patients present sustained paradoxical vasodilation in response to sympathetic stimulus, as assessed by cold pressor test (CPT). The clinical relevance of this finding is unknown.
Purpose
We sought to investigate the relationship between CPT-induced vascular response and mortality in AL amyloidosis.
Methods
We consecutively recruited 97 newly diagnosed patients with AL amyloidosis. CPT of the brachial artery was performed before treatment initiation. All measurements were assessed using high resolution ultrasonography (14.0Mhz multifrequency linear array probe, Vivid 7 Pro; General Electric Healthcare, Milwaukee, Wisconsin, USA). The maximum vasodilation of the brachial artery was measured during the sympathetic stimulus and 3 minutes after withdrawal (sustained response). All-cause mortality was defined as the primary end-point of the study.
Results
Mean age was 66 years with prevalence of male gender. Sustained vasodilation (but not vasodilation during CPT) was associated with heart failure, NYHA stage, BNP and peripheral vascular involvement (p<0.05 for all). Sustained vasodilation after withdrawal of the sympathetic stimulus was significantly associated with mortality as assessed by Cox regression analysis (HR: 1.149, 95% CI 1.042–1.269, p=0.005). This association remained significant after adjustment for age, sex, systolic blood pressure (SBP), nerve involvement and Mayo stage (HR: 1.123, 95% CI 1.014–1.243, p=0.026). A sustained vasodilation ≥3.35% from pre-stimulus diameter was associated with shorter survival (log-rank test, p=0.022, Figure 1). No association between vasodilation during sympathetic stress and mortality was observed.
Conclusions
In AL amyloidosis, sustained paradoxical vasodilation in response to sympathetic stimulus was associated with poor survival. The clinical utility of this index of vascular autonomic dysfunction as a potential prognostic and therapeutic biomarker in AL amyloidosis merits further investigation.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- R Patras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - F Theodorakakou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M Gavriatopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M A Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - O Neofytou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Terpos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M A Dimopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Kastritis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| |
Collapse
|
2
|
Simistiras A, Delialis D, Georgiopoulos G, Bampatsias D, Maneta E, Dimoula A, Petropoulos I, Neofytou O, Oikonomou E, Kontogiannis C, Ioannou S, Miliotou A, Kanakakis I, Evangelou E, Stamatelopoulos K. Lp(a) is not associated with arterial stiffness: a Mendelian randomization study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2310] [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: 11/14/2022] Open
Abstract
Abstract
Background
Deeper understanding of the potential causal relationship between Lp(a) and vascular injury will provide further insight to related pathways to be monitored and targeted by emerging treatments. Accumulating evidence supports the causal association of lipoprotein(a) [Lp(a)] with cardiovascular disease and calcific aortic valve disease (AVD). Arterial stiffening is mechanistically linked with cardiovascular disease and AVD severity. We hypothesized that Lp(a) may be causally associated with pulse-wave velocity (PWV) as the gold-standard marker of arterial stiffness.
Aim
To investigate the potential causal association of Lp(a) levels with PWV.
Methods
We performed a two sample Mendelian randomization (MR) analysis of LP(a) on PWV by combining the summary data of two independent Genetic-Wide Association Study (GWASs). Genetic variants associated with Lp(a) were retrieved from the UK Biobank (N=220,497). A GWAS based on a cohort in Germany (N=7,000) was used to obtain genetic associations for PWV index (outcome). We assessed two different measures of arterial stiffness, brachial ankle (baPWV) and carotid femoral pulse (cfPWV) wave velocity. In total, we used 170 SNPs as Instrument Variables (IV's) and applied a two sample MR with the main technique of Inverse Variance Weighting method (IVW). We conducted sensitivity analyses (MR-Egger and Median based) to detect pleiotropy of the causal variants and to test for robustness of our findings.
Results
Our analyses based on all 170 SNP's did not find evidence for causal relationship between Lp(a) and PWV for neither measurement [bivw (baPWV) = −0.0005, CI (−0.0043, 0.0034), P=0.8 and bivw (cfPWV) = −0.006, CI (−0.013, 0.002), P=0.16 for brachial ankle and carotid-femoral PWV, respectively]. Sensitivity analyses, including weighted median and mode-based estimation, did not show significant association of Lp (a) with neither baPWV nor cfPWV.
Conclusions
Lp(a) is not causally associated with arterial stiffness. These findings suggest that arterial stiffening is not involved Lp(a)-mediated cardiovascular and aortic valve disease.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Simistiras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Dimoula
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - O Neofytou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Oikonomou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - C Kontogiannis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - S Ioannou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Miliotou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Evangelou
- University of Ioannina Medical School, Department of Hygiene and Epidemiology , Ioannina , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| |
Collapse
|
3
|
Mavraganis G, Georgiopoulos G, Sakelliou A, Delialis D, Patras R, Sianis A, Dimopoulou AM, Oikonomou E, Athanasopoulos S, Kanakakis I, Fatouros I, Mitrakou A, Stamatelopoulos K. Protective effect of N-acetyl cysteine on vascular function of young individuals after a bout of resistance exercise: a randomized placebo-controlled study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2450] [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
High intensity resistance exercise may temporarily induce vascular dysfunction mediated by pro-oxidant and pro-inflammatory pathways. Whether antioxidant supplements ameliorate this dysfunction has not been clarified.
Purpose
In the present study we aimed to evaluate the effect of the antioxidant N-acetyl cysteine (NAC) on vascular function after a bout of high-intensity resistance exercise in healthy young individuals.
Methods
In this randomized, cross-over, placebo-controlled study, ten healthy male volunteers (mean age 24.2±2.1 years) who exercised regularly were randomized to a daily oral administration of NAC or placebo during an 8-day recovery after an acute intense eccentric exercise protocol. In order to estimate changes in vascular parameters of interest -pulse wave velocity (PWV) and flow-mediated dilation (FMD)-, measurements were performed pre-exercise and across 6 pre-specified time points post-exercise (from 2 to 120 hours) in both arms. Blood samples were collected at baseline, immediately after exercise, 2 hours after exercise, and daily for eight consecutive days thereafter for the measurement of cellular components of the immune system.
Results
Muscle exercise induced a significant decrease in FMD in the placebo arm (F=2.74, p=0.017). This phenomenon was evident until 48 hours after exercise while FMD progressively returned to baseline values thereafter. In contrast, in the NAC arm, FMD did not decrease significantly (p>0.05 for all time-points). By linear mixed model analysis, a higher increase in CD4 cells levels correlated with preserved FMD (coefficient=0.025, p=0.046) in the placebo arm whereas this association was not significant (coefficient=0.004, p=0.811) in the NAC arm. PWV did not present significant fluctuations before and after exercise in either arm (p>0.05 for all comparisons).
Conclusion
A bout of eccentric exercise in young regularly training individuals induced endothelial dysfunction peaking at 48 hours, possibly partly mediated by an attenuated CD4 response. NAC exerted protective action on FMD, indicating that oxidative stress may be implicated in vivo in this setting.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sakelliou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Oikonomou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - S Athanasopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Fatouros
- University of Thessaly, School of Physical Education and Sport Sciences , Trikala , Greece
| | - A Mitrakou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| |
Collapse
|
4
|
Delialis D, Mavraganis G, Dimoula A, Ajdini E, Bampatsias D, Dimopoulou AM, Sianis A, Maneta E, Neofytou O, Petropoulos I, Konstantinou G, Misegiannidis A, Kokras N, Stamatelopoulos K, Georgiopoulos G. A systematic review and meta-analysis on the effect of selective serotonin reuptake inhibitors on endothelial function. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2630] [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: 11/14/2022] Open
Abstract
Abstract
Background
Depression and atherosclerotic cardiovascular disease (ASCVD) are commonly clustered in affected patients. Endothelial dysfunction is an early marker of ASCVD while also reported in patients with depression. Emerging evidence suggests that selective serotonin receptor inhibitors (SSRIs) may improve endothelial function. However, clinical studies assessing flow-mediated dilation (FMD), the gold-standard method to evaluate conduit artery endothelial function, in response to SSRIs treatment included limited number of patients and did not provide consistent results.
Purpose
In the present study we aim to evaluate the effect of SSRIs treatment on endothelial function assessed by longitudinal changes in FMD.
Methods
We performed a systematic review to retrieve and subsequently meta-analyze eligible studies in patients with depression who received SSRIs and had available measurements of FMD change before and after treatment.
Results
In 5 studies and 323 individuals in total, SSRIs were associated with increased FMD at the end of follow-up compared to baseline measurement (pooled mean change 1.97%, 95% CI 0.17, 3.77, P=0.032, I2=87.4%). These results did not substantially change when analysis was restricted to patients with history of atherosclerotic cardiovascular disease (ASCVD). Similarly, FMD changes were higher in individuals receiving SSRIs compared to not-treated subjects (pooled mean difference 2.5%. 95% CI 0.7, 4.2, P<0.001, I2=82.7%). Substantial heterogeneity regarding with respect to follow-up duration, demographics, and SSRIs agents.
Conclusion
SSRIs significantly improve FMD, the gold-standard marker of endothelial function. Further investigation is warranted for the role of FMD as a possible therapeutic biomarker in patients with depression and established or subclinical ASCVD.
Prospero registration: CRD42021252241
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Dimoula
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Ajdini
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - O Neofytou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Konstantinou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Misegiannidis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - N Kokras
- National & Kapodistrian University of Athens , Athens , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| |
Collapse
|
5
|
Mavraganis G, Georgiopoulos G, Delialis D, Aivalioti E, Patras R, Petropoulos I, Dimopoulou AM, Angelidakis L, Sianis A, Bampatsias D, Dimoula A, Maneta E, Kosmopoulos M, Stellos K, Stamatelopoulos K. Carotid ultrasonography improves residual risk stratification in guidelines-defined high cardiovascular risk patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The clinical value of carotid atherosclerosis markers for residual risk stratification in high atherosclerotic cardiovascular disease (ASCVD) risk patients is not established.
Purpose
In the present study we aimed to derive and validate optimal values of markers of carotid subclinical atherosclerosis improving risk stratification in guidelines-defined high ASCVD risk patients.
Methods
We consecutively analysed high or very high ASCVD risk patients from a cardiovascular (CV) prevention registry (n=751, derivation cohort) and from the Atherosclerosis Risk in Communities (ARIC) study (n=2,897, validation cohort). Baseline ASCVD risk was defined using the 2021 European Society of Cardiology (ESC) guidelines (clinical ESCrisk). Intima-media thickness (IMT) excluding plaque, average maximal (avg.maxWT), maximal wall thickness (maxWT) and number of sites with carotid plaque were assessed. As endpoint of the study was defined the composite of CV death, acute myocardial infarction (MI) and revascularization after a median of 3.4 years in both cohorts and additionally for 16.7 years in the ARIC cohort.
Results
MaxWT >2.00mm and avg.maxWT >1.39mm provided incremental prognostic value, improved discrimination and correctly reclassified risk over the clinical ESCrisk both in the derivation and the validation cohort (p<0.05 for net reclassification index, integrated discrimination index and Delta Harrell's C index). MaxWT <0.9mm predicted very low probability of CV events (negative predictive value = 97% and 92% in the derivation and validation cohort, respectively). These findings were additionally confirmed for very long-term events in the validation cohort.
Conclusion
Integration of carotid ultrasonography in guidelines-defined risk stratification may identify very high risk patients in need for further residual risk reduction or at very low probability
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Dimoula
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M Kosmopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - K Stellos
- University of Heidelberg , Heidelberg , Germany
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| |
Collapse
|
6
|
Karagkouni I, Delialis D, Yannakoulia M, Armeni E, Papavangelis C, Augoulea A, Mavraganis G, Bampatsias D, Panoulis K, Aravantinos L, Panoskaltsis T, Stamatelopoulos K, Lambrinoudaki I. Dietary patterns are associated with arterial stiffness and carotid atherosclerosis in postmenopausal women. Endocrine 2022; 78:57-67. [PMID: 36038695 PMCID: PMC9423695 DOI: 10.1007/s12020-022-03152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The increase in cardiovascular risk after the menopausal transition remains partly explained until today. Further research is needed to identify risk factors potentially modifiable by primary prevention practices. This cross-sectional study, part of a larger prospective project, aims to investigate possible associations between dietary patterns and indices of vascular structure and function among healthy postmenopausal women. METHODS Postmenopausal women (n = 310) without clinically overt cardiovascular disease were recruited consecutively from a University Menopause Clinic over three years. Dietary intake was assessed by a validated food frequency questionnaire and the MedDietScore. In addition, we assessed anthropometric/biochemical parameters, including the Triglyceride-glucose index (TyG-Index), body fat distribution [triceps skinfold (TSF), mid-upper arm circumference (MUAC)] and physical activity. The vascular assessment included carotid-femoral pulse wave velocity (PWV), carotid and femoral-artery intima-media thickness (IMT) and atheromatous plaques presence. RESULTS Consumption of non-refined cereals was associated with carotid-bulb IMT (R2 = 5.5% b-coefficient = -0.142; p = 0.011), adjusting for age, physical activity, lipids, systolic blood pressure, smoking, body mass index, insulin resistance, and daily energy intake. PWV was associated with the intake of total dairy products (R2 = 27.3%, b-coefficient = -0.117; p = 0.017). Higher red meat consumption was related to a greater TyG-index (Model 1, R2 = 14.3%, b-coefficient=0.121; p = 0.048), an association mediated by total daily energy intake. Higher consumption of alcohol, as well as the MedDietScore, were inversely associated with TSF measurements, significant after Bonferroni correction. CONCLUSION Dietary patterns are associated with metabolic indices and subclinical atherosclerosis in postmenopausal women independently of traditional cardiovascular risk factors, total energy intake or physical activity.
Collapse
Affiliation(s)
- Iliana Karagkouni
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Dimitris Delialis
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Eleni Armeni
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Christos Papavangelis
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Areti Augoulea
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Georgios Mavraganis
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Bampatsias
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Panoulis
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Leon Aravantinos
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Theodoros Panoskaltsis
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Kimon Stamatelopoulos
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
7
|
Bampatsias D, Mavroeidis I, Tual-Chalot S, Vlachogiannis NL, Bonini F, Sachse M, Mavraganis G, Mareti A, Kritsioti C, Laina A, Delialis D, Ciliberti G, Sopova K, Gatsiou A, Martelli F, Georgiopoulos G, Stellos K, Stamatelopoulos K. Beta-secretase-1 antisense RNA is associated with vascular ageing and atherosclerotic cardiovascular disease. Thromb Haemost 2022; 122:1932-1942. [PMID: 35915966 PMCID: PMC9626031 DOI: 10.1055/a-1914-2094] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background
The noncoding antisense transcript for β-secretase-1 (
BACE1-AS
) is a long noncoding RNA with a pivotal role in the regulation of amyloid-β (Aβ). We aimed to explore the clinical value of
BACE1-AS
expression in atherosclerotic cardiovascular disease (ASCVD).
Methods
Expression of
BACE1-AS
and its target, β-secretase 1 (
BACE1
) mRNA, was measured in peripheral blood mononuclear cells derived from 434 individuals (259 without established ASCVD [non-CVD], 90 with stable coronary artery disease [CAD], and 85 with acute coronary syndrome). Intima-media thickness and atheromatous plaques evaluated by ultrasonography, as well as arterial wave reflections and pulse wave velocity, were measured as markers of subclinical ASCVD. Patients were followed for a median of 52 months for major adverse cardiovascular events (MACE).
Results
In the cross-sectional arm,
BACE1-AS
expression correlated with
BACE1
expression (
r
= 0.396,
p
< 0.001) and marginally with Aβ1–40 levels in plasma (
r
= 0.141,
p
= 0.008). Higher
BACE1-AS
was associated with higher estimated CVD risk assessed by HeartScore for non-CVD subjects and by European Society of Cardiology clinical criteria for the total population (
p
< 0.05 for both).
BACE1-AS
was associated with higher prevalence of CAD (odds ratio [OR] = 1.85, 95% confidence interval [CI]: 1.37–2.5), multivessel CAD (OR = 1.36, 95% CI: 1.06–1.75), and with higher number of diseased vascular beds (OR = 1.31, 95% CI: 1.07–1.61, for multiple diseased vascular beds) after multivariable adjustment for traditional cardiovascular risk factors. In the prospective arm,
BACE1-AS
was an independent predictor of MACE in high cardiovascular risk patients (adjusted hazard ratio = 1.86 per ascending tertile, 95% CI: 1.011–3.43,
p
= 0.046).
Conclusion
BACE1-AS
is associated with the incidence and severity of ASCVD.
Collapse
Affiliation(s)
- Dimitrios Bampatsias
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Ioannis Mavroeidis
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Simon Tual-Chalot
- Institute of Bioscience, Vascular Biology and Medicine Theme, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Nikolaos L Vlachogiannis
- Biosciences Institute, Vascular Biology and Medicine Theme, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Francesca Bonini
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Marco Sachse
- Department of Cardiovascular Research, Goethe University Frankfurt Faculty 16 Medicine, Frankfurt am Main, Germany.,Department of Cardiovascular Research, European Center for Angioscience (ECAS), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Georgios Mavraganis
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens Aiginitio Hospital, Athens, Greece
| | - Alexia Mareti
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysoula Kritsioti
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ageliki Laina
- Alexandra University Hospital, Department of Clinical Therapeutics,, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Delialis
- National and Kapodistrian University of Athens School of Medicine Therapeutic Clinic, Athens, Greece
| | - Giorgia Ciliberti
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Kateryna Sopova
- Faculty of Medical Sciences, Newcastle University, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Aikaterini Gatsiou
- , Biosciences Institute, Vascular Biology and Medicine Theme, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Fabio Martelli
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Georgios Georgiopoulos
- National and Kapodistrian University of Athens School of Medicine Therapeutic Clinic, Athens, Greece
| | - Konstantinos Stellos
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany.,Department of Cardiology, Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany.,Biosciences Institute, Vascular Biology and Medicine Theme, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Kimon Stamatelopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.,Vascular Biology and Medicine Theme, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
8
|
Stamatelopoulos K, Delialis D, Bampatsias D, Tselegkidi ME, Petropoulos I, Theodorakakou F, Gavriatopoulou M, Patras R, Pamboucas C, Kanakakis J, Ikonomidis I, Terpos E, Trougakos IP, Dimopoulos MA, Kastritis E. Peripheral vascular involvement in transthyretin cardiac amyloidosis. A comparative analysis with AL amyloidosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1798] [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
The pattern of peripheral vascular involvement in the wild type transthyretin-related cardiac amyloidosis (ATTRwt) and its diagnostic utility in differentiating this infiltrating cardiomyopathy from light chain (AL) cardiac amyloidosis (AL-CA) and heart failure with preserved ejection fraction (HFpEF) of different origin have not been explored.
Aims
To characterize the pattern of peripheral vascular involvement in ATTRwt and evaluate its value in differentiating ATTRwt from AL-CA and HFpEF.
Methods
Newly diagnosed patients with ATTRwt (n=42) were consecutively recruited from our amyloidosis center. These patients were matched 1:1 for age and sex to patients with AL-CA (n=32) and subjects without amyloidosis (n=32) and also matched 2:1 to HFpEF patients (n=16). All subjects underwent a series of non-invasive vascular examinations for the assessment of: 1. subclinical carotid atherosclerosis with B-mode ultrasonography, 2. Arterial stiffness with measurement of carotid-femoral pulse wave velocity, 3. Reactive vasodilation with flow-mediated dilation (FMD) and 4. Aortic blood pressures and arterial wave reflections with augmentation index (AI) and return time of reflected wave (Tr).
Results
ATTRwt patients had lower peripheral (pBP) and aortic blood pressure (aBP) markers compared to non-AL controls (p<0.05 for all). ATTRwt grouping was an independent determinant of these markers, after adjustment for cardiovascular risk factors (CVRF), including history of hypertension, hyperlipidemia and diabetes, glomerular filtration rate, body mass index and smoking status (core model). ATTRwt had lower aDBP and increased Tr compared to AL subjects. In a comparison between ATTRwt and AL patients with cardiac involvement, AI and Tr were higher and FMD lower in ATTRwt patients. ATTRwt was an independent determinant of these markers, after adjustment for the core model (p<0.05 for all). Compared to HFpEF, patients with ATTRwt had lower peripheral and central BP and higher Tr (p<0.05 for all). By ROC analysis, Tr provided high diagnostic value for ATTRwt vs. AL-CA (Area Under the Curve, AUC=0.809, CI: 0.65–0.96) and for ATTRwt vs combined AL-CA and HFpEF (AUC=0.880, CI: 0.79–0.97). Finally, AI was closely correlated with posterior (Spearman's Rho=−0.30) and intraventricular wall thickness (Rho=−0.329) and left ventricular global longitudinal strain (Rho=−0.4) and lower cDBP with higher Gilmore and New York Heart Association stage (p<0.05).
Conclusion
ATTRwt patients present differential characteristics of peripheral vascular function and aortic hemodynamics as compared to AL, HFpEF and healthy controls. The clinical value of these characteristics merit further investigation since differential diagnosis among amyloidosis types is clinically challenging, while it may have prognostic implications.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M E Tselegkidi
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - F Theodorakakou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M Gavriatopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - C Pamboucas
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - J Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Ikonomidis
- Attikon University Hospital, Second Cardiology Department, Athens, Greece
| | - E Terpos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I P Trougakos
- National & Kapodistrian University of Athens, Department of Cell Biology and Biophysics, Faculty of Biology, Athens, Greece
| | - M A Dimopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Kastritis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| |
Collapse
|
9
|
Delialis D, Aivalioti E, Mavraganis G, Dimopoulou AM, Sianis A, Angelidakis L, Patras R, Petropoulos I, Ioannou S, Syrigou R, Kanakakis J, Georgiopoulos G, Stellos K, Stamatelopoulos K. Remnant cholesterol is an independent determinant of the presence and extent of subclinical carotid atherosclerosis in statin-naive individuals. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite continuous improvements of diagnostic and therapeutic algorithms for cardiovascular disease (CVD), mortality from CVD remains high suggesting unaddressed residual risk. Remnant cholesterol (RC) consists the cholesterol content of triglyceride-rich lipoproteins, which along with LDL cholesterol infiltrate the arterial wall, accumulate and cause atherosclerosis. Increased remnant cholesterol (RC) levels have been previously associated with future adverse cardiac events despite hypolipidemic therapy. However, a mechanistic association of RC levels with human atherosclerosis in vivo has not been proven in a clinical setting.
Purpose
To evaluate the association of RC levels with the presence and extend of subclinical carotid atherosclerosis.
Methods
In this retrospective cohort study, 438 subjects from the Athens Vascular Registry without clinically overt CVD or treatment with statin were recruited. Atherosclerotic burden was assessed by B-mode carotid ultrasonography using: 1. Maximal carotid wall thickness [maxWT, the highest intima-media thickness (IMT) or highest atherosclerotic plaque thickness (PLQ) if present derived from all carotid sites], 2. Total thickness (sumWT, sum of maximal wall thickness), 3) high plaque burden (PLQ ≥2) and 4) average carotid IMT (avgIMT). RC was calculated using the formula RC=total cholesterol-LDL-C-HDL-C.
Results
Mean (SD) age was 54.8±12.4 years old with 41% being males. Subjects with RC>median (=18mg/dl) had higher sumWT (6.12±0.7 vs 5.57±1.7, p=0.002), maxWT (1.61±0.7 vs 1.43±0.7, p=0.008) and avgIMT (0.88±0.16 vs 0.83±0.16, p=0.003) vs RC<median.>median was associated with higher odds for increased sumWT (highest tertile, OR: 2.15 95% CI 1.26–3.66, p=0.006) and maxWT (OR: 2.15 95% CI: 1.38–3.33, p=0.001), and a higher plaque burden (≥2 plaques, OR: 2.1 95% CI 1.93–3.1, p<0.001) after adjustment for age, gender and systolic blood pressure, glomerular filtration rate, smoking, diabetes mellitus, body mass index and LDL-C
Conclusion
In a statin-naive population without clinically overt CVD, increased RC levels were associated with the presence and extend of subclinical carotid atherosclerosis. These findings provide novel mechanistic insight into mechanisms associated with increased CVD risk in individuals with high RC levels.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - S Ioannou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Syrigou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - J Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - K Stellos
- Newcastle University, Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle-Upon-Tyne, United Kingdom
| | | |
Collapse
|
10
|
Mavraganis G, Georgiopoulos G, Delialis D, Aivalioti E, Dimopoulou AM, Sianis A, Angelidakis L, Patras R, Petropoulos I, Ioannou S, Syrigou R, Kanakakis J, Stellos K, Stamatelopoulos K. Clinical utility of readily available novel markers of carotid atherosclerotic burden for reclassification and discrimination of very high cardiovascular risk. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Among high cardiovascular (CV) risk patients, there is emerging need to recognize those who will benefit from new treatments targeting residual risk. Readily available modalities providing reclassification value would be clinically useful in this setting. Preliminary data suggest that carotid ultrasonography using plaque burden but not intima-media thickness (IMT) is associated with very high risk.
Objectives
We aimed to assess the reclassification ability of two markers of carotid atherosclerosis in high-risk patients, reflecting total atherosclerotic burden and the most severe lesion and to compare them with the routinely used carotid indices IMT and number of carotid plaques.
Methods
In an ongoing registry of patients who visited a cardiovascular protection clinic for cardiovascular risk assessment, we enrolled 735 consecutively recruited patients (mean age 63.1 years, 68.8% male) classified as high or very-high CV risk according to 2019 European Society of Cardiology /European Atherosclerosis Society Guidelines. Sum of carotid wall thickness (sumWT) and maximal wall thickness (maxWT) using high-resolution ultrasonography at baseline were used to assess the total burden and the most severe carotid lesion, respectively. These markers integrate maximum plaque height or maximum IMT if no plaque is present. All patients were followed for a median of 41 months and the primary end-point consisted of CV mortality, acute myocardial infarction or coronary revascularization.
Results
After adjustment for traditional CV risk factors, maxWT and sumWT were associated with the primary end-point (hazard ratio [HR]=1.73 (95% confidence interval [CI]:1.39 to 2.17) and 1.19 (95% CI 1.10 to 1.30) respectively). Both markers were superior in terms of reclassification and discrimination to identify very high risk over validated CV risk scores including the Heartscore and the SMART score (net reclassification index [NRI]=0.624, p<0.0001, integrated discrimination index [IDI]=0.060, p<0.0001 and difference in the area under the curve (δAUC) = 0.136, p<0.001 for maxWT and NRI=0.497, p<0.0001, IDI=0.046, p<0.0001 and δAUC = 0.128, p<0.001 for sumWT), IMT (NRI=0.502, p<0.0001, IDI= 0.058, p=0.02 for maxWT and NRI=0.559, p<0.0001, IDI=0.051, p=0.016 for sumWT) and the number of carotid plaques (NRI=0.614, p<0.0001, IDI=0.038, p=0.001 for maxWT and NRI=0.292, p=0.019, IDI=0.022, p=0.009 for sumWT).
Conclusions
The use of two novel cumulative markers of atherosclerotic burden improves risk stratification and discriminates high from very high CV risk. Given that carotid ultrasonography is a readily available modality, its clinical application for risk refinement of high-risk patients to facilitate treatment decisions merits further investigation.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - S Ioannou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Syrigou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - J Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - K Stellos
- Newcastle University, Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle-Upon-Tyne, United Kingdom
| | | |
Collapse
|
11
|
Terpos E, Stamatelopoulos K, Makris N, Georgiopoulos G, Ntanasis-Stathopoulos I, Gavriatopoulou M, Laina A, Eleutherakis-Papaiakovou E, Fotiou D, Kanellias N, Malandrakis P, Delialis D, Andreadou I, Kastritis E, Dimopoulos MA. Daratumumab May Attenuate Cardiac Dysfunction Related to Carfilzomib in Patients with Relapsed/Refractory Multiple Myeloma: A Prospective Study. Cancers (Basel) 2021; 13:cancers13205057. [PMID: 34680206 PMCID: PMC8533991 DOI: 10.3390/cancers13205057] [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: 09/13/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary The management of cardiovascular adverse events in patients with relapsed/refractory multiple myeloma undergoing treatment with carfilzomib can be challenging. Herein, we evaluated the potential cardioprotective effect of daratumumab when administered in combination with carfilzomib and dexamethasone (DaraKd). The study included 25 patients receiving either DaraKd (n = 14) or Kd (n = 11) who were evaluated for echocardiographic changes at the sixth cycle of treatment compared with baseline assessment. DaraKd was associated with preserved post-treatment cardiac systolic function compared with Kd. CD38 inhibition by daratumumab might restore metabolic disequilibrium in the cardiac tissue and prevent cardiac injury. A trend for a lower rate of cardiovascular adverse events among patients receiving DaraKd was also evident, although larger studies are needed to determine the association between echocardiographic and/or biomarker changes with cardiovascular adverse events. Abstract Carfilzomib has improved survival in patients with relapsed/refractory multiple myeloma (RRMM), but it may exert cardiovascular adverse events (CVAEs). The aim of this study was to assess whether treatment with daratumumab may ameliorate carfilzomib-related toxicity. We prospectively evaluated 25 patients with RRMM who received either daratumumab in combination with carfilzomib and dexamethasone (DaraKd) (n = 14) or Kd (n = 11). Cardiac ultrasound was performed before treatment initiation and C6D16 or at the time of treatment interruption. Patients were followed for a median of 10 months for CVAEs. The mean (± SD) age was 67.8 ± 7.6 years and 60% were men. The two treatment groups did not significantly differ in baseline demographic characteristics (p > 0.1 for all). In the DaraKd group, we did not observe any significant change in markers of ventricular systolic function. However, these markers deteriorated in the Kd group; left ventricular (LV) ejection fraction, LV global longitudinal strain, tricuspid annular plane systolic excursion and RV free wall longitudinal strain significantly decreased from baseline to second visit (p < 0.05). A significant group interaction (p < 0.05) was observed for the abovementioned changes. CVAEs occurred more frequently in the Kd than the DaraKd group (45% vs. 28.6%). DaraKd was associated with preserved post-treatment cardiac systolic function and lower CVAE rate compared with Kd. The clinical significance and the underlying mechanisms merit further investigation.
Collapse
Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
- Correspondence:
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Nikolaos Makris
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Ageliki Laina
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Evangelos Eleutherakis-Papaiakovou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Despina Fotiou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Nikolaos Kanellias
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Panagiotis Malandrakis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Dimitris Delialis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Ioanna Andreadou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, 15771 Athens, Greece;
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (K.S.); (N.M.); (G.G.); (I.N.-S.); (M.G.); (A.L.); (E.E.-P.); (D.F.); (N.K.); (P.M.); (D.D.); (E.K.); (M.A.D.)
| |
Collapse
|
12
|
Delialis D, Lamprinoudaki I, Stergiotis S, Patras R, Chatzivasileiou P, Augoulea A, Anagnostis P, Armeni E, Rizos D, Kaparos G, Alexandrou A, Georgiopoulos G, Kontogiannis C, Fotellis D, Stamatelopoulos K. Anti-Mullerian hormone concentrations are inversely associated with subclinical atherosclerosis in premenopausal women. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Anti-Müllerian hormone (AMH) constitutes a marker of ovarian reserve and appears to have a predictive role regarding the time of menopause. Moreover, AMH is associated with adverse cardiac events. History of premature menopause and early onset of menopause have been associated with increased risk of cardiovascular (CV) disease. In addition, menopausal transition and duration of menopause have been associated with increased burden of subclinical atherosclerosis. However, the association between AMH as a marker of female reproductive age with atherosclerosis in premenopausal women is currently unknown.
Purpose
To investigate whether AMH concentrations are associated with markers of early atherosclerosis in healthy, normally menstruating women.
Methods
In a cross-sectional study, vascular structure and function were assessed by measurement of carotid and femoral intima-media thickness (IMT), lipid profile and serum AMH concentrations were assessed. Exclusion criteria were clinically overt CV disease, abnormal ovulatory cycles, polycystic ovarian syndrome, acute infection or chronic inflammatory disease, risk factors for CV disease and any medication
Results
Seventy premenopausal women, aged 32.7±6.5 years, were included. Mean AMH levels were lower in smokers than in non-smokers and negatively associated with total cholesterol (TC) levels. An inverse association between mean AMH concentrations and IMT in all segments was observed. No correlation with other markers of subclinical atherosclerosis or traditional CV risk factors was found. After multi-variable adjustment for traditional CV risk factors, the association between AMH concentrations combined IMT and carotid bulb IMT, remained significant.
Conclusions
In healthy, normally ovulating women, low AMH concentrations are associated with an adverse lipid profile and subclinical atherosclerosis, independently of traditional CV risk factors. This finding suggest a role of decreased follicular reserve with atherosclerotic disease.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Lamprinoudaki
- Aretaieio Hospital, Department of Obstetrics and Gynecology, Athens, Greece
| | - S Stergiotis
- Aretaieio Hospital, Department of Obstetrics and Gynecology, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - P Chatzivasileiou
- Aretaieio Hospital, Department of Obstetrics and Gynecology, Athens, Greece
| | - A Augoulea
- Aretaieio Hospital, Department of Obstetrics and Gynecology, Athens, Greece
| | - P Anagnostis
- Aristotle University of Thessaloniki, Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynaecology, Medical School, Thessaloniki, Greece
| | - E Armeni
- Aretaieio Hospital, Department of Obstetrics and Gynecology, Athens, Greece
| | - D Rizos
- Aretaieio Hospital, Hormonal and Biochemical Laboratory, Athens, Greece
| | - G Kaparos
- Aretaieio Hospital, Hormonal and Biochemical Laboratory, Athens, Greece
| | - A Alexandrou
- Aretaieio Hospital, Department of Obstetrics and Gynecology, Athens, Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - C Kontogiannis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - D Fotellis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| |
Collapse
|
13
|
Stamatelopoulos K, Delialis D, Bampatsias D, Tselegkidi M, Petropoulos I, Roussou M, Gavriatopoulou M, Aivalioti E, Patras R, Pamboucas C, Kanakakis I, Terpos E, Trougakos I, Dimopoulos M, Kastritis E. Characterization and clinical implications of peripheral arterial involvement in transthyretin cardiac amyloidosis cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3247] [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: 11/14/2022] Open
Abstract
Abstract
Background
The sporadic form of transthyretin amyloidosis cardiomyopathy (ATTR-CM) is underdiagnosed but its prevalence is increasing due to the aging population. Given the poor prognosis of ATTR-CM understanding the underlying pathophysiologic mechanisms of the disease is imperative in order to improve strategies for early diagnosis and risk stratification and to develop new effective therapeutic options. ATTR-CM is associated with hypotension and there is preliminary experimental evidence of vascular involvement but its presence and clinical significance remains unknown.
Purpose
To characterize peripheral arterial involvement and explore its clinical role in ATTR-CM.
Methods
We consecutively recruited 28 previously untreated patients with newly diagnosed ATTR-CM and 34 elderly controls >70 years old, without ATTR-CM or heart failure. In both groups, flow-mediated dilatation (FMD) and intima-media thickness (IMT) in the carotid arteries were measured by high-resolution ultrasonography as markers of peripheral vascular reactivity and of subclinical atherosclerosis, respectively. Carotid-femoral pulse wave velocity (PWV) was measured as a marker of arterial stiffness. Aortic blood pressure (BP) and augmentation index (AI) using applanation tonometry were measured as markers of arterial wave reflections, peripheral arterial resistance and central hemodynamics. Echocardiography was performed in all ATTR patients. All cardiovascular (CV) measurements were performed before administration of any ATTR-specific therapy.
Results
ATTR patients were older and had lower prevalence of hypertension and male gender (p<0.05 for all) than the control group. Aortic and peripheral BP (p=0.016–0.088) and AI (p=0.003) were lower in ATTR patients. IMT in the common (cc) and internal carotid (ic) as well as in the carotid bulb (cb) were significantly higher in ATTR patients (p=0.001–0.042). After multivariable adjustment for traditional CV disease (CVD) risk factors, the ATTR group was independently associated with AI and IMT in cc, cb and ic (p<0.05 for all). In a subgroup of subjects with similar age between groups (n=13 and n=33 and 74.5±2.9 vs. 75.6±3.6 years, for ATTR vs. controls, respectively) differences in AI and cbIMT remained significant. Interestingly, AI was strongly and inversely associated with interventricular wall thickness (IVwt) in ATTR patients (spearman rho=−0.651, p=0.001). After adjustment for traditional CVD risk factors this association remained significant.
Conclusion
ATTR-CM is associated with lower aortic wave reflections, which correlate with more advanced structural cardiac disease, as assessed by IVwt. Further, ATTR-CM patients present accelerated subclinical carotid atherosclerosis as compared to elderly control subjects. These findings suggest that in ATTR-CM there is disease-specific peripheral vascular involvement in parallel to cardiac involvement. The clinical significance of these findings merits further investigation.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M.E Tselegkidi
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M Roussou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M Gavriatopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - C Pamboucas
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Terpos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I.P Trougakos
- National & Kapodistrian University of Athens, Laboratory of Pharmacology,, Athens, Greece
| | - M.A Dimopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Kastritis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| |
Collapse
|
14
|
Stamatelopoulos K, Tsoltos N, Armeni E, Paschou SA, Augoulea A, Kaparos G, Rizos D, Karagouni I, Delialis D, Ioannou S, Apostolakis M, Makrakis E, Lambrinoudaki I. Physical activity is associated with lower arterial stiffness in normal‐weight postmenopausal women. J Clin Hypertens (Greenwich) 2020; 22:1682-1690. [DOI: 10.1111/jch.13954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/15/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Kimon Stamatelopoulos
- Vascular Laboratory Department of Therapeutics Alexandra Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Nikolaos Tsoltos
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Stavroula A. Paschou
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Areti Augoulea
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Georgios Kaparos
- Hormonal and Biochemical Laboratory Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Demetrios Rizos
- Hormonal and Biochemical Laboratory Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Iliana Karagouni
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Dimitris Delialis
- Vascular Laboratory Department of Therapeutics Alexandra Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Sophia Ioannou
- Vascular Laboratory Department of Therapeutics Alexandra Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Michail Apostolakis
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Evangelos Makrakis
- Third Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| |
Collapse
|
15
|
Mareti A, Kritsioti C, Georgiopoulos G, Vlachogiannis NI, Delialis D, Sachse M, Sopova K, Koutsoukis A, Kontogiannis C, Patras R, Tual-Chalot S, Koureas A, Gatsiou A, Stellos K, Stamatelopoulos K. Cathepsin B expression is associated with arterial stiffening and atherosclerotic vascular disease. Eur J Prev Cardiol 2019; 27:2288-2291. [PMID: 31801046 DOI: 10.1177/2047487319893042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/16/2022]
Affiliation(s)
- Alexia Mareti
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Chrysoula Kritsioti
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Nikolaos I Vlachogiannis
- Cardiovascular Disease Prevention Hub, Cardiovascular Research Theme Vascular Biology and Medicine, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dimitris Delialis
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Marco Sachse
- Medical School, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kateryna Sopova
- Cardiovascular Disease Prevention Hub, Cardiovascular Research Theme Vascular Biology and Medicine, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Athanasios Koutsoukis
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Christos Kontogiannis
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Simon Tual-Chalot
- Cardiovascular Disease Prevention Hub, Cardiovascular Research Theme Vascular Biology and Medicine, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andreas Koureas
- Department of Radiology, Aretaieion Hospital, Athens University, Medical School, Athens, Greece
| | - Aikaterini Gatsiou
- Cardiovascular Disease Prevention Hub, Cardiovascular Research Theme Vascular Biology and Medicine, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Konstantinos Stellos
- Cardiovascular Disease Prevention Hub, Cardiovascular Research Theme Vascular Biology and Medicine, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece.,Cardiovascular Disease Prevention Hub, Cardiovascular Research Theme Vascular Biology and Medicine, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
16
|
Georgiopoulos G, Mavroeidis I, Sopova K, Sacshe M, Mareti A, Kritsioti C, Vlachogiannis N, Laina A, Delialis D, Mantzou E, Martelli F, Spyridopoulos K, Gatsiou A, Stellos K, Stamatelopoulos K. 265Amyloid beta 1-40 and its upstream regulatory pathway BACE1-AS long noncoding RNA/BACE1 are associated with presence and severity of human atherosclerotic disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0081] [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
Amyloid-beta (1-40) (Aβ1–40), a proinflammatory and pro-atherosclerotic peptide, is associated with accelerated atherosclerosis and major adverse cardiac events. Abeta1–40 production is mainly dependent on the cleavage of amyloid precursor protein by β-amyloid cleaving enzyme-1 (BACE1), known as beta-secretase. BACE1 antisense (BACE1-AS) is a long noncoding RNA that enhances BACE1 stability.
Objectives
To evaluate the clinical value of plasma amyloid-beta levels and its upstream regulatory pathway BACE1/BACE1-AS in patients with subclinical and established atherosclerotic cardiovascular disease.
Methods
Plasma levels of Aβ40 were measured in 642 consecutively recruited patients with and without clinically overt coronary artery disease (CAD). BACE1-AS lncRNA and BACE1 mRNA expression were measured in peripheral blood mononuclear cells derived from 214 study participants. Intima-media thickness and atheromatous plaques by ultrasonography, markers of arterial wave reflections and pulse wave velocity were used as surrogate markers of subclinical CVD. Cardiovascular risk factors (CVRFs), including impaired glomerular filtration rate (<60 ml/min), smoking, hypertension, hyperlipidemia, diabetes, obesity and increased hsCRP (>2 mg/l) were assessed as a measure of CVRF burden.
Results
Both in non-CAD (n=369) and CAD (n=273) patients, Aβ1–40 was associated with age, aortic and peripheral systolic and pulse pressure, and low GFR (p<0.05 for all). In non-CAD subjects Aβ1–40 also correlated with diabetes and low HDL. Importantly, Aβ1–40 was associated with the presence of any plaque in subjects without CAD (p=0.035) and with increased number of diseased coronary arteries (p=0.022) independently of age, gender and CVRFs. Aβ1–40 plasma levels were increased in the highest tertile of BACE1 and BACE1AS (p<0.05) while their expression levels were highly intercorrelated (r=0.825, P<0.001). BACE1 and BACE1-AS levels progressively increased across the 3 groups of non-CAD (n=145), stable CAD (n=43) and acute myocardial infarction (n=26) patients (p for trend<0.001). Among non-CAD subjects, both BACE1 and BACE1-AS were increased in individuals with >2 CVRFs. Among CAD patients, BACE1-AS was associated with decreased LVEF (<50%) (adjusted OR=1.92 per 1-SD increase, p=0.047) while BACE1 in the highest tertile was associated with 5-fold higher odds for coronary multi-vessel disease (p=0.004) after adjustment for age, gender and CVRFs.
Conclusions
Circulating Aβ1–40 and increased expression of its upstream regulators BACE1/BACE1-AS are intercorrelated and associated with the presence and severity of subclinical and clinically overt atherosclerosis. These findings suggest that BACE1-AS/BACE1-mediated increased availability of Aβ1–40 may play a pivotal role in its adverse cardiovascular effects.
Collapse
Affiliation(s)
- G Georgiopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - I Mavroeidis
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - K Sopova
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - M Sacshe
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - A Mareti
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - C Kritsioti
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | | | - A Laina
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - D Delialis
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - E Mantzou
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - F Martelli
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | | | - A Gatsiou
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - K Stellos
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - K Stamatelopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| |
Collapse
|
17
|
Delialis D, Georgiopoulos G, Sopova K, Kanakakis I, Kontogiannis C, Bampatsias D, Karapanou L, Armeni E, Augoulea A, Spyridopoulos K, Stellos K, Lamprinoudaki I, Stamatelopoulos K. P2541Plasma levels of amyloid beta 1-40 are associated with the rate of progression of carotid subclinical atherosclerosis in postmenopausal women. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0869] [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: 11/15/2022] Open
Abstract
Abstract
Background
There is increasingly recognized undetected residual cardiovascular (CV) risk in postmenopausal women, suggesting the need for new risk biomarkers in this population. We have previously shown that amyloid-beta (1–40) (Aβ1–40), a proinflammatory and pro-atherosclerotic peptide, is associated with concurrent subclinical cardiovascular disease (CVD) in the general population and with major adverse cardiac events in patients with established cardiac disease. However, the clinical value of Aβ1–40 in menopause or whether this peptide is linked with an increased rate of progression of atherosclerotic disease is unknown.
Purpose
To examine the association of Aβ1–40 levels with the rate of progression of carotid intima-media thickness (IMT) in postmenopausal women.
Methods
In the settings of a Menopause Clinic, postmenopausal women (n=140) without clinically overt CVD or diabetes were consecutively recruited and re-evaluated after a median follow-up period of 24 months. IMT in the carotid arteries was measured by ultrasonography. The average of maximal IMT (mean cIMT) measured at both left and right common carotid, carotid bulb (cb)and internal carotid (ic) artery were used as the main end-point of the analysis. Aβ1–40 was measured in plasma samples at baseline and follow up. Fasting insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR).
Results
Women with increased plasma levels Aβ1–40 in the highest tertile presented the highest probability to have increased mean cIMT (adjusted OR=2.97, 95% CI 1.18–7.52, p=0.021) independently of age, smoke, hypertension, and hyperlipidemia. After adjustment for HOMA-IR, this association remained significant. Similarly, Aβ1–40 levels were associated with increased mean cb and icIMT (adjusted OR=3.34 for highest versus lower tertile, 95% CI 1.27–8.81, p=0.015). Mean cIMT significantly increased across the follow up period (0.73mm (0.065–0.08) to 0.77mm (0.07–0.089), median increase rate per year 0.024mm, p<0.001). By multi-level linear mixed model analysis, changes in Aβ1–40 levels were associated with increased rate of progression of mean cIMT (4.1% increase per 1-SD increase, p<0.001) after adjustment for differences in follow-up duration and age, hypertension, hyperlipidemia, and smoking. When repeated measurements of HOMA-IR were also considered, this association did not materially change (p=0.021). Similarly, longitudinal changes in Aβ1–40 correlated with the progression of mean cb and icIMT (3.9% increase per 1-SD increase, p=0.001), independently of time to re-evaluation and cardiovascular risk factors.
Conclusion
Aβ1–40 is an independent predictor of the rate of progression of subclinical carotid atherosclerosis in menopausal women. This finding supports the clinical value of Aβ1–40 in menopause and warrants further investigation for its prognostic role in this population.
Collapse
Affiliation(s)
- D Delialis
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - G Georgiopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - K Sopova
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - I Kanakakis
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - C Kontogiannis
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - D Bampatsias
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - L Karapanou
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - E Armeni
- Aretaieio Hospital, Department of Obstetrics and Gynecology, Athens, Greece
| | - A Augoulea
- Aretaieio Hospital, Department of Obstetrics and Gynecology, Athens, Greece
| | | | - K Stellos
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - I Lamprinoudaki
- Aretaieio Hospital, Department of Obstetrics and Gynecology, Athens, Greece
| | - K Stamatelopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| |
Collapse
|
18
|
Stamatelopoulos K, Georgiopoulos G, Athanasouli F, Nikolaou PE, Lykka M, Roussou M, Gavriatopoulou M, Laina A, Trakada G, Charakida M, Delialis D, Petropoulos I, Pamboukas C, Manios E, Karakitsou M, Papamichael C, Gatsiou A, Lambrinoudaki I, Terpos E, Stellos K, Andreadou I, Dimopoulos MA, Kastritis E. Reactive Vasodilation Predicts Mortality in Primary Systemic Light-Chain Amyloidosis. Circ Res 2019; 125:744-758. [PMID: 31401949 PMCID: PMC6784773 DOI: 10.1161/circresaha.119.314862] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 01/22/2023]
Abstract
Supplemental Digital Content is available in the text. Cardiac involvement and hypotension dominate the prognosis of light-chain amyloidosis (AL). Evidence suggests that there is also peripheral vascular involvement in AL but its prognostic significance is unknown.
Collapse
Affiliation(s)
- Kimon Stamatelopoulos
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.).,Newcastle Cardiovascular Disease Prevention Hub, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom (K. Stamatelopoulos, A.G., K. Stellos)
| | - Georgios Georgiopoulos
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.).,School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom (G.G., M.C.)
| | - Fani Athanasouli
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Panagiota-Efstathia Nikolaou
- National and Kapodistrian University of Athens, Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Laboratory of Pharmacology, Panepistimiopolis, Zografou, Athens, Greece (P.E.N., I.A.)
| | - Marita Lykka
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Maria Roussou
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Maria Gavriatopoulou
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Aggeliki Laina
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Georgia Trakada
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Marietta Charakida
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom (G.G., M.C.)
| | - Dimitris Delialis
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Ioannis Petropoulos
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Constantinos Pamboukas
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Efstathios Manios
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Marina Karakitsou
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Christos Papamichael
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Aikaterini Gatsiou
- Newcastle Cardiovascular Disease Prevention Hub, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom (K. Stamatelopoulos, A.G., K. Stellos)
| | - Irene Lambrinoudaki
- National and Kapodistrian University of Athens 2nd Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, Athens, Greece (I.L.)
| | - Evangelos Terpos
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Konstantinos Stellos
- Newcastle Cardiovascular Disease Prevention Hub, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom (K. Stamatelopoulos, A.G., K. Stellos).,Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK (K. Stellos)
| | - Ioanna Andreadou
- National and Kapodistrian University of Athens, Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Laboratory of Pharmacology, Panepistimiopolis, Zografou, Athens, Greece (P.E.N., I.A.)
| | - Meletios A Dimopoulos
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Efstathios Kastritis
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| |
Collapse
|
19
|
Georgiopoulos G, Papaioannou TG, Magkas N, Laina A, Mareti A, Georgiou S, Mavroeidis I, Samouilidou E, Delialis D, Tousoulis D, Kanakakis J, Stamatelopoulos K. Age-dependent association of pulse wave velocity with coronary artery disease and myocardial aging in high-risk patients. J Cardiovasc Med (Hagerstown) 2019; 20:201-209. [DOI: 10.2459/jcm.0000000000000769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|