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Rambarat P, Zern EK, Wang D, Roshandelpoor A, Zarbafian S, Liu EE, Wang JK, McNeill JN, Andrews CT, Pomerantsev EV, Diamant N, Batra P, Lubitz SA, Picard MH, Ho JE. Identifying high risk clinical phenogroups of pulmonary hypertension through a clustering analysis. PLoS One 2023; 18:e0290553. [PMID: 37624825 PMCID: PMC10456132 DOI: 10.1371/journal.pone.0290553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION The classification and management of pulmonary hypertension (PH) is challenging due to clinical heterogeneity of patients. We sought to identify distinct multimorbid phenogroups of patients with PH that are at particularly high-risk for adverse events. METHODS A hospital-based cohort of patients referred for right heart catheterization between 2005-2016 with PH were included. Key exclusion criteria were shock, cardiac arrest, cardiac transplant, or valvular surgery. K-prototypes was used to cluster patients into phenogroups based on 12 clinical covariates. RESULTS Among 5208 patients with mean age 64±12 years, 39% women, we identified 5 distinct multimorbid PH phenogroups with similar hemodynamic measures yet differing clinical outcomes: (1) "young men with obesity", (2) "women with hypertension", (3) "men with overweight", (4) "men with cardiometabolic and cardiovascular disease", and (5) "men with structural heart disease and atrial fibrillation." Over a median follow-up of 6.3 years, we observed 2182 deaths and 2002 major cardiovascular events (MACE). In age- and sex-adjusted analyses, phenogroups 4 and 5 had higher risk of MACE (HR 1.68, 95% CI 1.41-2.00 and HR 1.52, 95% CI 1.24-1.87, respectively, compared to the lowest risk phenogroup 1). Phenogroup 4 had the highest risk of mortality (HR 1.26, 95% CI 1.04-1.52, relative to phenogroup 1). CONCLUSIONS Cluster-based analyses identify patients with PH and specific comorbid cardiometabolic and cardiovascular disease burden that are at highest risk for adverse clinical outcomes. Interestingly, cardiopulmonary hemodynamics were similar across phenogroups, highlighting the importance of multimorbidity on clinical trajectory. Further studies are needed to better understand comorbid heterogeneity among patients with PH.
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Affiliation(s)
- Paula Rambarat
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Emily K. Zern
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Dongyu Wang
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Athar Roshandelpoor
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Shahrooz Zarbafian
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Elizabeth E. Liu
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Jessica K. Wang
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Jenna N. McNeill
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Carl T. Andrews
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Eugene V. Pomerantsev
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Nathaniel Diamant
- Broad Institute of the Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, United States of America
| | - Puneet Batra
- Broad Institute of the Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, United States of America
| | - Steven A. Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Michael H. Picard
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Jennifer E. Ho
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
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Sarma AA, Paniagua SM, Lau ES, Wang D, Liu EE, Larson MG, Hamburg NM, Mitchell GF, Kizer J, Psaty BM, Allen NB, Lely AT, Gansevoort RT, Rosenberg E, Mukamal K, Benjamin EJ, Vasan RS, Cheng S, Levy D, Boer RADE, Gottdiener JS, Shah SJ, Ho JE. Multiple Prior Live Births Are Associated With Cardiac Remodeling and Heart Failure Risk in Women. J Card Fail 2023; 29:1032-1042. [PMID: 36638956 PMCID: PMC10333450 DOI: 10.1016/j.cardfail.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Greater parity has been associated with cardiovascular disease risk. We sought to find whether the effects on cardiac remodeling and heart failure risk are clear. METHODS We examined the association of number of live births with echocardiographic measures of cardiac structure and function in participants of the Framingham Heart Study (FHS) using multivariable linear regression. We next examined the association of parity with incident heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fraction using a Fine-Gray subdistribution hazards model in a pooled analysis of n = 12,635 participants in the FHS, the Cardiovascular Health Study, the Multi-Ethnic Study of Atherosclerosis, and Prevention of Renal and Vascular Endstage Disease. Secondary analyses included major cardiovascular disease, myocardia infarction and stroke. RESULTS Among n = 3931 FHS participants (mean age 48 ± 13 years), higher numbers of live births were associated with worse left ventricular fractional shortening (multivariable β -1.11 (0.31); P = 0.0005 in ≥ 5 live births vs nulliparous women) and worse cardiac mechanics, including global circumferential strain and longitudinal and radial dyssynchrony (P < 0.01 for all comparing ≥ 5 live births vs nulliparity). When examining HF subtypes, women with ≥ 5 live births were at higher risk of developing future HFrEF compared with nulliparous women (HR 1.93, 95% CI 1.19-3.12; P = 0.008); by contrast, a lower risk of HFpEF was observed (HR 0.58, 95% CI 0.37-0.91; P = 0.02). CONCLUSIONS Greater numbers of live births are associated with worse cardiac structure and function. There was no association with overall HF, but a higher number of live births was associated with greater risk for incident HFrEF.
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Affiliation(s)
- Amy A Sarma
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Samantha M Paniagua
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Emily S Lau
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Dongyu Wang
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elizabeth E Liu
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Martin G Larson
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
| | - Naomi M Hamburg
- Department of Medicine, Sections of Cardiology and Vascular Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Gary F Mitchell
- Department of Research, Cardiovascular Engineering, Norwood, MA, USA
| | - Jorge Kizer
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Norrina B Allen
- Department of Epidemiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A Titia Lely
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Ronald T Gansevoort
- Division of Nephrology, Department of Medicine, University Medical Center Groningen, The Netherlands
| | - Emily Rosenberg
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Cardiovascular Medicine Section, Department of Medicine and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Cardiovascular Medicine Section, Department of Medicine and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, USA; Boston University Center for Computing and Data Sciences, Boston, MA, USA
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Levy
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
| | - Rudolf A DE Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | | | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer E Ho
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Suthahar N, Wang D, Aboumsallem JP, Shi C, de Wit S, Liu EE, Lau ES, Bakker SJL, Gansevoort RT, van der Vegt B, Jovani M, Kreger BE, Lee Splansky G, Benjamin EJ, Vasan RS, Larson MG, Levy D, Ho JE, de Boer RA. Association of Initial and Longitudinal Changes in C-reactive Protein With the Risk of Cardiovascular Disease, Cancer, and Mortality. Mayo Clin Proc 2023; 98:549-558. [PMID: 37019514 PMCID: PMC10698556 DOI: 10.1016/j.mayocp.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To evaluate the value of serial C-reactive protein (CRP) measurements in predicting the risk of cardiovascular disease (CVD), cancer, and mortality. METHODS The analysis was performed using data from two prospective, population-based observational cohorts: the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study and the Framingham Heart Study (FHS). A total of 9253 participants had CRP measurements available at two examinations (PREVEND: 1997-1998 and 2001-2002; FHS Offspring cohort: 1995-1998 and 1998-2001). All CRP measurements were natural log-transformed before analyses. Cardiovascular disease included fatal and nonfatal cardiovascular, cerebrovascular and peripheral vascular events, and heart failure. Cancer included all malignancies except nonmelanoma skin cancers. RESULTS The mean age of the study population at baseline was 52.4±12.1 years and 51.2% (n=4733) were women. Advanced age, female sex, smoking, body mass index, and total cholesterol were associated with greater increases in CRP levels over time (Pall<.001 in the multivariable model). Baseline CRP, as well as increase in CRP over time (ΔCRP), were associated with incident CVD (hazard ratio [HR]: 1.29 per 1-SD increase; 95% confidence interval [CI]: 1.29 to 1.47, and HR per 1-SD increase: 1.19; 95% CI: 1.09 to 1.29 respectively). Similar findings were observed for incident cancer (baseline CRP, HR: 1.17; 95% CI: 1.09 to 1.26; ΔCRP, HR: 1.08; 95% CI: 1.01 to 1.15) and mortality (baseline CRP, HR: 1.29; 95% CI: 1.21 to 1.37; ΔCRP, HR: 1.10; 95% CI: 1.05 to 1.16). CONCLUSION Initial as well as subsequent increases in CRP levels predict future CVD, cancer, and mortality in the general population.
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Affiliation(s)
- Navin Suthahar
- Department of Cardiology, University of Groningen, Groningen, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Dongyu Wang
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Biostatistics, Boston University, Boston, MA, USA
| | | | - Canxia Shi
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
| | - Sanne de Wit
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
| | - Elizabeth E Liu
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily S Lau
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Ron T Gansevoort
- Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology, University of Groningen, Groningen, the Netherlands
| | - Manol Jovani
- Digestive Diseases and Nutrition, University of Kentucky Albert B. Chandler Hospital, Lexington, KY, USA
| | - Bernard E Kreger
- Department of Medicine, School of Medicine, Boston University, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA
| | | | - Emelia J Benjamin
- Department of Biostatistics, Boston University, Boston, MA, USA; Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA; Department of Medicine, School of Medicine, Boston University, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA
| | - Ramachandran S Vasan
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA; Department of Medicine, School of Medicine, Boston University, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA
| | - Martin G Larson
- Department of Biostatistics, Boston University, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA
| | - Daniel Levy
- The Framingham Heart Study, Framingham, MA, USA; Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer E Ho
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, Groningen, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Liu EE, Suthahar N, de Boer RA, Ho JE. Reply. JACC CardioOncol 2022; 4:426. [PMID: 36213366 PMCID: PMC9537081 DOI: 10.1016/j.jaccao.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | - Jennifer E. Ho
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, E/CLS 945, Boston, Massachusetts 02215-5491, USA @JenHoCardiology
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Liu EE, Suthahar N, Paniagua SM, Wang D, Lau ES, Li SX, Jovani M, Takvorian KS, Kreger BE, Benjamin EJ, Meijers WC, Bakker SJ, Kieneker LM, Gruppen EG, van der Vegt B, de Bock GH, Gansevoort RT, Hussain SK, Hoffmann U, Splansky GL, Vasan RS, Larson MG, Levy D, Cheng S, de Boer RA, Ho JE. Association of Cardiometabolic Disease With Cancer in the Community. JACC CardioOncol 2022; 4:69-81. [PMID: 35492825 PMCID: PMC9040108 DOI: 10.1016/j.jaccao.2022.01.095] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/03/2022] Open
Abstract
Background Obesity and cardiometabolic dysfunction have been associated with cancer risk and severity. Underlying mechanisms remain unclear. Objectives The aim of this study was to examine associations of obesity and related cardiometabolic traits with incident cancer. Methods FHS (Framingham Heart Study) and PREVEND (Prevention of Renal and Vascular End-Stage Disease) study participants without prevalent cancer were studied, examining associations of obesity, body mass index (BMI), waist circumference, visceral adipose tissue (VAT) and subcutaneous adipose tissue depots, and C-reactive protein (CRP) with future cancer in Cox models. Results Among 20,667 participants (mean age 50 years, 53% women), 2,619 cancer events were observed over a median follow-up duration of 15 years. Obesity was associated with increased risk for future gastrointestinal (HR: 1.30; 95% CI: 1.05-1.60), gynecologic (HR: 1.62; 95% CI: 1.08-2.45), and breast (HR: 1.32; 95% CI: 1.05-1.66) cancer and lower risk for lung cancer (HR: 0.62; 95% CI: 0.44-0.87). Similarly, waist circumference was associated with increased risk for overall, gastrointestinal, and gynecologic but not lung cancer. VAT but not subcutaneous adipose tissue was associated with risk for overall cancer (HR: 1.22; 95% CI: 1.05-1.43), lung cancer (HR: 1.92; 95% CI: 1.01-3.66), and melanoma (HR: 1.56; 95% CI: 1.02-2.38) independent of BMI. Last, higher CRP levels were associated with higher risk for overall, colorectal, and lung cancer (P < 0.05 for all). Conclusions Obesity and abdominal adiposity are associated with future risk for specific cancers (eg, gastrointestinal, gynecologic). Although obesity was associated with lower risk for lung cancer, greater VAT and CRP were associated with higher lung cancer risk after adjusting for BMI.
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Affiliation(s)
- Elizabeth E. Liu
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Navin Suthahar
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Samantha M. Paniagua
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dongyu Wang
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Emily S. Lau
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shawn X. Li
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manol Jovani
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Gastroenterology, University of Kentucky Albert B. Chandler Hospital, Lexington, Kentucky, USA
| | | | - Bernard E. Kreger
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- The Framingham Heart Study, Framingham, Massachusetts, USA
| | - Emelia J. Benjamin
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Cardiology and Preventative Medicine Sections, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Wouter C. Meijers
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan J.L. Bakker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lyanne M. Kieneker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eke G. Gruppen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ron T. Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Shehnaz K. Hussain
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California, USA
| | - Udo Hoffmann
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ramachandran S. Vasan
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Cardiology and Preventative Medicine Sections, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martin G. Larson
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Daniel Levy
- The Framingham Heart Study, Framingham, Massachusetts, USA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rudolf A. de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jennifer E. Ho
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Zern EK, Wang D, Rambarat P, Bernard S, Paniagua SM, Liu EE, McNeill J, Wang JK, Andrews CT, Pomerantsev EV, Picard MH, Ho JE. Association of Pulmonary Artery Pulsatility Index With Adverse Cardiovascular Events Across a Hospital-Based Sample. Circ Heart Fail 2022; 15:e009085. [PMID: 35135302 PMCID: PMC8855684 DOI: 10.1161/circheartfailure.121.009085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The pulmonary artery pulsatility index (PAPi), calculated from the ratio of the pulmonary artery pulse pressure to right atrial pressure, is a predictor of right ventricular failure after inferior myocardial infarction and left ventricular assist device implantation. Whether PAPi is associated with adverse outcomes across a heterogeneous population is unknown. METHODS We examined consecutive patients undergoing right heart catheterization between 2005 and 2016 in a hospital-based cohort. Multivariable Cox models were utilized to examine the association between PAPi and all-cause mortality, major adverse cardiac events, and heart failure hospitalizations. RESULTS We studied 8285 individuals (mean age 63 years, 39% women) with median PAPi across quartiles 1.7, 2.8, 4.2, and 8.7, who were followed over a mean follow-up of 6.7±3.3 years. Patients in the lowest PAPi quartile had a 60% greater risk of death compared with the highest quartile (multivariable-adjusted hazard ratio, 1.60 [95% CI, 1.36-1.88], P<0.001) and a higher risk of major adverse cardiac events and heart failure hospitalizations (hazard ratio, 1.80 [95% CI, 1.56-2.07], P<0.001 and hazard ratio, 2.08 [95% CI, 1.76-2.47], P<0.001, respectively). Of note, patients in quartiles 2 and 3 also had increased risk of cardiovascular events compared with quartile 4 (multivariable P<0.05 for all). CONCLUSIONS Compared with the highest PAPi quartile, patients in PAPi quartiles 1 to 3 had a greater risk of all-cause mortality, major adverse cardiac events, and heart failure hospitalizations, with greatest risk observed in the lowest quartile. A low PAPi, even at values higher than previously reported, may serve an important role in identifying high-risk individuals across a broad spectrum of cardiovascular disease.
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Affiliation(s)
- Emily K. Zern
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Dongyu Wang
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Paula Rambarat
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Samuel Bernard
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine
| | - Samantha M. Paniagua
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Elizabeth E. Liu
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jenna McNeill
- Pulmonary and Critical Care Division, Massachusetts General Hospital, Boston, MA
| | - Jessica K. Wang
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Carl T. Andrews
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Eugene V. Pomerantsev
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Michael H. Picard
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Jennifer E. Ho
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Lau ES, Panah LG, Zern EK, Liu EE, Farrell R, Schoenike MW, Namasivayam M, Churchill TW, Curreri L, Malhotra R, Nayor M, Lewis GD, Ho JE. Arterial Stiffness and Vascular Load in HFpEF: Differences Among Women and Men. J Card Fail 2022; 28:202-211. [PMID: 34955334 PMCID: PMC8840989 DOI: 10.1016/j.cardfail.2021.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mechanisms underlying sex differences in heart failure with preserved ejection fraction (HFpEF) are poorly understood. We sought to examine sex differences in measures of arterial stiffness and the association of arterial stiffness measures with left ventricular hemodynamic responses to exercise in men and women. METHODS We studied 83 men (mean age 62 years) and 107 women (mean age 59 years) with HFpEF who underwent cardiopulmonary exercise testing with invasive hemodynamic monitoring and arterial stiffness measurement (augmentation pressure [AP], augmentation index [AIx], and aortic pulse pressure [AoPP]). Sex differences were compared using multivariable linear regression. We examined the association of arterial stiffness with abnormal left ventricular diastolic response to exercise, defined as a rise in pulmonary capillary wedge pressure relative to cardiac output (∆PCWP/∆CO) ≥ 2 mmHg/L/min by using logistic regression models. RESULTS Women with HFpEF had increased arterial stiffness compared with men. AP was nearly 10 mmHg higher, and AIx was more than 10% higher in women compared with men (P < 0.0001 for both). Arterial stiffness measures were associated with a greater pulmonary capillary wedge pressure response to exercise, particularly among women. A 1-standard deviation higher AP was associated with > 3-fold increased odds of abnormal diastolic exercise response (AP: OR 3.16, 95% CI 1.34-7.42; P = 0.008 [women] vs OR 2.07, 95% CI 0.95-5.49; P = 0.15 [men]) with similar findings for AIx and AoPP. CONCLUSIONS Arterial stiffness measures are significantly higher in women with HFpEF than in men and are associated with abnormally steep increases in pulmonary capillary wedge pressure with exercise, particularly in women. Arterial stiffness may preferentially contribute to abnormal diastolic function during exercise in women with HFpEF compared with men.
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Jovani M, Liu EE, Paniagua SM, Lau ES, Li SX, Takvorian KS, Kreger BE, Splansky GL, de Boer RA, Joshi AD, Hwang SJ, Yao C, Huan T, Courchesne P, Larson MG, Levy D, Chan AT, Ho JE. Cardiovascular disease related circulating biomarkers and cancer incidence and mortality: is there an association? Cardiovasc Res 2021; 118:2317-2328. [PMID: 34469519 DOI: 10.1093/cvr/cvab282] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/25/2020] [Accepted: 08/30/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS Recent studies suggest an association between cardiovascular disease (CVD) and cancer incidence/mortality, but the pathophysiological mechanisms underlying these associations are unclear. We aimed to examine biomarkers previously associated with CVD and study their association with incident cancer and cancer-related death in a prospective cohort study. METHODS AND RESULTS We used a proteomic platform to measure 71 cardiovascular biomarkers among 5,032 participants in the Framingham Heart Study who were free of cancer at baseline. We used multivariable-adjusted Cox models to examine the association of circulating protein biomarkers with risk of cancer incidence and mortality. To account for multiple testing, we set a 2-sided false discovery rate (FDR Q-value) <0.05.Growth differentiation factor-15 (GDF15; also known as macrophage inhibitory cytokine-1 [MIC1])) was associated with increased risk of incident cancer (hazards ratio [HR] per 1 standard deviation increment 1.31, 95% CI 1.17-1.47), incident gastrointestinal cancer (HR 1.85, 95% CI 1.37-2.50), incident colorectal cancer (HR 1.94, 95% CI 1.29-2.91) and cancer-related death (HR 2.15, 95% CI 1.72-2.70). Stromal cell-derived factor-1 (SFD1) showed an inverse association with cancer-related death (HR 0.75, 95% CI 0.65-0.86). Fibroblast growth factor-23 (FGF23) showed an association with colorectal cancer (HR 1.55, 95% CI 1.20-2.00), and granulin (GRN) was associated with hematologic cancer (HR 1.61, 95% CI 1.30-1.99). Other circulating biomarkers of inflammation, immune activation, metabolism, and fibrosis showed suggestive associations with future cancer diagnosis. CONCLUSION We observed several significant associations between circulating CVD biomarkers and cancer, supporting the idea that shared biological pathways underlie both diseases. Further investigations of specific mechanisms that lead to both CVD and cancer are warranted. TRANSLATIONAL PERSPECTIVE In our prospective cohort study, baseline levels of biomarkers previously associated with CVD were found to be associated with future development of cancer. In particular, GDF15 was associated with increased risk of cancer incidence and mortality, including gastrointestinal and colorectal cancers; SDF1 was inversely associated with cancer-related death, and FGF23 and GRN were associated with increased risk of colorectal and hematologic cancers, respectively. Other biomarkers of inflammation, immune activation, metabolism, and fibrosis showed suggestive associations. These results suggest potential shared biological pathways that underlie both development of cancer and CVD.
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Affiliation(s)
- Manol Jovani
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Division of Gastroenterology; University of Kentucky Albert B. Chandler Hospital
| | - Elizabeth E Liu
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA
| | | | - Emily S Lau
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA.,Cardiology Division, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Shawn X Li
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Bernard E Kreger
- General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.,The Framingham Heart Study, Framingham, MA
| | | | - Rudolf A de Boer
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Amit D Joshi
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Shih-Jen Hwang
- The Framingham Heart Study, Framingham, MA.,Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD
| | - Chen Yao
- The Framingham Heart Study, Framingham, MA.,Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD
| | - Tianxiao Huan
- The Framingham Heart Study, Framingham, MA.,Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD
| | - Paul Courchesne
- The Framingham Heart Study, Framingham, MA.,Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD
| | - Martin G Larson
- The Framingham Heart Study, Framingham, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Daniel Levy
- The Framingham Heart Study, Framingham, MA.,Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jennifer E Ho
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA.,Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA.,Cardiology Division, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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McNeill JN, Lau ES, Zern EK, Nayor M, Malhotra R, Liu EE, Bhat RR, Brooks LC, Farrell R, Sbarbaro JA, Schoenike MW, Medoff BD, Lewis GD, Ho JE. Association of obesity-related inflammatory pathways with lung function and exercise capacity. Respir Med 2021; 183:106434. [PMID: 33964816 DOI: 10.1016/j.rmed.2021.106434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Obesity has multifactorial effects on lung function and exercise capacity. The contributions of obesity-related inflammatory pathways to alterations in lung function remain unclear. RESEARCH QUESTION To examine the association of obesity-related inflammatory pathways with pulmonary function, exercise capacity, and pulmonary-specific contributors to exercise intolerance. METHOD We examined 695 patients who underwent cardiopulmonary exercise testing (CPET) with invasive hemodynamic monitoring at Massachusetts General Hospital between December 2006-June 2017. We investigated the association of adiponectin, leptin, resistin, IL-6, CRP, and insulin resistance (HOMA-IR) with pulmonary function and exercise parameters using multivariable linear regression. RESULTS Obesity-related inflammatory pathways were associated with worse lung function. Specifically, higher CRP, IL-6, and HOMA-IR were associated with lower percent predicted FEV1 and FVC with a preserved FEV1/FVC ratio suggesting a restrictive physiology pattern (P ≤ 0.001 for all). For example, a 1-SD higher natural-logged CRP level was associated with a nearly 5% lower percent predicted FEV1 and FVC (beta -4.8, s.e. 0.9 for FEV1; beta -4.9, s.e. 0.8 for FVC; P < 0.0001 for both). Obesity-related inflammatory pathways were associated with worse pulmonary vascular distensibility (adiponectin, IL-6, and CRP, P < 0.05 for all), as well as lower pulmonary artery compliance (IL-6 and CRP, P ≤ 0.01 for both). INTERPRETATION Our findings highlight the importance of obesity-related inflammatory pathways including inflammation and insulin resistance on pulmonary spirometry and pulmonary vascular function. Specifically, systemic inflammation as ascertained by CRP, IL-6 and insulin resistance are associated with restrictive pulmonary physiology independent of BMI. In addition, inflammatory markers were associated with lower exercise capacity and pulmonary vascular dysfunction.
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Affiliation(s)
- Jenna N McNeill
- From the Cardiovascular Research Center, Division of Massachusetts General Hospital, Boston, MA, USA; Pulmonary and Critical Care, Division of Massachusetts General Hospital, Boston, MA, USA
| | - Emily S Lau
- From the Cardiovascular Research Center, Division of Massachusetts General Hospital, Boston, MA, USA; Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Emily K Zern
- From the Cardiovascular Research Center, Division of Massachusetts General Hospital, Boston, MA, USA; Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Nayor
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Rajeev Malhotra
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth E Liu
- From the Cardiovascular Research Center, Division of Massachusetts General Hospital, Boston, MA, USA
| | - Rohan R Bhat
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Liana C Brooks
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Robyn Farrell
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - John A Sbarbaro
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Mark W Schoenike
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin D Medoff
- Pulmonary and Critical Care, Division of Massachusetts General Hospital, Boston, MA, USA
| | - Gregory D Lewis
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer E Ho
- From the Cardiovascular Research Center, Division of Massachusetts General Hospital, Boston, MA, USA; Cardiology Division of Massachusetts General Hospital, Boston, MA, USA.
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10
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Lau ES, McNeill JN, Paniagua SM, Liu EE, Wang JK, Bassett IV, Selvaggi CA, Lubitz SA, Foulkes AS, Ho JE. Sex differences in inflammatory markers in patients hospitalized with COVID-19 infection: Insights from the MGH COVID-19 patient registry. PLoS One 2021; 16:e0250774. [PMID: 33909684 PMCID: PMC8081177 DOI: 10.1371/journal.pone.0250774] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background Men are at higher risk for serious complications related to COVID-19 infection than women. More robust immune activation in women has been proposed to contribute to decreased disease severity, although systemic inflammation has been associated with worse outcomes in COVID-19 infection. Whether systemic inflammation contributes to sex differences in COVID-19 infection is not known. Study design and methods We examined sex differences in inflammatory markers among 453 men (mean age 61) and 328 women (mean age 62) hospitalized with COVID-19 infection at the Massachusetts General Hospital from March 8 to April 27, 2020. Multivariable linear regression models were used to examine the association of sex with initial and peak inflammatory markers. Exploratory analyses examined the association of sex and inflammatory markers with 28-day clinical outcomes using multivariable logistic regression. Results Initial and peak CRP were higher in men compared with women after adjustment for baseline differences (initial CRP: ß 0.29, SE 0.07, p = 0.0001; peak CRP: ß 0.31, SE 0.07, p<0.0001) with similar findings for IL-6, PCT, and ferritin (p<0.05 for all). Men had greater than 1.5-greater odds of dying compared with women (OR 1.71, 95% CI 1.04–2.80, p = 0.03). Sex modified the association of peak CRP with both death and ICU admission, with stronger associations observed in men compared with women (death: OR 9.19, 95% CI 4.29–19.7, p <0.0001 in men vs OR 2.81, 95% CI 1.52–5.18, p = 0.009 in women, Pinteraction = 0.02). Conclusions In a sample of 781 men and women hospitalized with COVID-19 infection, men exhibited more robust inflammatory activation as evidenced by higher initial and peak inflammatory markers, as well as worse clinical outcomes. Better understanding of sex differences in immune responses to COVID-19 infection may shed light on the pathophysiology of COVID-19 infection.
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Affiliation(s)
- Emily S. Lau
- From the Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jenna N. McNeill
- From the Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, United States of America
| | - Samantha M. Paniagua
- From the Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Elizabeth E. Liu
- From the Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jessica K. Wang
- From the Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ingrid V. Bassett
- Division Infectious Disease, Massachusetts General Hospital, Boston, MA, United States of America
- Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America
| | - Caitlin A. Selvaggi
- Biostatistics Center of Massachusetts General Hospital, Boston, MA, United States of America
| | - Steven A. Lubitz
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, United States of America
| | - Andrea S. Foulkes
- Biostatistics Center of Massachusetts General Hospital, Boston, MA, United States of America
| | - Jennifer E. Ho
- From the Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail:
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11
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Churchill TW, Li SX, Curreri L, Zern EK, Lau ES, Liu EE, Farrell R, Shoenike MW, Sbarbaro J, Malhotra R, Nayor M, Tschöpe C, de Boer RA, Lewis GD, Ho JE. Evaluation of 2 Existing Diagnostic Scores for Heart Failure With Preserved Ejection Fraction Against a Comprehensively Phenotyped Cohort. Circulation 2021; 143:289-291. [PMID: 33464963 PMCID: PMC8059354 DOI: 10.1161/circulationaha.120.050757] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Timothy W. Churchill
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Shawn X Li
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lisa Curreri
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily K Zern
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily S. Lau
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth E. Liu
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Robyn Farrell
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark W. Shoenike
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - John Sbarbaro
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Rajeev Malhotra
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew Nayor
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Carsten Tschöpe
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
- Department of Cardiology, Charité, University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Rudolf A. de Boer
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Gregory D. Lewis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer E. Ho
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
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12
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Li XC, Liao YY, Leung DWM, Wang HY, Chen BL, Peng XX, Liu EE. Divergent biochemical and enzymatic properties of oxalate oxidase isoforms encoded by four similar genes in rice. Phytochemistry 2015; 118:216-223. [PMID: 26347131 DOI: 10.1016/j.phytochem.2015.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/22/2015] [Accepted: 08/27/2015] [Indexed: 06/05/2023]
Abstract
The biochemical and enzymatic properties of four highly similar rice oxalate oxidase proteins (OsOxO1-4) were compared after their purification from the leaves of transgenic plants each overexpressing the respective OsOxO1-4 genes. Although alignment of their amino acid sequences has revealed divergence mainly in the signal peptides and they catalyze the same enzymic (oxalate oxidase) reaction, divergence in apparent molecular mass, Km, optimum pH, stability and responses to inhibitors and activators was uncovered by biochemical characterization of the purified OsOxO1-4 proteins. The apparent molecular mass of oligomer OsOxO1 was found to be similar to that of OsOxO3 but lower than the other two. The molecular mass of the subunit of OsOxO1 was lower than that of OsOxO3. The Km value of OsOxO3 was higher than the other three which had similar Km. OsOxO1 and OsOxO4 possessed peak activity at pH 8.5 which was close to that at the optimum pH 4.0. The activity of OsOxO2 at pH 8.5 was only 65% of that at its optimum pH 3.5, while the activity of OsOxO3 did not vary much at pH 6-9 and was also much lower than that at its optimum pH 3. OsOxO2 and OsOxO3 still maintained all their activities after being heated at 70°C for 1h while OsOxO1 and OsOxO4 lost about 30% of their activities. Pyruvate and oxaloacetic acid inhibited the activity of OsOxO3 more strongly than the other three. Interestingly, glucose 6-phosphate, fructose 6-phosphate and fructose 1,6-biphosphate related to photosynthetic assimilation of triose phosphate greatly increased the activities of OsOxO3 and OsOxO4. In addition to the differences in the biochemical properties of the four OsOxO proteins, an intriguing finding is that the purified OsOxO1-4 exhibited substrate inhibition, which is a typical of the classical Michaelis-Menten enzyme kinetics exhibited by a majority of other enzymes.
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Affiliation(s)
- Xiao Chun Li
- College of Life Sciences, South China Agricultural University, Guangzhou 510642, China
| | - Yuan Yang Liao
- College of Life Sciences, South China Agricultural University, Guangzhou 510642, China
| | - David W M Leung
- School of Biological Sciences, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand
| | - Hai Yan Wang
- College of Life Sciences, South China Agricultural University, Guangzhou 510642, China
| | - Bai Ling Chen
- College of Life Sciences, South China Agricultural University, Guangzhou 510642, China
| | - Xin Xiang Peng
- College of Life Sciences, South China Agricultural University, Guangzhou 510642, China
| | - E E Liu
- College of Life Sciences, South China Agricultural University, Guangzhou 510642, China.
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