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Mone P, Guerra G, Lombardi A, Illario M, Pansini A, Marro A, Frullone S, Taurino A, Sorriento D, Verri V, Iaccarino G, Santulli G. Effects of SGLT2 inhibition via empagliflozin on cognitive and physical impairment in frail diabetic elders with chronic kidney disease. Pharmacol Res 2024; 200:107055. [PMID: 38176528 DOI: 10.1016/j.phrs.2023.107055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Pasquale Mone
- Department of Medicine, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, New York, USA; ASL Avellino, Italy; University of Molise, Campobasso, Italy
| | - Germano Guerra
- University of Molise, Campobasso, Italy; International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
| | - Angela Lombardi
- Department of Medicine, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, New York, USA
| | | | | | | | | | | | - Daniela Sorriento
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | | | | | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy; International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy; Department of Medicine, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, New York, USA; Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (INI), Albert Einstein College of Medicine, New York City, New York 10461, USA.
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Mone P, De Gennaro S, Moriello D, Frullone S, D’Amelio R, Ferrante MNV, Marro A, Santulli G. Insulin resistance drives cognitive impairment in hypertensive pre-diabetic frail elders: the CENTENNIAL study. Eur J Prev Cardiol 2023; 30:1283-1288. [PMID: 37196030 PMCID: PMC10480019 DOI: 10.1093/eurjpc/zwad173] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/27/2023] [Accepted: 05/15/2023] [Indexed: 05/19/2023]
Abstract
AIMS Pre-diabetes is a condition that confers an increased cardiovascular risk. Frailty is very common in hypertensive patients, and insulin resistance has been linked to frailty in older adults with diabetes. On these grounds, our aim was to evaluate the association between insulin resistance and cognitive impairment in hypertensive and pre-diabetic and frail older adults. METHODS AND RESULTS We studied consecutive pre-diabetic and hypertensive elders with frailty presenting at the Avellino local health authority of the Italian Ministry of Health (ASL AV) from March 2021 to March 2022. All of them fulfilled the following inclusion criteria: a previous diagnosis of hypertension with no clinical or laboratory evidence of secondary causes, a confirmed diagnosis of pre-diabetes, age >65 years, Montreal Cognitive Assessment (MoCA) Score <26, and frailty. We enrolled 178 frail patients, of which 141 successfully completed the study. We observed a strong inverse correlation (r = -0.807; P < 0.001) between MoCA Score and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). The results were confirmed by a linear regression analysis using MoCA Score as dependent variable, after adjusting for several potential confounders. CONCLUSION Taken together, our data highlight for the first time the association between insulin resistance and global cognitive function in frail elders with hypertension and pre-diabetes.
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Affiliation(s)
- Pasquale Mone
- Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research (EIAR), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York City, NY 10461, USA
- Avellino Local Health Authority of the Italian Ministry of Health (ASL AV), Avellino 83100, Italy
- Department of Medicine and Health Science “V. Tiberio”, Molise University, Campobasso 86100, Italy
| | - Stefano De Gennaro
- Avellino Local Health Authority of the Italian Ministry of Health (ASL AV), Avellino 83100, Italy
| | - Divina Moriello
- Avellino Local Health Authority of the Italian Ministry of Health (ASL AV), Avellino 83100, Italy
| | - Salvatore Frullone
- Avellino Local Health Authority of the Italian Ministry of Health (ASL AV), Avellino 83100, Italy
| | - Rosa D’Amelio
- Avellino Local Health Authority of the Italian Ministry of Health (ASL AV), Avellino 83100, Italy
| | | | - Anna Marro
- Avellino Local Health Authority of the Italian Ministry of Health (ASL AV), Avellino 83100, Italy
| | - Gaetano Santulli
- Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research (EIAR), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York City, NY 10461, USA
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, University of Naples “Federico II”, Naples 80131, Italy
- Department of Molecular Pharmacology, Einstein-Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Institute for Neuroimmunology and Inflammation (INI), Albert Einstein College of Medicine, New York City, NY 10461, USA
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Mone P, De Gennaro S, Frullone S, Marro A, Santulli G. Hyperglycemia drives the transition from pre-frailty to frailty: The Monteforte study. Eur J Intern Med 2023; 111:135-137. [PMID: 36635128 PMCID: PMC10122706 DOI: 10.1016/j.ejim.2023.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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] [Received: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Pasquale Mone
- Department of Medicine, Institute for Neuroimmunology and Inflammation (INI), Einstein - Mount Sinai Diabetes Research Center (ES-DRC), Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, 1300 Morris Park Avenue, New York, NY 10461, United States; University of Campania "Luigi Vanvitelli", Naples, Italy; ASL Avellino, Italy
| | | | | | | | - Gaetano Santulli
- Department of Medicine, Institute for Neuroimmunology and Inflammation (INI), Einstein - Mount Sinai Diabetes Research Center (ES-DRC), Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, 1300 Morris Park Avenue, New York, NY 10461, United States; Department of Advanced Biomedical Sciences, "Federico II" University, Naples , Italy; Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, United States.
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Jankauskas SS, Mone P, Avvisato R, Varzideh F, De Gennaro S, Salemme L, Macina G, Kansakar U, Cioppa A, Frullone S, Gambardella J, Di Mauro M, Tesorio T, Santulli G. miR-181c targets Parkin and SMAD7 in human cardiac fibroblasts: Validation of differential microRNA expression in patients with diabetes and heart failure with preserved ejection fraction. Mech Ageing Dev 2023; 212:111818. [PMID: 37116731 DOI: 10.1016/j.mad.2023.111818] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Cardiac fibrosis represents a key feature in the pathophysiology of heart failure with preserved ejection fraction (HFpEF), a condition highly prevalent amongst geriatric patients, especially if diabetic. The microRNA miR-181c has been shown to be associated with the response to exercise training in HFpEF patients and has been also linked to diabetic cardiovascular complications. However, the underlying mechanisms have not been fully elucidated. OBJECTIVE To measure circulating miR-181c in elderly patients with HFpEF and DM and identify gene targets pathophysiologically relevant in HFpEF. METHODS We quantified circulating miR-181c in frail older adults with a confirmed diagnosis of HFpEF and diabetes, and, as control, we enrolled age-matched subjects without HFpEF and without diabetes. We validated in human cardiac fibroblasts the molecular mechanisms linking miR-181c to a pro-fibrotic response. RESULTS 51 frail patients were included (34 patients with diabetes and HFpEF and 17 age-matched controls. We observed that miR-181c was significantly upregulated (p<0.0001) in HFpEF patients vs controls. We confirmed in vitro that miR-181c is targeting PRKN and SMAD7. CONCLUSIONS We demonstrate that miR-181c levels are significantly increased in frail elderly adults with diabetes and HFpEF and that miR-181c targets PRKN and SMAD7 in human cardiac fibroblasts.
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Affiliation(s)
- Stanislovas S Jankauskas
- Department of Medicine, Einstein Institute for Aging Research, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Pasquale Mone
- Department of Medicine, Einstein Institute for Aging Research, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, NY 10461, USA; ASL Avellino, Avellino, 83100, Italy
| | - Roberta Avvisato
- Department of Medicine, Einstein Institute for Aging Research, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Fahimeh Varzideh
- Department of Medicine, Einstein Institute for Aging Research, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, NY 10461, USA
| | | | - Luigi Salemme
- Casa di Cura "Montevergine", Mercogliano (Avellino), 83013, Italy
| | | | - Urna Kansakar
- Department of Medicine, Einstein Institute for Aging Research, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Angelo Cioppa
- Casa di Cura "Montevergine", Mercogliano (Avellino), 83013, Italy
| | | | - Jessica Gambardella
- Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Neuroimmunology and Inflammation (INI), Albert Einstein College of Medicine, New York, NY 10461, USA
| | | | - Tullio Tesorio
- Casa di Cura "Montevergine", Mercogliano (Avellino), 83013, Italy
| | - Gaetano Santulli
- Department of Medicine, Einstein Institute for Aging Research, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Neuroimmunology and Inflammation (INI), Albert Einstein College of Medicine, New York, NY 10461, USA.
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Mone P, Martinelli G, Lucariello A, Leo AL, Marro A, De Gennaro S, Marzocco S, Moriello D, Frullone S, Cobellis L, Santulli G. Extended-release metformin improves cognitive impairment in frail older women with hypertension and diabetes: preliminary results from the LEOPARDESS Study. Cardiovasc Diabetol 2023; 22:94. [PMID: 37085892 PMCID: PMC10122301 DOI: 10.1186/s12933-023-01817-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/28/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Women have a high risk of frailty independently of age and menopause state. Diabetes and hypertension increase the risk of frailty and cognitive impairment. Metformin has been employed in post-menopausal women and some reports have shown encouraging effects in terms of attenuated frailty. However, the impact on cognitive performance of a recently introduced extended-release formulation of metformin has never been explored. METHODS We studied consecutive frail hypertensive and diabetic older women presenting at the ASL (local health authority of the Italian Ministry of Health) Avellino, Italy, from June 2021 to August 2022, who were treated or not with extended-release metformin. We included a control group of frail older males with diabetes and hypertension treated with extended-release metformin and a control group of frail older women with diabetes and hypertension treated with regular metformin. RESULTS A total of 145 patients successfully completed the study. At the end of the 6-month follow-up, we observed a significantly different cognitive performance compared to baseline in the group of frail women treated with extended-release metformin (p: 0.007). Then, we compared the follow-up groups and we observed significant differences between frail women treated vs. untreated (p: 0.041), between treated frail women and treated frail men (p: 0.016), and between women treated with extended-release metformin vs. women treated with regular metformin (p: 0.048). We confirmed the crucial role of extended-release metformin applying a multivariable logistic analysis to adjust for potential confounders. CONCLUSIONS We evidenced, for the first time to the best of our knowledge, the favorable effects on cognitive impairment of extended-release metformin in frail women with diabetes and hypertension.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine, Division of Cardiology, Einstein Institute for Aging Research, Fleischer Institute for Diabetes Research (FIDAM), Einstein - Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, NY, USA.
- ASL Avellino, Avellino, Italy.
- University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | | | | | | | | | | | | | | | | | - Luigi Cobellis
- University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Gaetano Santulli
- Department of Medicine, Division of Cardiology, Einstein Institute for Aging Research, Fleischer Institute for Diabetes Research (FIDAM), Einstein - Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, NY, USA.
- Department of Molecular Pharmacology, Institute for Neuroimmunology and Inflammation (INI), Albert Einstein College of Medicine, New York City, NY, USA.
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Mone P, Lombardi A, Kansakar U, Varzideh F, Jankauskas SS, Pansini A, Marzocco S, De Gennaro S, Famiglietti M, Macina G, Frullone S, Santulli G. Empagliflozin Improves the MicroRNA Signature of Endothelial Dysfunction in Patients with Heart Failure with Preserved Ejection Fraction and Diabetes. J Pharmacol Exp Ther 2023; 384:116-122. [PMID: 36549862 PMCID: PMC9827502 DOI: 10.1124/jpet.121.001251] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [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: 09/08/2021] [Revised: 04/29/2022] [Accepted: 06/06/2022] [Indexed: 01/12/2023] Open
Abstract
Endothelial dysfunction represents a key mechanism underlying heart failure with preserved ejection fraction (HFpEF), diabetes mellitus (DM), and frailty. However, reliable biomarkers to monitor endothelial dysfunction in these patients are lacking. In this study, we evaluated the expression of a panel of circulating microRNAs (miRs) involved in the regulation of endothelial function in a population of frail older adults with HFpEF and DM treated for 3 months with empagliflozin, metformin, or insulin. We identified a distinctive pattern of miRs that were significantly regulated in HFpEF patients compared to healthy controls and to HFpEF patients treated with the sodium glucose cotransporter 2 (SGLT2) inhibitor empagliflozin. Three miRs were significantly downregulated (miR-126, miR-342-3p, and miR-638) and two were significantly upregulated (miR-21 and miR-92) in HFpEF patients compared to healthy controls. Strikingly, two of these miRs (miR-21 and miR-92) were significantly reduced in HFpEF patients after the 3-month treatment with empagliflozin, whereas no significant differences in the profile of endothelial miRs were detected in patients treated with metformin or insulin. Taken together, our findings demonstrate for the first time that specific circulating miRs involved in the regulation of endothelial function are significantly regulated in frail HFpEF patients with DM and in response to SGLT2 inhibition. SIGNIFICANCE STATEMENT: We have identified a novel microRNA signature functionally involved in the regulation of endothelial function that is significantly regulated in frail patients with HFpEF and diabetes. Moreover, the treatment with the SGLT2 inhibitor empagliflozin caused a modification of some of these microRNAs in a direction that was opposite to what observed in HFpEF patients, indicating a rescue of endothelial function. Our findings are relevant for clinical practice inasmuch as we were able to establish novel biomarkers of disease and response to therapy.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Angela Lombardi
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Urna Kansakar
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Fahimeh Varzideh
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Stanislovas S Jankauskas
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Antonella Pansini
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Stefania Marzocco
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Stefano De Gennaro
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Michele Famiglietti
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Gaetano Macina
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Salvatore Frullone
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
| | - Gaetano Santulli
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, New York (P.M., A.L., U.K., F.V., S.S.J., G.S.); Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy (P.M., A.P., S.D.G., M.F., G.M., S.F.); University of Salerno, Fisciano, Italy (S.M.); International Translational Research and Medical Education Consortium (ITME) and Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (G.S.); and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York City, New York (U.K., F.V., S.S.J., G.S.)
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Mone P, Lombardi A, Frullone S, Santulli G. LBODP062 SGLT2 Inhibition Ameliorates Cognitive And Physical Impairment In Patients With HFpEF And Diabetes. J Endocr Soc 2022. [PMCID: PMC9629380 DOI: 10.1210/jendso/bvac150.572] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aim The aim of this study was to assess whether the inhibitor of sodium-glucose cotransporter-2 (SGLT2) empagliflozin improves cognitive impairment in frail older adults with diabetes mellitus (DM) and Heart Failure with Preserved Ejection Fraction (HFpEF). Methods We designed a prospective study to assess cognitive and physical function in consecutive frail older adults with DM and HFpEF, comparing the effects of empagliflozin, metformin, and insulin. Results A total of 162 frail elders with HFpEF and DM successfully completed the study. The Montreal Cognitive Assessment (MoCA) score was measured at baseline and after 1-month: 19.80±3.77 vs. 22.25±3.27 (p<0. 001) in the empagliflozin group; 19.95±3.81 vs. 20.71±3.56 (p: 0.26) in the metformin group; 19. 00±3.71 vs. 19.1±3.56 (p: 0.81) in the insulin group. A multivariate regression analysis confirmed the beneficial effects of empagliflozin. Additionally, we observed a marked amelioration of physical impairment, assessed by the 5-meter gait speed test, in the empagliflozin and in the metformin arms, but not in patients receiving insulin. Conclusions To the best of our knowledge, this is the first study to show significant beneficial effects of empagliflozin treatment on cognitive and physical impairment in frail subjects with HFpEF and DM. Presentation: No date and time listed
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Santulli G, Frullone S, Morgante M, Macina G, Pansini A, Gambardella J, Lombardi A, Mone P. Response to Comment on Mone et al. Empagliflozin Improves Cognitive Impairment in Frail Older Adults With Type 2 Diabetes and Heart Failure With Preserved Ejection Fraction. Diabetes Care 2022;45:1247-1251. Diabetes Care 2022; 45:e151-e152. [PMID: 36150055 PMCID: PMC9643146 DOI: 10.2337/dci22-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Gaetano Santulli
- Department of Medicine, Einstein-Sinai Diabetes Research Center (FIDAM), The Fleischer Institute for Diabetes and Metabolism (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, NY
- International Translational Research and Medical Education Consortium (ITME), “Federico II” University, Naples, Italy
| | | | | | | | | | - Jessica Gambardella
- Department of Medicine, Einstein-Sinai Diabetes Research Center (FIDAM), The Fleischer Institute for Diabetes and Metabolism (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY
- International Translational Research and Medical Education Consortium (ITME), “Federico II” University, Naples, Italy
| | - Angela Lombardi
- Department of Medicine, Einstein-Sinai Diabetes Research Center (FIDAM), The Fleischer Institute for Diabetes and Metabolism (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY
| | - Pasquale Mone
- Department of Medicine, Einstein-Sinai Diabetes Research Center (FIDAM), The Fleischer Institute for Diabetes and Metabolism (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, NY
- Department of Preventive Medicine, Campania University, Naples, Italy
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Mone P, Varzideh F, Jankauskas SS, Pansini A, Lombardi A, Frullone S, Santulli G. SGLT2 Inhibition via Empagliflozin Improves Endothelial Function and Reduces Mitochondrial Oxidative Stress: Insights From Frail Hypertensive and Diabetic Patients. Hypertension 2022; 79:1633-1643. [PMID: 35703100 PMCID: PMC9642044 DOI: 10.1161/hypertensionaha.122.19586] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Frailty is a multidimensional condition often diagnosed in older adults with hypertension and diabetes, and both these conditions are associated with endothelial dysfunction and oxidative stress. We investigated the functional role of the SGLT2 (sodium glucose cotransporter 2) inhibitor empagliflozin in frail diabetic and hypertensive older adults. METHODS We studied the effects of empagliflozin in consecutive hypertensive and diabetic older patients with frailty presenting at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, from March 2021 to January 2022. Moreover, we performed in vitro experiments in human endothelial cells to measure cell viability, permeability, mitochondrial Ca2+, and oxidative stress. RESULTS We evaluated 407 patients; 325 frail elders with diabetes successfully completed the study. We propensity-score matched 75 patients treated with empagliflozin and 75 with no empagliflozin. We observed a correlation between glycemia and Montreal Cognitive Assessment (MoCA) score and between glycemia and 5-meter gait speed (5mGS). At 3-month follow-up, we detected a significant improvement in the MoCA score and in the 5mGS in patients receiving empagliflozin compared with non-treated subjects. Mechanistically, we demonstrate that empagliflozin significantly reduces mitochondrial Ca2+ overload and reactive oxygen species production triggered by high glucose in human endothelial cells, attenuates cellular permeability, and improves cell viability in response to oxidative stress. CONCLUSIONS Taken together, our data indicate that empagliflozin reduces frailty in diabetic and hypertensive patients, most likely by decreasing the mitochondrial generation of reactive oxygen species in endothelial cells.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, New York, NY,Asl Avellino,Corresponding Author: Prof. Gaetano Santulli, MD, PhD () or Dr. Pasquale Mone, MD () Address: 1300 Morris PARK AVENUE, 10461 New York, NY
| | - Fahimeh Varzideh
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, New York, NY
| | | | | | - Angela Lombardi
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, New York, NY
| | | | - Gaetano Santulli
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, New York, NY,Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY.,Corresponding Author: Prof. Gaetano Santulli, MD, PhD () or Dr. Pasquale Mone, MD () Address: 1300 Morris PARK AVENUE, 10461 New York, NY
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Mone P, Pansini A, Jankauskas SS, Varzideh F, Kansakar U, Lombardi A, Trimarco V, Frullone S, Santulli G. L-Arginine Improves Cognitive Impairment in Hypertensive Frail Older Adults. Front Cardiovasc Med 2022; 9:868521. [PMID: 35498050 PMCID: PMC9039514 DOI: 10.3389/fcvm.2022.868521] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/28/2022] [Indexed: 12/11/2022] Open
Abstract
Cognitive impairment is a prevailing event in hypertensive patients and in frail older adults. Endothelial dysfunction has been shown to underlie both hypertension and cognitive dysfunction. Our hypothesis is that L-Arginine, which is known to ameliorate endothelial dysfunction, could counteract cognitive impairment in a high-risk population of hypertensive frail older adults. We designed a clinical trial to verify the effects of 4-weeks oral supplementation of L-Arginine on global cognitive function of hypertensive frail older patients. The study was successfully completed by 35 frail hypertensive elderly patients assigned to L-Arginine and 37 assigned to placebo. At follow-up, we found a significant difference in the Montreal Cognitive Assessment (MoCA) test score between the L-Arginine treated group and placebo (p: 0.0178). Moreover, we demonstrated that L-Arginine significantly attenuates Angiotensin II-induced mitochondrial oxidative stress in human endothelial cells. In conclusion, our findings indicate for the first time that oral L-Arginine supplementation significantly improves cognitive impairment in frail hypertensive older adults.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States.,Azienda Sanitaria Locale (ASL) Avellino, Avellino, Italy.,Campania University, Naples, Italy
| | | | | | - Fahimeh Varzideh
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
| | - Urna Kansakar
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
| | - Angela Lombardi
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - Gaetano Santulli
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States.,University of Naples "Federico II", Naples, Italy
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Mone P, Lombardi A, Gambardella J, Pansini A, Macina G, Morgante M, Frullone S, Santulli G. Empagliflozin Improves Cognitive Impairment in Frail Older Adults With Type 2 Diabetes and Heart Failure With Preserved Ejection Fraction. Diabetes Care 2022; 45:1247-1251. [PMID: 35287171 PMCID: PMC9174954 DOI: 10.2337/dc21-2434] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/11/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin improves cognitive impairment in frail older adults with diabetes and heart failure with preserved ejection fraction (HFpEF). RESEARCH DESIGN AND METHODS We designed a prospective study to assess cognitive and physical function in consecutive frail older adults with diabetes and HFpEF, comparing the effects of empagliflozin, metformin, and insulin. RESULTS A total of 162 frail older adults with HFpEF and diabetes successfully completed the study. Montreal Cognitive Assessment scores at baseline and after 1 month were 19.80 ± 3.77 vs. 22.25 ± 3.27 (P < 0.001) in the empagliflozin group, 19.95 ± 3.81 vs. 20.71 ± 3.56 (P = 0.26) in the metformin group, and 19.00 ± 3.71 vs. 19.1 ± 3.56 (P = 0.81) in the insulin group. A multivariable regression analysis confirmed the beneficial effects of empagliflozin. Additionally, we observed a marked amelioration of physical impairment, assessed by the 5-m gait speed test, in the empagliflozin and metformin groups but not in the insulin group. CONCLUSIONS This study is the first to show significant beneficial effects of the SGLT2 inhibitor empagliflozin on cognitive and physical impairment in frail older adults with diabetes and HFpEF.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY
- Azienda Sanitaria Locale Avellino, Avellino, Italy
- Department of Preventive Medicine, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Angela Lombardi
- Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY
| | - Jessica Gambardella
- Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY
- International Translational Research and Medical Education (ITME) Consortium and Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | | | | | | | | | - Gaetano Santulli
- Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY
- International Translational Research and Medical Education (ITME) Consortium and Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
- Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, NY
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Mone P, Pansini A, Frullone S, de Donato A, Buonincontri V, De Blasiis P, Marro A, Morgante M, De Luca A, Santulli G. Physical decline and cognitive impairment in frail hypertensive elders during COVID-19. Eur J Intern Med 2022; 99:89-92. [PMID: 35300886 PMCID: PMC8919809 DOI: 10.1016/j.ejim.2022.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypertension is common in older adults and its incidence increases with age. We investigated the correlation between physical and cognitive impairment in older adults with frailty and hypertension. METHODS We recruited frail hypertensive older adults during the COVID-19 pandemic, between March 2021 and December 2021. Global cognitive function was assessed through the Montreal Cognitive Assessment (MoCA), physical frailty assessment was performed following the Fried criteria, and all patients underwent physical evaluation through 5-meter gait speed test. RESULTS We enrolled 203 frail hypertensive older adults and we found a significant correlation between MoCA score and gait speed test (r: 0.495; p<0.001) in our population. To evaluate the impact of comorbidities and other factors on our results, we applied a linear regression analysis with MoCA score as a dependent variable, observing a significant association with age, diabetes, chronic obstructive pulmonary disease (COPD), and gait speed test. CONCLUSIONS Our study revealed for the first time a significant correlation between physical and cognitive impairment in frail hypertensive elderly subjects.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine and Department of Molecular Pharmacology - Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA; ASL Avellino, Avellino, Italy; University of Campania "Luigi Vanvitelli", Naples, Italy.
| | | | | | | | | | | | | | | | | | - Gaetano Santulli
- Department of Medicine and Department of Molecular Pharmacology - Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA; "Federico II" University, Naples, Italy
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Pansini A, Lombardi A, Morgante M, Frullone S, Marro A, Rizzo M, Martinelli G, Boccalone E, De Luca A, Santulli G, Mone P. Hyperglycemia and Physical Impairment in Frail Hypertensive Older Adults. Front Endocrinol (Lausanne) 2022; 13:831556. [PMID: 35498439 PMCID: PMC9048203 DOI: 10.3389/fendo.2022.831556] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/23/2022] [Indexed: 01/08/2023] Open
Abstract
Background Frailty is a multidimensional condition typical of elders. Frail older adults have a high risk of functional decline, hospitalization, and mortality. Hypertension is one of the most common comorbidities in elders. Hyperglycemia (HG) is frequently observed in frail older adults, and represents an independent predictor of worst outcomes, with or without diabetes mellitus (DM). We aimed at investigating the impact of HG on physical impairment in frailty. Methods We studied consecutive older adults with frailty and hypertension at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, from March 2021 to September 2021. Exclusion criteria were: age <65 years, no frailty, no hypertension, left ventricular ejection fraction <25%, previous myocardial infarction, previous primary percutaneous coronary intervention and/or coronary artery bypass grafting. Blood glucose, Hb1Ac, and creatinine were measured in all patients. Physical frailty was assessed applying the Fried Criteria; we performed a 5-meter gait speed (5mGS) test in all patients. Results 149 frail hypertensive older adults were enrolled in the study, of which 82 had normoglycemia (NG), and 67 had HG. We observed a significantly slower 5mGS in the HG group compared to the NG group (0.52 ± 0.1 vs. 0.69 ± 0.06; p<0.001). Moreover, we found a strong and significant correlation between 5mGS and glycemia (r: 0.833; p<0.001). A multivariable linear regression analysis using 5mGS as a dependent variable revealed a significant independent association with glycemia (p<0.001) after adjusting for likely confounders. Conclusions HG drives physical impairment in frail hypertensive older adults independently of DM.
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Affiliation(s)
| | - Angela Lombardi
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, United States
| | | | | | | | - Mario Rizzo
- ASL Avellino, Avellino, Italy
- Campania University, Caserta, Italy
| | | | | | | | - Gaetano Santulli
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, United States
| | - Pasquale Mone
- ASL Avellino, Avellino, Italy
- Department of Medicine, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, United States
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Mone P, Varzideh F, Kansakar U, Infante C, Lombardi A, de Donato A, Frullone S, Santulli G. Omega-3 fatty acids coordinate glucose and lipid metabolism in diabetic patients. Lipids Health Dis 2022; 21:31. [PMID: 35337345 PMCID: PMC8957175 DOI: 10.1186/s12944-022-01642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Omega 3 polyunsaturated fatty acids (n-3 PUFA) are known to have beneficial effects on cardiovascular and metabolic health. However, whether different sources of n-3 PUFA, for instance fatty fish vs vegetable oils, could elicit different effects on glucose and lipid metabolism, remains to be determined. Herein we examine recent findings showing that while a plant-based n-3 PUFA supplementation for six months can reduce fasting blood glucose, marine-based n-3 PUFA can instead reduce serum levels of triglycerides. We also discuss the potential molecular mechanisms that could underlie these different effects on the regulation of glycolipid metabolism.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine - Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York, USA. .,ASL Avellino, Avellino, Italy. .,University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Fahimeh Varzideh
- Department of Medicine - Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York, USA
| | - Urna Kansakar
- Department of Medicine - Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York, USA
| | | | - Angela Lombardi
- Department of Medicine - Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York, USA
| | | | | | - Gaetano Santulli
- Department of Medicine - Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York, USA. .,University of Naples "Federico II", Naples, Italy.
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Mone P, Pansini A, Calabrò F, De Gennaro S, Esposito M, Rinaldi P, Colin A, Minicucci F, Coppola A, Frullone S, Santulli G. Global cognitive function correlates with P-wave dispersion in frail hypertensive older adults. J Clin Hypertens (Greenwich) 2022; 24:638-643. [PMID: 35229449 PMCID: PMC9106080 DOI: 10.1111/jch.14439] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/15/2022]
Abstract
P‐Wave Dispersion (PWD) is an ECG parameter defined as the difference between the longest and the shortest P‐Wave duration. PWD has been associated with hypertension, a leading cause of age‐related cognitive decline. Moreover, hypertension is associated with vascular dementia and Alzheimer's Disease. Based on these considerations, we evaluated PWD and global cognitive function in frail hypertensive older adults with a previous diagnosis of cognitive decline. We evaluated consecutive frail hypertensive patients ≥65‐year‐old with a Mini‐Mental State Examination (MMSE) score <26. Patients with evidence of secondary hypertension, history of stroke, myocardial infarction, or therapy with beta‐blockers or acetylcholinesterase inhibitors were excluded. Beta‐blocker therapy causes a significant decrease in PWD; patients treated with acetylcholinesterase inhibitors were not included to avoid confounding effects on cognitive function. By examining 180 patients, we found that PWD significantly correlated with MMSE score. Strikingly, these effects were confirmed in a linear multivariate analysis with a regression model. To our knowledge, this is the first study showing that PWD correlates with global cognitive function in frail hypertensive older adults.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA.,University Campania "Luigi Vanvitelli", Naples, Italy.,ASL Avellino, Avellino, Italy
| | | | | | | | | | | | | | | | | | | | - Gaetano Santulli
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA.,University of Naples "Federico II", Naples, Italy.,International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
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Mone P, Gambardella J, Lombardi A, Pansini A, De Gennaro S, Leo AL, Famiglietti M, Marro A, Morgante M, Frullone S, De Luca A, Santulli G. Correlation of physical and cognitive impairment in diabetic and hypertensive frail older adults. Cardiovasc Diabetol 2022; 21:10. [PMID: 35045834 PMCID: PMC8772197 DOI: 10.1186/s12933-021-01442-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/30/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Diabetes and hypertension are common in older adults and represent established risk factors for frailty. Frailty is a multidimensional condition due to reserve loss and susceptibility to stressors with a high risk of death, hospitalizations, functional and cognitive impairment. Comorbidities such as diabetes and hypertension play a key role in increasing the risk of mortality, hospitalization, and disability. Moreover, frail patients with diabetes and hypertension are known to have an increased risk of cognitive and physical impairment. Nevertheless, no study assessed the correlation between physical and cognitive impairment in frail older adults with diabetes and hypertension. METHODS We evaluated consecutive frail older patients with diabetes and hypertension who presented at ASL (local health unit of the Italian Ministry of Health) Avellino, Italy, from March 2021 to October 2021. The inclusion criteria were: a previous diagnosis of diabetes and hypertension with no evidence of secondary causes; age > 65 years; a frailty status; Montreal Cognitive Assessment (MoCA) score < 26. RESULTS 179 patients successfully completed the study. We found a strong and significant correlation between MoCA score and 5-m gait speed test (r: 0.877; p < 0.001). To further verify our results, we performed a linear multivariate analysis adjusting for potential confounding factors, with MoCA score as dependent variable, which confirmed the significant association with glycemia (p < 0.001). CONCLUSIONS This is the first study showing a significant correlation between 5-m gait speed test and MoCA score in frail diabetic and hypertensive older adults.
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Affiliation(s)
- Pasquale Mone
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.9841.40000 0001 2200 8888Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy ,Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Jessica Gambardella
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.4691.a0000 0001 0790 385XInternational Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Angela Lombardi
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA
| | - Antonella Pansini
- Elderly Assistance and Home Care, ASL (Local Health Unit), Avellino, Italy
| | - Stefano De Gennaro
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Anna Luisa Leo
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Michele Famiglietti
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Anna Marro
- Elderly Assistance and Home Care, ASL (Local Health Unit), Avellino, Italy
| | - Maria Morgante
- Elderly Assistance and Home Care, ASL (Local Health Unit), Avellino, Italy
| | - Salvatore Frullone
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Antonio De Luca
- grid.9841.40000 0001 2200 8888Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gaetano Santulli
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.4691.a0000 0001 0790 385XInternational Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy ,grid.251993.50000000121791997Department of Molecular Pharmacology, Institute for Neuroimmunology and Inflammation (INI), Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, NY USA
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Mone P, Morgante M, Pansini A, Jankauskas SS, Rizzo M, Lombardi A, Frullone S, Santulli G. Effects of insulin resistance on mitochondrial (dys)function. Atherosclerosis 2022; 341:52-54. [PMID: 34903382 PMCID: PMC8943707 DOI: 10.1016/j.atherosclerosis.2021.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 01/02/2023]
Affiliation(s)
- Pasquale Mone
- Corresponding author. Departments of Medicine and Molecular Pharmacology – Wilf Family Cardiovascular Research Center, Institute for Aging Research, Einstein/Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism, Institute for Neuroimmunology and Inflammation (INI), Albert Einstein College of Medicine, New York City, NY, USA., , (P. Mone)
| | | | | | - Stanislovas S. Jankauskas
- Departments of Medicine and Molecular Pharmacology – Wilf Family Cardiovascular Research Center, Institute for Aging Research, Einstein/Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism, Institute for Neuroimmunology and Inflammation (INI), Albert Einstein College of Medicine, New York City, NY, USA
| | - Mario Rizzo
- University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | | | - Gaetano Santulli
- Departments of Medicine and Molecular Pharmacology – Wilf Family Cardiovascular Research Center, Institute for Aging Research, Einstein/Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism, Institute for Neuroimmunology and Inflammation (INI), Albert Einstein College of Medicine, New York City, NY, USA; Department of Advanced Biomedical Sciences, “Federico II” University Naples, Naples, Italy
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Mone P, Gambardella J, Pansini A, Rizzo M, Frullone S, Santulli G. Abstract P183: Effects Of L-arginine Supplementation On Cognitive Impairment In Hypertensive Frail Elderly Adults. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.p183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
L-Arginine is an amino acid which is involved in nitric oxide production regulating vascular tone and cardiovascular homeostasis. Hypertension is one of the most common comorbidities worldwide, and leads to endothelial dysfunction contributing to atherosclerosis, inflammation, and oxidative stress. Frailty is a syndrome of decreased physiological reserves with increased susceptibility to stressors leading to higher mortality, hospitalization, disability, and functional and cognitive impairment. Cognitive impairment is a very common feature in hypertensive frail older adults. Hence, it is very important to treat cognitive impairment to delay and/or prevent adverse events. Our study, thus, investigated the effects of 4-weeks supplementation of L-Arginine on global cognitive function.
Methods:
We studied 101 frail older patients from April 2020 to April 2021. All subjects were recruited from ASL (local health company of Italian Ministry of Health) Avellino, Italy. All patients fulfilled all of the following inclusion criteria: a previous diagnosis of hypertension, a confirmed frail status, age >65 years. The exclusion criteria were: age <65 years, absence of frailty status, absence of hypertension, left ventricular ejection fraction <25%, with previous myocardial infarction or previous PPCI or/and coronary by-pass grafting, or previous fibrinolytic therapy. The study was approved by the local Ethics Committee and a written consent was signed.
Results:
We are reporting here the results in 52 patients who hitherto successfully completed the study. The cognitive screening was available at baseline (before treatment) and during a follow-up of 4 weeks. The non-treated group (n=27) had a Montreal Cognitive Assessment (MoCA) score 22.9±0.9 at basal and 23.4±1.0 at follow-up (p=0.06). The treated group (oral L-Arginine, 1.66 g, twice a day; n=25) displayed a MoCA score 23.1±0.7 at basal and 24.2±0.6 at follow-up (p<0.001); the difference between the follow-up groups was significant as well (p<0.001).
Conclusions:
Our data show a significant improvement in the MoCA score in the group treated with L-Arginine. More extensive studies are needed to verify the efficacy of L-Arginine in this population.
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Affiliation(s)
| | | | | | - Mario Rizzo
- Univ of Campania Luigi Vanvitelli, Naples, Italy
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Mone P, Gambardella J, Pansini A, de Donato A, Martinelli G, Boccalone E, Matarese A, Frullone S, Santulli G. Cognitive Impairment in Frail Hypertensive Elderly Patients: Role of Hyperglycemia. Cells 2021; 10:2115. [PMID: 34440883 PMCID: PMC8391431 DOI: 10.3390/cells10082115] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022] Open
Abstract
Endothelial dysfunction is a key hallmark of hypertension, which is a leading risk factor for cognitive decline in older adults with or without frailty. Similarly, hyperglycemia is known to impair endothelial function and is a predictor of severe cardiovascular outcomes, independent of the presence of diabetes. On these grounds, we designed a study to assess the effects of high-glucose and metformin on brain microvascular endothelial cells (ECs) and on cognitive impairment in frail hypertensive patients. We tested the effects of metformin on high-glucose-induced cell death, cell permeability, and generation of reactive oxygen species in vitro, in human brain microvascular ECs. To investigate the consequences of hyperglycemia and metformin in the clinical scenario, we recruited frail hypertensive patients and we evaluated their Montreal Cognitive Assessment (MoCA) scores, comparing them according to the glycemic status (normoglycemic vs. hyperglycemic) and the use of metformin. We enrolled 376 patients, of which 209 successfully completed the study. We observed a significant correlation between MoCA score and glycemia. We found that hyperglycemic patients treated with metformin had a significantly better MoCA score than hyperglycemic patients treated with insulin (18.32 ± 3.9 vs. 14.94 ± 3.8; p < 0.001). Our in vitro assays confirmed the beneficial effects of metformin on human brain microvascular ECs. To our knowledge, this is the first study correlating MoCA score and glycemia in frail and hypertensive older adults, showing that hyperglycemia aggravates cognitive impairment.
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Affiliation(s)
- Pasquale Mone
- ASL Avellino, 83100 Avellino, Italy; (A.P.); (S.F.)
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy;
- Department of Medicine (Cardiology), Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY 10461, USA;
| | - Jessica Gambardella
- Department of Medicine (Cardiology), Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY 10461, USA;
- International Translational Research and Medical Education Consortium (ITME), University “Federico II” of Naples, 80131 Naples, Italy
| | | | - Antonio de Donato
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy;
| | | | | | | | | | - Gaetano Santulli
- Department of Medicine (Cardiology), Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY 10461, USA;
- International Translational Research and Medical Education Consortium (ITME), University “Federico II” of Naples, 80131 Naples, Italy
- Department of Molecular Pharmacology, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA
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20
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Parisi P, De Vizia A, Macina G, Frullone S, Cascia M, Carratù R. Acute liver disorders in left-sided heart failure. Ital J Gastroenterol 1990; 22:133-5. [PMID: 2131943] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of apparent acute hepatitis developed during a mild attack of left-sided heart failure is reported. No shock or significant systemic hypotension was observed which are usually reported in such patients. The signs of the liver impairment were transient, subsiding with the successful treatment of the heart failure.
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Affiliation(s)
- P Parisi
- Divisione di Medicina Interna, Ospedale Civile di Bisaccia, Avellino, Italy
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21
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Cerciello GC, Polverino M, Di Marino F, Silvestri O, Pio A, Frullone S, Parisi P, Manganiello V, D'Antonio A, Ambrosone L, Rambaldi M. [Semi-logarithmic volume-time diagram obtained by mathematical analysis of the flow-volume curve. Preliminary data]. Arch Monaldi 1981; 36:141-52. [PMID: 6756333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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