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Xu SL, Li K, Cao WW, Chen SH, Ren SB, Zhang BF, Zhang YM. The association between admission mean corpuscular volume and preoperative deep venous thrombosis in geriatrics hip fracture: a retrospective study. BMC Musculoskelet Disord 2024; 25:40. [PMID: 38191314 PMCID: PMC10773051 DOI: 10.1186/s12891-023-07147-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/22/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE This study evaluated the association between admission MCV and preoperative deep vein thrombosis (DVT) in geriatric hip fractures. METHODS Older adult patients with hip fractures were screened between January 2015 and September 2019. The demographic and clinical characteristics of the patients were collected at the largest trauma center in northwest China. MCV was measured at admission and converted into a categorical variable according to the quartile. Multivariate binary logistic regression and generalized additive model were used to identify the linear and nonlinear association between MCV and preoperative DVT. Analyses were performed using EmpowerStats and the R software. RESULTS A total of 1840 patients who met the criteria were finally enrolled and divided into four groups according to their MCV levels. The mean MCV was 93.82 ± 6.49 (80.96 to 105.91 fL), and 587 patients (31.9%) were diagnosed with preoperative DVT. When MCV was a continuous variable, the incidence of preoperative DVT increased with mean corpuscular volume. In the fully adjusted model, admission MCV was positively correlated with the incidence of preoperative DVT (OR: 1.03; 95% CI: 1.01-1.05; P = 0.0013). After excluding the effect of other factors, each additional 1fL of MCV increased the prevalence of preoperative DVT by 1.03 times as a continuous variable. CONCLUSION MCV was linearly associated with preoperative DVT in geriatric patients with hip fractures and could be considered a predictor of DVT risk. The MCV may contribute to risk assessment and preventing adverse outcomes in the elderly. STUDY REGISTRATION This study is registered on the website of the Chinese Clinical Trial Registry (ChiCTR: ChiCTR2200057323).
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Affiliation(s)
- Shuai-Liang Xu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
- Xi'an Medical University, Beilin District, Xi'an, Shaanxi Province, China
| | - Kun Li
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Wen-Wen Cao
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Shao-Hua Chen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Shang-Bo Ren
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China.
| | - Yu-Min Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
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Cheung AS, Nolan BJ, Zwickl S. Transgender health and the impact of aging and menopause. Climacteric 2023; 26:256-262. [PMID: 37011669 DOI: 10.1080/13697137.2023.2176217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Gender affirming hormone therapy (GAHT) is used by many transgender people to reduce gender incongruence and improve psychological functioning. As GAHT shares many similarities with menopausal hormone therapy, clinicians supporting people through menopause are ideally placed to manage GAHT. This narrative review provides an overview of transgender health and discusses long-term effects of GAHT to consider when managing transgender individuals across the lifespan. Menopause is less relevant for transgender individuals who take GAHT (often given lifelong) to achieve sex steroid concentrations generally in the range of the affirmed gender. For people using feminizing hormone therapy, there is an elevated risk of venous thromboembolism, myocardial infarction, stroke and osteoporosis relative to cisgender individuals. For trans people using masculinizing hormone therapy, there is an increased risk of polycythemia, probable higher risk of myocardial infarction and pelvic pain which is poorly understood. Proactive mitigation of cardiovascular risk factors is important for all transgender people and optimization of bone health is important for those using feminizing hormones. With a lack of research to guide GAHT in older age, a shared decision-making approach is recommended for the provision of GAHT to achieve individual goals whilst minimizing potential adverse effects.
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Affiliation(s)
- A S Cheung
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - B J Nolan
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - S Zwickl
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
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3
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Piesanen J, Kunnas T, Nikkari ST. Hematocrit value at early middle age predicts hypertension at late middle age; the Tampere adult population cardiovascular risk study, a 30-year follow-up. Prev Med Rep 2023; 33:102192. [DOI: 10.1016/j.pmedr.2023.102192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/24/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
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Sheridan A, Brown AC. Recent Advances in Blood Cell-Inspired and Clot Targeted Thrombolytic Therapies. J Tissue Eng Regen Med 2023; 2023:6117810. [PMID: 37731481 PMCID: PMC10511217 DOI: 10.1155/2023/6117810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Myocardial infarction, stroke, and pulmonary embolism are all deadly conditions associated with excessive thrombus formation. Standard treatment for these conditions involves systemic delivery of thrombolytic agents to break up clots and restore blood flow; however, this treatment can impact the hemostatic balance in other parts of the vasculature, which can lead to excessive bleeding. To avoid this potential danger, targeted thrombolytic treatments that can successfully target thrombi and release an effective therapeutic load are necessary. Because activated platelets and fibrin make up a large proportion of clots, these two components provide ample opportunities for targeting. This review will highlight potential thrombus targeting mechanisms as well as recent advances in thrombolytic therapies which utilize blood-cells and clotting proteins to effectively target and lyse clots.
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Affiliation(s)
- Anastasia Sheridan
- Joint Department of Biomedical Engineering of University of North Carolina – Chapel Hill and North Carolina State University, Raleigh, NC 27695
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27606
| | - Ashley C. Brown
- Joint Department of Biomedical Engineering of University of North Carolina – Chapel Hill and North Carolina State University, Raleigh, NC 27695
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27606
- Department of Material Science and Engineering, North Carolina State University, Raleigh, NC 27606
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5
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Zhao H, Li P, Zhong G, Xie K, Zhou H, Ning Y, Xu D, Zeng Q. Machine learning models in heart failure with mildly reduced ejection fraction patients. Front Cardiovasc Med 2022; 9:1042139. [DOI: 10.3389/fcvm.2022.1042139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
ObjectiveHeart failure with mildly reduced ejection fraction (HFmrEF) has been recently recognized as a unique phenotype of heart failure (HF) in current practical guideline. However, risk stratification models for mortality and HF re-hospitalization are still lacking. This study aimed to develop and validate a novel machine learning (ML)-derived model to predict the risk of mortality and re-hospitalization for HFmrEF patients.MethodsWe assessed the risks of mortality and HF re-hospitalization in HFmrEF (45–49%) patients enrolled in the TOPCAT trial. Eight ML-based models were constructed, including 72 candidate variables. The Harrell concordance index (C-index) and DeLong test were used to assess discrimination and the improvement in discrimination between models, respectively. Calibration of the HF risk prediction model was plotted to obtain bias-corrected estimates of predicted versus observed values.ResultsLeast absolute shrinkage and selection operator (LASSO) Cox regression was the best-performing model for 1- and 6-year mortality, with a highest C-indices at 0.83 (95% CI: 0.68–0.94) over a maximum of 6 years of follow-up and 0.77 (95% CI: 0.64–0.89) for the 1-year follow-up. The random forest (RF) showed the best discrimination for HF re-hospitalization, scoring 0.80 (95% CI: 0.66–0.94) and 0.85 (95% CI: 0.71–0.99) at the 6- and 1-year follow-ups, respectively. For risk assessment analysis, Kansas City Cardiomyopathy Questionnaire (KCCQ) subscale scores were the most important predictor of readmission outcome in the HFmrEF patients.ConclusionML-based models outperformed traditional models at predicting mortality and re-hospitalization in patients with HFmrEF. The results of the risk assessment showed that KCCQ score should be paid increasing attention to in the management of HFmrEF patients.
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Thirumalai A, Anawalt BD. Androgenic Steroids Use and Abuse. Urol Clin North Am 2022; 49:645-663. [DOI: 10.1016/j.ucl.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Abacioglu OO, Yildirim A, Karadeniz M, Abacioglu S, Koyunsever NY, Dindas F, Dogdus M, Kaplangoray M. A New Score for Determining Thrombus Burden in STEMI Patients: The MAPH Score. Clin Appl Thromb Hemost 2022; 28:10760296211073767. [PMID: 35018837 PMCID: PMC8761881 DOI: 10.1177/10760296211073767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Aim to investigate whether the MAPH score, which is a new score that combines blood viscosity biomarkers such as mean platelet volume (MPV), total protein and hematocrit, can be used to predict thrombus burden in ST-segment elevation myocardial infarction (STEMI) patients. Methods A total of 473 consecutive patients with STEMI were included in the study. Intracoronary tirofiban/abciximab infusion was applied to patients with thrombus load ≥3 and these patients (n = 71) were defined as the patient group with high thrombus load. MPV, age, hematocrit and total protein values of the patients were recorded. High shear rate (HSR) and low shear rate (LSR) were calculated from total protein and hematocrit values. Cut-off values were determined for high thrombus load by using Youden index, and score was determined as 0 or 1 according to cut-offs. The sum of the scores was calculated as the MAPH score. Results The mean age of the patients included in the study was 59.6 ± 12.6 (n = 354 male, 74.8%). There was no difference between the groups in terms of gender, HT and DM (P = .127, P = .402 and P = .576, respectively). In the group with high thrombus load; total protein, MPV and hematocrit values were higher (P < .001, P = .001 and P = .03, respectively). Comparison of receiver operating characteristic (ROC) curve analysis revealed that the MAPH score had better performance in predicting higher thrombus load than both other self-containing parameters and HSR and LSR. Conclusion The MAPH score may be a new score that can be used to determine thrombus burden in STEMI patients.
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8
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Oz O, Gonel A. The Association Between Parameters of Erythrocytes Morphology and Thrombophilia-Related Mutations. Rev Recent Clin Trials 2021; 17:40-45. [PMID: 34814821 DOI: 10.2174/1574887116666211123092603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alterations in erythrocyte morphology parameters have been identified and associated with hematological disorders and other chronic and cardiovascular diseases. Erythrocytes are abundant in thrombus content. Their hemoglobin density and differences in the ratio of macrocytic and microcytic cells may be associated with hypercoagulopathy in those with a history of thrombosis. OBJECTIVE This cross-sectional study aimed to investigate the relationship between hemogram parameters and thrombophilia genetic parameters. METHOD A total of 55 patients whose thrombophilia panel was reviewed due to the diagnosis of thrombosis were included in the study. %MIC, %MAC, %HPO, %HPR and all hemogram parameters were measured using Abbott Alinity HQ. Prothrombin G20210A, MTHFR C677T, MTHFR A1298C, Factor V Leiden G169A and PAI-1 4G/5G mutations were studied using Real Time-PCR. RESULTS The MTHFR C677T mutation was detected in 58.2% of the patients. The Factor V Leiden mutation was detected in 5.5% of the patients. The MTHFR A1298C mutation was detected in 58.2%, The PAI mutation was detected in 74.5%, and the Factor 13 mutation was detected in 29% of the patients. Prothrombin G20210A mutation was not detected in any of the patients. Red blood cell (RBC) and Hct values were higher in Factor 13 mutant group; the Hgb and Htc values were higher in the MTHFR C677T mutant group. CONCLUSION The MTHFR C677T and Factor 13 mutations may be associated with high Hct and RBC, Hgb, and Htc values, respectively and coagulation tendency in patients with a history of thrombosis.
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Affiliation(s)
- Ozlem Oz
- Department of Medical Genetics, Harran University. Turkey
| | - Ataman Gonel
- Department of Medicinal Biochemistry, Harran University. Turkey
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Tamura N, Shimizu K, Shiozaki S, Sugiyama K, Nakayama M, Goto S, Takagi S, Goto S. Important Regulatory Roles of Erythrocytes on Platelet Adhesion to the von Willebrand Factor on the Wall Under Blood Flow Conditions. Thromb Haemost 2021; 122:974-983. [PMID: 34695874 DOI: 10.1055/a-1677-9499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The roles of erythrocytes on platelet adhesion to von Willebrand factor (VWF) on the vessel wall through their membrane glycoprotein (GP)Ibα under blood flow condition is still to be elucidated. Blood specimens containing fluorescently labeled platelet and native, biochemically fixed, or artificial erythrocytes, at various hematocrits were perfused on a surface of VWF immobilized on the wall at a shear rate of 1,500 s-1. Rates of platelet adhesions were measured in each condition. Computer simulation of platelet adhesion to the VWF on the wall at the same shear rate was conducted by solving governing equations with a finite-difference method on K-computer. The rates of platelet adhesion were calculated at various hematocrits conditions in the computational domain of 100 µm (x-axis) x 400 µm (y-axis) x 100 µm (z-axis). Biological experiments demonstrated the positive correlation between the rates of platelet adhesion and hematocrit values in native, fixed, and artificial erythrocytes. (r=0.992, 0.934, and 0.825 respectively, p<0.05 for all). The computer simulation results supported the hematocrit dependent increase in platelet adhesion rates on VWF (94.3/sec at 10%, 185.2/sec at 20%, and 327.9/sec at 30%, respectively). These results suggest the important contributing role of erythrocytes on platelet adhesion to the VWF. The augmented z-axis fluctuation of flowing platelet caused by the physical presence of erythrocytes is speculated as the cause for hematocrit dependent increase in platelet adhesion.
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Affiliation(s)
- Noriko Tamura
- Niigata University of Health and Welfare, Niigata, Japan
| | - Kazuya Shimizu
- The University of Tokyo Graduate School of Engineering Faculty of Engineering, Bunkyo-ku, Japan
| | - Seiji Shiozaki
- Tokai University School of Medicine Graduate School of Medicine, Isehara, Japan
| | - Kazuyasu Sugiyama
- Osaka University School of Engineering Graduate School of Engineering, Suita, Japan
| | - Masamitsu Nakayama
- Tokai University School of Medicine Graduate School of Medicine, Isehara, Japan
| | - Shinichi Goto
- Department of Cardiology, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Japan
| | - Shu Takagi
- Department of Mechanical Engineering, University of Tokyo, Tokyo, Japan
| | - Shinya Goto
- Department of Medicine, Tokai University, Isehara, Japan
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Nolan BJ, Leemaqz SY, Ooi O, Cundill P, Silberstein N, Locke P, Grossmann M, Zajac JD, Cheung AS. Prevalence of polycythaemia with different formulations of testosterone therapy in transmasculine individuals. Intern Med J 2021; 51:873-878. [PMID: 32237098 DOI: 10.1111/imj.14839] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/14/2020] [Accepted: 03/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Masculinising hormone therapy with testosterone is used to align an individual's physical characteristics with his or her gender identity. Testosterone therapy is typically administered via intramuscular or transdermal routes, and polycythaemia is the most common adverse event. AIMS To compare the risk of polycythaemia with different formulations of testosterone therapy in transmasculine individuals. METHODS A retrospective cross-sectional analysis was undertaken of transmasculine individuals at a primary and secondary care clinic in Melbourne, Australia. A total of 180 individuals who were on testosterone therapy for >6 months was included. Groups included those receiving: (i) intramuscular testosterone undecanoate (n = 125); (ii) intramuscular testosterone enantate (n = 31); or (iii) transdermal testosterone (n = 24). Outcome was prevalence of polycythaemia (defined as haematocrit > 0.5). RESULTS Mean age was 28.4 (8.8) years, with a median duration of testosterone therapy of 37.7 (24.2) months; 27% were smokers. There was no difference between groups in serum total testosterone concentration measured. While there was no difference between groups in haematocrit, there was a higher proportion of patients with polycythaemia in those who were on intramuscular testosterone enantate (23.3%) than on transdermal testosterone (0%), P = 0.040. There was no statistically significant difference in polycythaemia between intramuscular testosterone undecanoate (15%) and transdermal testosterone, P = 0.066 nor between intramuscular testosterone enantate and undecanoate, P = 0.275. CONCLUSIONS One in four individuals treated with intramuscular testosterone enantate and one in six treated with testosterone undecanoate had polycythaemia. No individual treated with transdermal testosterone had polycythaemia. This highlights the importance of regular monitoring of haematocrit in transmasculine individuals treated with testosterone, and findings may inform treatment choices.
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Affiliation(s)
- Brendan J Nolan
- Department of Endocrinology, Austin Health, Victoria, Australia.,Department of Medicine (Austin Health), University of Melbourne, Victoria, Australia
| | - Shalem Y Leemaqz
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Olivia Ooi
- Department of Medicine (Austin Health), University of Melbourne, Victoria, Australia
| | - Pauline Cundill
- Equinox Gender Diverse Clinic, Thorne Harbour Health, Melbourne, Victoria, Australia
| | - Nicholas Silberstein
- Equinox Gender Diverse Clinic, Thorne Harbour Health, Melbourne, Victoria, Australia
| | - Peter Locke
- Equinox Gender Diverse Clinic, Thorne Harbour Health, Melbourne, Victoria, Australia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, Victoria, Australia.,Department of Medicine (Austin Health), University of Melbourne, Victoria, Australia
| | - Jeffrey D Zajac
- Department of Endocrinology, Austin Health, Victoria, Australia.,Department of Medicine (Austin Health), University of Melbourne, Victoria, Australia
| | - Ada S Cheung
- Department of Endocrinology, Austin Health, Victoria, Australia.,Department of Medicine (Austin Health), University of Melbourne, Victoria, Australia
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Wan J, Konings J, de Laat B, Hackeng TM, Roest M. Added Value of Blood Cells in Thrombin Generation Testing. Thromb Haemost 2021; 121:1574-1587. [PMID: 33742437 DOI: 10.1055/a-1450-8300] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The capacity of blood to form thrombin is a critical determinant of coagulability. Plasma thrombin generation (TG), a test that probes the capacity of plasma to form thrombin, has improved our knowledge of the coagulation system and shows promising utility in coagulation management. Although plasma TG gives comprehensive insights into the function of pro- and anticoagulation drivers, it does not measure the role of blood cells in TG. In this literature review, we discuss currently available continuous TG tests that can reflect the involvement of blood cells in coagulation, in particular the fluorogenic assays that allow continuous measurement in platelet-rich plasma and whole blood. We also provide an overview about the influence of blood cells on blood coagulation, with emphasis on the direct influence of blood cells on TG. Platelets accelerate the initiation and velocity of TG by phosphatidylserine exposure, granule content release and surface receptor interaction with coagulation proteins. Erythrocytes are also major providers of phosphatidylserine, and erythrocyte membranes trigger contact activation. Furthermore, leukocytes and cancer cells may be important players in cell-mediated coagulation because, under certain conditions, they express tissue factor, release procoagulant components and can induce platelet activation. We argue that testing TG in the presence of blood cells may be useful to distinguish blood cell-related coagulation disorders. However, it should also be noted that these blood cell-dependent TG assays are not clinically validated. Further standardization and validation studies are needed to explore their clinical usefulness.
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Affiliation(s)
- Jun Wan
- Synapse Research Institute, Maastricht, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Joke Konings
- Synapse Research Institute, Maastricht, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Bas de Laat
- Synapse Research Institute, Maastricht, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Tilman M Hackeng
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Mark Roest
- Synapse Research Institute, Maastricht, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
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Porro B, Conte E, Zaninoni A, Bianchi P, Veglia F, Barbieri S, Fiorelli S, Eligini S, Di Minno A, Mushtaq S, Tremoli E, Cavalca V, Andreini D. Red Blood Cell Morphodynamics: A New Potential Marker in High-Risk Patients. Front Physiol 2021; 11:603633. [PMID: 33519509 PMCID: PMC7838560 DOI: 10.3389/fphys.2020.603633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
In the last years, a substantial contribution of red blood cells (RBCs) in cardiovascular homeostasis has been evidenced, as these cells are able to regulate cardiovascular function by the export of adenosine triphosphate and nitric oxide as well as to maintain redox balance through a well-developed antioxidant system. Recently a link between high-risk plaque (HRP) features and myocardial ischemia, in the absence of severe lumen stenosis, has been evidenced. Nonobstructive coronary artery disease (nonob CAD) has been associated in fact with a greater 1-year risk of myocardial infarction and all-cause mortality compared with no apparent CAD. This new evidence increases interest in searching new triggers to identify these high-risk patients, in the absence/or on top of traditional hazard markers. In this study, we investigated the existence of any association between RBC morphodynamics and HRP features in individuals with different grades of coronary stenosis detected by coronary computed tomography angiography (CCTA). Ninety-one consecutive individuals who underwent CCTA [33 no CAD; 26 nonobstructive (nonob), and 32 obstructive (ob) CAD] were enrolled. RBC morphodynamic features, i.e., RBC aggregability and deformability, were analyzed by means of Laser Assisted Optical Rotation Cell Analyzer (LoRRca MaxSis). The putative global RBC morphodynamic (RMD) score and the related risk chart, associating the extent of HRP (e.g., the non-calcified plaque volume) with both the RMD score and the max % stenosis were computed. In nonob CAD group only positive correlations between RBC rigidity, osmotic fragility or aggregability and HRP features (plaque necrotic core, fibro-fatty and fibro-fatty plus necrotic core plaque volumes) were highlighted. Interestingly, in this patient cohort three of these RBC morphodynamic features result to be independent predictors of the presence of non-calcified plaque volume in this patients group. The risk chart created shows that only in nonob CAD plaque vulnerability increases according to the score quartile. Findings of this work, by evidencing the association between erythrocyte morphodynamic characteristics assessed by LoRRca and plaque instability in a high-risk cohort of nonob CAD, suggest the use of these blood cell features in the identification of high-risk patients, in the absence of severe coronary stenosis.
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Affiliation(s)
- Benedetta Porro
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Anna Zaninoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Unità Operativa Complessa (UOC) Ematologia, Unità Operativa Semplice (UOS) Fisiopatologia delle Anemie, Milan, Italy
| | - Paola Bianchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Unità Operativa Complessa (UOC) Ematologia, Unità Operativa Semplice (UOS) Fisiopatologia delle Anemie, Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Simone Barbieri
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Susanna Fiorelli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sonia Eligini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Alessandro Di Minno
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Viviana Cavalca
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Houghton DE, Koh I, Ellis A, Key NS, Douce DR, Howard G, Cushman M, Safford M, Zakai NA. Hemoglobin levels and coronary heart disease risk by age, race, and sex in the reasons for geographic and racial differences in stroke study (REGARDS). Am J Hematol 2020; 95:258-266. [PMID: 31840854 DOI: 10.1002/ajh.25703] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/22/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022]
Abstract
Higher and lower hemoglobin concentrations are associated with coronary heart disease (CHD), but whether this risk is consistent across age, sex, and race is unclear. The Reasons for Geographic And Racial Differences in Stroke (REGARDS) study is an observational cohort study of 30 239 black, and white, adults aged 45 and older recruited 2003-7. Participants were included if they had hemoglobin measures, were CHD-free at baseline, and had all baseline variables. The primary outcome was incident CHD. Multivariable Cox proportional hazards models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for incident CHD by hemoglobin concentration. This was expressed as a continuous variable and divided into age-, sex-, and race-specific quintiles. The 16 332 participants were included, contributing 114 362 person-years of follow-up and 915 incident CHD events. The mean age was 63 years, 35% were male, 41% were black, and the mean baseline hemoglobin was 13.6 g/dL (SD 1.4). A significant non-linear association between hemoglobin and CHD was identified (P < .001). This association differed significantly by race (P = .025) but not by sex or age. In whites, the risk for incident CHD was higher in the lowest (HR 2.28, 95% CI 1.61, 3.33) and highest (HR 1.94, 95% CI 1.35, 2.79) hemoglobin quintiles relative to the third quintile. For blacks, only those in the lowest hemoglobin quintile had an increased risk for incident CHD events (HR 1.70, 95% CI 1.20, 2.41). Hemoglobin is an independent risk factor for CHD in whites and blacks but with different hemoglobin concentrations conferring different risks.
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Affiliation(s)
- Damon E. Houghton
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Department of Internal Medicine, Division of Hematology/OncologyMayo Clinic Rochester Minnesota
| | - Insu Koh
- Department of Pathology and Laboratory MedicineLarner College of Medicine at the University of Vermont Burlington Vermont
| | - Alicia Ellis
- Duke Clinical Research InstituteDuke University Durham North Carolina
| | - Nigel S. Key
- Department of Medicine, Division of Hematology/OncologyUniversity of North Carolina Chapel Hill North Carolina
| | - Daniel R. Douce
- Department of MedicineLarner College of Medicine at the University of Vermont Burlington Vermont
| | - George Howard
- School of Public Health, Department of BiostatisticsUniversity of Alabama at Birmingham Birmingham Alabama
| | - Mary Cushman
- Department of Pathology and Laboratory MedicineLarner College of Medicine at the University of Vermont Burlington Vermont
- Department of MedicineLarner College of Medicine at the University of Vermont Burlington Vermont
| | - Monika Safford
- Department of General Internal MedicineWeill Cornell Medical College of Cornell University New York New York
| | - Neil A. Zakai
- Department of Pathology and Laboratory MedicineLarner College of Medicine at the University of Vermont Burlington Vermont
- Department of MedicineLarner College of Medicine at the University of Vermont Burlington Vermont
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14
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Hultcrantz M, Modlitba A, Vasan SK, Sjölander A, Rostgaard K, Landgren O, Hjalgrim H, Ullum H, Erikstrup C, Kristinsson SY, Edgren G. Hemoglobin concentration and risk of arterial and venous thrombosis in 1.5 million Swedish and Danish blood donors. Thromb Res 2019; 186:86-92. [PMID: 31927271 DOI: 10.1016/j.thromres.2019.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION There are conflicting results whether elevated hematocrit is associated with an increased risk of thromboembolic events in individuals without polycythemia vera. To assess the risk of vascular events in relation to hemoglobin concentration, we conducted a large population-based cohort study based on Scandinavian health registers. MATERIALS AND METHODS We included 1,538,019 Swedish and Danish blood donors between 1987 and 2012. Hazard ratios (HRs) of arterial and venous thrombosis were estimated using Cox regression. Additionally, we fitted person-stratified models where each donor was compared only to him-/herself. RESULTS The risk of myocardial infarction and ischemic stroke increased with higher hemoglobin concentration in both men and women. The HRs for myocardial infarction and ischemic stroke in men with hemoglobin concentration ≥ 17.5 g/dL were 3.52 (95% confidence interval [CI], 2.85-4.36) and 2.36 (95% CI, 1.63-3.43), respectively, compared to the reference group. The corresponding HRs for women with hemoglobin concentration ≥ 16.0 g/dL were 3.22 (2.12-4.89) and 2.35 (1.37-4.02) for myocardial infarction and ischemic stroke, respectively. The risk of venous thrombosis was highest in men with subnormal hemoglobin concentration (<13.0 g/dL), HR 1.69 (95% CI, 1.40-2.04). In the person-stratified model, the association between elevated hemoglobin concentration and risk of myocardial infarction was attenuated but remained significant. CONCLUSIONS In this large cohort of Scandinavian blood donors, elevated hemoglobin concentration was associated with an increased risk of vascular events, primarily arterial events. Even though associations were weakened when each person served as their own control, a high hemoglobin concentration may serve as a cardiovascular risk marker.
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Affiliation(s)
- Malin Hultcrantz
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | - Anton Modlitba
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Senthil K Vasan
- Oxford Center for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, United Kingdom
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Henrik Hjalgrim
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Sigurdur Y Kristinsson
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Faculty of Medicine, University of Iceland and Department of Hematology, Landspitali National University Hospital, Reykjavik, Iceland
| | - Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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15
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de la Harpe KM, Kondiah PPD, Choonara YE, Marimuthu T, du Toit LC, Pillay V. The Hemocompatibility of Nanoparticles: A Review of Cell-Nanoparticle Interactions and Hemostasis. Cells 2019; 8:E1209. [PMID: 31591302 PMCID: PMC6829615 DOI: 10.3390/cells8101209] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 12/12/2022] Open
Abstract
Understanding cell-nanoparticle interactions is critical to developing effective nanosized drug delivery systems. Nanoparticles have already advanced the treatment of several challenging conditions including cancer and human immunodeficiency virus (HIV), yet still hold the potential to improve drug delivery to elusive target sites. Even though most nanoparticles will encounter blood at a certain stage of their transport through the body, the interactions between nanoparticles and blood cells is still poorly understood and the importance of evaluating nanoparticle hemocompatibility is vastly understated. In contrast to most review articles that look at the interference of nanoparticles with the intricate coagulation cascade, this review will explore nanoparticle hemocompatibility from a cellular angle. The most important functions of the three cellular components of blood, namely erythrocytes, platelets and leukocytes, in hemostasis are highlighted. The potential deleterious effects that nanoparticles can have on these cells are discussed and insight is provided into some of the complex mechanisms involved in nanoparticle-blood cell interactions. Throughout the review, emphasis is placed on the importance of undertaking thorough, all-inclusive hemocompatibility studies on newly engineered nanoparticles to facilitate their translation into clinical application.
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Affiliation(s)
- Kara M de la Harpe
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2193, South Africa.
| | - Pierre P D Kondiah
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2193, South Africa
| | - Yahya E Choonara
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2193, South Africa.
| | - Thashree Marimuthu
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2193, South Africa.
| | - Lisa C du Toit
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2193, South Africa.
| | - Viness Pillay
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2193, South Africa.
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16
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Takaoka N, Sairenchi T, Irie F, Matsushita M, Nagao M, Umesawa M, Haruyama Y, Watanabe H, Yamagishi K, Iso H, Kobashi G, Ota H. High Hematocrit Levels Are Associated with Risk of Cardiovascular Mortality among Middle-Aged Japanese Women: The Ibaraki Prefectural Health Study (IPHS). TOHOKU J EXP MED 2019; 249:65-73. [PMID: 31564685 DOI: 10.1620/tjem.249.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In Japan, heart disease and cerebrovascular disease were the second and fourth leading cause of death, respectively in 2014. Hematocrit, the ratio of the red blood cells to the total volume of blood is known to play a role in cardiovascular diseases. However, the relationship between elevated hematocrit and the risk of cardiovascular disease based on sex has not been examined in Asian countries. We analyzed data from the Ibaraki Prefectural Health Study, a community-based large cohort study, which included 87,533 individuals, aged 40 to 79 years living in 38 municipalities of the Ibaraki Prefecture, who had completed an annual health checkup in 1993, and were followed until 2013. The hematocrit levels of the subjects were categorized into 5 quintiles (Q1-Q5), and hazard ratios for cause-specific mortality were calculated using the Cox proportional hazards regression models. Age and other cardiovascular risk factors were the covariates in the study. During the follow-up for a mean of 17.9 years, 1,207 deaths (615 men and 592 women) due to acute myocardial infarction (AMI) were reported in this population. The p values for the trend in the Q3-Q5 groups were 0.661 for men and 0.020 for women. Additionally, these values were significant in younger (40 to 59 years) women but not in older (60 to 79 years) women. This study is the first one to demonstrate an association between high hematocrit level and risk of AMI mortality in younger Japanese women, but not in men and older women.
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Affiliation(s)
- Nobuko Takaoka
- Department of Public Health, Dokkyo Medical University School of Medicine.,Office of International Affairs, Center for International Cooperation, Dokkyo Medical University School of Medicine.,Ibaraki Health Plaza
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University School of Medicine.,Ibaraki Health Plaza.,Ibaraki Health Service Association
| | - Fujiko Irie
- Department of Health and Welfare, Ibaraki Prefectural Office
| | - Munehiro Matsushita
- Department of Public Health, Dokkyo Medical University School of Medicine.,Department of Physical Recreation, Tokai University School of Physical Education
| | - Masanori Nagao
- Office of Epidemiology, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | | | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University School of Medicine
| | | | - Kazumasa Yamagishi
- Ibaraki Health Plaza.,Ibaraki Health Service Association.,Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine
| | - Hitoshi Ota
- Ibaraki Health Plaza.,Ibaraki Health Service Association
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17
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Abstract
Red blood cells (RBCs) have historically been considered passive bystanders in thrombosis. However, clinical and epidemiological studies have associated quantitative and qualitative abnormalities in RBCs, including altered hematocrit, sickle cell disease, thalassemia, hemolytic anemias, and malaria, with both arterial and venous thrombosis. A growing body of mechanistic studies suggests that RBCs can promote thrombus formation and enhance thrombus stability. These findings suggest that RBCs may contribute to thrombosis pathophysiology and reveal potential strategies for therapeutically targeting RBCs to reduce thrombosis.
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18
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Elevated hematocrit enhances platelet accumulation following vascular injury. Blood 2017; 129:2537-2546. [PMID: 28251913 DOI: 10.1182/blood-2016-10-746479] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/22/2017] [Indexed: 12/30/2022] Open
Abstract
Red blood cells (RBCs) demonstrate procoagulant properties in vitro, and elevated hematocrit is associated with reduced bleeding and increased thrombosis risk in humans. These observations suggest RBCs contribute to thrombus formation. However, effects of RBCs on thrombosis are difficult to assess because humans and mice with elevated hematocrit typically have coexisting pathologies. Using an experimental model of elevated hematocrit in healthy mice, we measured effects of hematocrit in 2 in vivo clot formation models. We also assessed thrombin generation, platelet-thrombus interactions, and platelet accumulation in thrombi ex vivo, in vitro, and in silico. Compared with controls, mice with elevated hematocrit (RBCHIGH) formed thrombi at a faster rate and had a shortened vessel occlusion time. Thrombi in control and RBCHIGH mice did not differ in size or fibrin content, and there was no difference in levels of circulating thrombin-antithrombin complexes. In vitro, increasing the hematocrit increased thrombin generation in the absence of platelets; however, this effect was reduced in the presence of platelets. In silico, direct numerical simulations of whole blood predicted elevated hematocrit increases the frequency and duration of interactions between platelets and a thrombus. When human whole blood was perfused over collagen at arterial shear rates, elevating the hematocrit increased the rate of platelet deposition and thrombus growth. These data suggest RBCs promote arterial thrombosis by enhancing platelet accumulation at the site of vessel injury. Maintaining a normal hematocrit may reduce arterial thrombosis risk in humans.
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19
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ISHIMARU T, ARPHORN S, JIRAPONGSUWAN A. Hematocrit levels as cardiovascular risk among taxi drivers in Bangkok, Thailand. INDUSTRIAL HEALTH 2016; 54:433-438. [PMID: 27151439 PMCID: PMC5054284 DOI: 10.2486/indhealth.2015-0248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/25/2016] [Indexed: 06/05/2023]
Abstract
In Thailand, taxi drivers employed in the informal sector often experience hazardous working conditions. Previous studies revealed that elevated Hematocrit (HCT) is a predictor of cardiovascular disease (CVD) risk. This study assessed factors associated with HCT in taxi drivers to predict their occupational CVD risk factors. A cross-sectional study was conducted on 298 male taxi drivers who joined a health check-up campaign in Bangkok, Thailand. HCT and body mass index were retrieved from participant health check-up files. Self-administered questionnaires assessed demographics, driving mileage, working hours, and lifestyle. Statistical associations were analyzed using stepwise linear regression. Our results showed that obesity (p=0.007), daily alcohol drinking (p=0.003), and current or past smoking (p=0.016) were associated with higher HCT levels. While working hours were not directly associated with HCT levels in the current study, the effect on overworking is statistically arguable because most participants worked substantially longer hours. Our findings suggest that taxi drivers' CVD risk may be increased by their unhealthy work styles. Initiatives to improve general working conditions for taxi drivers should take into account health promotion and CVD prevention. The policy of providing periodic health check-ups is important to make workers in the informal sector aware of their health status.
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Affiliation(s)
- Tomohiro ISHIMARU
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Thailand
- Occupational Health Training Center, University of Occupational and Environmental Health, Japan
| | - Sara ARPHORN
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Thailand
| | - Ann JIRAPONGSUWAN
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
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20
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Wang L, de Kloet AD, Pati D, Hiller H, Smith JA, Pioquinto DJ, Ludin JA, Oh SP, Katovich MJ, Frazier CJ, Raizada MK, Krause EG. Increasing brain angiotensin converting enzyme 2 activity decreases anxiety-like behavior in male mice by activating central Mas receptors. Neuropharmacology 2016; 105:114-123. [PMID: 26767952 DOI: 10.1016/j.neuropharm.2015.12.026] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/04/2015] [Accepted: 12/31/2015] [Indexed: 12/25/2022]
Abstract
Over-activation of the brain renin-angiotensin system (RAS) has been implicated in the etiology of anxiety disorders. Angiotensin converting enzyme 2 (ACE2) inhibits RAS activity by converting angiotensin-II, the effector peptide of RAS, to angiotensin-(1-7), which activates the Mas receptor (MasR). Whether increasing brain ACE2 activity reduces anxiety by stimulating central MasR is unknown. To test the hypothesis that increasing brain ACE2 activity reduces anxiety-like behavior via central MasR stimulation, we generated male mice overexpressing ACE2 (ACE2 KI mice) and wild type littermate controls (WT). ACE2 KI mice explored the open arms of the elevated plus maze (EPM) significantly more than WT, suggesting increasing ACE2 activity is anxiolytic. Central delivery of diminazene aceturate, an ACE2 activator, to C57BL/6 mice also reduced anxiety-like behavior in the EPM, but centrally administering ACE2 KI mice A-779, a MasR antagonist, abolished their anxiolytic phenotype, suggesting that ACE2 reduces anxiety-like behavior by activating central MasR. To identify the brain circuits mediating these effects, we measured Fos, a marker of neuronal activation, subsequent to EPM exposure and found that ACE2 KI mice had decreased Fos in the bed nucleus of stria terminalis but had increased Fos in the basolateral amygdala (BLA). Within the BLA, we determined that ∼62% of GABAergic neurons contained MasR mRNA and expression of MasR mRNA was upregulated by ACE2 overexpression, suggesting that ACE2 may influence GABA neurotransmission within the BLA via MasR activation. Indeed, ACE2 overexpression was associated with increased frequency of spontaneous inhibitory postsynaptic currents (indicative of presynaptic release of GABA) onto BLA pyramidal neurons and central infusion of A-779 eliminated this effect. Collectively, these results suggest that ACE2 may reduce anxiety-like behavior by activating central MasR that facilitate GABA release onto pyramidal neurons within the BLA.
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Affiliation(s)
- Lei Wang
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, 32611, USA
| | - Annette D de Kloet
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, 32611, USA
| | - Dipanwita Pati
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, 32611, USA
| | - Helmut Hiller
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, 32611, USA
| | - Justin A Smith
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, 32611, USA
| | - David J Pioquinto
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, 32611, USA
| | - Jacob A Ludin
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, 32611, USA
| | - S Paul Oh
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, 32611, USA
| | - Michael J Katovich
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, 32611, USA
| | - Charles J Frazier
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, 32611, USA
| | - Mohan K Raizada
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, 32611, USA
| | - Eric G Krause
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, 32611, USA.
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21
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Gotoh S, Hata J, Ninomiya T, Hirakawa Y, Nagata M, Mukai N, Fukuhara M, Ikeda F, Ago T, Kitazono T, Kiyohara Y. Hematocrit and the risk of cardiovascular disease in a Japanese community: The Hisayama Study. Atherosclerosis 2015. [PMID: 26204496 DOI: 10.1016/j.atherosclerosis.2015.07.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The association between hematocrit levels and the risk of cardiovascular disease (CVD) has been reported inconsistently. We aimed to investigate the association of hematocrit levels with the development of stroke and coronary heart disease (CHD) in a general Japanese population. METHODS A total of 2585 community-dwelling Japanese individuals aged 40 years or older in 1988 were followed up for 19 years. These subjects were divided into four groups according to the sex-specific quartiles of hematocrit at baseline. RESULTS During the follow-up, 301 subjects developed stroke (210 ischemic and 91 hemorrhagic) and 187 developed CHD. The risk of ischemic stroke was higher in both the lowest (Q1: men, ≤44.7%; women, ≤39.3%) and the highest (Q4: men, ≥49.7%; women, ≥43.8%) quartiles than in the third quartile (Q3: men, 47.1%-49.6%; women, 41.7%-43.7%) used as a reference (multivariable-adjusted hazard ratios [95% confidence intervals]: Q1, 1.55 [0.99-2.43]; Q2, 1.44 [0.93-2.23]; Q3, 1.00; and Q4, 1.62 [1.06-2.50]; P = 0.86 for trend). In contrast, hematocrit levels and the risk of hemorrhagic stroke showed a linear inverse association (Q1, 1.91 [1.03-3.54]; Q2, 1.26 [0.68-2.34]; Q3, 1.00; and Q4, 0.81 [0.41-1.61]; P = 0.009 for trend). The risk of CHD increased significantly in Q4 (Q1, 1.13 [0.71-1.80]; Q2, 1.08 [0.69-1.71]; Q3, 1.00; and Q4, 1.60 [1.04-2.46]; P = 0.13 for trend). CONCLUSIONS Our findings suggest that both elevated and decreased hematocrit levels are associated with an increased risk of CVD, but the influence of hematocrit is different among subtypes of CVD.
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Affiliation(s)
- Seiji Gotoh
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Toshiharu Ninomiya
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichiro Hirakawa
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaharu Nagata
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoko Mukai
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayo Fukuhara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumie Ikeda
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Kiyohara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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22
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Klip IT, Postmus D, Voors AA, Brouwers FPJ, Gansevoort RT, Bakker SJL, Hillege HL, de Boer RA, van der Harst P, van Gilst WH, van Veldhuisen DJ, van der Meer P. Hemoglobin levels and new-onset heart failure in the community. Am Heart J 2015; 169:94-101.e2. [PMID: 25497253 DOI: 10.1016/j.ahj.2014.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/16/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND In established cardiovascular disease and heart failure (HF), low hemoglobin levels are associated with unfavorable outcome. Whether hemoglobin levels are associated with the development of new-onset HF in the population is unclear. This study sought to investigate the relationship between hemoglobin levels and development of new-onset HF in the community. METHODS In 6,744 patients from PREVEND, a prospective, community-based, cohort study, we analyzed the relationship between hemoglobin levels and the risk of new-onset HF. RESULTS Mean age (±SD) was 53 ± 12 years, 49.8% was male, and mean hemoglobin level was 13.7 ± 1.2 g/dL. During a median follow-up of 8.3 years (interquartile range 7.8-8.9), 217 subjects (3.2%) were newly diagnosed with HF. The association between hemoglobin levels and the risk for new-onset HF was U shaped (P< .001), remaining significant after full adjustment in a multivariable model with established cardiovascular risk factors (P= .015). Furthermore, a increased annual HF incidence was already observed in subjects with high-normal hemoglobin levels (men >16 g/dL or women >15 g/dL; P= .041), whereas on the other side of the distribution, only severe anemia (men <11 g/dL or women <10 g/dL; P= .018) was associated with a higher annual incidence. CONCLUSIONS The impact of hemoglobin level on the risk of new-onset HF in the community is best described as U shaped. Interestingly, higher hemoglobin levels, already within the high-reference range, are associated with an increased incidence. This in contrast to anemia, where a higher annual HF incidence was only observed for severe anemia.
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Affiliation(s)
- Ijsbrand T Klip
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Douwe Postmus
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank P J Brouwers
- Department of Cardiology, 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
| | - Stephan J L Bakker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans L Hillege
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wiek H van Gilst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Scovell J, Ramasamy R, Kovac JR. A critical analysis of testosterone supplementation therapy and cardiovascular risk in elderly men. Can Urol Assoc J 2014; 8:E356-7. [PMID: 24940464 DOI: 10.5489/cuaj.1962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Ranjith Ramasamy
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
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Toss F, Nordström A, Nordström P. Association between hematocrit in late adolescence and subsequent myocardial infarction in Swedish men. Int J Cardiol 2013; 168:3588-93. [DOI: 10.1016/j.ijcard.2013.05.065] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 03/18/2013] [Accepted: 05/04/2013] [Indexed: 11/28/2022]
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Determining the role of testosterone deficiency in sexual function: the beginning of the end or the end of the beginning? Eur Urol 2013; 65:113-4. [PMID: 24079954 DOI: 10.1016/j.eururo.2013.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 09/13/2013] [Indexed: 11/21/2022]
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A randomized cross-over study of inhalation of diesel exhaust, hematological indices, and endothelial markers in humans. Part Fibre Toxicol 2013; 10:7. [PMID: 23531317 PMCID: PMC3637197 DOI: 10.1186/1743-8977-10-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 03/12/2013] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Exposure to traffic-related air pollution (TRAP) is considered a trigger for acute cardiovascular events. Diesel Exhaust (DE) is a major contributor to TRAP in the world. We evaluated the effect of DE inhalation on circulating blood cell populations, hematological indices, and systemic inflammatory cytokines in humans using a specialized facility. METHODS In a randomized double-blind crossover study balanced to order, 17 metabolic syndrome (MetS) and 15 healthy subjects inhaled filtered air (FA) or DE exposure in two-hour sessions on different days with a minimum 2-week washout period. We collected blood pre-exposure, 7, and 22 hours after exposure initiation and measured the complete blood count and differential. We performed multiplex cytokine assay to measure the changes in the systemic inflammatory cytokines, and endothelial adhesion molecules (n=15). A paired analysis compared the effect of DE and FA exposures for the change from pre-exposure to the subsequent time points. RESULTS A significant increase in the hematocrit was noted 7 hrs after DE [1.4% (95% CI: 0.9 to 1.9%)] compared to FA exposure [0.5% (95% CI: -0.09 to 1.0%); p=0.008. The hemoglobin levels increased non-significantly at 7 hrs post DE [0.3 gm/dL (95% CI: 0.2 to 0.5 gm/dL)] versus FA exposure [0.2 gm/dL (95% CI: 0 to 0.3 gm/dL)]; p=0.06. Furthermore, the platelet count increased 22 hrs after DE exposure in healthy, but not in MetS subjects [DE: 16.6 (95% CI: 10.2 to 23) thousand platelets/mL versus [FA: 3.4 (95% CI: -9.5 to 16.3) thousand platelets/mL)]; p=0.04. No DE effect was observed for WBC, neutrophils, lymphocytes or erythrocytes. Using the multiplex assay, small borderline significant increases in matrix metalloproteinase-9, interleukins (IL)-1 beta, 6 and 10 occurred 7 hrs post exposure initiation, whereas E-selectin, intercellular adhesion molecule-1, and vascular cell adhesion molecule -1, and myeloperoxidase 22 hrs post exposure. CONCLUSIONS Our results suggest that short-term DE exposure results in hemoconcentration and thrombocytosis, which are important determinants of acute cardiovascular events. Multiplex assay showed a non-significant increase in IL-1β and IL-6 immediately post exposure followed by myeloperoxidase and endothelial activation molecules. Further specific assays in a larger population will improve our understanding of the systemic inflammatory mechanisms following acute exposure to TRAP.
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Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. High blood hemoglobin concentration as risk factor of major atherosclerotic cardiovascular events in 114,159 healthy men and women in the apolipoprotein mortality risk study (AMORIS). Ann Med 2012; 44:476-86. [PMID: 21585246 DOI: 10.3109/07853890.2011.573804] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies have tested differences in relationships between hemoglobin (Hb) and long-term risk of major cardiovascular diseases according to age and gender in healthy subjects as opposed to anemia. AIMS Such relationships were examined and risk-tested in relation to Hb values in the Apolipoprotein MOrtality RISk (AMORIS) Study. METHODS Using data from AMORIS and the Swedish hospital discharge and mortality registers, a prospective cohort study of 114,159 subjects with mean follow-up of 11.8 years, the association between Hb and risk of acute myocardial infarction (AMI), ischemic stroke (IS), and congestive heart failure (CHF) by Cox regression analysis according to age and gender was studied. RESULTS Elevated Hb levels were associated to acute myocardial infarction (AMI) (HR 1.10 (1.06-1.13) per SD change), mostly confined to men and younger subjects but with greater sex similarity trends for CHF. Slightly increased risks were seen for the lowest Hb levels in the elderly and in females. IS risk was positively and more linearly associated to Hb. INTERPRETATION In AMORIS the highest AMI and CHF risks were found in the upper region of the distribution, but different shapes of relationships according to age and gender were found. IS associated positively with Hb. Key words:
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Affiliation(s)
- Ingar Holme
- Department of Preventive Cardiology, Centre of Preventive Medicine, Oslo University, Hospital, Ulleval, Oslo, Norway.
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Austin AW, Patterson SM, von Känel R. Hemoconcentration and hemostasis during acute stress: interacting and independent effects. Ann Behav Med 2012; 42:153-73. [PMID: 21562905 DOI: 10.1007/s12160-011-9274-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Acute psychological stress can produce significant hemoconcentration as well as prothrombotic changes in blood, both of which may have potentially harmful effects on the cardiovascular system. It is unclear whether these effects are independent or have influence on each other. PURPOSE This review discusses research investigating the effects of acute psychological stress on hemoconcentration and hemostasis and explores future directions for psychohematology research. Physiology, associations with cardiovascular disease, and relationships between acute psychological stress are discussed independently for hemoconcentration and hemostasis, followed by an examination of the effects of stress-hemoconcentration on hemostasis. CONCLUSIONS Traditional methods of adjusting for stress-hemoconcentration effects (e.g., calculated plasma volume or hematocrit level corrections) may not be appropriate when examining stress-induced changes in hemostasis. The effects of acute stress on hemostasis should be examined in conjunction with hemoconcentration.
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Coglianese EE, Qureshi MM, Vasan RS, Wang TJ, Moore LL. Usefulness of the blood hematocrit level to predict development of heart failure in a community. Am J Cardiol 2012; 109:241-5. [PMID: 21996141 DOI: 10.1016/j.amjcard.2011.08.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 08/30/2011] [Accepted: 08/30/2011] [Indexed: 10/16/2022]
Abstract
Current data suggest that increases in hemoglobin may decrease nitric oxide and adversely affect vascular function. In the preclinical setting, these changes could precipitate the development of heart failure (HF). We hypothesized that higher hematocrit (HCT) would be associated with an increased incidence of new-onset HF in the community. We evaluated 3,523 participants (59% women) from the Framingham Heart Study who were 50 to 65 years old and free of HF. Participants were followed prospectively until an HF event, death, or the end of 20 years of follow up. HCT was subdivided into 4 gender-specific categories (women: HCT 36.0 to 40.0, 40.1 to 42.0, 42.1 to 45.0, >45.0; men: 39.0 to 44.0, 44.1 to 45.0, 45.1 to 49.0, >49.0). Gender-pooled multivariable Cox proportional hazards models were used to estimate the association of HCT with incident HF, adjusting for clinical risk factors. During the follow-up period (61,417 person-years), 217 participants developed HF (100 events in women). There was a linear increase in risk of HF across the 4 HCT categories (p for trend = 0.002). Hazards ratios for HF in the low-normal, normal, and high HCT categories were 1.27 (95% confidence interval 0.82 to 1.97), 1.47 (1.01 to 2.15), and 1.78 (1.15 to 2.75), respectively, compared to the lowest HCT category (p for trend <0.0001). Adjustment for interim development of other cardiovascular diseases and restriction of the sample to nonsmokers did not alter the results. In conclusion, higher levels of HCT, even within the normal range, were associated with an increased risk of developing HF in this long-term follow-up study.
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Friedewald VE, Emmett M, McCullough P, Yancy CW, Roberts WC. The editor's roundtable: anemia and cardiovascular disease. Am J Cardiol 2011; 107:1630-5. [PMID: 21575751 DOI: 10.1016/j.amjcard.2010.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 07/09/2010] [Indexed: 10/18/2022]
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Abstract
CONTEXT Symptoms and signs consistent with androgen deficiency and low testosterone levels are recognized frequently in clinical practice. Recent population-based epidemiological studies indicate that low testosterone levels in men are associated with increased morbidity and mortality. The clinician must be able to counsel patients to help them determine whether testosterone replacement therapy is appropriate for them. EVIDENCE ACQUISITION The authors have conducted a literature search in PubMed, and we have reviewed references in the multiple systematic reviews and meta-analyses that have been published on this topic. EVIDENCE SYNTHESIS We have attempted to provide the reader with an appreciation of the evidence that can be used to support the diagnosis of androgen deficiency, the efficacy of treatment, the potential risks of treatment, the therapeutic options, and the recommendations for monitoring treatment. CONCLUSIONS We think that published clinical experience justifies testosterone replacement therapy in males who have not initiated puberty by age 14 and in males with low testosterone levels due to classical diseases of the hypothalamic-pituitary-gonadal axis. The benefit:risk ratio is less certain in older men and in those with chronic diseases associated with low testosterone levels. The decision to treat in this setting is much more controversial because there are few large clinical trials that have demonstrated efficacy and no large clinical trials that have determined potential risks of increasing the incidence of clinical prostate cancers or cardiovascular events. We provide a critical review of the evidence that supports treatment and potential risks and ways to reduce the risks if the physician and patient elect testosterone replacement.
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Affiliation(s)
- Glenn R Cunningham
- Baylor College of Medicine and St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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Paz-Filho G, Licinio J, Wong ML. Pathophysiological basis of cardiovascular disease and depression: a chicken-and-egg dilemma. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2010; 32:181-91. [PMID: 20658057 PMCID: PMC4259495 DOI: 10.1590/s1516-44462010000200015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 03/10/2010] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To describe the pathophysiological basis linking cardiovascular disease (CVD) and depression; to discuss the causal relationship between them, and to review the effects of antidepressant treatment on cardiovascular disease. METHOD A review of the literature based on the PubMed database. DISCUSSION Depression and cardiovascular disease are both highly prevalent. Several studies have shown that the two are closely related. They share common pathophysiological etiologies or co-morbidities, such as alterations in the hypothalamic-pituitary axis, cardiac rhythm disturbances, and hemorheologic, inflammatory and serotoninergic changes. Furthermore, antidepressant treatment is associated with worse cardiac outcomes (in case of tricyclics), which are not observed with selective serotonin reuptake inhibitors. CONCLUSION Although there is a strong association between depression and cardiovascular disease, it is still unclear whether depression is actually a causal factor for CVD, or is a mere consequence, or whether both conditions share a common pathophysiological etiology. Nevertheless, both conditions must be treated concomitantly. Drugs other than tricyclics must be used, when needed, to treat the underlying depression and not as mere prophylactic of cardiac outcomes.
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Affiliation(s)
- Gilberto Paz-Filho
- The John Curtin School of Medical Research, Australian National University, Canberra, Australia
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Meroño T, Sorroche P, Gómez Rosso LA, Casañas L, Boero LE, Arbelbide JA, Brites FD. Proatherogenic disturbances in lipoprotein profile, associated enzymes and transfer proteins in women with iron deficiency anaemia. Clin Biochem 2010; 43:416-23. [DOI: 10.1016/j.clinbiochem.2009.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 09/11/2009] [Accepted: 10/08/2009] [Indexed: 11/25/2022]
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Abstract
Association between androgens and erythropoiesis has been known for more than seven decades. Androgens stimulate hematopoietic system by various mechanisms. These include stimulation of erythropoietin release, increasing bone marrow activity and iron incorporation into the red cells. Before the discovery of recombinant erythropoietin (rhEpo), androgens were used in the treatment of anemia associated with renal disease, bone marrow suppression, and hypopituitarism. Anabolism is an additional advantage of androgen therapy. Furthermore, in light of recent reports regarding adverse effects of rhEpo, the role of androgen therapy in various types of anemias should be readdressed. Polycythemia remains a known side effect of androgen therapy. In this review, we will briefly discuss the initial animal and human studies which demonstrated the role of androgens in the treatment of anemia, their mechanism of action, a detailed account of the efficacy of androgens in the treatment of various anemias, the erythropoietic side effects of androgens and finally, the relationship between hematocrit levels and cardiovascular disease.
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Affiliation(s)
- S Shahani
- Division of Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
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Kunnas T, Solakivi T, Huuskonen K, Kalela A, Renko J, Nikkari ST. Hematocrit and the risk of coronary heart disease mortality in the TAMRISK study, a 28-year follow-up. Prev Med 2009; 49:45-7. [PMID: 19409924 DOI: 10.1016/j.ypmed.2009.04.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 04/27/2009] [Accepted: 04/27/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate whether hematocrit (HCT) is associated with coronary heart disease (CHD) mortality in men over 55 years of age in Finland. METHODS Health survey data were recorded in 1980 from 670 men, aged 55 years. The causes of deaths during a 28-year follow-up were obtained from official records. Statistical comparisons were done by Cox proportional hazard regression model after dividing the men into two groups, one with HCT<50% and the other, HCT> or =50%. RESULTS There were altogether 412 deaths of all causes, including 140 from CHD. In men having HCT<50%, the crude CHD mortality rate per 10,000 population was 2203, while in men with HCT> or =50%, the corresponding figure was 4255. Men with HCT> or =50% were 2.4 times (95% CI 1.6-3.5) more likely to die from CHD than were men with HCT<50%. After adjusting for established coronary risk factors, the increased risk remained 1.8-fold (95 % CI, 1.1-2.7). CONCLUSIONS Borderline polycythemia was associated with increased CHD mortality. The cut-off value in our study was > or =50%, proposing that for men over 55 years of age such HCT levels might be an additional risk factor.
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Affiliation(s)
- T Kunnas
- Department of Medical Biochemistry, University of Tampere Medical School FI-33014 University of Tampere, Finland
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Prognostic importance of hemoglobin in hypertensive patients with electrocardiographic left ventricular hypertrophy: the Losartan Intervention For End point reduction in hypertension (LIFE) study. Am Heart J 2009; 157:177-84. [PMID: 19081416 DOI: 10.1016/j.ahj.2008.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 08/08/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND The prognostic importance of hemoglobin is controversial. We investigated the prognostic importance of baseline and in-treatment hemoglobin in the LIFE study. METHODS Eight thousand one hundred ninety-four LIFE patients with hypertension and left ventricular hypertrophy with available baseline hemoglobin measurements were randomized to losartan- or atenolol-based treatment and followed for 4.8 years for end points of all-cause mortality and composite of cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction. RESULTS U-shaped relations were observed between deciles of baseline hemoglobin and all-cause mortality and the composite end point. In univariate Cox models, baseline hemoglobin in the lowest gender-specific decile (women/men: <12.5/13.4 g/dL) was associated with all-cause mortality (hazard ratio [HR] 2.01, 95% CI 1.64-2.64) and the composite end point (HR 1.53, 95% CI 1.27-1.85, both P < .001), whereas hemoglobin in the highest gender-specific decile (women/men: > or =15.0/16.2 g/dL) was not. The decrease in hemoglobin was higher (P < .001) in patients allocated to losartan- (14.3-13.8 g/dL) versus atenolol-based treatment (14.3-14.0 g/dL). In Cox models with the same gender-specific definitions for high and low hemoglobin as time-varying covariates with adjustment for treatment allocation and established risk factors and diseases, hemoglobin in the lowest decile was associated with higher rates of all-cause mortality (HR 3.03, 95% CI 1.89-4.85, P < .001) and the composite end point (HR 1.36, 95% CI 1.08-1.71, P < .01), whereas hemoglobin in the highest decile was not. CONCLUSIONS After adjusting for other risk factors, relatively low, but not high, hemoglobin during antihypertensive treatment was associated with higher incidence of all-cause mortality and the composite end point.
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Rasouli M, Kiasari AM, Arab S. INDICATORS OF DEHYDRATION AND HAEMOCONCENTRATION ARE ASSOCIATED WITH THE PREVALENCE AND SEVERITY OF CORONARY ARTERY DISEASE. Clin Exp Pharmacol Physiol 2008; 35:889-94. [DOI: 10.1111/j.1440-1681.2008.04932.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Elevated stress-hemoconcentration in major depression is normalized by antidepressant treatment: secondary analysis from a randomized, double-blind clinical trial and relevance to cardiovascular disease risk. PLoS One 2008; 3:e2350. [PMID: 18985146 PMCID: PMC2391294 DOI: 10.1371/journal.pone.0002350] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 04/16/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is an independent risk factor for cardiovascular disease (CVD); the presence of MDD symptoms in patients with CVD is associated with a higher incidence of cardiac complications following acute myocardial infarction (MI). Stress-hemoconcentration, a result of psychological stress that might be a risk factor for the pathogenesis of CVD, has been studied in stress-challenge paradigms but has not been systematically studied in MDD. METHODS Secondary analysis of stress hemoconcentration was performed on data from controls and subjects with mild to moderate MDD participating in an ongoing pharmacogenetic study of antidepressant treatment response to desipramine or fluoxetine. Hematologic and hemorheologic measures of stress-hemoconcentration included blood cell counts, hematocrit, hemoglobin, total serum protein, and albumin, and whole blood viscosity. FINDINGS Subjects with mild to moderate MDD had significantly increased hemorheologic measures of stress-hemoconcentration and blood viscosity when compared to controls; these measures were correlated with depression severity. Measures of stress-hemoconcentration improved significantly after 8 weeks of antidepressant treatment. Improvements in white blood cell count, red blood cell measures and plasma volume were correlated with decreased severity of depression. CONCLUSIONS Our secondary data analyses support that stress-hemoconcentration, possibly caused by decrements in plasma volume during psychological stress, is present in Mexican-American subjects with mild to moderate MDD at non-challenged baseline conditions. We also found that after antidepressant treatment hemorheologic measures of stress-hemoconcentration are improved and are correlated with improvement of depressive symptoms. These findings suggest that antidepressant treatment may have a positive impact in CVD by ameliorating increased blood viscosity. Physicians should be aware of the potential impact of measures of hemoconcentration and consider the implications for cardiovascular risk in depressed patients.
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Abstract
BACKGROUND Anemia is a risk factor for adverse cardiovascular disease outcomes. However, there is limited information concerning the association of hemoglobin concentration and new onset of clinically recognized coronary artery disease (CAD). METHODS An historical cohort study was conducted with patients from Veterans Affairs medical centers. Baseline hemoglobin determinations were evaluated with respect to CAD using data from records of 25,622 subjects with no known heart disease. Coronary artery disease was identified from a new diagnosis based on the International Classification of Diseases, Ninth Edition, coding or a new prescription for nitroglycerin. Models were adjusted for age, sex, body mass index, smoking, systolic blood pressure, diastolic blood pressure, fasting glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, creatinine clearance, and use of statin or beta-blocker. RESULTS Among the cohort, 5297 (20.7%) subjects developed CAD over 73,895 person-years of follow-up. Compared with control hemoglobin levels of 15.0 to 17.0 g/dL, the multivariable-adjusted risk of CAD increased with lower hemoglobin levels: an adjusted hazard ratio (HR) of 1.47 and 95% confidence interval (CI) of 1.18 to 1.84 for hemoglobin levels of 9.0 to 11.0 g/dL; an HR of 1.34 and 95% CI of 1.20 to 1.49 for 11.0 to 13.0 g/dL; and an HR of 1.07 and 95% CI of 1.01 to 1.13 for 13.0 to 15.0 g/dL. Hemoglobin levels > or = 17.0 g/dL were also associated with increased risk for CAD (adjusted HR 1.22, 95% CI 1.08-1.37). CONCLUSIONS Hemoglobin levels > or = 17 or < 15 g/dL are independently associated with increase risk for new cardiac events.
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Affiliation(s)
- Michel Chonchol
- University of Colorado Health Sciences Center, Division of Renal Diseases and Hypertension, Denver, CO 80262, USA.
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Mahmoodi MR, Kimiagar SM, Abadi AR. Is Anemia an Independent Predictor of Occurrence of Acute Coronary Syndrome? Results From the Modares Heart Study. ACTA ACUST UNITED AC 2007; 5:73-9. [PMID: 17478972 DOI: 10.1111/j.1541-9215.2007.06110.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors sought to investigate whether an increase or decrease of hemoglobin (Hgb) and hematocrit (Hct) levels were a predictor of occurrence of acute coronary syndrome. This retrospective case-control study included 594 myocardial infarction (MI) patients, 596 unstable angina patients, and 590 controls who were hospitalized from 1994 to 2005. Results show that prevalence of MI based on Hgb and Hct levels in anemic patients was 17.9% and 14.0%, respectively, and in patients with high levels in the normal range was 8.8% and 20.2%, respectively. A logistic regression between MI patients and controls showed that the odds ratio and 95% confidence interval of MI for patients with low vs high Hgb and mean corpuscular volume were 0.215 (0.112-0.412) and 0.368 (0.243-0.558), respectively. Anemia was an independent predictor of occurrence of acute coronary syndrome based on Hgb, while, based on Hct, both anemia and high Hct level were predictors of occurrence of MI.
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Affiliation(s)
- Mohammad Reza Mahmoodi
- Nutrition Department, School of Health, Kerman University of Medical Sciences, Kerman, Iran.
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Skjelbakken T, Wilsgaard T, Førde OH, Arnesen E, Løchen ML. Haemoglobin predicts total mortality in a general young and middle-aged male population. The Tromsø Study. Scandinavian Journal of Clinical and Laboratory Investigation 2007; 66:567-76. [PMID: 17101548 DOI: 10.1080/00365510600863895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The prognostic value of haemoglobin within normal references is seldom emphasized. The relationship between haemoglobin and mortality has been questioned because of the possible confounding of other risk factors. We investigated whether there was a curve linear relationship between haemoglobin and total mortality, and evaluated the possible modifying effects of smoking, body mass index, total cholesterol and systolic blood pressure. MATERIALS AND METHODS In all, 6541 men aged between 20 and 49 years were examined in 1974 in a prospective, population-based study from the municipality of Tromsø, Northern Norway. During 20 years of follow-up (127 120 person-years), 495 deaths were identified. RESULTS We found a U-shaped relationship between quintiles of haemoglobin and total mortality. Among the 35-49 years group, the multiple adjusted hazard ratios (95% CI) were 1.83 (1.31-2.57) in quintile 1 and 1.72 (1.23-2.41) in quintile 5, compared to quintile 3 of haemoglobin. Compared to the age-adjusted hazard ratios, the multiple adjustments tended to non-significantly enhance the association in the lowest quintiles and non-significantly attenuate the association in the highest quintiles. The relationship was most pronounced in smokers in a dose-response manner, but also present in non-smokers. CONCLUSIONS High and low haemoglobin levels have an independent prognostic effect on mortality, although a possible effect of residual confounding cannot be ruled out. Smokers in quintile 1 and quintile 5 of haemoglobin were at increased risk of dying.
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Affiliation(s)
- T Skjelbakken
- Institute of Medicine, University of Trømso, Trømso, Norway.
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Di Nisio M, Barbui T, Di Gennaro L, Borrelli G, Finazzi G, Landolfi R, Leone G, Marfisi R, Porreca E, Ruggeri M, Rutjes AWS, Tognoni G, Vannucchi AM, Marchioli R. The haematocrit and platelet target in polycythemia vera. Br J Haematol 2006; 136:249-59. [PMID: 17156406 DOI: 10.1111/j.1365-2141.2006.06430.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Polycythemia vera (PV) is a chronic myeloproliferative disorder whose major morbidity and mortality are thrombohaemorragic events and progression to acute leukaemia or myelofibrosis. Whether the haematocrit and platelet count predict such complications remains unclear. The European Collaboration on Low-dose Aspirin in Polycythemia Vera prospective study included 1638 PV patients. A total of 164 deaths (10%), 145 (8.85%) major thrombosis and 226 (13.8%) total thrombosis were encountered during 4393 person-years follow-up (median 2.8 years). In time-dependent multivariable analysis, a haematocrit in the evaluable range of 40-55% was neither associated with the occurrence of thrombotic events, mortality nor with haematological progression in the studied population. The haematocrit of patients in the highest and lowest deciles at baseline was maintained within a narrow interval of haematocrit values ranging from 40% to 47% throughout follow-up. High platelet count was associated with a lower progression rate to acute leukaemia/myelofibrosis, whereas it had no significant relationship with thrombotic events or mortality. Our findings do not suggest that the range of haematocrit (<55%) and platelet counts (<600 x 10(9)/l) we encountered in our population had an impact on the outcome of PV patients treated by current therapeutic strategies.
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Affiliation(s)
- Marcello Di Nisio
- Department of Medicine and Aging, School of Medicine, and Aging Research Centre, Ce S I, Gabriele D'Annunzio University Foundation, Chieti-Pescara, Italy
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43
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Tassiopoulos S, Deftereos S, Konstantopoulos K, Farmakis D, Tsironi M, Kyriakidis M, Aessopos A. Does heterozygous beta-thalassemia confer a protection against coronary artery disease? Ann N Y Acad Sci 2006; 1054:467-70. [PMID: 16339699 DOI: 10.1196/annals.1345.068] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Six hundred and thirty-eight patients who presented with clinical symptoms and/or electrocardiographic findings suggestive of stable angina pectoris were studied; they were also investigated by coronary arteriography. Hemoglobin electrophoresis was performed on all patients to detect the presence of the beta-thalassemia trait. Results were analyzed by logistic regression analysis to determine whether the latter confers any protective effect against advanced coronary artery disease (aCAD; defined as the presence of atheromas in coronary arteries, resulting in stenosis at least 70%). The role of the currently accepted risk factors (smoking, hypertension, hypercholesterolemia, and diabetes) in developing aCAD were reconfirmed, while at the same time it was found that beta-thalassemia heterozygosity is associated with a reduced risk against aCAD (odds ratio 0.39, 95% confidence interval 0.16-0.98). The lipoprotein and blood rheology profile of these individuals may be the underlying causes of this protective effect.
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Affiliation(s)
- Stergios Tassiopoulos
- First Department of Internal Medicine, University of Athens Medical School, Laiko Hospital, Athens, Greece
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Martini J, Tsai AG, Cabrales P, Johnson PC, Intaglietta M. Increased cardiac output and microvascular blood flow during mild hemoconcentration in hamster window model. Am J Physiol Heart Circ Physiol 2006; 291:H310-7. [PMID: 16489106 DOI: 10.1152/ajpheart.01218.2005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effect of small hematocrit (Hct) increases on cardiac index (cardiac output/body wt) and oxygen release to the microcirculation was investigated in the awake hamster window chamber model by means of exchange transfusions of homologous packed red blood cells. Increasing Hct between 8 and 13% from baseline increased cardiac index by 5–31% from baseline ( P < 0.05) and significantly lowered systemic blood pressure ( P < 0.05). The relationship between Hct and cardiac index is described by a second-order polynomial ( R2 = 0.84; P < 0.05) showing that Hct increases up to 20% from baseline increase cardiac index, whereas increases over 20% from baseline decrease cardiac index. Combining this data with measurements of blood pressure allowed to determine total peripheral vascular resistance, which was a minimum at 8–13% Hct increase and was described by a second-order polynomial ( R2 = 0.83; P < 0.05). Oxygen measurements in arterioles, venules, and the tissue at 8–13% Hct increase were identical to control; thus, as a consequence of increased flow and oxygen-carrying capacity, oxygen delivery and extraction increased, but the change was not statistically significant. Previous results with the same model showed that the observed effects are related to shear stress-mediated release of nitric oxide, an effect that should be also present in the heart microcirculation, leading to increased blood flow, myocardial oxygen consumption, and contractility. We conclude that a minimum viscosity level is necessary for generating the shear stress required for maintaining normal cardiovascular function.
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Affiliation(s)
- Judith Martini
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093-0412, USA.
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Kobayashi T, Miyosht Y, Yamaoka K, Yano E. Relationship between Hematological Parameters and Incidence of Ischemic Heart Diseases among Japanese White‐Collar Male Workers. J Occup Health 2006. [DOI: 10.1539/joh.43.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Toshio Kobayashi
- Department of Hygiene and Preventive MedicineFukushima Medical University School of Medicine
| | - Yuji Miyosht
- Health Insurance Society, Meiji Life Insurance Company
| | - Kazue Yamaoka
- Department of Hygiene and Public HealthTeikyo University School of Medicine
| | - Eiji Yano
- Department of Hygiene and Public HealthTeikyo University School of Medicine
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46
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Culleton BF, Manns BJ, Zhang J, Tonelli M, Klarenbach S, Hemmelgarn BR. Impact of anemia on hospitalization and mortality in older adults. Blood 2006; 107:3841-6. [PMID: 16403909 DOI: 10.1182/blood-2005-10-4308] [Citation(s) in RCA: 264] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Although anemia is common in older adults, its prognostic significance is uncertain. A total of 17 030 community-dwelling subjects 66 years and older were identified between July 1 and December 31, 2001, and followed until December 31, 2004. Cox proportional hazards analyses were performed to determine the associations between anemia (defined as hemoglobin < 110 g/L) and hemoglobin and all-cause mortality, all-cause hospitalization, and cardiovascular-specific hospitalization. Overall, there were 1983 deaths and 7278 first hospitalizations. In patients with normal kidney function, adjusting for age, sex, diabetes mellitus, and comorbidity, anemia was associated with an increased risk for death (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.55-5.12), first all-cause hospitalization (HR, 2.16; 95% CI, 1.88-2.48), and first cardiovascular-specific hospitalization (HR, 2.49; 95% CI, 1.99-3.12). An inverse J-shaped relationship between hemoglobin and all-cause mortality was observed; the lowest risk for mortality occurred at hemoglobin values between 130 to 150 g/L for women and 140 to 170 g/L for men. Anemia is associated with an increased risk for hospitalization and death in community-dwelling older adults. Consideration should be given to redefine "normal" hemoglobin values in the elderly. Clinical trials are also necessary to determine whether anemia correction improves quality or quantity of life in this population.
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Affiliation(s)
- Bruce F Culleton
- Department of Medicine, University of Calgary, Foothills Hospital, Rm C210, 1403-29th St NW, Calgary, AB, Canada T2N 2T9.
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Abstract
Anaemia is common in patients with congestive heart failure (CHF). Its prevalence increases with disease severity as a consequence of renal insufficiency, cytokine production, blood loss, iron deficiency, malnutrition and/or plasma volume overload. Anaemia can contribute to worsening of CHF. There is a nonlinear relationship (U-shaped curve) between haemoglobin and survival. Prevalence of anaemia among elderly people with acute myocardial infarction is high and is associated with more frequent in-hospital events, including death. Anaemia is also associated with higher in-hospital mortality rate after coronary bypass surgery and with all-cause and cardiac mortality after percutaneous coronary interventions. Patients with anaemia and cardiovascular disease have a higher mortality rate after cardiac/noncardiac surgery as compared to those with anaemia but without cardiovascular disease or those with cardiovascular disease but without anaemia. However, not all authors confirmed these findings. Therefore, multicentre trials to clarify this issue are urgently needed. Pleiotropic effects of recombinant human erythropoietin include reduction of myocardial and cerebral infarct size without an increase in haematocrit, neovascularization as well as mobilization of endothelial progenitor cells.
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Affiliation(s)
- W H Hörl
- Department of Medicine, University of Vienna, Austria.
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Madjid M, Awan I, Willerson JT, Casscells SW. Leukocyte count and coronary heart disease. J Am Coll Cardiol 2004; 44:1945-56. [PMID: 15542275 DOI: 10.1016/j.jacc.2004.07.056] [Citation(s) in RCA: 445] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Revised: 07/10/2004] [Accepted: 07/13/2004] [Indexed: 11/29/2022]
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Abstract
In the present review we examine the physiologic response to chronic anemia and describe potential adverse effects of anemia on myocardial and large arterial remodeling. We present observational data demonstrating that anemia is a risk factor for cardiovascular disease (CVD) outcomes in patients with chronic kidney disease and patients with heart failure. We also present data that have evaluated the relationship of level of hematocrit to CVD outcomes in patients with ischemic heart disease and in patients in the general population. The results from the latter studies have been inconclusive and have been limited by lack of knowledge of the cause of anemia. This is potentially important because iron deficiency anemia may, in fact, improve endothelial function. We conclude that additional randomized controlled trials of treatment of anemia are needed in chronic kidney disease and patients with heart failure; however, further exploration of the cause of anemia and the effect of different types of anemia on various CVD outcomes are needed in patients with ischemic heart disease and patients in the general population.
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Affiliation(s)
- Arema A Pereira
- Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Boston, MA 02111, USA
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Jurkovitz CT, Abramson JL, Vaccarino LV, Weintraub WS, McClellan WM. Association of high serum creatinine and anemia increases the risk of coronary events: results from the prospective community-based atherosclerosis risk in communities (ARIC) study. J Am Soc Nephrol 2004; 14:2919-25. [PMID: 14569102 DOI: 10.1097/01.asn.0000092138.65211.71] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Coronary heart disease (CHD) is a major cause of morbidity and mortality in patients with chronic kidney disease or anemia. The purpose of this study was to examine whether the association between renal function and risk of CHD is modified by hemoglobin (Hgb) status. Analyses were based on data from the Atherosclerosis Risk in Communities study, a community-based study of risk factors for CHD in middle-aged people. People with known CHD at baseline were excluded from the analysis. Participants were followed for 9 yr for the occurrence of CHD. Anemia was defined as Hgb <13 g/dl in men and <12 g/dl in women. Cox proportional hazards models were used to assess the relative risk (RR) of CHD occurrence according to Hgb status, after adjusting for other risk factors (demographics, lipids, diabetes, hypertension, smoking, body mass index, and carotid intima-media thickness). A total of 13,329 participants were included. The interaction between Hgb concentration and serum creatinine (Scr) was significant (P = 0.02). Among people with anemia, a Scr >/=1.2 mg/dl in women or >/=1.5 mg/dl in men was associated with a higher risk of CHD (RR, 2.74; 95% confidence interval, 1.42 to 5.28) than those with normal Scr. In contrast, among those without anemia, this association was not noted (RR, 1.20; 95% confidence interval, 0.86 to 1.67). In conclusion, this study indicates that high Scr is associated with almost a threefold risk of CHD among middle-aged people with anemia, whereas no increased risk is found in people with high Scr in the absence of anemia.
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Affiliation(s)
- Claudine T Jurkovitz
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30306, USA.
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