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Sahu S, Shah DN, Vempati R, Kandhi PR, Parmar MP, Bethanabotla S, Gadgil S, Chandra P, Malipatil SN, Patel Y, Natarajan B, Bingi TC. Rapid N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) Kit as a Differentiating Tool for Acute Dyspnea in a Resource-Limited Setting. Cureus 2023; 15:e48306. [PMID: 38058332 PMCID: PMC10697234 DOI: 10.7759/cureus.48306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Dyspnea is among the most prevalent symptoms experienced by patients presenting as an emergency. The underlying etiology is often a cardiovascular or pulmonary condition, of which heart failure is recognized as a major contributor. The differentials are primarily established based on the patient's clinical presentation and physical examinations but are not conclusive. Of the various investigations undertaken to determine the cause of dyspnea, the biomarker N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) was found to be significantly associated with heart failure. Its level has been proven to be in direct correlation with the severity of the disease. This study demonstrates the usability of an economical rapid test kit in measuring NT-ProBNP levels to help differentiate the cause of dyspnea in the presenting patient in a resource-limited setting. Methodology We studied 115 participants from a tertiary care center in India, which included 70 males and 45 females aged ≤30 to ≥75 years, presenting with shortness of breath. Rapid NT-ProBNP tests were conducted alongside recording their symptoms, vitals, examination findings, and other parameters. They were also classified according to New York Heart Association (NYHA) Classification, and further investigated. Results The study elucidated the efficacy and accuracy of the rapid kits in determining NT-ProBNP levels, and its relation with the severity and prognosis of heart failure. The kits utilized had a sensitivity of greater than 93% for ruling out heart failure as a cause of dyspnea, and a sensitivity of greater than 96% for ruling out elevated NT-ProBNP levels in general. Other parameters such as presenting symptoms and vitals were also analyzed, establishing a correlation with NT-ProBNP levels. Conclusion This study guided us in understanding the effective utilization of the rapid testing kits for emergency care, minimizing the burden on other limited resources. The lower cost and ease of use would serve as a quick means of reaching a conclusive diagnosis, especially in an emergency, which in turn would aid in receiving timely and specific treatment. These kits could act as a stepping stone in creating a sustainable and efficient healthcare system for patients as well as healthcare workers.
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Affiliation(s)
- Sweta Sahu
- Surgery, JJM (Jagadguru Jayadeva Murugarajendra) Medical College, Davanagere, IND
| | - Devarsh N Shah
- Medicine and Surgery, Medical College Baroda, Vadodara, IND
| | - Roopeessh Vempati
- Internal Medicine, Gandhi Medical College, Secunderabad, IND
- Cardiology, Heart & Vascular Institute, Detroit, USA
| | | | - Mihirkumar P Parmar
- Internal Medicine, Gujarat Medical Education and Research Society, Vadnagar, IND
| | | | - Shardool Gadgil
- Medicine and Surgery, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, IND
| | - Prerna Chandra
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | | | - Yash Patel
- Internal Medicine, Gujarat Medical Education and Research Society, Vadnagar, IND
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Kianmehr H, Guo J, Lin Y, Luo J, Cushman W, Shi L, Fonseca V, Shao H. A machine learning approach identifies modulators of heart failure hospitalization prevention among patients with type 2 diabetes: A revisit to the ACCORD trial. J Diabetes Complications 2022; 36:108287. [PMID: 36007486 PMCID: PMC11003517 DOI: 10.1016/j.jdiacomp.2022.108287] [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: 06/19/2022] [Revised: 07/28/2022] [Accepted: 08/14/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND To examine patient characteristics that may modulate the heterogeneous treatment effect of intensive systolic blood pressure control (SBP) and intensive glycemic control on incident heart failure (HF) risk in people with type 2 diabetes. METHODS We analyzed 10,251 participants from the ACCORD glucose trial, and 4733 from the SBP sub-trial separately. We applied a robust machine-learning (ML) algorithm, namely the causal forest/causal tree analysis, to each trial to identify participants' characteristics that modulate the effectiveness of each trial intervention. RESULTS Diastolic blood pressure (DBP) was found to interact with intensive glycemic control and impact outcomes. An increased HF risk associated with intensive glycemic control (absolute risk change (ARC): 2.28 %, 95 % confidence interval (CI): 0.69 % to 3.90 %; relative risk (RR):1.57, 95 % CI: 1.15 to 2.20; P < 0.05) was observed in individuals with baseline DBP at the lowest tertile (45-69 mmHg), while no changes in HF risk associated with intensive glycemic control were observed in individuals with baseline DBP at the middle (70-79 mmHg) and the highest tertiles (80-100 mmHg). Liver function was identified as a modulator of intensive BP control, and baseline Alanine transaminase (ALT) level was a sensitive marker for the modulating effect. Only individuals with baseline ALT at the lowest tertile (8-19 mg/dl) benefited from the intensive BP control for HF prevention (ARC: -1.95 %, 95 % CI: -4.06 % to 0.11 %; RR:0.62. 95 % CI: 0.27 to 0.94; P < 0.05). CONCLUSIONS Our study is the first to observe and quantify the potential synergistic harmful effect when low DBP was combined with an intensive blood glucose intervention. Recognizing these may help clinicians develop a more precise approach to such treatments, thus increasing the efficiency and outcomes of diabetes treatments.
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Affiliation(s)
- Hamed Kianmehr
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
| | - Yilu Lin
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jing Luo
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - William Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center, TN, USA
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Vivian Fonseca
- Department of Medicine and Pharmacology, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA.
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Moringa oleifera: Miracle Plant with a Plethora of Medicinal, Therapeutic, and Economic Importance. HORTICULTURAE 2022. [DOI: 10.3390/horticulturae8060492] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Moringa oleifera Lam. (Moringaceae) is one of the most essential medicinal plants primarily found in the rainforest area and forest ecosystem, but is now well-adapted in an organized cultivation system. Moringa oleifera (M. oleifera) is well-known as Drumstick tree, Moringa kai, color, Marengo, Moringe, mulangay, Sahjan, and Sajna, which are its native names commonly used. It has nourishing, beneficial, and preventive effects when taken as food and has an extensive scope of high restorative properties with huge dietary benefits. Different parts of the M. oleifera plants, such as leaves, flowers, fruits, seeds, and roots, contain a significant amount of protein, ß-carotene, amino acids, important minerals, and various phenolic compounds. Because of its multifarious health benefits for its therapeutic value, it is considered an essential plant. The plant is found to be blessed with several medicinal characteristics such as antitumor, anti-inflammatory, antiulcer, antipyretic, antiepileptic, antispasmodic, diuretic, antihypertensive, antidiabetic, cholesterol-level down, cell reinforcement, and hepatoprotective. Moreover, it is used traditionally in the local curative system against cardiac problems, and the antifungal properties are efficiently utilized for the treatment of a wide range of ailments. The present review article was designed to explore the nutritional and economic benefits, medicinal and therapeutic applications, and the future biomedical prospects of Moringa with a view towards human wellbeing.
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Shuman WH, Neifert SN, Gal JS, Snyder DJ, Deutsch BC, Zimering JH, Rothrock RJ, Caridi JM. The Impact of Diabetes on Outcomes and Health Care Costs Following Anterior Cervical Discectomy and Fusion. Global Spine J 2022; 12:780-786. [PMID: 33034217 PMCID: PMC9344522 DOI: 10.1177/2192568220964053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Anterior cervical discectomy and fusion (ACDF) is commonly used to treat an array of cervical spine pathology and is associated with good outcomes and low complication rates. Diabetes mellitus (DM) is a common comorbidity for patients undergoing ACDF, but the literature is equivocal about the impact it has on outcomes. Because DM is a highly prevalent comorbidity, it is crucial to determine if it is an associated risk factor for outcomes after ACDF procedures. METHODS Patients at a single institution from 2008 to 2016 undergoing ACDF were compared on the basis of having a prior diagnosis of DM versus no DM. The 2 cohorts were compared utilizing univariate tests and multivariate logistic and linear regressions. RESULTS Data for 2470 patients was analyzed. Diabetic patients had significantly higher Elixhauser scores (P < .0001). Univariate testing showed diabetic patients were more likely to suffer from sepsis (0.82% vs 0.10%, P = .03) and bleeding complications (3.0% vs 1.5%, P = .04). In multivariate analyses, diabetic patients had higher rates of non-home discharge (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.07-1.75, P = .013) and prolonged length of stay (OR = 1.95, 95% CI = 1.25-3.05, P = .003), but similar complication (OR = 1.46, 95% CI = 0.85-2.52, P = .17), reoperation (OR = 0.77, 95% CI = 0.33-1.81, P = .55), and 90-day readmission (OR = 1.53, 95% CI = 0.97-2.43) rates compared to nondiabetic patients. Direct cost was also shown to be similar between the cohorts after adjusting for patient, surgical, and hospital-related factors (estimate = -$30.25, 95% CI = -$515.69 to $455.18, P = .90). CONCLUSIONS Diabetic patients undergoing ACDF had similar complication, reoperation, and readmission rates, as well as similar cost of care compared to nondiabetic patients.
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Affiliation(s)
- William H. Shuman
- Icahn School of Medicine at Mount
Sinai, New York, NY, USA,Will Shuman, Department of Neurosurgery,
Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY
10029, USA.
| | | | | | | | | | | | | | - John M. Caridi
- Icahn School of Medicine at Mount
Sinai, New York, NY, USA
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Dave CV, Strom BL, Kobylarz FA, Horton DB, Gerhard T, Tseng CL, Dejanovic I, Nyandege A, Setoguchi S. Risk of clinically relevant hyperglycemia with metoprolol compared to carvedilol in older adults with heart failure and diabetes. Pharmacoepidemiol Drug Saf 2021; 30:1420-1427. [PMID: 34101945 DOI: 10.1002/pds.5303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/26/2021] [Accepted: 06/06/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although prior literature suggests that metoprolol may worsen glucose control compared to carvedilol, whether this has clinical relevance among older adults with diabetes and heart failure (HF) remains an open question. METHODS This was a US retrospective cohort study utilizing data sourced from a 50% national sample of Medicare fee-for-service claims of patients with part D prescription drug coverage (2007-2017). Among patients with diabetes and HF, we identified initiators of metoprolol or carvedilol, which were 1:1 propensity score matched on >90 variables. The primary outcome was initiation of a new oral or injectable antidiabetic medication (proxy for uncontrolled diabetes); secondary outcomes included initiation of insulin and severe hyperglycemic event (composite of emergency room visits or hospitalizations related to hyperglycemia). RESULTS Among 24 239 propensity score-matched pairs (mean [SD] age 77.7 [8.0] years; male [39.1%]), there were 8150 (incidence rate per 100 person-years [IR] = 33.5) episodes of antidiabetic medication initiation among metoprolol users (exposure arm) compared to 8576 (IR = 33.4) among carvedilol users (comparator arm) compared to corresponding to an adjusted hazard ratio (aHR) of 0.97 (95% confidence interval [CI]: 0.94, 1.01). Similarly, metoprolol was not associated with a significant increase in the risk of secondary outcomes including insulin initiation: aHR of 0.98 (95% CI: 0.93, 1.04) and severe hyperglycemic events: aHR of 0.98 (95% CI: 0.93, 1.02). CONCLUSIONS In this large study of older adults with HF and diabetes, initiation of metoprolol compared to carvedilol was not associated with an increase in the risk of clinically relevant hyperglycemia.
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Affiliation(s)
- Chintan V Dave
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.,Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA.,Department of Veterans Affairs-New Jersey Health Care System, East Orange, New Jersey, USA
| | - Brian L Strom
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.,Rutgers Biomedical and Health Sciences, Stratford, New Jersey, USA
| | - Fred A Kobylarz
- Department of Family Medicine and Community Health, Geriatrics Program, Robert Wood Johnson Medical School, Rutgers University Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Daniel B Horton
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.,Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Tobias Gerhard
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.,Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA.,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Chin-Lin Tseng
- Department of Veterans Affairs-New Jersey Health Care System, East Orange, New Jersey, USA
| | - Ilja Dejanovic
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Abner Nyandege
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
| | - Soko Setoguchi
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA.,Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Borner T, Workinger JL, Tinsley IC, Fortin SM, Stein LM, Chepurny OG, Holz GG, Wierzba AJ, Gryko D, Nexø E, Shaulson ED, Bamezai A, Da Silva VAR, De Jonghe BC, Hayes MR, Doyle RP. Corrination of a GLP-1 Receptor Agonist for Glycemic Control without Emesis. Cell Rep 2021; 31:107768. [PMID: 32553160 PMCID: PMC7376604 DOI: 10.1016/j.celrep.2020.107768] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/10/2019] [Accepted: 05/22/2020] [Indexed: 12/21/2022] Open
Abstract
Glucagon-like peptide-1 receptor (GLP-1R) agonists used to treat type 2 diabetes mellitus often produce nausea, vomiting, and in some patients, undesired anorexia. Notably, these behavioral effects are caused by direct central GLP-1R activation. Herein, we describe the creation of a GLP-1R agonist conjugate with modified brain penetrance that enhances GLP-1R-mediated glycemic control without inducing vomiting. Covalent attachment of the GLP-1R agonist exendin-4 (Ex4) to dicyanocobinamide (Cbi), a corrin ring containing precursor of vitamin B12, produces a "corrinated" Ex4 construct (Cbi-Ex4). Data collected in the musk shrew (Suncus murinus), an emetic mammal, reveal beneficial effects of Cbi-Ex4 relative to Ex4, as evidenced by improvements in glycemic responses in glucose tolerance tests and a profound reduction of emetic events. Our findings highlight the potential for clinical use of Cbi-Ex4 for millions of patients seeking improved glycemic control without common side effects (e.g., emesis) characteristic of current GLP-1 therapeutics.
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Affiliation(s)
- Tito Borner
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Ian C Tinsley
- Department of Chemistry, Syracuse University, Syracuse, NY, USA
| | - Samantha M Fortin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren M Stein
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oleg G Chepurny
- Department of Medicine, Upstate Medical University, State University of New York, Syracuse, NY, USA
| | - George G Holz
- Department of Medicine, Upstate Medical University, State University of New York, Syracuse, NY, USA
| | | | - Dorota Gryko
- Institute of Organic Chemistry, Polish Academy of Sciences, Warsaw, Poland
| | - Ebba Nexø
- Department of Clinical Biochemistry and Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Evan D Shaulson
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ankur Bamezai
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Valentina A Rodriguez Da Silva
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Bart C De Jonghe
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew R Hayes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert P Doyle
- Department of Chemistry, Syracuse University, Syracuse, NY, USA; Department of Medicine, Upstate Medical University, State University of New York, Syracuse, NY, USA.
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Frantsiyants E, Neskubina I, Shikhlyarova A, Cheryarina N, Kaplieva I, Bandovkina V, Trepitaki L, Nemashkalova L, Lysenko I, Kachesova P, Sheiko E, Morozova M, Kotieva I. The effect of diabetes mellitus under tumor growth on respiratory function and free radical processes in heart cell mitochondria in rats. CARDIOMETRY 2021. [DOI: 10.18137/cardiometry.2021.18.5055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim is to study the effect of comorbid pathology, namely, diabetes mellitus, on free radical oxidation in the mitochondria in the heart cells in female rats with experimental Guerin carcinoma.
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8
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Borner T, Shaulson ED, Tinsley IC, Stein LM, Horn CC, Hayes MR, Doyle RP, De Jonghe BC. A second-generation glucagon-like peptide-1 receptor agonist mitigates vomiting and anorexia while retaining glucoregulatory potency in lean diabetic and emetic mammalian models. Diabetes Obes Metab 2020; 22:1729-1741. [PMID: 32410372 PMCID: PMC7927944 DOI: 10.1111/dom.14089] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/01/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022]
Abstract
AIM To develop a conjugate of vitamin B12 bound to the glucagon-like peptide-1 receptor (GLP-1R) agonist exendin-4 (Ex4) that shows reduced penetrance into the central nervous system while maintaining peripheral glucoregulatory function. METHODS We evaluated whether a vitamin B12 conjugate of Ex4 (B12-Ex4) improves glucose tolerance without inducing anorexia in Goto-Kakizaki (GK) rats, a lean type 2 diabetes model of an understudied but medically compromised population of patients requiring the glucoregulatory effects of GLP-1R agonists without anorexia. We also utilized the musk shrew (Suncus murinus), a mammalian model capable of emesis, to test B12-Ex4 on glycaemic profile, feeding and emesis. RESULTS In both models, native Ex4 and B12-Ex4 equivalently blunted the rise in blood glucose levels during a glucose tolerance test. In both GK rats and shrews, acute Ex4 administration decreased food intake, leading to weight loss; by contrast, equimolar administration of B12-Ex4 had no effect on feeding and body weight. There was a near absence of emesis in shrews given systemic B12-Ex4, in contrast to reliable emesis produced by Ex4. When administered centrally, both B12-Ex4 and Ex4 induced similar potency of emesis, suggesting that brain penetrance of B12-Ex4 is required for induction of emesis. CONCLUSIONS These findings highlight the potential therapeutic value of B12-Ex4 as a novel treatment for type 2 diabetes devoid of weight loss and with reduced adverse effects and better tolerance, but similar glucoregulation to current GLP-1R agonists.
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Affiliation(s)
- Tito Borner
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Evan D. Shaulson
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ian C. Tinsley
- Department of Chemistry, Syracuse University, Syracuse, New York
| | - Lauren M. Stein
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles C. Horn
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew R. Hayes
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert P. Doyle
- Department of Chemistry, Syracuse University, Syracuse, New York
- Department of Medicine, Upstate Medical University, State University of New York, Syracuse, New York
| | - Bart C. De Jonghe
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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Butler J, Januzzi JL, Rosenstock J. Management of heart failure and type 2 diabetes mellitus: Maximizing complementary drug therapy. Diabetes Obes Metab 2020; 22:1243-1262. [PMID: 32243706 DOI: 10.1111/dom.14042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease and occurs in ~25% of patients with heart failure (HF). Patients with co-morbid HF and T2DM are at elevated risk of adverse outcomes, making optimization of complementary drug therapies essential. While research is ongoing, recent advances in drug therapy, including the introduction of sacubitril/valsartan for HF with reduced ejection fraction and the finding of positive cardiovascular effects of glucose-lowering agents (particularly sodium-glucose co-transporter-2 [SGLT2] inhibitors) have the potential to transform pharmacologic management of co-morbid HF and T2DM. In this review, we provide a comprehensive overview of cardiovascular clinical trials of therapies for HF and diabetes mellitus to date and identify areas requiring further investigation. We also discuss the pathophysiologic overlap of the two diseases and explore the complementary therapeutic effects of HF and T2DM drugs, with a particular focus on sacubitril/valsartan and SGLT2 inhibitors.
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10
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Wang H, Zhang J, Shi CF, Jia J, Zhang ZM, Sun JJ, Lu BB. Distribution of traditional Chinese medicine syndromes in type 2 diabetes mellitus with chronic heart failure: A clinical study. Medicine (Baltimore) 2020; 99:e21091. [PMID: 32791683 PMCID: PMC7387054 DOI: 10.1097/md.0000000000021091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The incidence of type 2 diabetes has been increasing year by year in recent years. Type 2 diabetes is an important risk factor in the occurrence and development of heart failure, and it is the second potential risk factor after coronary artery disease. At present, there is no unified etiology, pathogenesis, and syndrome differentiation criteria for type 2 diabetes with chronic heart failure, and it is susceptible to subjective factors. Therefore, standardized, objective, and standardized research is needed to provide reference and guidance for clinical diagnosis and treatment. In this study, the theory of syndrome differentiation is used to initially explore the distribution of traditional Chinese medicine syndromes in patients with type 2 diabetes and chronic heart failure through case data collection, syndrome extraction, and clinical data analysis. METHODS/DESIGN In this study, we will collect at least 500 cases of type 2 diabetes with chronic heart failure that meet the standard outpatient and hospitalization, and fill out the case information collection form. Then we will collect a number of clinical diagnosis and treatment information, and judge the syndrome based on the sum of the contribution of each syndrome to the relevant syndrome. We will use Microsoft Excel to establish a database, enter the relevant diagnosis and treatment, and syndrome information of the case information collection table, and verify and correct in time to ensure the accuracy of the data. DISCUSSION This study will provide reference and guidance for the clinical diagnosis and treatment of type 2 diabetes with chronic heart failure. TRIAL REGISTRATION ClinicalTrials.gov, ChiCTR2000033010, Registered on May 18, 2020.
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Affiliation(s)
- Hui Wang
- Department of Traditional Chinese Medicine, Majiagou Hospital of Kailuan
| | - Jun Zhang
- Department of Endocrinology, Tangshan Hospital of Traditional Chinese Medicine
| | - Chun-fang Shi
- Department of Traditional Chinese Medicine, Majiagou Hospital of Kailuan
| | - Jing Jia
- Department of Internal Medicine, Majiagou Hospital of Kailuan
| | - Zhi-min Zhang
- Department of Internal Medicine, Majiagou Hospital of Kailuan
| | - Jia-jia Sun
- Department of Endocrinology, Tangshan Hospital of Traditional Chinese Medicine
| | - Bing-bing Lu
- Kailuan General Hospital, Tangshan, Hebei, China
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Yazaki M, Nabeta T, Inomata T, Maemura K, Ooki T, Fujita T, Iida Y, Ikeda Y, Ishii S, Naruke T, Ako J. Clinical Considerations When Introducing Sodium-Glucose Co-Transporter 2 Inhibition in Patients With Heart Failure. Circ Rep 2019; 2:51-59. [PMID: 33693174 PMCID: PMC7929704 DOI: 10.1253/circrep.cr-19-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/14/2019] [Indexed: 11/09/2022] Open
Abstract
Background: In patients with heart failure (HF), discontinued medical therapy because of adverse events (AE) is associated with high mortality. Patients with type 2 diabetes mellitus (T2DM) treated with sodium-glucose co-transporter 2 inhibitors (SGLT2i) have a lower risk of HF, but AE sometimes occur with the introduction of SGLT2i. In order to use SGLT2i safely in patients with HF, we investigated factors associated with AE following the introduction of SGLT2i. Methods and Results: AE were defined as hypotension or an increase in serum creatinine ≥0.3 mg/dL by the fifth day after SGLT2i introduction. Sixty-four hospitalized patients with HF and T2DM treated with an SGLT2i were enrolled in this study. Patients were divided into 2 groups: with AE (n=13, 20.3%) and without (n=51, 79.7%). On logistic regression analysis, female sex, hemoglobin ≥15.2 g/dL, serum creatinine ≥1.05 mg/dL, and cardiac index on echocardiography ≤2.15 L/min/m2, were significantly associated with AE. A scoring system was constructed to predict AE according to significant variables (area under the receiver operating characteristic curve, 0.83; P<0.001) and the cut-off point was 2 points. Conclusions: Female sex, hemoconcentration, kidney injury, and low cardiac output were associated with AE at SGLT2i initiation in patients with HF. Using this scoring system, introduction of SGLT2i could be done safely in patients with HF.
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Affiliation(s)
- Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital Tokyo Japan
| | - Kenji Maemura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Takumi Ooki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Yuichiro Iida
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Takashi Naruke
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
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12
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Kuan W, Beavers CJ, Guglin ME. Still sour about lactic acidosis years later: role of metformin in heart failure. Heart Fail Rev 2019; 23:347-353. [PMID: 28868582 DOI: 10.1007/s10741-017-9649-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Metformin remains a widely-used, first-line pharmacotherapy agent for patients with type 2 diabetes mellitus because of its efficacy, mild side effects, and affordability.However, use of this medication has traditionally been shunned by clinicians in patient populations that are considered at risk of lactic acidosis, such as those with heart failure. The underutilization of metformin can largely be attributed to the historical stigma of its biguanide predecessor, phenformin, and its association with lactic acidosis. Despite various studies finding low rates of lactic acidosis and the United States Federal Drug Administration's subsequent removal of heart failure from metformin's contraindication labeling in 2006, this oral hypoglycemic remains underutilized in this patient population. In addition to reports of the safe use of metformin in the heart failure population, a multitude of studies have also additionally suggested a modest reduction in mortality and morbidity. Metformin's role should be strongly reconsidered in the armamentarium of diabetes management in heart failure patients.
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Affiliation(s)
- William Kuan
- Department of Pharmacy Services, University of Kentucky Albert B. Chandler Hospital, 800 Rose Street, Room H110, Lexington, KY, 40536, USA.
| | - Craig J Beavers
- Department of Pharmacy Services, University of Kentucky Albert B. Chandler Hospital, 800 Rose Street, Room H110, Lexington, KY, 40536, USA
| | - Maya E Guglin
- Division of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky Albert B. Chandler Hospital, 800 Rose Street, Lexington, KY, 40536, USA
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13
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Munukutla S, Pan G, Palaniyandi SS. Aldehyde Dehydrogenase (ALDH) 2 in Diabetic Heart Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1193:155-174. [PMID: 31368103 DOI: 10.1007/978-981-13-6260-6_9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A major pathophysiological mechanism behind the development of diabetic heart diseases is oxidative stress mediated by toxic reactive aldehydes such as 4-hydroxynonenal (4HNE). Aldehyde dehydrogenase (ALDH) 2 is a mitochondrial enzyme that has been found to detoxify these deleterious aldehydes and thereby mitigate cardiac damage. Furthermore, its protective role in cellular signaling reverses aberrations caused by hyperglycemia, thereby protecting cardiac function. This chapter assesses the role of ALDH2 in diabetic heart diseases by examining preclinical studies where ALDH2 activity is perturbed in both decreased and increased directions. In doing so, issues in improving ALDH2 activity in select human populations are elucidated, and further research directions are discussed.
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Affiliation(s)
- Srikar Munukutla
- Division of Hypertension and Vascular Research, Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Guodong Pan
- Division of Hypertension and Vascular Research, Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Suresh S Palaniyandi
- Division of Hypertension and Vascular Research, Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA.
- Department of Physiology, Wayne State University, Detroit, MI, USA.
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14
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Tsai TH, Lin CJ, Chua S, Chung SY, Chen SM, Lee CH, Hang CL. Deletion of RasGRF1 Attenuated Interstitial Fibrosis in Streptozotocin-Induced Diabetic Cardiomyopathy in Mice through Affecting Inflammation and Oxidative Stress. Int J Mol Sci 2018; 19:ijms19103094. [PMID: 30308936 PMCID: PMC6213028 DOI: 10.3390/ijms19103094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/30/2018] [Accepted: 09/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background: Diabetic cardiomyopathy (DCM) is characterized by cardiac fibrosis and stiffness, which often develops into heart failure. This study investigated the role of Ras protein-specific guanine nucleotide releasing factor 1 (RasGRF1) in the development of DCM. Methods: Forty-eight mice were divided into four groups (n = 12 per group): Group 1: Wild-type (WT) mice, Group 2: RasGRF1 deficiency (RasGRF1−/−) mice. Group 3: Streptozotocin (STZ)-induced diabetic WT mice, Group 4: STZ-induced diabetic RasGRF1−/− mice. Myocardial functions were assessed by cardiac echography. Heart tissues from all of the mice were investigated for cardiac fibrosis, inflammation, and oxidative stress markers. Results: Worse impaired diastolic function with elevation serum interleukin (IL)-6 was found in the diabetic group compared with the non-diabetic groups. Serum IL-6 levels were found to be elevated in the diabetic compared with the non-diabetic groups. However, the diabetic RasGRF1−/− mice exhibited lower serum IL-6 levels and better diastolic function than the diabetic WT mice. The diabetic RasGRF1−/− mice were associated with reduced cardiac inflammation, which was shown by lower invading inflammation cells, lower expression of matrix metalloproteinase 9, and less chemokines compared to the diabetic WT mice. Furthermore, less oxidative stress as well as extracellular matrix deposition leading to a reduction in cardiac fibrosis was also found in the diabetic RasGRF1−/− mice compared with the diabetic WT mice. Conclusion: The deletion of RasGRF1 attenuated myocardial fibrosis and improved cardiac function in diabetic mice through inhibiting inflammation and oxidative stress.
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Affiliation(s)
- Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan.
| | - Cheng-Jei Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Sarah Chua
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Sheng-Ying Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Shyh-Ming Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Chien-Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
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15
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Hyperglycaemia-induced epigenetic changes drive persistent cardiac dysfunction via the adaptor p66 Shc. Int J Cardiol 2018; 268:179-186. [PMID: 30047409 DOI: 10.1016/j.ijcard.2018.04.082] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/19/2018] [Accepted: 04/18/2018] [Indexed: 01/13/2023]
Abstract
AIMS Hyperglycaemia-induced reactive oxygen species (ROS) are key mediators of cardiac dysfunction. Intensive glycaemic control (IGC) has failed to reduce risk of heart failure in patients with diabetes but the underlying mechanisms remain to be elucidated. The present study investigates whether epigenetic regulation of the pro-oxidant adaptor p66Shc contributes to persistent myocardial dysfunction despite IGC. METHODS AND RESULTS p66Shc expression was increased in the heart of diabetic mice, and 3-week IGC by slow-release insulin implants did not revert this phenomenon. Sustained p66Shc upregulation was associated with oxidative stress, myocardial inflammation and left ventricular dysfunction, as assessed by conventional and 2D speckle-tracking echocardiography. In vivo gene silencing of p66Shc, performed during IGC, inhibited ROS production and restored cardiac function. Furthermore, we show that dysregulation of methyltransferase DNMT3b and deacetylase SIRT1 causes CpG demethylation and histone 3 acetylation on p66Shc promoter, leading to persistent transcription of the adaptor. Altered DNMT3b/SIRT1 axis in the diabetic heart was explained by upregulation of miR-218 and miR-34a. Indeed, in human cardiomyocytes exposed to high glucose, inhibition of these miRNAs restored the expression of DNMT3b and SIRT1 and erased the adverse epigenetic signatures on p66Shc promoter. Consistently, reprogramming miR-218 and miR-34a attenuated persistent p66Shc expression and ROS generation. CONCLUSIONS In diabetic left ventricular dysfunction, a complex epigenetic mechanism linking miRNAs and chromatin modifying enzymes drives persistent p66Shc transcription and ROS generation. Our results set the stage for pharmacological targeting of epigenetic networks to alleviate the clinical burden of diabetic cardiomyopathy.
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Hitsumoto T. Clinical Significance of Skin Autofluorescence in Patients With Type 2 Diabetes Mellitus With Chronic Heart Failure. Cardiol Res 2018; 9:83-89. [PMID: 29755624 PMCID: PMC5942236 DOI: 10.14740/cr713w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background Recent clinical studies have shown that skin autofluorescence (AF) levels are significantly associated with diabetic complications. In contrast, data regarding the relationships between skin AF and chronic heart failure (CHF) are limited. The aim of this study was to clarify the clinical significance of skin AF in patients with type 2 diabetes mellitus (DM) with CHF. Methods This cross-sectional study enrolled 257 outpatients with type 2 DM with CHF who were treated medically (96 men and 161 women; mean age, 79 ± 7 years). Associations between skin AF and various clinical parameters were examined. Results Incidence of skin AF in patients with a history of hospitalization due to HF was significantly higher than in those without a history of hospitalization due to HF (3.0 ± 0.5 AU vs. 2.7 ± 0.5 AU, respectively, P < 0.001). Significant positive correlations were found between skin AF and various clinical parameters, such as E/e′ as a maker of left ventricular diastolic function (r = 0.30, P < 0.001), high-sensitivity cardiac troponin T levels as a marker of myocardial injury (r = 0.45, P < 0.001), reactive oxygen metabolite levels as an oxidative stress marker (r = 0.31, P < 0.001), and cardio-ankle vascular index as a marker of arterial function (r = 0.38, P < 0.001). Furthermore, multiple regression analyses showed that these clinical parameters (E/e′ (β = 0.25, P < 0.001)), high-sensitivity cardiac troponin T levels (β = 0.30, P < 0.001), cardio-ankle vascular index (β = 0.21, P < 0.001), reactive oxygen metabolite levels (β = 0.15, P < 0.01), and a history of hospitalization due to HF (β = 0.23, P < 0.001) were independent variables when skin AF was used as a subordinate factor. Conclusion The findings of this study showed that skin AF may be a determining factor for prognosis in patients with type 2 DM with CHF. Further investigations in a large prospective study, including intervention therapies, are required to validate the results of this study.
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Affiliation(s)
- Takashi Hitsumoto
- Hitsumoto Medical Clinic, 2-7-7, Takezakicyou, Shimonoseki City, Yamaguchi 750-0025, Japan.
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17
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Boudia D, Domergue V, Mateo P, Fazal L, Prud'homme M, Prigent H, Delcayre C, Cohen-Solal A, Garnier A, Ventura-Clapier R, Samuel JL. Beneficial effects of exercise training in heart failure are lost in male diabetic rats. J Appl Physiol (1985) 2017; 123:1579-1591. [PMID: 28883044 DOI: 10.1152/japplphysiol.00117.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise training has been demonstrated to have beneficial effects in patients with heart failure (HF) or diabetes. However, it is unknown whether diabetic patients with HF will benefit from exercise training. Male Wistar rats were fed either a standard (Sham, n = 53) or high-fat, high-sucrose diet ( n = 66) for 6 mo. After 2 mo of diet, the rats were already diabetic. Rats were then randomly subjected to either myocardial infarction by coronary artery ligation (MI) or sham operation. Two months later, heart failure was documented by echocardiography and animals were randomly subjected to exercise training with treadmill for an additional 8 wk or remained sedentary. At the end, rats were euthanized and tissues were assayed by RT-PCR, immunoblotting, spectrophotometry, and immunohistology. MI induced a similar decrease in ejection fraction in diabetic and lean animals but a higher premature mortality in the diabetic group. Exercise for 8 wk resulted in a higher working power developed by MI animals with diabetes and improved glycaemia but not ejection fraction or pathological phenotype. In contrast, exercise improved the ejection fraction and increased adaptive hypertrophy after MI in the lean group. Trained diabetic rats with MI were nevertheless able to develop cardiomyocyte hypertrophy but without angiogenic responses. Exercise improved stress markers and cardiac energy metabolism in lean but not diabetic-MI rats. Hence, following HF, the benefits of exercise training on cardiac function are blunted in diabetic animals. In conclusion, exercise training only improved the myocardial profile of infarcted lean rats fed the standard diet. NEW & NOTEWORTHY Exercise training is beneficial in patients with heart failure (HF) or diabetes. However, less is known of the possible benefit of exercise training for HF patients with diabetes. Using a rat model where both diabetes and MI had been induced, we showed that 2 mo after MI, 8 wk of exercise training failed to improve cardiac function and metabolism in diabetic animals in contrast to lean animals.
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Affiliation(s)
- Dalila Boudia
- UMR-S 942 Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Diderot, Sorbonne Paris Cité, France
| | - Valérie Domergue
- UMS IPSIT Animex Platform, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - Philippe Mateo
- UMR-S 1180 INSERM, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - Loubina Fazal
- UMR-S 942 Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Diderot, Sorbonne Paris Cité, France
| | - Mathilde Prud'homme
- UMR-S 942 Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Diderot, Sorbonne Paris Cité, France
| | - Héloïse Prigent
- UMR-S 942 Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Diderot, Sorbonne Paris Cité, France.,Cardiology, Assistance Publique-Hópitaux de Paris (AP-HP), Ambroise Paré, Paris
| | - Claude Delcayre
- UMR-S 942 Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Diderot, Sorbonne Paris Cité, France
| | - Alain Cohen-Solal
- UMR-S 942 Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Diderot, Sorbonne Paris Cité, France.,Cardiology, Assistance Publique-Hópitaux de Paris (AP-HP), Ambroise Paré, Paris
| | - Anne Garnier
- UMR-S 1180 INSERM, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - Renée Ventura-Clapier
- UMR-S 1180 INSERM, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - Jane-Lise Samuel
- UMR-S 942 Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Diderot, Sorbonne Paris Cité, France
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18
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Tan SH, Kng KK, Lim SM, Chan A, Loh JKK, Lee JYC. Long-term Clinical and Cost Outcomes of a Pharmacist-managed Risk Factor Management Clinic in Singapore: An Observational Study. Clin Ther 2017; 39:2355-2365. [PMID: 29100730 DOI: 10.1016/j.clinthera.2017.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/26/2017] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Few studies have determined the benefits of pharmacist-run clinics within a tertiary institution, and specifically on their capability to improve clinical outcomes as well as reduce the cost of illness. This study was designed to investigate the effectiveness of a pharmacist-managed risk factor management clinic (RFMP) in an acute care setting through the comparison of clinical (improvement in glycosylated hemoglobin level) and cost outcomes with patients receiving usual care. METHODS This single-center, observational study included patients aged ≥21 years old and diagnosed with type 2 diabetes mellitus (DM) who received care within the cardiology department of a tertiary institution between January 1, 2014, and December 31, 2015. The intervention group comprised patients who attended the RFMP for 3 to 6 months, and the usual-care group comprised patients who received standard cardiologist care. Univariate analysis and multiple linear regression were conducted to analyze the clinical and cost outcomes. FINDINGS A total of 142 patients with DM (71 patients in the intervention group and 71 patients in the usual-care group) with similar baseline characteristics were included. After adjusting for differences in baseline systolic blood pressure and triglyceride levels, the mean reduction in glycosylated hemoglobin level at 6 months from baseline in the intervention group was significantly lower by 0.78% compared with the usual-care group. Patients in the usual-care group had a significantly higher risk of hospital admissions within the 12 months from baseline compared with the intervention group (odds ratio, 3.84 [95% CI, 1.17-12.57]; P = 0.026). Significantly lower mean annual direct medical costs were also observed in the intervention group (US $8667.03 [$17,416.20] vs US $56,665.02 [$127,250.10]; P = 0.001). IMPLICATIONS The pharmacist-managed RFMP exhibited improved clinical outcomes and reduced health care costs compared with usual care within a tertiary institute.
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Affiliation(s)
- She Hui Tan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Kwee Keng Kng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | - Sze Mian Lim
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | | | - Joyce Yu-Chia Lee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore; Department of Pharmacy, Tan Tock Seng Hospital, Singapore.
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Kim MS, Lee JH, Kim EJ, Park DG, Park SJ, Park JJ, Shin MS, Yoo BS, Youn JC, Lee SE, Ihm SH, Jang SY, Jo SH, Cho JY, Cho HJ, Choi S, Choi JO, Han SW, Hwang KK, Jeon ES, Cho MC, Chae SC, Choi DJ. Korean Guidelines for Diagnosis and Management of Chronic Heart Failure. Korean Circ J 2017; 47:555-643. [PMID: 28955381 PMCID: PMC5614939 DOI: 10.4070/kcj.2017.0009] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 11/11/2022] Open
Abstract
The prevalence of heart failure (HF) is skyrocketing worldwide, and is closely associated with serious morbidity and mortality. In particular, HF is one of the main causes for the hospitalization and mortality in elderly individuals. Korea also has these epidemiological problems, and HF is responsible for huge socioeconomic burden. However, there has been no clinical guideline for HF management in Korea.
The present guideline provides the first set of practical guidelines for the management of HF in Korea and was developed using the guideline adaptation process while including as many data from Korean studies as possible. The scope of the present guideline includes the definition, diagnosis, and treatment of chronic HF with reduced/preserved ejection fraction of various etiologies.
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Affiliation(s)
- Min-Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eung Ju Kim
- Department of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Hyun Ihm
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Hallym University Pyeongchon Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Woo Han
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyung Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun Seok Jeon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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20
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Sutton CX, Carpenter DA, Sumida W, Taira D. 2016 Writing Contest Undergraduate Winner: The Relationship Between Medication Adherence and Total Healthcare Expenditures by Race/Ethnicity in Patients with Diabetes in Hawai'i. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2017; 76:183-189. [PMID: 28721312 PMCID: PMC5511336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Diabetes is a costly, chronic disease that is becoming increasingly prevalent worldwide. Studies show that Native Hawaiians suffer from higher rates of diabetes and lower rates of medication adherence compared to Caucasians and Japanese. This study compared total annual healthcare expenditures of patients with diabetes in Hawai'i by race and ethnicity and determined whether any existing differences persisted after controlling for medication adherence and demographic factors. The study population consisted of 30,445 individuals, using administrative claims data from a large health plan in Hawai'i. Filipinos, Native Hawaiians, and Other Pacific Islanders had significantly lower medication adherence rates compared to other groups. These ethnic groups also had the lowest median healthcare costs. In contrast, Caucasians had one of the highest medication adherence rates coupled with the highest median annual healthcare expenditures at $5,132. Generalized linear regression models showed that after controlling for demographic factors and medication adherence, Japanese (RR=0.86, 95%CI [0.78, 0.94]), Chinese (RR=0.83, 95%CI [0.73, 0.95]), Filipinos (RR=0.74, 95%CI [0.67, 0.82]), and Native Hawaiians (RR=0.74, 95%CI [0.67, 0.82]) had significantly lower total healthcare costs compared to Caucasians. Costs for Other Pacific Islanders were not significantly different from those of Caucasians. This study provides evidence that total health-related cost is associated with a multitude of factors that further research may reveal.
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Affiliation(s)
- Cori X Sutton
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (CXS, D-AC)
| | - Dee-Ann Carpenter
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (CXS, D-AC)
| | - Wesley Sumida
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (CXS, D-AC)
| | - Deborah Taira
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (CXS, D-AC)
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Marx N. Heart failure and diabetes - underestimated, underdiagnosed and poorly understood: A call for action. Diab Vasc Dis Res 2017; 14:67-68. [PMID: 28128001 DOI: 10.1177/1479164116683150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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22
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Chen MD, Dong SS, Cai NY, Fan MD, Gu SP, Zheng JJ, Yin HM, Zhou XH, Wang LX, Li CY, Zheng C. Efficacy and safety of mineralocorticoid receptor antagonists for patients with heart failure and diabetes mellitus: a systematic review and meta-analysis. BMC Cardiovasc Disord 2016; 16:28. [PMID: 26822790 PMCID: PMC4731899 DOI: 10.1186/s12872-016-0198-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/22/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to systematically assess the efficacy and safety of mineralocorticoid receptor antagonists (MRAs) for patients with heart failure (HF) and diabetes mellitus (DM). METHODS We conducted a comprehensive search for controlled studies that evaluated the efficacy and safety of MRAs in patients with DM and HF. Medline, Embase and Cochrane databases were searched. Two reviewers independently identified citations, extracted data and evaluated quality. Risk estimations were abstracted and pooled where appropriate. RESULTS Four observational studies were included. MRAs use was associated with reduced mortality compared with controls (RR = 0.78; 95% CI: 0.69-0.88; I(2) = 0%; P < 0.001). Increased risk of developing hyperkalaemia was observed in those patients taking MRAs (RR = 1.74; 95% CI: 1.27-2.38; I(2) = 0%; P = 0.0005). CONCLUSIONS The current cumulative evidence suggests that MRAs can improve clinical outcomes but increase the risk of hyperkalaemia in patients with DM and HF. TRIAL REGISTRATION PROSPERO CRD42015025690 .
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Affiliation(s)
- Meng-Die Chen
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Si-Si Dong
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Ning-Yu Cai
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, 325027, Wenzhou, Zhejiang, China.
| | - Meng-Di Fan
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Su-Ping Gu
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Jin-Jue Zheng
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Hai-Min Yin
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Xin-He Zhou
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Liang-Xue Wang
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Chun-Ying Li
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Chao Zheng
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
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Exenatide exerts a PKA-dependent positive inotropic effect in human atrial myocardium. J Mol Cell Cardiol 2015; 89:365-75. [DOI: 10.1016/j.yjmcc.2015.09.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 12/31/2022]
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24
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Riggs K, Ali H, Taegtmeyer H, Gutierrez AD. The Use of SGLT-2 Inhibitors in Type 2 Diabetes and Heart Failure. Metab Syndr Relat Disord 2015; 13:292-7. [PMID: 26125313 DOI: 10.1089/met.2015.0038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The concurrent management of type 2 diabetes mellitus (T2DM) and chronic congestive heart failure presents several therapeutic challenges. Of concern is that insulin and insulin-sensitizing medications detrimentally "flood" the heart with energy-providing substrates, including fats and glucose. In this population, treatment of T2DM should focus on the reduction of increased substrate supply. Sodium glucose cotransporter-2 (SGLT-2) inhibitors, a new class of antidiabetic medication, operate via this principle by blocking the reabsorption of glucose in the kidney and subsequently releasing glucose through the urine. In this review, we begin with an examination of the mechanisms of glucotoxicity and lipotoxicity in the heart. Then we analyze the potential role of SGLT-2 inhibitor therapy in patients with concurrent T2DM and chronic heart failure. Based on the available evidence, SGLT-2 inhibitors are safe and can be recommended to treat T2DM in patients with chronic heart failure and intact renal function. Further studies are in progress to assess long-term survival benefits.
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Affiliation(s)
- Kayla Riggs
- 1 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Texas Health Science Center at Houston School of Medicine , Houston, Texas
| | - Hiba Ali
- 1 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Texas Health Science Center at Houston School of Medicine , Houston, Texas
| | - Heinrich Taegtmeyer
- 2 Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston School of Medicine , Houston, Texas
| | - Absalon D Gutierrez
- 1 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Texas Health Science Center at Houston School of Medicine , Houston, Texas
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25
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Shahreyar M, Mupiddi V, Choudhuri I, Sra J, Tajik AJ, Jahangir A. Implantable cardioverter defibrillators in diabetics: efficacy and safety in patients at risk of sudden cardiac death. Expert Rev Cardiovasc Ther 2015; 13:897-906. [PMID: 26098816 DOI: 10.1586/14779072.2015.1059276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Diabetes mellitus is a major risk factor for arrhythmogenesis and is associated with a two-fold increase in all-cause mortality and a four-fold increase in cardiovascular mortality including sudden cardiac death when compared with nondiabetics. Implantable cardioverter defibrillators (ICD) have been shown to effectively reduce arrhythmic death and all-cause mortality in patients with severe myocardial dysfunction. With a high competing risk of nonarrhythmic cardiac and noncardiac death, survival benefit of ICD in patients with diabetes mellitus could be reduced, but the subanalysis of diabetic patients in randomized clinical trials provides reassurance regarding a similar beneficial survival effect of ICD and cardiac resynchronization therapy in diabetics, as observed in the overall population with advanced heart disease. In this article, the authors highlight some of the clinical issues related to diabetes, summarize the data on the efficacy of ICD in diabetics when compared with nondiabetics and discuss concerns related to ICD implantation in patients with diabetes.
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Affiliation(s)
- Muhammad Shahreyar
- Sheikh Khalifa bin Hamad Al Thani Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora University of Wisconsin Medical Group, Milwaukee, WI, USA
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26
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Monami M, Mannucci E. Dipeptidyl Peptidase-4 Inhibitors and Heart Failure: Friends or Foes? CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0465-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Diabetes is a predictor of coronary artery stenosis in patients hospitalized with heart failure. Heart Vessels 2015; 31:671-6. [DOI: 10.1007/s00380-015-0669-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/20/2015] [Indexed: 01/03/2023]
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28
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Vasiliadis I, Kolovou G, Mavrogeni S, Nair DR, Mikhailidis DP. Sudden cardiac death and diabetes mellitus. J Diabetes Complications 2014; 28:573-9. [PMID: 24666923 DOI: 10.1016/j.jdiacomp.2014.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/07/2014] [Accepted: 02/10/2014] [Indexed: 01/11/2023]
Abstract
Sudden cardiac death (SCD) affects a significant percentage of diabetic patients. SCD in these patients can be due to several factors, such as diastolic dysfunction, heart failure, altered platelet function, inflammation, sympathetic nervous stimulation and other factors. In the present review, we discuss the association between diabetes mellitus and SCD.
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MESH Headings
- Animals
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/therapy
- Diabetic Angiopathies/complications
- Diabetic Angiopathies/physiopathology
- Diabetic Angiopathies/prevention & control
- Diabetic Angiopathies/therapy
- Diabetic Cardiomyopathies/complications
- Diabetic Cardiomyopathies/physiopathology
- Diabetic Cardiomyopathies/prevention & control
- Diabetic Cardiomyopathies/therapy
- Disease Progression
- Evidence-Based Medicine
- Humans
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Affiliation(s)
- I Vasiliadis
- Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom; Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - G Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - S Mavrogeni
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - D R Nair
- Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom
| | - D P Mikhailidis
- Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom.
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Abstract
Heart failure with preserved ejection fraction (HFpEF), which currently represents approximately 50 % of heart failure (HF) cases, is common and associated with high morbidity and mortality. Understanding the epidemiology of HFpEF has been difficult due to the challenges in HFpEF diagnosis and the heterogeneous etiologies and pathophysiologies that underlie HFpEF. Nevertheless, several high-quality epidemiology and observational registry studies of HFpEF demonstrate that an increasing prevalence of HFpEF in both the outpatient and inpatient settings, coupled with a lack of evidence-based effective treatments for HFpEF, is resulting in an emerging epidemic of HFpEF. In this review, we discuss the emerging HFpEF epidemic, focusing on: (1) reasons for the rising prevalence of HFpEF; (2) the abnormalities in cardiac structure and function that dictate the transition from risk factors to HFpEF; (3) novel HFpEF mechanisms that may underlie the increase in HFpEF prevalence; (4) prognosis of HFpEF; and (5) risk prediction in HFpEF. We conclude with 10 unanswered questions onHFpEF epidemiology thatwill be important areas for future investigation.
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