1
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Wang X, Chen Z, Tian W, Zhang J, Li Q, Ju J, Xu H, Chen K. Plasma homocysteine levels and risk of congestive heart failure or cardiomyopathy: A Mendelian randomization study. Front Cardiovasc Med 2023; 10:1030257. [PMID: 36776266 PMCID: PMC9908956 DOI: 10.3389/fcvm.2023.1030257] [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: 08/30/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Background Although observational studies have demonstrated associations between elevated plasma homocysteine levels and the risk of cardiovascular diseases, controversy remains. Objective This study investigated the causal association of plasma homocysteine levels with congestive heart failure and cardiomyopathy risk. Methods We performed a two-sample Mendelian randomization (MR) study of congestive heart failure (n = 218,792), cardiomyopathy (n = 159,811), and non-ischemic cardiomyopathy (n = 187,152). Genetic summary data on the association of single-nucleotide polymorphisms with homocysteine were extracted from the most extensive genome-wide association study of 44,147 individuals. MR analyses, including the random-effect inverse variance-weighted (IVW) meta-analysis, weighted median, simple median, maximum likelihood, penalized weighted median, MR-PRESSO, and MR-Egger regression, were used to estimate the associations between the selected single-nucleotide polymorphisms and congestive heart failure or cardiomyopathy. Results The MR analyses revealed no causal role of higher genetically predicted plasma homocysteine levels with congestive heart failure risk (random-effect IVW, odds ratio [OR] per standard deviation (SD) increase in homocysteine levels = 1.753, 95% confidence interval [CI] = 0.674-4.562, P = 0.250), cardiomyopathy (random-effect IVW, OR per SD increase in homocysteine levels = 0.805, 95% CI = 0.583 to 1.020, P = 0.189), or non-ischemic cardiomyopathy (random-effect IVW, OR per SD increase in homocysteine levels = 1.064, 95% CI = 0.927-1.222, P = 0.379). The results were consistent with other analytical methods and sensitivity analyses. Conclusion Genetically predicted homocysteine level was not associated with congestive heart failure or cardiomyopathy risk. It is unlikely that homocysteine-lowering therapy decreases the incidence or improves the outcomes of congestive heart failure and cardiomyopathy.
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Affiliation(s)
- Xinyi Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhuo Chen
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wende Tian
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Qiuyi Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jianqing Ju
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Xu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,*Correspondence: Hao Xu,
| | - Keji Chen
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Keji Chen,
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2
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Huang X, Yang S, Chen X, Zhao Q, Pan J, Lai S, Ouyang F, Deng L, Du Y, Chen J, Hu Q, Guo B, Liu J. Development and validation of a clinical predictive model for 1-year prognosis in coronary heart disease patients combine with acute heart failure. Front Cardiovasc Med 2022; 9:976844. [PMID: 36312262 PMCID: PMC9609152 DOI: 10.3389/fcvm.2022.976844] [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: 06/23/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background The risk factors for acute heart failure (AHF) vary, reducing the accuracy and convenience of AHF prediction. The most common causes of AHF are coronary heart disease (CHD). A short-term clinical predictive model is needed to predict the outcome of AHF, which can help guide early therapeutic intervention. This study aimed to develop a clinical predictive model for 1-year prognosis in CHD patients combined with AHF. Materials and methods A retrospective analysis was performed on data of 692 patients CHD combined with AHF admitted between January 2020 and December 2020 at a single center. After systemic treatment, patients were discharged and followed up for 1-year for major adverse cardiovascular events (MACE). The clinical characteristics of all patients were collected. Patients were randomly divided into the training (n = 484) and validation cohort (n = 208). Step-wise regression using the Akaike information criterion was performed to select predictors associated with 1-year MACE prognosis. A clinical predictive model was constructed based on the selected predictors. The predictive performance and discriminative ability of the predictive model were determined using the area under the curve, calibration curve, and clinical usefulness. Results On step-wise regression analysis of the training cohort, predictors for MACE of CHD patients combined with AHF were diabetes, NYHA ≥ 3, HF history, Hcy, Lp-PLA2, and NT-proBNP, which were incorporated into the predictive model. The AUC of the predictive model was 0.847 [95% confidence interval (CI): 0.811–0.882] in the training cohort and 0.839 (95% CI: 0.780–0.893) in the validation cohort. The calibration curve indicated good agreement between prediction by nomogram and actual observation. Decision curve analysis showed that the nomogram was clinically useful. Conclusion The proposed clinical prediction model we have established is effective, which can accurately predict the occurrence of early MACE in CHD patients combined with AHF.
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Affiliation(s)
- Xiyi Huang
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Shaomin Yang
- Department of Radiology, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Xinjie Chen
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Qiang Zhao
- Department of Cardiovascular Medicine, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Jialing Pan
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Shaofen Lai
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Fusheng Ouyang
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Lingda Deng
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Yongxing Du
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Jiacheng Chen
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Baoliang Guo
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China,*Correspondence: Baoliang Guo,
| | - Jiemei Liu
- Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China,Jiemei Liu,
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Miao L, Guo M, Pan D, Chen P, Chen Z, Gao J, Yu Y, Shi D, Du J. Serum Uric Acid and Risk of Chronic Heart Failure: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 8:785327. [PMID: 34977088 PMCID: PMC8715937 DOI: 10.3389/fmed.2021.785327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives: A systematic review and meta-analysis was performed to evaluate the potential prognostic role of serum uric acid (SUA) in patients with chronic heart failure (CHF). Methods: The Embase, PubMed, Web of Science and Cochrane Library databases were searched up to 5 April 2021 for relevant publications. Random effects model was used to pool data. STATA15.0 software was used to perform meta-analysis. Heterogeneity was assessed using the Cochran Q statistic (significance level of P < 0.10) and I2 statistics (significance level of 50%). Results: Ultimately, 18 publications reporting adverse events in CHF patients were included. The results indicate reveal associations between a high level of SUA and the risk of all-cause mortality (HR 2.24, 95% CI 1.49–3.37), cardiovascular mortality (HR 1.14, 95% CI 1.06–1.23), and the composite of death or cardiac events (HR 1.26, 95% CI 1.01–1.56) in CHF patients. A 1 mg/dL increase in serum uric acid led to 4% (HR 1.04, 95% CI 1.02–1.05) and 9% (HR 1.09, 95% CI 1.03–1.17) increases in the risk of all-cause mortality and the composite endpoint of death or cardiac events in CHF patients, respectively. Conclusion: Serum uric acid is positively associated with the risk of adverse events in CHF patients. This study protocol has been registered at PROSPERO as CRD42021247084 (https://www.crd.york.ac.uk/PROSPERO). Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO.
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Affiliation(s)
- Lina Miao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Department of Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Ming Guo
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Deng Pan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Department of Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Pengfei Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhuhong Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Gao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanqiao Yu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Department of Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Dazhuo Shi
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianpeng Du
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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4
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Wang X, Wang F, Feng Z, Cai J, Liu J. The association between levels of serum homocysteine and chronic heart failure: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24117. [PMID: 33592862 PMCID: PMC7870206 DOI: 10.1097/md.0000000000024117] [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] [Received: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Homocysteine (Hcy) is one of the main factors leading to arteriosclerosis, which is closely related to cardiovascular disease. Recent studies have found that serum Hcy levels are increased in patients with chronic heart failure (CHF), and it is speculated that Hcy may be a risk factor for CHF, but evidence-based medicine evidence is lacking. The aim of this study was to investigate the correlation between serum Hcy levels and CHF by means of systematic review. METHODS The databases of PubMed, Embase, The Cochrance Library, Web of Science, CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), Wanfang and China Biology Medicine disc were searched by computer. In addition, Baidu Scholar and Google Scholar were manually searched to collect all case-control studies related to serum Hcy and CHF. The search time limit was from database establishment to November 2020. Two reviewers independently screened the literatures, extracted the data and evaluated the risk of bias of the included literatures. RESULTS In this study, we evaluated the correlation between serum Hcy levels and CHF by the levels of serum Hcy in CHF patients and non-CHF patients. CONCLUSIONS This study will provide reliable evidence for the clinical value of serum Hcy in the field of CHF disease. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/QMPRC.
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Affiliation(s)
| | - Fu Wang
- Gulang County People's Hospital, Wuwei, Gansu Province, China
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5
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Zhang Z, Gu X, Fang X, Tang Z, Guan S, Liu H, Wu X, Wang C, Zhao Y. Homocysteine and the Risk of Cardiovascular Events and All-Cause Death in Elderly Population: A Community-Based Prospective Cohort Study. Ther Clin Risk Manag 2020; 16:471-481. [PMID: 32547044 PMCID: PMC7250705 DOI: 10.2147/tcrm.s239496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background The association between homocysteine and cardiovascular diseases (CVD) and all-cause death was inconclusive. A community-based prospective cohort study was carried out in Beijing to evaluate this association in elderly population for more effective clinical prediction and primary prevention of CVD. Patients and Methods Participants were randomly selected from Beijing, China. Questionnaire survey, physical examinations, and laboratory tests were carried out to collect baseline information and investigate clinical characteristics. Each participant was predetermined to be followed by 5 years. CVD events and death were collected as primary variables. A Cox regression analysis was performed to assess the risk of CVD events, CVD death, and all-cause death contributed by homocysteine as well as some other risk factors. Results A total of 1257 participants with an average age of 69.16 years were enrolled in this study. After adjusting for confounders, the hazard ratios (HRs) and 95% confidence intervals of CVD event, CVD death, and all-cause death caused by intermediate-to-severe hyperhomocysteinemia as compared with normal homocysteine levels were 1.68 (95% CI 1.06–2.67), 1.97 (95% CI 0.95–4.29) and 2.02 (95% CI 1.26–3.24), respectively. Intermediate-to-severe hyperhomocysteinemia increased the risks of CVD event (HR 2.07, 95% CI 1.01–4.26) and all-cause death (HR 3.08, 95% CI 1.56–6.07) among male participants. However, the positive association was not statistically significant among female participants (HR 1.59, 95% CI 0.83–3.04 for CVD event and HR 0.90, 95% CI 0.52–6.07 for all-cause death). Every 5μmol/L increment in homocysteine concentration was shown to be associated with a 4% (HR 1.04, 95% CI 1.01–1.07) and 5% (HR 1.05, 95% CI 1.01–1.07) higher risk of CVD events and all-cause death in all participants. There was no significant association between moderate hyperhomocysteinemia and the risk of the CVD events and all-cause death. Conclusion Intermediate-to-severe hyperhomocysteinemia was significantly associated with CVD events and all-cause death in elderly population without a history of ischemia or congestive heart failure (CHF). The positive association was pronounced among males.
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Affiliation(s)
- Zhongying Zhang
- Geriatric Department, Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiang Gu
- Medical Affair Department, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xianghua Fang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhe Tang
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shaochen Guan
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongjun Liu
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoguang Wu
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chunxiu Wang
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yan Zhao
- Education Department, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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Luo JL, Chien KL, Hsu HC, Su TC, Lin HJ, Chen PC, Chen MF, Lee YT. Association between plasma homocysteine concentration and the risk of all-cause death in adults with diastolic dysfunction in a community: A 13-year cohort study. Medicine (Baltimore) 2017; 96:e6716. [PMID: 28445283 PMCID: PMC5413248 DOI: 10.1097/md.0000000000006716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Hyperhomocysteinemia (HHCYS) has been associated with systolic heart failure. However, it is still unknown that serum homocycsteine level was useful in predicting the outcome in patients with diastolic dysfunction. We conducted a cohort study to determine if HHCYS was associated with poor prognosis in diastolic dysfunction patients. The Chin-Shan Community Cardiovascular Cohort (CCCC) study was designated to investigate the trends of cardiovascular morbidity and mortality in a community. Individuals who were 35 years and above were enrolled. Participants were categorized by homocysteine concentration quartiles. We used multivariate Cox proportional hazards models to calculate the hazard ratio (HR) of the 4th quartiles versus the 1st quartile. Area under the receiver-operating characteristic (ROC) curve was to compare prediction measures. A total of 2020 participants had completed the echocardiography examination, and 231 individuals were diagnosed as diastolic dysfunction. A total 75 participants had died during follow-up period. HHCYS was found to be significantly associated with poor prognosis. The adjusted HR for homocysteine level was 1.07 (95% confidence interval [CI], 1.01-1.14). Participants in the highest quartile had a 1.90 (95% CI, 0.88-4.12, P for trend, .026) fold risk for all cause death, compared with those in the lowest quartiles. The HR was 1.88 (95% CI, 1.07-3.29) using 11.11 μmol/L as cut point for hyperhomocysteine. HHCYS was significantly associated with poor prognosis in diastolic dysfunction participants in the community.
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Affiliation(s)
- Jing-Ling Luo
- Division of Cardiology, Department of Internal Medicine, Min-sheng Hospital, Taoyuan county
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public School, National Taiwan University
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiung-Ching Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Chen Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Ju Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Fong Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan-Teh Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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7
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Strauss E, Supinski W, Radziemski A, Oszkinis G, Pawlak AL, Gluszek J. Is hyperhomocysteinemia a causal factor for heart failure? The impact of the functional variants of MTHFR and PON1 on ischemic and non-ischemic etiology. Int J Cardiol 2016; 228:37-44. [PMID: 27863359 DOI: 10.1016/j.ijcard.2016.11.213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/06/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hyperhomocysteinemia was found to be uniformly associated with the development of heart failure (HF) and HF mortality; however, it is uncertain whether this relation is causative or not. We used Mendelian randomization to examine the associations of the methylene tetrahydrofolate gene (MTHFR) and paraoxonase 1 gene (PON1) variants as a proxy for lifelong exposure to high Hcy and Hcy-thiolactone concentrations with the development of HF in men aged ≤60years and the occurrence of adverse effects at one-year follow-up. METHODS The study enrolled 172 men with HF: 117 with ischemic etiology (iHF) related to coronary artery disease (CAD) and 55 with non-ischemic etiology (niHF) related to dilated cardiomyopathy (DCM). The reference group of 329 CAD patients without HF and the control group of 384 men were also analyzed. RESULTS Hyperhomocysteinemia (OR=2.0, P<0.05) and the MTHFR 677TT/1298AA, 677CC/1298CC genotypes (OR=1.6, P=0.03) were associated with HF regardless of its etiology, especially among normotensives (OR=4.6, P=0.001 and OR=2.3, P=0.003, respectively). In niHF, the PON1 162AA (OR=2.3, P=0.03) and 575AG+GG (OR=0.46, P=0.01) genotypes also influenced the risk. The interaction between HDLC<1mmol/L and the PON1 575GG genotype was found to influence the risk of iHF (OR=7.2, P=0.009). Hyperhomocysteinemia improved the classification of niHF patients as 'high-risk' by 10.1%. Ejection fraction <30% and DCM increased the probability of HF death or re-hospitalization within one year. CONCLUSION Our results provide evidence that hyperhomocysteinemia is a causal factor for niHF in DCM, while dysfunctional HDL could contribute to the pathogenesis of iHF.
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Affiliation(s)
- Ewa Strauss
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479 Poznan, Poland; Department of General and Vascular Surgery, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland.
| | - Wieslaw Supinski
- Regional Public Hospital, Dekerta 1, 66-400 Gorzow Wielkopolski, Poland
| | - Artur Radziemski
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Grzegorz Oszkinis
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Andrzej Leon Pawlak
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479 Poznan, Poland
| | - Jerzy Gluszek
- The State Higher Vocational School in Kalisz, Nowy Swiat 4, 62-800 Kalisz, Poland
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Abstract
Although cardiac resuscitation can revive the whole body, the mechanisms are unclear. To this end, we propose that reviving a dead/dysfunctional cardiomyocyte will shed light on resuscitation mechanisms and pave the way to treat cardiac myopathies. The degradation of the myocyte cytoskeleton by the proteasome system which involves calpains, ubiquitin, caspases and matrix metalloproteases is the main focus of this review. The activation of calpains beyond the calpastatin-mediated inhibition due to extensive calcium harbor can lead to titin degradation, damage to the sarcomere and contractile dysfunction. The ubiquitin proteasome system can disturb the protein homeostasis within the cell and generate a dysfunctional myocyte. The matrix metalloproteases disrupt the collagen/elastin ratio and connexins to generate arrhythmias. The concept of cardiac resuscitation stems from protecting the myocyte cytoskeleton and keeping the protein homeostasis intact through management of the degradation machinery. In this regard, proteasome inhibitors for the degradation machinery have an elegant space. Recently exosomes have been identified potentially, as carriers of microRNAs or proteins that can modify the target cells. Exosomes loaded with the inhibitor "cargo" which comprises microRNAs, siRNAs or proteins to inhibit the degradation machinery can be a method of choice for cardiac resuscitation-a process difficult to execute.
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9
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Huang H, Huang B, Li Y, Huang Y, Li J, Yao H, Jing X, Chen J, Wang J. Uric acid and risk of heart failure: a systematic review and meta-analysis. Eur J Heart Fail 2013; 16:15-24. [PMID: 23933579 DOI: 10.1093/eurjhf/hft132] [Citation(s) in RCA: 207] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/09/2013] [Accepted: 07/12/2013] [Indexed: 02/05/2023] Open
Abstract
AIMS We aimed to perform a systematic review and meta-analysis to assess the association between serum uric acid and incident heart failure (HF)/prognosis of HF patients. METHODS AND RESULTS A systematic electronic literature search was conducted in Embase (Ovid SP, from 1974 to May 2013), Medline (Ovid SP, from 1946 to May 2013), and the Chinese Biomedical Literature Database (CBM, from 1978 to May 2013) to identify studies reporting on the association between serum uric acid and HF. Either a random effects model or a fixed effects model was used for pooling data. Five studies reporting on incident HF and 28 studies reporting on the adverse outcomes of HF patients were included. The results showed that hyperuricaemia was associated with an increased risk of incident HF [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.41-1.94], and the risk of all-cause mortality (HR 2.15, 95% CI 1.64-2.83), cardiovascular mortality (HR 1.45, 95% CI 1.18-1.78), and the composite of death or cardiac events (HR 1.39, 95% CI 1.18-1.63) in HF patients. For every 1 mg/dL increase in serum uric acid, the odds of development of HF increased by 19% (HR 1.19, 95% CI 1.17-1.21), and the risk of all-cause mortality and the composite endpoint in HF patients increased by 4% (HR 1.04, 95% CI 1.02-1.06) and 28% (HR 1.28, 95% CI 0.97-1.70), respectively. Subgroup analyses supported the positive association between serum uric acid and HF. CONCLUSIONS Elevated serum uric acid is associated with an increased risk of incident HF and adverse outcomes in HF patients.
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Affiliation(s)
- He Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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10
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Joseph J, Loscalzo J. Methoxistasis: integrating the roles of homocysteine and folic acid in cardiovascular pathobiology. Nutrients 2013; 5:3235-56. [PMID: 23955381 PMCID: PMC3775251 DOI: 10.3390/nu5083235] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/22/2013] [Accepted: 08/01/2013] [Indexed: 12/31/2022] Open
Abstract
Over the last four decades, abnormalities in the methionine-homocysteine cycle and associated folate metabolism have garnered great interest due to the reported link between hyperhomocysteinemia and human pathology, especially atherothrombotic cardiovascular disease. However, clinical trials of B-vitamin supplementation including high doses of folic acid have not demonstrated any benefit in preventing or treating cardiovascular disease. In addition to the fact that these clinical trials may have been shorter in duration than appropriate for modulating chronic disease states, it is likely that reduction of the blood homocysteine level may be an oversimplified approach to a complex biologic perturbation. The methionine-homocysteine cycle and folate metabolism regulate redox and methylation reactions and are, in turn, regulated by redox and methylation status. Under normal conditions, a normal redox-methylation balance, or “methoxistasis”, exists, coordinated by the methionine-homocysteine cycle. An abnormal homocysteine level seen in pathologic states may reflect a disturbance of methoxistasis. We propose that future research should be targeted at estimating the deviation from methoxistasis and how best to restore it. This approach could lead to significant advances in preventing and treating cardiovascular diseases, including heart failure.
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Affiliation(s)
- Jacob Joseph
- Department of Medicine, VA Boston Healthcare System, Boston, MA 02132, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: /; Tel.: +1-857-203-6841; Fax: +1-857-203-5550
| | - Joseph Loscalzo
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; E-Mail:
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11
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Azizi-Namini P, Ahmed M, Yan AT, Keith M. The role of B vitamins in the management of heart failure. Nutr Clin Pract 2012; 27:363-74. [PMID: 22516940 DOI: 10.1177/0884533612444539] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Heart failure (HF) is the leading cause of morbidity and mortality in industrialized countries, creating a significant burden on both the healthcare system and quality of life. Research efforts continue to explore new pharmaceutical or surgically based approaches to HF management, but the role of nutrition as an adjunct therapy has been largely ignored. Elderly age, anorexia, malabsorption, premature satiety, and disease severity are among the factors identified as contributing to reduced nutrient intakes in patients with HF. These factors suggest that patients with HF are at increased risk of multiple-nutrient deficiencies, including B vitamins. B vitamins may be of particular therapeutic interest because of their key roles as cofactors in energy-producing pathways. Recently, impaired stores of high-energy compounds have been linked with myocardial dysfunction and prognosis in patients with HF. Therefore, deficiencies of B vitamins might contribute to reduced energy stores and disease progression. This review summarizes the existing literature both with respect to the prevalence of B vitamin deficiency as well as evidence from supplementation trials in patients with HF. The findings suggest that most of the literature in this area has focused on thiamin deficiency in patients with HF, whereas other B vitamins remain largely unstudied. Although few sporadic trials suggest a role for B vitamins in the management of HF, none are conclusive. Therefore, there is a need for larger, more robust trials to assist in defining the B vitamin requirements as well as the impact of supplementation on both morbidity and mortality in patients with HF.
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Affiliation(s)
- Parastoo Azizi-Namini
- Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Ghassibe-Sabbagh M, Platt DE, Youhanna S, Abchee AB, Stewart K, Badro DA, Haber M, Salloum AK, Douaihy B, el Bayeh H, Othman R, Shasha N, Kibbani S, Chammas E, Milane A, Nemr R, Kamatani Y, Hager J, Cazier JB, Gauguier D, Zalloua PA. Genetic and environmental influences on total plasma homocysteine and its role in coronary artery disease risk. Atherosclerosis 2012; 222:180-6. [PMID: 22425167 DOI: 10.1016/j.atherosclerosis.2012.02.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 02/20/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Elevated levels of total plasma homocysteine are a risk factor for atherosclerotic disease. AIMS The rationale behind this study is to explore the correlation between degree and site of coronary lesion and hyperhomocysteinemia in Lebanese CAD patients and assess environmental and genetic factors for elevated levels of total plasma homocysteine. METHODS A total of 2644 patients were analyzed for traditional CAD risk factors. Logistic regression was performed to determine the association of hyperhomocysteinemia with degree and site of coronary lesions controlling for risk factors. Environmental and genetic factors for hyperhomocysteinemia were analyzed by logistic regression using a candidate gene approach. RESULTS Traditional risk factors were correlated with stenosis. Hyperhomocysteinemia associated with increased risk of overall stenosis, and risk of mild and severe occlusion in major arteries. Hyperhomocysteinemia and hypertension were highly correlated suggesting that hyperhomocysteinemia acts as a hypertensive agent leading to CAD. Diuretics and genetic polymorphisms in MTHFR and SLCO1B1 were associated with hyperhomocysteinemia. CONCLUSIONS Hyperhomocysteinemia is a medical indicator of specific vessel stenosis in the Lebanese population. Hypertension is a major link between hyperhomocysteinemia and CAD occurrence. Genetic polymorphisms and diuretics' intake explain partly elevated homocysteine levels. This study has important implications in CAD risk prediction.
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Tsarouhas K, Karatzaferi C, Tsitsimpikou C, Haliassos A, Kouretas D, Pavlidis P, Veskoukis A, Adamopoulos S, Kyriakides Z, Constantinou L, Koutedakis Y, Rentoukas E. Effects of walking on heart rate recovery, endothelium modulators and quality of life in patients with heart failure. ACTA ACUST UNITED AC 2011; 18:594-600. [DOI: 10.1177/1741826710397099] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Konstantinos Tsarouhas
- ‘Amalia Fleming’ General Hospital, Athens, Greece
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Christina Karatzaferi
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Christina Tsitsimpikou
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | | | - Demetrios Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, Larisa, Greece
| | | | - Aristidis Veskoukis
- Department of Biochemistry and Biotechnology, University of Thessaly, Larisa, Greece
| | - Stamatis Adamopoulos
- 2nd Department of Cardiovascular Medicine, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Zenon Kyriakides
- B Cardiology Department, Red Cross General Hospital, Athens, Greece
| | | | - Yannis Koutedakis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
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14
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Profitlich LE, Kirmse B, Wasserstein MP, Diaz GA, Srivastava S. High prevalence of structural heart disease in children with cblC-type methylmalonic aciduria and homocystinuria. Mol Genet Metab 2009; 98:344-8. [PMID: 19767224 DOI: 10.1016/j.ymgme.2009.07.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 07/31/2009] [Accepted: 07/31/2009] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize the frequency and nature of cardiovascular defects in patients with CblC-type methylmalonic aciduria and homocystinuria (cblC), an inborn error of cobalamin (vitamin B12) metabolism resulting in accumulation of methylmalonic acid and homocysteine. STUDY DESIGN A retrospective observational study was conducted investigating 10 patients with cblC ranging in age from 2 weeks to 24 years (mean 4.4 years +/- 7.5 years, median 0.6 years). All patients underwent a complete 2-D echocardiogram including quantitative assessment of left ventricular systolic function. RESULTS Structural heart defects were detected in 50% of patients with cblC. Heart defects included left ventricular (LV) non-compaction (3), secundum atrial septal defect (2), muscular ventricular septal defect (1), dysplastic pulmonary valve without pulmonary stenosis (1) and mitral valve prolapse with mild mitral regurgitation (1). One patient had resolved cor pulmonale and right heart failure secondary to pulmonary embolism. All patients had quantitatively normal LV systolic function. CONCLUSIONS Diverse and clinically significant structural heart defects appear to be highly prevalent in cblC, perhaps due to abnormal DNA and histone methylation during embryogenesis. The specific cardiac defects detected in our cohort were variable, and studies with a larger number of patients are needed to establish which forms are most common. Routine and periodic cardiovascular evaluation may be indicated in patients with cblC.
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Affiliation(s)
- Laurie E Profitlich
- Mount Sinai School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, NY 10029, USA.
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15
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Jurgoński A, Juśkiewicz J, Zduńczyk Z. Ingestion of black chokeberry fruit extract leads to intestinal and systemic changes in a rat model of prediabetes and hyperlipidemia. PLANT FOODS FOR HUMAN NUTRITION (DORDRECHT, NETHERLANDS) 2008; 63:176-182. [PMID: 18726160 DOI: 10.1007/s11130-008-0087-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 07/25/2008] [Indexed: 05/26/2023]
Abstract
This report presents a complex analysis of changes proceeding in the gut, blood and internal organs of rats with induced oxidative stress, glucose intolerance and hyperlipidemia after dietary supplementation with an extract from black chokeberry (Aronia melanocarpa) fruit, that is a condensed source of polyphenols (714 mg/g), especially anthocyanin glycosides (56.6%). The disturbances mimicking those observed in metabolic syndrome were induced by a high-fructose diet and simultaneous single injection of streptozotocin (20 mg/kg). Dietary supplementation with the chokeberry fruit extract (0.2%) decreased activity of maltase and sucrase as well as increased activity of lactase in the mucosa of the small intestine. Its ingestion led also to the improvement of antioxidant status, especially, the concentration of a lipid peroxidation indicator (TBARS) in organ tissues (liver, kidney and lung) was normalized; some cholesterol-lowering and distinct hypoglycemic actions were also observed. The mechanism of glucose reduction is likely to be multifactorial, and we suggest the factors related with the decreased activity of mucosal disaccharidases important for further investigation. In conclusion, chokeberry fruit derivatives may act as a promising supplementary therapeutic option in the prevention and treatment of disorders occurring in metabolic syndrome, as well as their complications.
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Affiliation(s)
- Adam Jurgoński
- Department of Biological Analysis of Food, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland.
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Herrmann W, Herrmann M, Joseph J, Tyagi SC. Homocysteine, brain natriuretic peptide and chronic heart failure: a critical review. ACTA ACUST UNITED AC 2007; 45:1633-44. [DOI: 10.1515/cclm.2007.360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractChronic heart failure (CHF) is a major public health problem causing considerable morbidity and mortality. Recently, plasma homocysteine (HCY) has been suggested to be significantly increased in CHF patients. This article reviews the relation between hyperhomocysteinemia (HHCY) and CHF. Clinical data indicate that HHCY is associated with an increased incidence, as well as severity, of CHF. In addition, HCY correlates with brain natriuretic peptide (BNP), a modern biochemical marker of CHF, which is used for diagnosis, treatment guidance and risk assessment. Animal studies showed that experimental HHCY induces systolic and diastolic dysfunction, as well as an increased BNP expression. Moreover, hyperhomocysteinemic animals exhibit an adverse cardiac remodeling characterized by accumulation of interstitial and perivascular collagen. In vitro superfusion experiments with increasing concentrations of HCY in the superfusion medium stimulated myocardial BNP release independent from myocardial wall stress. Thus, clinical and experimental data underline a correlation between HHCY and BNP supporting the role of HHCY as a causal factor for CHF. The mechanisms leading from an elevated HCY level to reduced pump function and adverse cardiac remodeling are a matter of speculation. Existing data indicate that direct effects of HCY on the myocardium, as well as nitric oxide independent vascular effects, are involved. Preliminary data from small intervention trials have initiated the speculation that HCY lowering therapy by micronutrients may improve clinical as well as laboratory markers of CHF.In conclusion, HHCY might be a potential etiological factor in CHF. Future studies need to explore the pathomechanisms of HHCY in CHF. Moreover, larger intervention trials are needed to clarify whether modification of plasma HCY by B-vitamin supplementation improves the clinical outcome in CHF patients.Clin Chem Lab Med 2007;45:1633–44.
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