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Qiu S, Liu Z, Jiang WD, Sun JH, Liu ZQ, Sun XD, Wang CT, Liu W. Diabetes and aortic dissection: unraveling the role of 3-hydroxybutyrate through mendelian randomization. Cardiovasc Diabetol 2024; 23:159. [PMID: 38715052 PMCID: PMC11077732 DOI: 10.1186/s12933-024-02266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND In observational and experimental studies, diabetes has been reported as a protective factor for aortic dissection. 3-Hydroxybutyrate, a key constituent of ketone bodies, has been found to favor improvements in cardiovascular disease. However, whether the protective effect of diabetes on aortic dissection is mediated by 3-hydroxybutyrate is unclear. We aimed to investigate the causal effects of diabetes on the risk of aortic dissection and the mediating role of 3-hydroxybutyrate in them through two-step Mendelian randomization. MATERIALS AND METHODS We performed a two-step Mendelian randomization to investigate the causal connections between diabetes, 3-hydroxybutyrate, and aortic dissection and calculate the mediating effect of 3-hydroxybutyrate. Publicly accessible data for Type 1 diabetes, Type 2 diabetes, dissection of aorta and 3-hydroxybutyrate were obtained from genome-wide association studies. The association between Type 1 diabetes and dissection of aorta, the association between Type 2 diabetes and dissection of aorta, and mediation effect of 3-hydroxybutyrate were carried out separately. RESULTS The IVW method showed that Type 1 diabetes was negatively associated with the risk of aortic dissection (OR 0.912, 95% CI 0.836-0.995), The weighted median, simple mode and weighted mode method showed consistent results. The mediated proportion of 3-hydroxybutyrate on the relationship between Type 1 diabetes and dissection of aorta was 24.80% (95% CI 5.12-44.47%). The IVW method showed that Type 2 diabetes was negatively associated with the risk of aortic dissection (OR 0.763, 95% CI 0.607-0.960), The weighted median, simple mode and weighted mode method showed consistent results. 3-Hydroxybutyrate does not have causal mediation effect on the relationship between Type 2 diabetes and dissection of aorta. CONCLUSION Mendelian randomization study revealed diabetes as a protective factor for dissection of aorta. The protective effect of type 1 diabetes on aortic dissection was partially mediated by 3-hydroxybutyrate, but type 2 diabetes was not 3-hydroxybutyrate mediated.
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Affiliation(s)
- Shi Qiu
- Department of Cardiac Surgery, The Second Hospital of Shandong University, 250033, Jinan, Shandong, China
| | - Zhen Liu
- Department of Cadre Health Care, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shangdong, People's Republic of China
| | - Wei-Dong Jiang
- Department of Cadre Health Care, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shangdong, People's Republic of China
| | - Jin-Hui Sun
- Department of Cardiac Surgery, The Second Hospital of Shandong University, 250033, Jinan, Shandong, China
| | - Zeng-Qiang Liu
- Department of Cadre Health Care, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shangdong, People's Republic of China
| | - Xiao-Di Sun
- Department of Cadre Health Care, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shangdong, People's Republic of China
| | - Chun-Ting Wang
- Department of Cardiac Surgery, The Second Hospital of Shandong University, 250033, Jinan, Shandong, China
| | - Wen Liu
- Department of Cadre Health Care, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shangdong, People's Republic of China.
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Deng C, Wang H, Chen X, Tang X. A Closure Look at the Pregnancy-Associated Arterial Dissection. Front Cell Dev Biol 2021; 9:658656. [PMID: 33777964 PMCID: PMC7994598 DOI: 10.3389/fcell.2021.658656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cechuan Deng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Han Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiangqi Chen
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaoqiang Tang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, China
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Li S, Zhang L, Zhu G, Feng R, Zhou J, Jing Z. Diabetes Mellitus Lowers the Risk of Aortic Dissection: a Systematic Review and Meta-Analysis. Ann Vasc Surg 2021; 74:209-219. [PMID: 33529778 DOI: 10.1016/j.avsg.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/11/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to investigate the association between diabetes mellitus and aortic dissection. METHODS The PubMed and Embase databases were searched until December 2019 to identify all articles reporting diabetes mellitus and aortic dissection. The pooled odds ratio and 95% confidence interval were calculated using random-effects model. RESULTS A total of 14 articles with 15,794 participants, of which 2133 diabetes mellitus patients, were eligible and included in this meta-analysis. The data suggested that diabetes mellitus decreased the risk of aortic dissection. In the subgroup analysis, this association was significant in worldwide studies except for the Chinese cohort and in studies adjusted for confounding factors. The results were stable after sensitivity analysis and no evidence of publication bias was found among studies. CONCLUSIONS The result of this meta-analysis indicated that diabetes mellitus was associated with a lower risk of aortic dissection.
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Affiliation(s)
- Shuangshuang Li
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China
| | - Guanglang Zhu
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China.
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Wang R, Yu X, Gkousioudi A, Zhang Y. Effect of Glycation on Interlamellar Bonding of Arterial Elastin. EXPERIMENTAL MECHANICS 2021; 61:81-94. [PMID: 33583947 PMCID: PMC7880226 DOI: 10.1007/s11340-020-00644-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/21/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Interlamellar bonding in the arterial wall is often compromised by cardiovascular diseases. However, several recent nationwide and hospital-based studies have uniformly reported reduced risk of thoracic aortic dissection in patients with diabetes. As one of the primary structural constituents in the arterial wall, elastin plays an important role in providing its interlamellar structural integrity. OBJECTIVE The purpose of this study is to examine the effects of glycation on the interlamellar bonding properties of arterial elastin. METHODS Purified elastin network was isolated from porcine descending thoracic aorta and incubated in 2 M glucose solution for 7, 14 or 21 days at 37 °C. Peeling and direct tension tests were performed to provide complimentary information on understanding the interlamellar layer separation properties of elastin network with glycation effect. Peeling tests were simulated using a cohesive zone model (CZM). Multiphoton imaging was used to visualize the interlamellar elastin fibers in samples subjected to peeling and direct tension. RESULTS Peeling and direct tension tests show that interlamellar energy release rate and strength both increases with the duration of glucose treatment. The traction at damage initiation estimated for the CZM agrees well with the interlamellar strength measurements from direct tension tests. Glycation was also found to increase the interlamellar failure strain of arterial elastin. Multiphoton imaging confirmed the contribution of radially running elastin fibers to resisting dissection. CONCLUSIONS Nonenzymatic glycation reduces the propensity of arterial elastin to dissection. This study also suggests that the CZM effectively describes the interlamellar bonding properties of arterial elastin.
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Affiliation(s)
- R Wang
- Department of Mechanical Engineering, Boston University, Boston, MA 02215
| | - X Yu
- Department of Mechanical Engineering, Boston University, Boston, MA 02215
| | - A Gkousioudi
- Department of Mechanical Engineering, Boston University, Boston, MA 02215
| | - Y Zhang
- Department of Mechanical Engineering, Boston University, Boston, MA 02215
- Department of Biomedical Engineering, Boston University, Boston, MA 02215
- Divison of Materials Science & Engineering, Boston University, Boston, MA 02215
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Effect of diabetes mellitus on the dissection properties of the rabbit descending thoracic aortas. J Biomech 2019; 100:109592. [PMID: 31911049 DOI: 10.1016/j.jbiomech.2019.109592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 01/02/2023]
Abstract
Effect of diabetes mellitus (DM) on the dissection properties of thoracic aortas remains largely unclear and relevant biomechanical analysis is lacking. In the present study forty adult rabbits (1.6-2.2 kg) were collected and type 1 diabetic rabbit model was induced by injection of alloxan. A total of 10 control and 30 diabetic (with different time exposure to diabetic condition) rabbit descending thoracic aortas were harvested. Peeling tests were performed to quantitatively determine force/width values and dissection energy in the control and diabetic aortas. Histological and mass fraction analyses were performed to characterize the dissected morphology and to quantify dry weight percentages of elastin and collagen. The resisting force/width values were significantly higher for the diabetic thoracic aortas (in 8 weeks) than those of the control thoracic aortas (axial: 26.1 ± 4.0 vs. 20.5 ± 3.1 mN/mm, p = 0.04; circ: 19.7 ± 2.8 vs. 15.3 ± 1.9 mN/mm, p = 0.03). There was a higher resistance to the dissection in both axial and circumferential directions for the diabetic aortas. The dissection energy generated by axial and circumferential peeling of the diabetic aortas (in 6 and 8 weeks) was statistically significantly higher than that of the control aortas (axial: 5.6 ± 0.7 vs. 4.3 ± 0.5 mJ/cm2, p = 0.02; circ: 3.9 ± 0.3 vs. 3.2 ± 0.3 mJ/cm2, p = 0.02). Histology showed that dissection mainly occurred in the aortic media and the dissected surfaces were close to external elastic lamina for some specimens. The mass fractions of collagen within the diabetic aortas increased significantly as compared to the control aortas, whereas no significant change was found for that of elastin. Our data suggest that the experimentally induced DM may lead to a lower propensity of dissection for the rabbit thoracic aortas. The dissection properties of the rabbit thoracic aortas vary with time exposed to diabetic condition.
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Son SA, Lee DH, Oh TH, Cho JY, Lee YO, Kim YE, Kim JW, Kim GJ. Risk Factors Associated With Reintervention After Thoracic Endovascular Aortic Repair for Descending Aortic Pathologies. Vasc Endovascular Surg 2019; 53:181-188. [PMID: 30866751 DOI: 10.1177/1538574418814989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is associated with several short-term benefits, including reduced morbidity and mortality; however, the long-term durability of TEVAR and the need for secondary aortic reintervention remain unclear. We aimed to determine the adverse outcomes, including aortic reintervention, after TEVAR for thoracic aortic aneurysms and dissection. METHODS: Between October 2009 and July 2016, 130 patients underwent TEVAR at Kyungpook National University Hospital. We excluded 35 patients with traumatic injury and included the remaining 95 patients in our study after TEVAR. The patients included in this study were categorized into 2 groups (reintervention [R] and nonintervention [N] groups) according to the need for reintervention. The mean follow-up period for all 95 patients was 22.4 (20.6) months. RESULTS: The overall actuarial survival rates were 83.7% (4.1%) and 63.6% (8.8%) at 1 and 5 years, respectively. The rates of freedom from aortic reintervention after TEVAR were 94.0% (3.5%), 72.8% (8.2%), and 48.9% (10.5%) at 2, 3, and 5 years, respectively. The independent risk factors for aortic reintervention were endoleaks after TEVAR (odds ratio [OR] 6.13, P = .017), increase in aortic size by over 5% per year (OR 20.40, P = .001), and peripheral vascular occlusive disease (PVOD; OR 13.62, P = .007). Patients with preoperative hemoptysis tended to show a greater need for aortic reintervention ( P = .059). Increase in aortic size by over 5% per year and PVOD were the primary risk factors for endoleaks (OR 3.82, P = .013 and OR 4.37, P = .021, respectively). CONCLUSION: Survival after TEVAR for thoracic aortic pathologies was satisfactory in most of the patients chosen as candidates for the procedure. However, the occurrence of endoleaks, increase in aortic size by over 5% per year, and PVOD were the primary causes of aortic reintervention.
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Affiliation(s)
- Shin-Ah Son
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Deok Heon Lee
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Tak-Hyuk Oh
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Joon Yong Cho
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Young Ok Lee
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Young Eun Kim
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jung Won Kim
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Gun-Jik Kim
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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Avdic T, Franzén S, Zarrouk M, Acosta S, Nilsson P, Gottsäter A, Svensson AM, Gudbjörnsdottir S, Eliasson B. Reduced Long-Term Risk of Aortic Aneurysm and Aortic Dissection Among Individuals With Type 2 Diabetes Mellitus: A Nationwide Observational Study. J Am Heart Assoc 2018; 7:e007618. [PMID: 29367416 PMCID: PMC5850251 DOI: 10.1161/jaha.117.007618] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND No studies have examined long-term risks for aortic aneurysm (AA) and aortic dissection (AD) or mortality after AA or AD hospitalization among patients with type 2 diabetes mellitus (T2DM). METHODS AND RESULTS In this observational cohort study, we linked data for patients with T2DM in the Swedish National Diabetes Register, and 5 individually matched population-based control subjects (CSs) without diabetes mellitus (on the basis of sex, age, and county), to other national databases to capture hospitalizations and death. We examined the risk of hospitalization for AA and AD, as well as mortality risk after AA and AD using Kaplan-Meier curves and Cox regression hazards models. Data on 448 319 patients with T2DM and 2 251 015 CSs were obtained between 1998 and 2015. Mean follow-up time was 7.0 years for the T2DM group and 7.2 years for the CS group. Patients with T2DM had a relative risk reduction of 28% (hazard ratio, 0.72; 95% confidence interval, 0.68-0.76; P<0.0001) for AA and a 47% relative risk reduction (hazard ratio, 0.53; 95% confidence interval, 0.42-0.65; P<0.0001) for AD compared with CSs. Patients with T2DM had a relative risk reduction of 12% (hazard ratio, 0.88; 95% confidence interval, 0.82-0.94; P<0.0001) for mortality after hospitalization for AA, and unaltered risk (hazard ratio, 1.07; 95% confidence interval, 0.85-1.34; P=0.5859) for mortality after AD, up to 2 years compared with CSs. CONCLUSIONS Patients with T2DM had significantly reduced risks of AA and AD as well as reduced risk of mortality after hospitalization for AA, compared to CS. Data suggest that glycated cross-links in aortic tissue may play a protective role in the progression of aortic diseases among patients with T2DM.
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Affiliation(s)
- Tarik Avdic
- Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden
| | - Stefan Franzén
- Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden
| | - Moncef Zarrouk
- Department of Clinical Sciences, Vascular Center, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Vascular Center, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Peter Nilsson
- Department of Internal Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anders Gottsäter
- Department of Clinical Sciences, Vascular Center, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ann-Marie Svensson
- Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden
| | - Björn Eliasson
- Swedish National Diabetes Register, Center of Registers in Region, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden
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Ohle R, Um J, Anjum O, Bleeker H, Luo L, Wells G, Perry JJ. High Risk Clinical Features for Acute Aortic Dissection: A Case-Control Study. Acad Emerg Med 2018; 25:378-387. [DOI: 10.1111/acem.13356] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/15/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Robert Ohle
- Department of Emergency Medicine, the Ottawa Hospital Research Institute; University of Ottawa; Ottawa Ontario
| | - Justin Um
- Department of Undergraduate Medicine; University of Ottawa; Ottawa Ontario
| | - Omar Anjum
- Department of Undergraduate Medicine; University of Ottawa; Ottawa Ontario
| | - Helena Bleeker
- Department of Undergraduate Medicine; University of Ottawa; Ottawa Ontario
| | - Lindy Luo
- Department of Undergraduate Medicine; University of Ottawa; Ottawa Ontario
| | - George Wells
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa Ontario
- Cardiovascular Research Methods Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - Jeffrey J. Perry
- Department of Emergency Medicine, the Ottawa Hospital Research Institute; University of Ottawa; Ottawa Ontario
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Shen YH, LeMaire SA. Molecular pathogenesis of genetic and sporadic aortic aneurysms and dissections. Curr Probl Surg 2017; 54:95-155. [PMID: 28521856 DOI: 10.1067/j.cpsurg.2017.01.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/16/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Ying H Shen
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX; Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX.
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX; Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX.
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Milewicz DM, Prakash SK, Ramirez F. Therapeutics Targeting Drivers of Thoracic Aortic Aneurysms and Acute Aortic Dissections: Insights from Predisposing Genes and Mouse Models. Annu Rev Med 2017; 68:51-67. [PMID: 28099082 PMCID: PMC5499376 DOI: 10.1146/annurev-med-100415-022956] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Thoracic aortic diseases, including aneurysms and dissections of the thoracic aorta, are a major cause of morbidity and mortality. Risk factors for thoracic aortic disease include increased hemodynamic forces on the ascending aorta, typically due to poorly controlled hypertension, and heritable genetic variants. The altered genes predisposing to thoracic aortic disease either disrupt smooth muscle cell (SMC) contraction or adherence to an impaired extracellular matrix, or decrease canonical transforming growth factor beta (TGF-β) signaling. Paradoxically, TGF-β hyperactivity has been postulated to be the primary driver for the disease. More recently, it has been proposed that the response of aortic SMCs to the hemodynamic load on a structurally defective aorta is the primary driver of thoracic aortic disease, and that TGF-β overactivity in diseased aortas is a secondary, unproductive response to restore tissue function. The engineering of mouse models of inherited aortopathies has identified potential therapeutic agents to prevent thoracic aortic disease.
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Affiliation(s)
- Dianna M Milewicz
- Division of Medical Genetics, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas 77030;
| | - Siddharth K Prakash
- Division of Medical Genetics, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas 77030;
| | - Francesco Ramirez
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
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Zhang L, Zhao Z, Chen Y, Sun Y, Bao J, Jing Z, Zhou J. Reintervention after endovascular repair for aortic dissection: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2016; 152:1279-1288.e3. [DOI: 10.1016/j.jtcvs.2016.06.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/01/2016] [Accepted: 06/17/2016] [Indexed: 01/01/2023]
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Hu R, Wang Z, Ren Z, Liu M. Autonomic remodeling may be responsible for decreased incidence of aortic dissection in STZ-induced diabetic rats via down-regulation of matrix metalloprotease 2. BMC Cardiovasc Disord 2016; 16:200. [PMID: 27769178 PMCID: PMC5073431 DOI: 10.1186/s12872-016-0375-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 10/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background Epidemiological studies reported that diabetic patients had a lower incidence of aortic dissection (AD), but the definite mechanism is unknown. We aim to investigate the possible protective effect of diabetes mellitus (DM) on AD formation with an emphasis on autonomic remodeling. Methods Streptozotocin (STZ) intraperitoneal injection was applied to induce diabetes, unilateral renal artery stenosis (URAS) together with β-amino propionitrile (BAPN) oral treatment was used to induce AD. Sixty SD rats were equally and randomly divided into four groups (normal group, DM group, URAS + BAPN oral treatment group, DM + URAS + BAPN oral treatment group). Rats were fed for 6 weeks, the number of AD was recorded and remained rats were sacrificed. Thoracic aorta were harvested, morphological changes were assessed. Expression of tyrosine hydroxylase (TH), choline acetylase (ChAT), matrix metalloprotease 2 (MMP2) and matrix metalloprotease 9 (MMP9) were evaluated. Results A total of 7 AD was noted in S + B group, DM rats did not develop AD. Diabetic rats had a lower incidence of AD (P < 0.01). In dissected aorta, collagen deposition increased while elastic fiber became fragmented. These pathological changes diminished in diabetic rats. Diabetic rats had a lower expression of ChAT (P < 0.01). URAS + BAPN treatment elevated expression of TH in normal rat and ChAT in diabetic rats (P < 0.001). Expression of MMP2 and MMP9 elevated in all the rats after URAS + BAPN, but the elevation range of MMP2 in diabetic rats was smaller (P < 0.001). Conclusions STZ-induced diabetic rats have a lower incidence of AD after URAS and BAPN treatment, this protective effect could be possibly attributed to autonomic innervation modification and possible related down-regulation of MMP2.
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Affiliation(s)
- Rui Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuhan, Hubei, People's Republic of China
| | - Zhiwei Wang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuhan, Hubei, People's Republic of China.
| | - Zongli Ren
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuhan, Hubei, People's Republic of China
| | - Min Liu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
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Takagi H, Umemoto T. Negative Association of Diabetes With Thoracic Aortic Dissection and Aneurysm. Angiology 2016; 68:216-224. [DOI: 10.1177/0003319716647626] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
We performed a meta-analysis to assess the association of diabetes mellitus (DM) with the presence of thoracic aortic dissection (TAD) and/or thoracic aortic aneurysm (TAA). MEDLINE and EMBASE were searched through December 2015 using PubMed and OVID. For each study, data regarding DM prevalence in both the TAD/TAA and control groups were used to generate unadjusted odds ratios (ORs) for DM and 95% confidence intervals (CIs). Alternatively, an unadjusted and/or adjusted OR was directly abstracted from each individual study. Eleven eligible studies enrolling a total of 47 827 participants were included. A primary pooled analysis of all the 11 studies demonstrated that TAD/TAA was associated with significantly lower DM prevalence than controls (OR, 0.43; 95% CI, 0.31-0.59; P < .00001). Separate pooled analyses of 6 TAD case studies and 4 TAA case studies demonstrated TAD (OR, 0.34; 95% CI, 0.19-0.61; P = .0003) and TAA (OR, 0.65; 95% CI, 0.45-0.94; P = .02) were associated with significantly lower DM prevalence than controls. In conclusion, DM may be negatively associated with the presence of TAD/TAA.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Takuya Umemoto
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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He X, Liu X, Liu W, Wang B, Liu Y, Li Z, Wang T, Tan R, Gao B, Zeng H. Association between Diabetes and Risk of Aortic Dissection: A Case-Control Study in a Chinese Population. PLoS One 2015; 10:e0142697. [PMID: 26562793 PMCID: PMC4643043 DOI: 10.1371/journal.pone.0142697] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/26/2015] [Indexed: 12/17/2022] Open
Abstract
Background It is well-recognized that diabetes represents a powerful independent risk factor for cardiovascular diseases. However, very few studies have investigated the relationship between diabetes and risk of aortic dissection (AD). Aim The aim of this case-control study was to evaluate the association between diabetes and risk of AD in Chinese population. Methods A hospital-based case-control study, consisting of 2160 AD patients and 4320 controls, was conducted in a Chinese population. Demographic, clinical characteristics and risk factors were collected. Diabetes rate of patients with overall AD, Stanford type A AD and type B AD group was compared with that of corresponding matched control groups. Logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for relationship between diabetes and AD risk. Results The prevalence of diabetes was lower in AD cases than that of control subjects, whether it is the overall AD, type A AD or type B AD group (4.7% vs. 10.0%, 2.9% vs. 8.8%, 5.9% vs. 10.9%, all P<0.001). Furthermore, in multivariate model, diabetes was found to be associated with lower AD risk, which not only applies to the overall AD (OR = 0.2, 95%CI: 0.15–0.26), but also type A AD (OR = 0.12, 95% CI: 0.07–0.20) and type B AD (OR = 0.25, 95%CI: 0.18–0.33). Conclusions We observed the paradoxical inverse relationship between DM and risk of AD in the Chinese population. These results suggest diabetes may play a protective role in the development of AD. However, further studies are needed to enrich related evidence, especially with regard to underlying mechanisms for these trends.
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Affiliation(s)
- Xingwei He
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xintian Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanjun Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bei Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujian Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuxi Li
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Tan
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Gao
- Department of Cardiology, Suizhou Affiliated Hospital of Hubei Medical College, Suizhou, China
| | - Hesong Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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