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Turecamo S, Downie CG, Wolska A, Mora S, Otvos JD, Connelly MA, Remaley AT, Conners KM, Joo J, Sampson M, Bielinski SJ, Shearer JJ, Roger VL. Lipoprotein Insulin Resistance Score and Mortality Risk Stratification in Heart Failure. Am J Med 2024; 137:640-648. [PMID: 38583752 PMCID: PMC11213682 DOI: 10.1016/j.amjmed.2024.03.033] [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: 03/06/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Higher total serum cholesterol is associated with lower mortality in heart failure. Evaluating associations between lipoprotein subfractions and mortality among people with heart failure may provide insights into this observation. METHODS We prospectively enrolled a community cohort of people with heart failure from 2003 to 2012 and assessed vital status through 2021. Plasma collected at enrollment was used to measure lipoprotein subfractions via nuclear magnetic resonance spectroscopy. A composite score of 6 lipoprotein subfractions was generated using the lipoprotein insulin resistance index (LP-IR) algorithm. Using covariate-adjusted proportional hazards regression models, we evaluated associations between LP-IR score and all-cause mortality. RESULTS Among 1382 patients with heart failure (median follow-up 13.9 years), a one-standard-deviation (SD) increment in LP-IR score was associated with lower mortality (hazard ratio [HR] 0.93; 95% confidence interval [CI], 0.97-0.99). Among LP-IR parameters, mean high-density lipoprotein (HDL) particle size was significantly associated with lower mortality (HR per 1-SD decrement in mean HDL particle size = 0.83; 95% CI, 0.78-0.89), suggesting that the inverse association between LP-IR score and mortality may be driven by smaller mean HDL particle size. CONCLUSIONS LP-IR score was inversely associated with mortality among patients with heart failure and may be driven by smaller HDL particle size.
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Affiliation(s)
- Sarah Turecamo
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Carolina G Downie
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Anna Wolska
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - James D Otvos
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Katherine M Conners
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jungnam Joo
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Maureen Sampson
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Suzette J Bielinski
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Joseph J Shearer
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Véronique L Roger
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
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Gerhardt LMS, Kordsmeyer M, Sehner S, Güder G, Störk S, Edelmann F, Wachter R, Pankuweit S, Prettin C, Ertl G, Wanner C, Angermann CE. Prevalence and prognostic impact of chronic kidney disease and anaemia across ACC/AHA precursor and symptomatic heart failure stages. Clin Res Cardiol 2023; 112:868-879. [PMID: 35648270 PMCID: PMC10293329 DOI: 10.1007/s00392-022-02027-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The importance of chronic kidney disease (CKD) and anaemia has not been comprehensively studied in asymptomatic patients at risk for heart failure (HF) versus those with symptomatic HF. We analysed the prevalence, characteristics and prognostic impact of both conditions across American College of Cardiology/American Heart Association (ACC/AHA) precursor and HF stages A-D. METHODS AND RESULTS 2496 participants from three non-pharmacological German Competence Network HF studies were categorized by ACC/AHA stage; stage C patients were subdivided into C1 and C2 (corresponding to NYHA classes I/II and III, respectively). Overall, patient distribution was 8.1%/35.3%/32.9% and 23.7% in ACC/AHA stages A/B/C1 and C2/D, respectively. These subgroups were stratified by the absence ( - ) or presence ( +) of CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73m2) and anaemia (haemoglobin in women/men < 12/ < 13 g/dL). The primary outcome was all-cause mortality at 5-year follow-up. Prevalence increased across stages A/B/C1 and C2/D (CKD: 22.3%/23.6%/31.6%/54.7%; anaemia: 3.0%/7.9%/21.7%/33.2%, respectively), with concordant decreases in median eGFR and haemoglobin (all p < 0.001). Across all stages, hazard ratios [95% confidence intervals] for all-cause mortality were 2.1 [1.8-2.6] for CKD + , 1.7 [1.4-2.0] for anaemia, and 3.6 [2.9-4.6] for CKD + /anaemia + (all p < 0.001). Population attributable fractions (PAFs) for 5-year mortality related to CKD and/or anaemia were similar across stages A/B, C1 and C2/D (up to 33.4%, 30.8% and 34.7%, respectively). CONCLUSIONS Prevalence and severity of CKD and anaemia increased across ACC/AHA stages. Both conditions were individually and additively associated with increased 5-year mortality risk, with similar PAFs in asymptomatic patients and those with symptomatic HF.
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Affiliation(s)
- Louisa M S Gerhardt
- Department of Stem Cell Biology and Regenerative Medicine, Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Maren Kordsmeyer
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
- Department of Medicine I, St Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Susanne Sehner
- Medical Centre Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Hamburg, Germany
| | - Gülmisal Güder
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Frank Edelmann
- Department of Internal Medicine, Cardiology, Charité - Campus Virchow Klinikum, Universitätsmedizin Berlin, and German Centre for Cardiovascular Research, Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology and Pneumology, University Hospital Leipzig, Leipzig, Germany
| | - Sabine Pankuweit
- Department of Cardiology, Philips-University Marburg, Marburg, Germany
| | | | - Georg Ertl
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
| | - Christoph Wanner
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
- Department of Medicine I (Nephrology), University Hospital Würzburg, Würzburg, Germany
| | - Christiane E Angermann
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany.
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Donini LM, Pinto A, Giusti AM, Lenzi A, Poggiogalle E. Obesity or BMI Paradox? Beneath the Tip of the Iceberg. Front Nutr 2020; 7:53. [PMID: 32457915 PMCID: PMC7221058 DOI: 10.3389/fnut.2020.00053] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022] Open
Abstract
The obesity paradox refers to extant evidence showing that obesity in older subjects or in patients with several chronic diseases may be protective and associated with decreased mortality. A number of mechanisms have been postulated to support the existence of obesity paradox; however, marked heterogeneity was found across studies and this has cast doubt on the actual presence of this phenomenon. The aim of the present narrative review is to summarize evidence underlying the concept of obesity paradox, focusing on limitations and bias related to this phenomenon, with emphasis on the use of body mass index (BMI). A major cause of the discrepancy between studies may be related to the use of BMI in the definition of obesity, that should consider, instead, excess body fat as the main characteristic of this disease and as the unique determinant of its complications. In addition, the adjustment for potential confounders (e.g., stage and grade of diseases, smoking habit, inability to capture the presence of signs of undernutrition in the normal-weight comparative group, consideration of body composition) may significantly scale down the protective role of obesity in terms of mortality. However, it is still necessary to acknowledge few biases (e.g., reverse causation, attrition bias, selection bias of healthy obese subjects or resilient survivors) that would still apply to obesity even when defined according with body composition. Further research should be prompted in order to promote correct phenotyping of patients in order to capture properly the trajectories of mortality in a number of diseases.
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Affiliation(s)
| | - Alessandro Pinto
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Anna Maria Giusti
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University, Rome, Italy
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Šimić S, Svaguša T, Prkačin I, Bulum T. Relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events. J Diabetes Metab Disord 2020; 18:693-704. [PMID: 31890693 DOI: 10.1007/s40200-019-00460-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022]
Abstract
Objectives Diabetes mellitus is a group of metabolic disorders associated with high risk for cardiovascular disease. Although troponins are primarily clinically used for the diagnosis of acute coronary syndrome, they are also used in risk assessment in patients with acute coronary syndrome as well as in a number of other conditions. The aim of this review was to investigate the relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events. Methods Hemoglobin A1c has been chosen as the best clinical indicator of glucose control and risk of micro and macrovascular complications. We investigated cardiac troponins as a group of markers of muscle injury which includes troponin T, troponin I and troponin C. Troponin T and I are specific for myocardial injury, compared to C which is specific for skeletal muscle. Results In this review, we showed that there was a causal relation between hemoglobin A1c levels and serum troponin concentrations. Hemoglobin A1c has shown to be a positive predictive factor of incidence, mortality and morbidity of conditions such as acute coronary syndrome, arrhythmias, stroke, pulmonary embolism and other conditions that causes troponin elevation by its release in circulation. Conclusions Chronic hyperglycemia decreases glomerular filtration and consequently decreases troponin elimination and also by affecting the heart microcirculation it leads to microvascular damage and consequently to ischemia which contribute to troponin concentration elevation. Furthermore, correlation between hemoglobin A1c and troponin concentration manifests in their prognostic value for mortality.
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Affiliation(s)
- Stjepan Šimić
- 1School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Tomo Svaguša
- 1School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- 2Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
| | - Ingrid Prkačin
- 1School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- 3Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Tomislav Bulum
- 1School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- 4Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
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Cunha FM, Pereira J, Ribeiro A, Silva S, Araújo JP, Leite-Moreira A, Bettencourt P, Lourenço P. The cholesterol paradox may be attenuated in heart failure patients with diabetes. Minerva Med 2019; 110:507-514. [PMID: 31638359 DOI: 10.23736/s0026-4806.19.06067-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In heart failure (HF) patients, a lower total cholesterol (TC) appears to portend an ominous prognosis. We studied if the prognostic impact of TC was different according to diabetes mellitus (DM) status in a chronic HF population. METHODS Patients with systolic HF under optimized and stable evidence-based therapy were prospectively recruited from our HF clinic. We excluded patients on renal replacement therapy and those hospitalized in the previous 2 months. A venous blood sample was collected. Patients were followed for up to 5 years and all-cause mortality was the endpoint under analysis. The prognostic impact of TC was analyzed using a Cox-regression analysis. Analysis was stratified according to coexistence of DM. RESULTS We studied 262 chronic HF patients, 182 males, mean age 69 years, 98 (37.4%) diabetic and 62.2% with severe left ventricular systolic dysfunction. Median B-type natriuretic peptide: 237.8 pg/mL; median TC: 169 mg/dL. During follow-up 121 (46.2%) patients died. Patients with TC>200 mg/dL had better survival than those with lower TC; however, this protective effect was mostly observed in non-diabetic HF patients. In non-diabetics the multivariate adjusted 5-year mortality hazard ratio (HR) was 0.36 (95% CI: 0.16-0.79) for those with TC>200 mg/dL. In diabetic HF patients, there was a non-significant survival benefit of TC>200 mg/dL; HR 0.51 (95% CI: 0.20-1.30). CONCLUSIONS Non-diabetic chronic HF patients with TC>200 mg/dL have a 64% lower risk of 5-year death. In diabetics, there is a non-significant 49% protective effect of elevated TC. The cholesterol paradox may be attenuated in diabetic HF patients.
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Affiliation(s)
- Filipe M Cunha
- Department of Endocrinology, Tâmega e Sousa Hospital, Penafiel, Portugal -
| | - Joana Pereira
- Department of Internal Medicine, São João Hospital, Porto, Portugal
| | - Ana Ribeiro
- Department of Internal Medicine, São João Hospital, Porto, Portugal
| | - Sérgio Silva
- Department of Internal Medicine, Trofa Saúde Hospital, Gaia, Portugal
| | - José P Araújo
- Department of Internal Medicine, São João Hospital, Porto, Portugal.,Cardiovascular R&D Center (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal.,Internal Medicine Heart Failure Clinic, São João Hospital, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Center (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiothoracic Surgery, São João Hospital, Porto, Portugal
| | - Paulo Bettencourt
- Cardiovascular R&D Center (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal.,Service of Internal Medicine, CUF Porto Hospital, Porto, Portugal
| | - Patrícia Lourenço
- Department of Internal Medicine, São João Hospital, Porto, Portugal.,Cardiovascular R&D Center (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal.,Internal Medicine Heart Failure Clinic, São João Hospital, Porto, Portugal
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Charnigo R, Guglin M. Obesity paradox in heart failure: statistical artifact, or impetus to rethink clinical practice? Heart Fail Rev 2018; 22:13-23. [PMID: 27567626 DOI: 10.1007/s10741-016-9577-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The "obesity paradox" in heart failure (HF) is a phenomenon of more favorable prognosis, especially better survival, in obese versus normal-weight HF patients. Various explanations for the paradox have been offered; while different in their details, they typically share the premise that obesity per se is not actually the cause of reduced mortality in HF. Even so, there is a lingering question of whether clinicians should refrain from, or at least soft-pedal on, encouraging weight loss among their obese HF patients. Against the backdrop of recent epidemiological analysis by Banack and Kaufman, which speculates that collider stratification bias may generate the obesity paradox, we seek to address the aforementioned question. Following a literature review, which confirms that obese HF patients are demographically and clinically different from their normal-weight counterparts, we present four hypothetical data sets to illustrate a spectrum of possibilities regarding the obesity-mortality association. Importantly, these hypothetical data sets become indistinguishable from each other when a crucial variable is unmeasured or unreported. While thorough, the discussion of these data sets is intended to be accessible to a wide audience, especially including clinicians, without a prerequisite of familiarity with advanced epidemiology. We also furnish intuitive visual diagrams which depict a version of the obesity paradox. These illustrations, along with reflection on the distinction between weight and weight loss (and, furthermore, between voluntary and involuntary weight loss), lead to our recommendation for clinicians regarding the encouragement of weight loss. Finally, our conclusion explicitly addresses the questions posed in the title of this article.
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Affiliation(s)
- Richard Charnigo
- Departments of Statistics and Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Maya Guglin
- Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
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Lima LFD, Barbosa F, Simões MV, Navarro AM. Heart failure, micronutrient profile, and its connection with thyroid dysfunction and nutritional status. Clin Nutr 2018; 38:800-805. [PMID: 29551406 DOI: 10.1016/j.clnu.2018.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/12/2018] [Accepted: 02/25/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Heart failure (HF) is a growing public health issue; its risk factors include inappropriate dietary intake of microelements such as iodine, selenium, zinc and iron, which may lead to thyroid dysfunction. OBJECTIVE This study aimed to assess the correlation among the functional class stages of patients with HF, iodine, selenium, iron and zinc levels with the presence of thyroid dysfunction. METHODOLOGY One hundred nine patients from the HF outpatient clinic of the Clinics Hospital of Ribeirão Preto whose blood and urine were collected for micronutrient analysis and laboratory tests were selected. The subjects' weight and height were also measured to calculate their BMI. First, a descriptive analysis of the data was made into tables, and then statistical analyses were done at a 5% significance level (p < 0.05). RESULTS Most patients whose data was analysed were elderly and overweight. Excess ioduria, serum selenium and zinc, erythrocyte zinc and deficiency in serum iron and erythrocyte selenium were observed. The prevalence of thyroid dysfunction was 8.3%. Multivariate logistic regression verified that thyroid dysfunction increases the chance of classification in functional class III or IV (p = 0.015; OR = 8.72) by 8.7 times; each year of age increases the chance by 4.6% of classification in functional class III or IV (p = 0.008; odds ratio [OR] = 1.05), and each unit of BMI increases the chance of classification in functional class III or IV by 9.2% (p = 0.028; OR = 1.09). CONCLUSION Patients with HF were deficient in serum iron and erythrocyte selenium. No connection was found between hypothyroidism and mineral deficiency, which seems to be related more to the severity of the disease than to the micronutrient nutritional profile.
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Affiliation(s)
- Livia Fernandes de Lima
- Department of Internal Medicine, Medical School of Ribeirão Preto, Avenida Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP, Brazil.
| | - Fernando Barbosa
- Department of Clinical, Toxicological and Bromatological Analyses, Faculty of Pharmacy of Ribeirão Preto, Avenida do Café s/n, Monte Alegre, 14049-903 Ribeirão Preto, SP, Brazil
| | - Marcus Vinícius Simões
- Department of Internal Medicine, Medical School of Ribeirão Preto, Avenida Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP, Brazil
| | - Anderson Marliere Navarro
- Department of Internal Medicine, Medical School of Ribeirão Preto, Avenida Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP, Brazil
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Association of preexisting hypertension with the morality in patients with systolic heart failure in Taiwan: The TSOC-HFrEF registry. Indian Heart J 2018; 70:604-607. [PMID: 30392495 PMCID: PMC6205028 DOI: 10.1016/j.ihj.2018.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/27/2017] [Accepted: 01/08/2018] [Indexed: 12/01/2022] Open
Abstract
Purpose To investigate the association of preexisting hypertension at admission with the mortality in patients with systolic heart failure (HF). Method We prospectively investigated the association of preexisting hypertension with the mortality among 1351 patients with HF in Taiwan during an average 12 months (range: 8 months–18 months) follow-up period. A multivariate cox regression analysis for the overall cohort and a subgroup analysis by age were performed. Results After adjustment for all potential risk factors, the associations of preexisting hypertension with cardiovascular mortality were significantly reduced in the overall cohort and those aged less than 65 years (hazard ratios (HR): 0.53, 95% confidence intervals (CI): 0.33–0.84, and 0.28, 95% CI: 0.11–0.67, respectively). However, the associations with all-cause mortality were not significantly different in these two groups (HR: 0.77, 95% CI: 0.54–1.09, and 0.59, 95% CI: 0.32–1.07, respectively). Furthermore, the associations were all nonsignificant in the patients aged older than 65 years. Conclusion Preexisting hypertension have an inverse association with cardiovascular mortality in the Asian patients with systolic HF, particularly for those with younger ages.
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Lawson CA, Jones PW, Teece L, Dunbar SB, Seferovic PM, Khunti K, Mamas M, Kadam UT. Association Between Type 2 Diabetes and All-Cause Hospitalization and Mortality in the UK General Heart Failure Population: Stratification by Diabetic Glycemic Control and Medication Intensification. JACC-HEART FAILURE 2017; 6:18-26. [PMID: 29032131 DOI: 10.1016/j.jchf.2017.08.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study sought to investigate in the general heart failure (HF) population, whether the associations between type 2 diabetes (T2D) and risk of hospitalization and death, are modified by changing glycemic or drug treatment intensity. BACKGROUND In the general HF population, T2D confers a higher risk of poor outcomes, but whether this risk is modified by the diabetes status is unknown. METHODS A nested case-control study in an incident HF database cohort (2002 to 2014) compared patients with T2D with those without for risk of all-cause first hospitalization and death. T2D was stratified by categories of glycosylated hemoglobin (HbA1c) or drug treatments measured 6 months before hospitalization and 1 year before death and compared with the HF group without T2D. RESULTS In HF, T2D was associated with risk of first hospitalization (adjusted odds ratio [aOR]: 1.29; 95% confidence interval [CI]: 1.24 to 1.34) and mortality (aOR: 1.24; 95% CI: 1.29 to 1.40). Stratification of T2D by HbA1c levels, compared with the reference HF group without T2D, showed U-shaped associations with both outcomes. Highest risk categories were HbA1c >9.5% (hospitalization, aOR: 1.75; 95% CI: 1.52 to 2.02; mortality, aOR: 1.30; 95% CI: 1.24 to 1.47) and <5.5% (hospitalization, aOR: 1.42; 95% CI: 1.12 to 1.80; mortality, aOR: 1.29; 95% CI: 1.10 to 1.51, respectively). T2D group with change in HbA1c of >1% decrease was associated with hospitalization (aOR: 1.33; 95% CI: 1.18 to 1.49) and mortality (aOR: 1.36; 95% CI: 1.24 to 1.48). T2D drug group associations with hospitalization were no medication (aOR: 1.12; 95% CI: 1.04 to 1.19), oral antihyperglycemic only (aOR: 1.34; 95% CI: 1.27 to 1.41), oral antihyperglycemic+insulin (aOR: 1.36; 95% CI: 1.21 to 1.52), and insulin only (aOR: 1.61; 95% CI: 1.43 to 1.81); and with mortality for the same drug groups were 1.31 (95% CI: 1.23 to 1.39), 1.16 (95% CI: 1.11 to 1.22), 1.19 (95% CI: 1.06 to 1.34), and 1.43 (95% CI: 1.31 to 1.57), respectively. The T2D group with reduced drug treatments were associated with hospitalization (aOR: 2.13; 95% CI: 1.68 to 2.69) and mortality (aOR: 2.09; 95% CI: 1.81 to 2.41). CONCLUSIONS In the general HF population, T2D stratified by glycemic control and drug treatments showed differential risk associations. Routine measures of dynamic diabetes status provide important prognostic indication of poor outcomes in HF.
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Affiliation(s)
- Claire A Lawson
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
| | - Peter W Jones
- Faculty of Medicine and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
| | - Lucy Teece
- Faculty of Medicine and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
| | | | | | - Kamlesh Khunti
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
| | - Umesh T Kadam
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
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Torrente Iranzo S, Garcés Horna V, Josa Laorden C, Rubio Gracia J, Ruiz Laiglesia FJ, Sánchez Marteles M, Pérez Calvo JI. Influence of blood pressure at the beginning of decompensations in the prognosis of patients with heart failure. Med Clin (Barc) 2017; 149:147-152. [PMID: 28284812 DOI: 10.1016/j.medcli.2017.01.028] [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: 09/28/2016] [Revised: 01/14/2017] [Accepted: 01/19/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE An inverse relationship has been described between blood pressure and the prognosis in heart failure (HF). The characteristics of this relationship are not well unknown. The objective of this study was to determine if this relationship is maintained in a non-selected cohort of patients with HF and if it can be modified by treatment. MATERIAL AND METHODS Prospective study of cohorts including patients hospitalized for decompensated HF in Internal Medicine departments and followed as outpatients in a monographic consultation. Patients were classified according to their levels of systolic (SBP) and diastolic blood pressure (DBP). Clinical characteristics, all-cause mortality and readmissions after the first, third and sixth month of follow-up were analysed. RESULTS Two hundred and twenty-one patients were included after their admission to the hospital for acute HF. Mean patient age was 79.5 years(SD 8.09); 115 patients were male. No significant differences between SBP quartiles and basal characteristics were found. Patients with lower SBP (Q1) had higher mortality rates (20%, P<.05). No significant differences between mortality/readmissions and DBP were found. However, the Kaplan-Meier analysis showed higher all-cause mortality rates for the group of patients with lower SBP and DBP (log-rank=0.011 and 0.041, respectively). The pharmacological treatment did not differ significantly between both study groups. CONCLUSION For non-selected patients suffering HF, higher SBP upon the admission is associated with significantly lower all-cause mortality rates during follow-up. Pharmacological treatment of HF does not seem to influence this inverse relationship between SBP at admission and patient mortality.
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Affiliation(s)
| | - Vanesa Garcés Horna
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España
| | - Claudia Josa Laorden
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España
| | - Jorge Rubio Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España
| | - Fernando José Ruiz Laiglesia
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España
| | - Marta Sánchez Marteles
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España
| | - Juan Ignacio Pérez Calvo
- Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España; Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España
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11
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Lüers C, Edelmann F, Wachter R, Pieske B, Mende M, Angermann C, Ertl G, Düngen HD, Störk S. Prognostic impact of diastolic dysfunction in systolic heart failure-A cross-project analysis from the German Competence Network Heart Failure. Clin Cardiol 2017; 40:667-673. [PMID: 28467622 DOI: 10.1002/clc.22710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We investigated the modifying role and prognostic importance of diastolic dysfunction (DD) in patients with heart failure and systolic dysfunction (SD). HYPOTHESIS The echocardiographic evaluation of diastolic function in patients with SD provides further prognostic information. METHODS From the German Competence Network Heart Failure, 1046 heart failure patients with reduced left ventricular ejection fraction (LVEF; <50%) were echocardiographically studied and followed for a median of 5 years. SD was subdivided into nonsevere (LVEF 36%-49%) and severe (LVEF ≤35%); DD was subdivided into nonsevere (E/E' <15) and severe (E/E' ≥15). RESULTS In general, severe SD was associated with higher hazard ratios (HRs; 2-fold to 3.5-fold) for all endpoints (all-cause death, cardiac death, cardiovascular hospitalization, duration of hospitalization). Patients with severe SD had a 2.5-fold risk of death (95% confidence interval [CI]: 1.84-3.47, P < 0.001), and patients with severe DD showed a 1.8-fold risk (95% CI: 1.17-2.61, P = 0.004). Furthermore, we observed a strong interaction of SD and DD: concomitant severe DD in patients with moderate SD increased risk substantially (HR: 1.73, 95% CI: 1.16-2.6, P = 0.007); by contrast, in patients with severe SD, additional presence of severe DD added little or no risk (HR for interaction: 0.5-1.2). CONCLUSIONS In heart failure patients with reduced LVEF, the evaluation of diastolic function provides additional prognostic information. Although severe SD generally increased the risk for all endpoints, the degree of DD and its impact as a prognostic marker for overall and cardiovascular mortality appeared of particular relevance in subjects with nonsevere SD.
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Affiliation(s)
- Claus Lüers
- University of Oldenburg, European Medical School Oldenburg-Groningen, Germany
| | - Frank Edelmann
- Department of Cardiology and Pneumology, University of Göttingen, Germany.,Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | - Rolf Wachter
- Department of Cardiology and Pneumology, University of Göttingen, Germany
| | - Burkert Pieske
- Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | | | - Christiane Angermann
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
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12
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Fröhlich H, Raman N, Täger T, Schellberg D, Goode KM, Kazmi S, Grundtvig M, Hole T, Cleland JGF, Katus HA, Agewall S, Clark AL, Atar D, Frankenstein L. Statins attenuate but do not eliminate the reverse epidemiology of total serum cholesterol in patients with non-ischemic chronic heart failure. Int J Cardiol 2017; 238:97-104. [PMID: 28342630 DOI: 10.1016/j.ijcard.2017.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 03/01/2017] [Accepted: 03/08/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND In patients with chronic heart failure (CHF) increasing levels of total serum cholesterol are associated with improved survival - while statin usage is not. The impact of statin treatment on the "reverse epidemiology" of cholesterol is unclear. METHODS 2992 consecutive patients with non-ischemic CHF due to left ventricular systolic dysfunction from the Norwegian CHF Registry and the CHF Registries of the Universities of Hull, UK, and Heidelberg, Germany, were studied. 1736 patients were individually double-matched on both cholesterol levels and the individual propensity scores for statin treatment. All-cause mortality was analyzed as a function of baseline cholesterol and statin use in both the general and the matched sample. RESULTS 1209 patients (40.4%) received a statin. During a follow-up of 13,740 patient-years, 360 statin users (29.8%) and 573 (32.1%) statin non-users died. When grouped according to total cholesterol levels as low (≤3.6mmol/L), moderate (3.7-4.9mmol/L), high (4.8-6.2mmol/L), and very high (>6.2mmol/L), we found improved survival with very high as compared with low cholesterol levels. This association was present in statin users and non-users in both the general and matched sample (p<0.05 for each group comparison). The negative association of total cholesterol and mortality persisted when cholesterol was treated as a continuous variable (HR 0.83, 95%CI 0.77-0.90, p<0.001 for matched patients), but it was less pronounced in statin users than in non-users (F-test p<0.001). CONCLUSIONS Statins attenuate but do not eliminate the reverse epidemiological association between increasing total serum cholesterol and improved survival in patients with non-ischemic CHF.
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Affiliation(s)
- Hanna Fröhlich
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany
| | - Nandita Raman
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany
| | - Tobias Täger
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany
| | - Dieter Schellberg
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany
| | - Kevin M Goode
- Castle Hill Hospital, Hull York Medical School in the University of Hull, Cottingham HU165JQ, United Kingdom
| | - Syed Kazmi
- Castle Hill Hospital, Hull York Medical School in the University of Hull, Cottingham HU165JQ, United Kingdom
| | - Morten Grundtvig
- Medical Department, Innlandet Hospital Trust Division Lillehammer, Anders Sandvigs gate 17, 2609 Lillehammer, Norway
| | - Torstein Hole
- Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway & Medical Clinic, Helse Møre and Romsdal CHF, Åsehaugen 1, 6017 Ålesund, Norway
| | - John G F Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, SW72AZ London, United Kingdom
| | - Hugo A Katus
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Andrew L Clark
- Castle Hill Hospital, Hull York Medical School in the University of Hull, Cottingham HU165JQ, United Kingdom
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Lutz Frankenstein
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology. Im Neuenheimer Feld 410, 69221 Heidelberg, Germany.
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13
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Berezin A. Epigenetics in heart failure phenotypes. BBA CLINICAL 2016; 6:31-7. [PMID: 27335803 PMCID: PMC4909708 DOI: 10.1016/j.bbacli.2016.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 12/29/2022]
Abstract
Chronic heart failure (HF) is a leading clinical and public problem posing a higher risk of morbidity and mortality in different populations. HF appears to be in both phenotypic forms: HF with reduced left ventricular ejection fraction (HFrEF) and HF with preserved left ventricular ejection fraction (HFpEF). Although both HF phenotypes can be distinguished through clinical features, co-morbidity status, prediction score, and treatment, the clinical outcomes in patients with HFrEF and HFpEF are similar. In this context, investigation of various molecular and cellular mechanisms leading to the development and progression of both HF phenotypes is very important. There is emerging evidence that epigenetic regulation may have a clue in the pathogenesis of HF. This review represents current available evidence regarding the implication of epigenetic modifications in the development of different HF phenotypes and perspectives of epigenetic-based therapies of HF.
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14
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Aksu U, Kalkan K, Yildirim E, Tanboga IH. Ruling out white coat hypertension with NT-proBNP. Int J Cardiol 2016; 214:512. [PMID: 26952862 DOI: 10.1016/j.ijcard.2016.02.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/14/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Uğur Aksu
- Kars State Hospital Department of Cardiology, Kars, Turkey.
| | - Kamuran Kalkan
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Erkan Yildirim
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
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15
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Lifetime prediction of coronary heart disease and heart disease of uncertain etiology in a 50-year follow-up population study. Int J Cardiol 2015; 196:55-60. [DOI: 10.1016/j.ijcard.2015.05.151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 11/17/2022]
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16
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The role of circulatory power and cardiac reserve in reverse epidemiology — Assessing heart failure severity. Int J Cardiol 2015; 191:48-9. [DOI: 10.1016/j.ijcard.2015.04.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/30/2015] [Indexed: 11/22/2022]
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17
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Reverse epidemiology in patients with heart failure: The role of circulatory power and cardiac reserve. Int J Cardiol 2015; 188:54-5. [DOI: 10.1016/j.ijcard.2015.04.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/05/2015] [Indexed: 11/21/2022]
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