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Zhang W, Chen Y, Hu LX, Xia JH, Ye XF, Cheng YB, Wang Y, Guo QH, Li Y, Lowres N, Freedman B, Wang JG. New-onset hypertension as a contributing factor to the incidence of atrial fibrillation in the elderly. Hypertens Res 2024; 47:1490-1499. [PMID: 38438728 DOI: 10.1038/s41440-024-01617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/20/2024] [Accepted: 01/27/2024] [Indexed: 03/06/2024]
Abstract
Hypertension and atrial fibrillation are closely related. However, hypertension is already prevalent in young adults, but atrial fibrillation usually occurs in the elderly. In the present analysis, we investigated incident atrial fibrillation in relation to new-onset hypertension in an elderly Chinese population. Our study participants were elderly (≥65 years) hypertensive residents, recruited from community health centers in the urban Shanghai (n = 4161). Previous and new-onset hypertension were defined as the use of antihypertensive medication or elevated systolic/diastolic blood pressure (≥140/90 mmHg), respectively, at entry and during follow-up on ≥ 2 consecutive clinic visits. Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG. During a median of 2.1 years follow-up, the incidence rate of atrial fibrillation was 7.60 per 1000 person-years in all study participants; it was significantly higher in patients with new-onset hypertension (n = 368) than those with previous hypertension (n = 3793, 15.76 vs. 6.77 per 1000 person-years, P = 0.02). After adjustment for confounding factors, the hazard ratio for the incidence of atrial fibrillation was 2.21 (95% confidence interval 1.15-4.23, P = 0.02) in patients with new-onset hypertension versus those with previous hypertension. The association was even stronger in those aged ≥ 75 years (hazard ratio 2.70, 95% confidence interval 1.11-6.56, P = 0.03). In patients with previous hypertension, curvilinear association (P for non-linear trend = 0.04) was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension. Our study showed a significant association between new-onset hypertension and the incidence of atrial fibrillation in elderly Chinese. In an elderly Chinese population with previous and new-onset hypertension, we found that the new-onset hypertension during follow-up, compared with previous hypertension, was associated with a significantly higher risk of incident atrial fibrillation. In patients with previous hypertension, curvilinear association was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension.
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Affiliation(s)
- Wei Zhang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei-Xiao Hu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia-Hui Xia
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Fei Ye
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nicole Lowres
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ben Freedman
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Fenger-Grøn M, Vestergaard CH, Ribe AR, Johnsen SP, Frost L, Sandbæk A, Davydow DS. Association Between Bipolar Disorder or Schizophrenia and Oral Anticoagulation Use in Danish Adults With Incident or Prevalent Atrial Fibrillation. JAMA Netw Open 2021; 4:e2110096. [PMID: 33999163 PMCID: PMC8129823 DOI: 10.1001/jamanetworkopen.2021.10096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Individuals with bipolar disorder or schizophrenia have a higher risk of adverse outcomes from cardiovascular diseases. Oral anticoagulation therapy (OAT) for patients with atrial fibrillation (AF) is needed for stroke prevention, but whether patients with bipolar disorder or schizophrenia face disparities in receiving this therapy is unknown. OBJECTIVE To assess whether bipolar disorder or schizophrenia is associated with a lower rate of OAT initiation in patients with incident AF and lower prevalence of OAT in those with prevalent AF. DESIGN, SETTING, AND PARTICIPANTS A nationwide cohort study of Danish patients with AF was conducted from January 1, 2005, to December 31, 2016, and data were analyzed from January 1 to June 15, 2020. Data from national registries included information on all redeemed prescriptions and all hospital contacts of all patients with incident or prevalent AF (age, 18-100 years) and increased risk status, defined by a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) risk score greater than or equal to 2. EXPOSURES Hospital diagnosis of bipolar disorder or schizophrenia. MAIN OUTCOMES AND MEASURES Adjusted proportion differences for OAT initiation and OAT prevalence, comparing individuals with and without bipolar disorder or schizophrenia. RESULTS Patients included with incident AF (n = 147 810) had a mean (SD) age of 76.9 (10.1) years, 78 577 (53.2%) were women, 1208 (0.8%) had bipolar disorder, and 572 (0.4%) had schizophrenia. Accounting for age, sex, and calendar time, bipolar disorder and schizophrenia were associated with significantly lower frequency of OAT initiation within 90 days after incident AF (bipolar disorder: -12.7%; 95% CI, -15.3% to -10.0%; schizophrenia: -24.5%; 95% CI, -28.3% to -20.7%) and lower OAT prevalence in patients with prevalent AF (bipolar disorder: -11.6%; 95% CI, -13.9% to -9.3% schizophrenia: -21.6%; 95% CI, -24.8% to -18.4%). Adjusting for socioeconomic factors and other comorbid conditions attenuated these associations, particularly for patients with bipolar disorder. However, schizophrenia continued to be associated with a with a lower rate of OAT initiation (-15.5%, 95% CI, -19.3% to -11.7%) and a -12.8% (95% CI, -15.9% to -9.7%) lower OAT prevalence. These associations were also present after the introduction of non-vitamin K antagonists (adjusted proportion difference in 2013-2016: -12.4%; 95% CI, -18.7% to -6.1% for initiation and -10.1%; 95% CI, -13.8% to -6.4% for prevalence). CONCLUSIONS AND RELEVANCE In this study, patients with bipolar disorder or schizophrenia were less likely to receive OAT in the setting of AF. For patients with bipolar disorder, this deficit was largely associated with socioeconomic factors and comorbidities, especially toward the end of the study period. For patients with schizophrenia, disparities in this stroke prevention therapy persistently exceeded what could be explained by other patient characteristics.
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Affiliation(s)
- Morten Fenger-Grøn
- Research Unit for General Practice, Aarhus Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Frost
- Department of Clinical Medicine, Aarhus University, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center, Aarhus University Hospital, Aarhus, Denmark
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Atrial fibrillation as presenting sign of primary aldosteronism: results of the Prospective Appraisal on the Prevalence of Primary Aldosteronism in Hypertensive (PAPPHY) Study. J Hypertens 2021; 38:332-339. [PMID: 31834121 DOI: 10.1097/hjh.0000000000002250] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite hyperaldosteronism being suggested as predisposing to arrhythmias, the relationship between atrial fibrillation and primary aldosteronism remains uncertain. Therefore, we tested the hypothesis that atrial fibrillation is a presentation of primary aldosteronism in hypertensive patients with unexplained atrial fibrillation. DESIGN AND METHODS The Prospective Appraisal on the Prevalence of Primary Aldosteronism in Hypertensive (PAPPHY) Study recruited consecutive patients with atrial fibrillation and an unambiguous diagnosis of arterial hypertension at three referral centers for hypertension. RESULTS In a cohort entailing 411 atrial fibrillation patients, we identified 18% (age 61 ± 11 years; 32% women), who showed no known cause of the arrhythmia. A thorough diagnostic work-up allowed us to identify primary aldosteronism in 73 of these patients, i.e. 42% [95% confidence interval (CI) 31.8-53.9]. Subtyping of primary aldosteronism demonstrated that surgically curable forms of primary aldosteronism accounted for 48% of the cases (95% CI 31.9-65.2). The high prevalence of primary aldosteronism was confirmed at sensitivity analyses. CONCLUSION These results provided compelling evidence that primary aldosteronism is highly prevalent in hypertensive patients with unexplained atrial fibrillation. Accordingly, they suggest that patients with no identifiable cause of the arrhythmia should be screened for primary aldosteronism to identify those who can be cured or markedly improved with target treatment. CLINICAL TRIAL REGISTRATION: :: https://clinicaltrials.gov, Identifier: NCT01267747.
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Aguilar M, Rose RA, Takawale A, Nattel S, Reilly S. New aspects of endocrine control of atrial fibrillation and possibilities for clinical translation. Cardiovasc Res 2021; 117:1645-1661. [PMID: 33723575 PMCID: PMC8208746 DOI: 10.1093/cvr/cvab080] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Hormones are potent endo-, para-, and autocrine endogenous regulators of the function of multiple organs, including the heart. Endocrine dysfunction promotes a number of cardiovascular diseases, including atrial fibrillation (AF). While the heart is a target for endocrine regulation, it is also an active endocrine organ itself, secreting a number of important bioactive hormones that convey significant endocrine effects, but also through para-/autocrine actions, actively participate in cardiac self-regulation. The hormones regulating heart-function work in concert to support myocardial performance. AF is a serious clinical problem associated with increased morbidity and mortality, mainly due to stroke and heart failure. Current therapies for AF remain inadequate. AF is characterized by altered atrial function and structure, including electrical and profibrotic remodelling in the atria and ventricles, which facilitates AF progression and hampers its treatment. Although features of this remodelling are well-established and its mechanisms are partly understood, important pathways pertinent to AF arrhythmogenesis are still unidentified. The discovery of these missing pathways has the potential to lead to therapeutic breakthroughs. Endocrine dysfunction is well-recognized to lead to AF. In this review, we discuss endocrine and cardiocrine signalling systems that directly, or as a consequence of an underlying cardiac pathology, contribute to AF pathogenesis. More specifically, we consider the roles of products from the hypothalamic-pituitary axis, the adrenal glands, adipose tissue, the renin–angiotensin system, atrial cardiomyocytes, and the thyroid gland in controlling atrial electrical and structural properties. The influence of endocrine/paracrine dysfunction on AF risk and mechanisms is evaluated and discussed. We focus on the most recent findings and reflect on the potential of translating them into clinical application.
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Affiliation(s)
- Martin Aguilar
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Robert A Rose
- Department of Cardiac Sciences, Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, Health Research Innovation Center, University of Calgary, AB, Canada
| | - Abhijit Takawale
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Stanley Nattel
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada.,Faculty of Medicine, Department of Pharmacology and Physiology, and Research Centre, Montreal Heart Institute and University of Montreal, Montreal, QC, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
| | - Svetlana Reilly
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
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5
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Ma C, Zheng X, Yang Y, Bu P. The effect of black tea supplementation on blood pressure: a systematic review and dose-response meta-analysis of randomized controlled trials. Food Funct 2020; 12:41-56. [PMID: 33237083 DOI: 10.1039/d0fo02122a] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The main goal of this work was to clarify the effects of black tea supplementation on blood pressure (BP) by performing a systematic review according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, followed by a dose-response meta-analysis of randomized controlled trials (RCTs). Electronic search was carried out in PubMed, Embase and the Cochrane Library databases published up to March 2020. To be included, RCTs had to report the effect of black tea supplementation on systolic blood pressure (SBP) or diastolic blood pressure (DBP) in adults. A total of 13 trials, including 22 study arms were eligible for inclusion in the final quantitative analysis. It was observed that black tea supplementation significantly reduced SBP (WMD - 1.04 mmHg; 95% CI - 2.05 to -0.03; and P = 0.04) and DBP (WMD - 0.59 mmHg; 95% CI - 1.05 to -0.13; and P = 0.01) compared to the control. However, nonlinear analysis failed to indicate a significant influence of black tea flavonoid supplementation dose or duration on both SBP and DBP. Sensitivity analysis showed that no individual study had a significant impact on our results. In addition, we found no evidence for the presence of small-study effects among studies for both SBP and DBP. Thus, the favorable effect of black tea supplementation emerging from the current meta-analysis suggests the possible use of this tea as an active compound in order to promote cardiovascular health, mostly when used for longer duration (>7 days) and in men. Furthermore RCTs using different doses of black tea and various durations may contribute to confirming our conclusion.
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Affiliation(s)
- Chang Ma
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Xuehui Zheng
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Yi Yang
- Department of Cardiology of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
| | - Peili Bu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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6
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Jansen HJ, Bohne LJ, Gillis AM, Rose RA. Atrial remodeling and atrial fibrillation in acquired forms of cardiovascular disease. Heart Rhythm O2 2020; 1:147-159. [PMID: 34113869 PMCID: PMC8183954 DOI: 10.1016/j.hroo.2020.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Atrial fibrillation (AF) is prevalent in common conditions and acquired forms of heart disease, including diabetes mellitus (DM), hypertension, cardiac hypertrophy, and heart failure. AF is also prevalent in aging. Although acquired heart disease is common in aging individuals, age is also an independent risk factor for AF. Importantly, not all individuals age at the same rate. Rather, individuals of the same chronological age can vary in health status from fit to frail. Frailty can be quantified using a frailty index, which can be used to assess heterogeneity in individuals of the same chronological age. AF is thought to occur in association with electrical remodeling due to changes in ion channel expression or function as well as structural remodeling due to fibrosis, myocyte hypertrophy, or adiposity. These forms of remodeling can lead to triggered activity and electrical re-entry, which are fundamental mechanisms of AF initiation and maintenance. Nevertheless, the underlying determinants of electrical and structural remodeling are distinct in different conditions and disease states. In this focused review, we consider the factors leading to atrial electrical and structural remodeling in human patients and animal models of acquired cardiovascular disease or associated risk factors. Our goal is to identify similarities and differences in the cellular and molecular bases for atrial electrical and structural remodeling in conditions including DM, hypertension, hypertrophy, heart failure, aging, and frailty.
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Affiliation(s)
- Hailey J Jansen
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Loryn J Bohne
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anne M Gillis
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert A Rose
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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7
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Kim MN, Park SM. Heart failure with preserved ejection fraction: insights from recent clinical researches. Korean J Intern Med 2020; 35:514-534. [PMID: 32392659 PMCID: PMC7214356 DOI: 10.3904/kjim.2020.104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/23/2020] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for nearly half of the cases of HF and its incidence might be increasing with the aging society. Patients with HFpEF present with significant symptoms, including exercise intolerance, impaired quality of life, and have a poor prognosis as well as frequent hospitalization and increased mortality compared with HF with reduced ejection fraction. The concept of HFpEF is still evolving and may be a virtual complex rather than a real systemic disorder. Thus, beyond solely targeting cardiac abnormalities management strategies need to be extended, such as left ventricular diastolic dysfunction. In this review, we examine new diagnostic algorithms, pathophysiology, current management status, and ongoing trials based on heterogeneous pathophysiology and etiology in HFpEF.
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Affiliation(s)
- Mi-Na Kim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
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8
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Patel D, Druck A, Hoppensteadt D, Bansal V, Brailovsky Y, Syed M, Fareed J. Relationship Between 25-Hydroxyvitamin D, Renin, and Collagen Remodeling Biomarkers in Atrial Fibrillation. Clin Appl Thromb Hemost 2020; 26:1076029619899702. [PMID: 32072817 PMCID: PMC7288844 DOI: 10.1177/1076029619899702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The interplay between vitamin D, the renin-angiotensin system (RAS), and collagen remodeling has been implicated in the pathogenesis of various cardiovascular diseases. This study sought to explore this relationship in atrial fibrillation (AF) by profiling plasma levels of 25-hydroxyvitamin D, RAS biomarkers, and collagen remodeling biomarkers using the enzyme-linked immunosorbent assay method. We hypothesized that 25-hydroxyvitamin D levels would inversely correlate with RAS biomarkers and that levels of RAS and collagen remodeling biomarkers would positively correlate with each other. Although our AF cohort (n = 37) did not exhibit decreased 25-hydroxyvitamin D levels compared to normal controls (n = 26), these levels inversely correlated with renin (Spearman r = -0.57, P = 0.005). Renin levels were elevated in patients with AF compared to normal controls (1233 ± 238 ng/mL vs 401 ± 27 ng/mL, P = 0.0002) and positively correlated with levels of matrix metalloproteinase 1 (MMP-1; Spearman r = 0.89, P = 0.01) and MMP-2 (Spearman r = 0.82, P = 0.03). These data suggest that 25-hydroxyvitamin D may influence RAS activation, and renin may help mediate the collagen remodeling process in AF. Understanding mediators of RAS dysregulation in AF may elucidate targets for therapeutic intervention to prevent collagen remodeling.
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Affiliation(s)
- Dimpi Patel
- Loyola University of Chicago, Stritch School of Medicine, Maywood, IL, USA.,Hemostasis and Thrombosis Laboratories, Center of Translational Research and Education, Maywood, IL, USA
| | - Aleksander Druck
- Loyola University of Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Debra Hoppensteadt
- Hemostasis and Thrombosis Laboratories, Center of Translational Research and Education, Maywood, IL, USA
| | - Vinod Bansal
- Loyola University Medical Center, Maywood, IL, USA
| | - Yevgeniy Brailovsky
- Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY, USA
| | | | - Jawed Fareed
- Hemostasis and Thrombosis Laboratories, Center of Translational Research and Education, Maywood, IL, USA
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9
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Abstract
Hypertension is the most common cardiovascular risk factor and underlies heart failure, coronary artery disease, stroke, and chronic kidney disease. Hypertensive heart disease can manifest as cardiac arrhythmias. Supraventricular and ventricular arrhythmias may occur in the hypertensive patients. Atrial fibrillation and hypertension contribute to an increased risk of stroke. Some antihypertensive drugs predispose to electrolyte abnormalities, which may result in atrial and ventricular arrhythmias. A multipronged strategy involving appropriate screening, aggressive lifestyle modifications, and optimal pharmacotherapy can result in improved blood pressure control and prevent the onset or delay progression of heart failure, coronary artery disease, and cardiac arrhythmias.
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Affiliation(s)
- Muhammad R Afzal
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Salvatore Savona
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Omar Mohamed
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Aayah Mohamed-Osman
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA.
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10
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Seccia TM, Caroccia B, Maiolino G, Cesari M, Rossi GP. Arterial Hypertension, Aldosterone, and Atrial Fibrillation. Curr Hypertens Rep 2019; 21:94. [PMID: 31741119 DOI: 10.1007/s11906-019-1001-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Atrial fibrillation is the most common sustained arrhythmia, with a prevalence of 1-2% in the general population and over 15% in people older than 80 years. Due to aging of the population it imposes an increasing burden on the healthcare system because of the need for life-long pharmacological treatment and the associated increased risk of heart failure and hospitalization. Hence, identification of the factors that predispose to atrial fibrillation it is of utmost relevance. RECENT FINDINGS Several conditions exist that are characterized by inappropriately high levels of aldosterone, mostly primary aldosteronism and the severe or drug-resistant forms of arterial hypertension. In these forms, aldosterone can cause prominent target organ damage, mostly in the heart, vasculature, and kidney. This review examines the experimental data and clinical evidences that support a link between hyperaldosteronism and atrial fibrillation, and how this knowledge should lead to a change in our management of the hypertensive patients presenting with atrial fibrillation.
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Affiliation(s)
- Teresa M Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 35128, Padova, Italy
| | - Brasilina Caroccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 35128, Padova, Italy
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 35128, Padova, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 35128, Padova, Italy
| | - Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Via Giustiniani, 2, 35128, Padova, Italy.
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11
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Invited review: hypertension and atrial fibrillation: epidemiology, pathophysiology, and implications for management. J Hum Hypertens 2019; 33:824-836. [DOI: 10.1038/s41371-019-0279-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023]
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12
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Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Incidence of Atrial Fibrillation and Mineralocorticoid Receptor Activity in Patients With Medically and Surgically Treated Primary Aldosteronism. JAMA Cardiol 2019; 3:768-774. [PMID: 30027227 DOI: 10.1001/jamacardio.2018.2003] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance Primary aldosteronism (PA) is an ideal condition to evaluate the role of the mineralocorticoid receptor (MR) in the pathogenesis of atrial fibrillation (AF). Objective To investigate whether MR antagonist therapy or surgical adrenalectomy in PA influence the risk for incident AF. Design This cohort study included patients aged 18 years and older. Patients with PA and age-matched patients with essential hypertension were identified via electronic health records. Patients with a history of AF, myocardial infarction, congestive heart failure, or stroke were excluded. Data were collected between 1991 and the end of 2016 in an academic medical center, with a mean follow-up duration of approximately 8 years. Exposures Patients with PA treated with MR antagonists or surgical adrenalectomy were compared with patients with essential hypertension. Patients with PA who were treated with MR antagonists were categorized by whether their plasma renin activity remained suppressed (< 1 ng/mL/h) or substantially increased (≥ 1 ng/mL/h), as proxies for insufficient or sufficient MR blockade. Main Outcomes and Measure Incident AF. Results A total of 195 patients with PA who were treated with MR antagonists and 201 patients with PA treated with surgical adrenalectomy were included, as well as 40 092 age-matched patients with essential hypertension. Despite similar blood pressure at study entry and throughout follow-up, patients with PA who were treated with MR antagonists whose renin remained suppressed had a higher risk for incident AF than patients with essential hypertension (adjusted HR, 2.55 [95% CI, 1.75-3.71]). They also had an adjusted 10-year cumulative AF incidence difference of 14.1 (95% CI, 6.7-21.5) excess cases per 100 persons compared with patients with essential hypertension. In contrast, patients with PA who were treated with MR antagonists and whose renin increased and patients with PA who were treated with surgical adrenalectomy had no statistically significant difference in risk for incident AF compared with patients with essential hypertension. Conclusions and Relevance When compared with patients with essential hypertension, patients with PA treated with MR antagonists such that renin remained suppressed (as a proxy for insufficient MR blockade) had a significantly higher risk for incident AF; however, treatment of PA with MR antagonists to substantially increase renin (suggesting sufficient MR blockade), or with surgical adrenalectomy (to remove the source of aldosteronism), was associated with no significant difference in risk for developing AF. These findings add to the growing body of evidence suggesting that MR blockade may be a potential therapy to decrease the incidence of AF.
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Affiliation(s)
- Gregory L Hundemer
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gary C Curhan
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Nicholas Yozamp
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Molin Wang
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Anand Vaidya
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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13
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Suo Y, Zhang Z, Fu H, Zhang Y, Yuan M, Wang Y, Goudis CA, Tse G, Liu T, Li G. Inhibition of renin-angiotensin axis reduces the risk of thrombus formation in the left atrial appendage in patients with hypertension complicated by atrial fibrillation. J Renin Angiotensin Aldosterone Syst 2018; 19:1470320318782623. [PMID: 29956583 PMCID: PMC6077910 DOI: 10.1177/1470320318782623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aims: We examined whether the use of a renin-angiotensin-aldosterone system (RAS)
inhibitor plays a role in protecting against left atrial appendage thrombus
(LAAT) in patients with hypertension complicated by atrial fibrillation
(AF). Methods: Two observational studies were conducted on patients with diagnoses of
hypertension and AF, who were categorized into RAS inhibitor user or nonuser
groups. Demographic characteristics, clinical characteristics,
echocardiographic parameters and hemostatic markers were examined and the
occurrence of LAAT during follow-up were recorded. Results: In the first study (n = 131), LA peak systolic strain and
LAA emptying flow velocity (LAA eV) were significantly increased in patients
on RAS inhibitors compared with the nonuser group (p <
0.05). Lower D-dimer and fibrinogen levels were observed in patients on RAS
inhibitors (p < 0.05). In the second study
(n = 99), 25.9% (n = 11) of patients
on RAS inhibitors developed LAAT, compared with 46.7% (n =
21) in the nonuser group (p < 0.05). After controlling
for risk factors related to LAAT, use of RAS inhibitors remained associated
with a significantly lower risk of developing LAAT (HR, 0.406; 95% CI,
0.191–0.862; p = 0.019). Conclusions: RAS inhibitors use was associated with a significant reduction in the risk of
LAAT in patients with hypertension and AF.
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Affiliation(s)
- Ya Suo
- 1 Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | - Zhiwei Zhang
- 1 Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | - Huaying Fu
- 1 Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | - Yue Zhang
- 1 Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | - Meng Yuan
- 1 Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | - Yuanyuan Wang
- 1 Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | | | - Gary Tse
- 3 Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, People's Republic of China.,4 Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, People's Republic of China
| | - Tong Liu
- 1 Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | - Guangping Li
- 1 Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
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14
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Musial DC, Miranda-Ferreira R, Padin JF, Arranz-Tagarro JA, Parra-Vitela AJ, Jurkiewicz A, Garcia AG, Jurkiewicz NH. Function of AT1 and AT2 receptors in atrial contractions from spontaneous hypertensive and diabetic-induced streptozotocin rats. Clin Exp Pharmacol Physiol 2018; 45:1274-1285. [DOI: 10.1111/1440-1681.13019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Diego Castro Musial
- Departamento de Farmacología; Universidade Federal de São Paulo; São Paulo Brazil
- Centro de Ciências da Saúde e do Desporto; Universidade Federal do Acre; São Paulo Brazil
| | | | - Juan Fernando Padin
- Departamento Ciencias Médicas (Farmacología); Facultad de Medicina; Universidad de Castilla-La Mancha (UCLM); Ciudad Real España
| | - Juan Alberto Arranz-Tagarro
- Departamento de Farmacología; Facultad de Medicina; Universidad Autónoma de Madrid; Madrid Spain
- Instituto Teófilo Hernando; Madrid Spain
| | - Alberto J. Parra-Vitela
- THRCE - Tulane Hypertension and Renal Center of Excellence; Department of Physiology; School of Medicine; Tulane University; New Orleans Louisiana
| | - Aron Jurkiewicz
- Departamento de Farmacología; Universidade Federal de São Paulo; São Paulo Brazil
| | - Antonio Garcia Garcia
- Departamento de Farmacología; Facultad de Medicina; Universidad Autónoma de Madrid; Madrid Spain
- Instituto Teófilo Hernando; Madrid Spain
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15
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Seccia TM, Calò LA. Smoking causes atrial fibrillation? Further evidence on a debated issue. Eur J Prev Cardiol 2018; 25:1434-1436. [PMID: 30058842 DOI: 10.1177/2047487318791272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Teresa M Seccia
- 1 Department of Medicine (DIMED), Hypertension, University of Padova, Italy
| | - Lorenzo A Calò
- 2 Department of Medicine (DIMED), Nephrology, University of Padova, Italy
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16
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Hillaert MA, den Ruijter HM, Hoefer IE, Lentjes EG, de Borst GJ, de Vries JPPM, Doevendans PA, Pasterkamp G, Timmers L. Renin and aldosterone are not associated with vulnerable plaque characteristics in patients with carotid artery disease. J Vasc Surg 2018; 68:128-135. [PMID: 29548814 DOI: 10.1016/j.jvs.2017.05.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/26/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The renin-angiotensin-aldosterone system is increasingly being recognized to play an important role in the development and clinical course of cardiovascular diseases. Renin-angiotensin-aldosterone system activation is associated with clinical outcome in various populations of cardiovascular patients, such as patients with coronary artery, peripheral artery, and cerebrovascular disease. In this study, we investigated the associations between plasma renin and aldosterone concentrations and atherosclerotic plaque characteristics and secondary vascular events in patients undergoing carotid endarterectomy. METHODS AND RESULTS Baseline plasma renin and aldosterone concentrations from 506 subjects undergoing carotid endarterectomy (mean age, 67 ± 9 years; 65% male) were correlated with histopathologic characteristics and inflammatory protein concentrations of the excised atherosclerotic plaque. Ordinal logistic regression (for ordinal outcome parameters) or linear regression (for linear outcome) analysis did not show a statistically significant relationship between plasma renin or aldosterone concentrations and plaque fat, thrombus, calcifications, collagen, smooth muscle cells, or macrophage content. Neither could any association be found with intraplaque inflammatory mediators. During a median follow-up of 3 years, 102 (20%) patients experienced a major secondary vascular event (composite of stroke, myocardial infarction, leg amputation, vascular death, or coronary revascularization or peripheral intervention). In multivariable Cox regression analysis, including both renin and aldosterone, baseline renin concentrations were associated with the occurrence of secondary events. CONCLUSIONS In patients with established atherosclerotic disease undergoing carotid endarterectomy, plasma renin and aldosterone concentrations were not associated with atherosclerotic plaque characteristics. Plasma renin concentration was positively associated with the occurrence of major secondary vascular events.
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Affiliation(s)
- Marieke A Hillaert
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester M den Ruijter
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Imo E Hoefer
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eef G Lentjes
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Gerard Pasterkamp
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leo Timmers
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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17
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Abstract
New-onset atrial fibrillation (NOAF) is the most common perioperative complication of heart surgery, typically occurring in the perioperative period. NOAF commonly occurs in patients who are elderly, or have left atrial enlargement, or left ventricular hypertrophy. Various factors have been identified as being involved in the development of NOAF, and numerous approaches have been proposed for its prevention and treatment. Risk factors include diabetes, obesity, and metabolic syndrome. For prevention of NOAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. NOAF can be treated by rhythm/rate control, and antithrombotic therapy. Treatment is required in patients with decreased cardiac function, a heart rate exceeding 130 beats/min, or persistent NOAF lasting for ≥ 48 h. It is anticipated that anticoagulant therapies, as well as hemodynamic management, will also play a major role in the management of NOAF. When using warfarin as an anticoagulant, its dose should be adjusted based on PT-INR. PT-INR should be controlled between 2.0 and 3.0 in patients aged < 70 years and between 1.6 and 2.6 in those aged ≥ 70 years. Rate control combined with antithrombotic therapies for NOAF is expected to contribute to further advances in treatment and improvement of survival.
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Affiliation(s)
- Takeshi Omae
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka, 410-2295, Japan. .,Department of Anesthesiology and Pain Medicine, School of Medicine, Juntendo University, Tokyo, Japan.
| | - Eiichi Inada
- Department of Anesthesiology and Pain Medicine, School of Medicine, Juntendo University, Tokyo, Japan
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18
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Abstract
BACKGROUND Inflammation markers have been associated with cardiovascular diseases including atrial fibrillation. This arrhythmia is the most frequent, with an incidence of 38/1000 person-years. PURPOSE OF REVIEW The aims of this study are to discuss the association between inflammation, atherosclerosis and atrial fibrillation and its clinical implications. Atherosclerosis is a chronic inflammatory disease and inflammation is a triggering factor of atherosclerotic plaque rupture. In addition to coronary artery disease, clinical conditions identified as risk factors for atrial fibrillation (AF) are also associated with the inflammatory state such as obesity, diabetes mellitus, hypertension, heart failure, metabolic syndrome and sedentary lifestyle. Biomarkers of inflammation, oxidative stress, coagulation, and myocardial necrosis have been identified in patients with atrial fibrillation and these traditional risk factors. Some markers of inflammation were identified as predictors of recurrence of this arrhythmia, subsequent myocardial infarction, stroke by embolism, and death. Thus, approaches to manipulate the inflammatory pathways may be therapeutic interventions, benefiting patients with AF and increased inflammatory markers.
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Affiliation(s)
- Rose Mary Ferreira Lisboa da Silva
- Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Avenue Alfredo Balena, 190, room 246, Centro, 30130-100, Belo Horizonte, MG, Brazil.
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19
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Seccia TM, Calò LA. Is exercise becoming a danger for our health? The complex relationship between exercise and atrial fibrillation. Eur J Prev Cardiol 2018; 25:621-623. [PMID: 29488811 DOI: 10.1177/2047487318762445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Teresa M Seccia
- 1 Department of Medicine - DIMED Hypertension, University of Padova, Italy
| | - Lorenzo A Calò
- 2 Department of Medicine - DIMED Nephrology, University of Padova, Italy
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20
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Seccia TM, Caroccia B, Adler GK, Maiolino G, Cesari M, Rossi GP. Arterial Hypertension, Atrial Fibrillation, and Hyperaldosteronism: The Triple Trouble. Hypertension 2018; 69:545-550. [PMID: 28264920 DOI: 10.1161/hypertensionaha.116.08956] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Teresa M Seccia
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Brasilina Caroccia
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Gail K Adler
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Giuseppe Maiolino
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Maurizio Cesari
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Gian Paolo Rossi
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.).
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21
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Borghi C, Paolillo S, Cicero AFG, Gargiulo P, Trimarco B, Perrone Filardi P. New oral anticoagulants and prevention of thromboembolic events in patients with hypertension and atrial fibrillation: an appraisal. J Hypertens 2017; 35:689-695. [PMID: 28033129 DOI: 10.1097/hjh.0000000000001228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Arterial hypertension (HTN) and atrial fibrillation often coexist and the combination of these two conditions carries an increased risk of stroke. HTN is one of the most important risk factors included in the scores for stoke prediction in atrial fibrillation used to assess the need of anticoagulation, and HTN has also been strictly related to bleeding complications of antithrombotic therapy. Antithrombotic drugs options include vitamin K antagonists, or new oral anticoagulants, recently approved for stroke prevention in nonvalvular atrial fibrillation. More favorable new oral anticoagulant efficacy and safety, compared with warfarin, have been reported in hypertensive patients, making these drugs a first-line choice in this population to prevent cerebrovascular events and reduce the risk of major bleedings. The aim of this review is to explore the relationship among HTN, atrial fibrillation and the risk of stroke and to summarize the evidence on the impact of HTN on the choice of the most appropriate anticoagulation treatment.
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Affiliation(s)
- Claudio Borghi
- aDepartment of Medical and Surgical Sciences, University of Bologna, Bologna bIRCCS SDN, Institute of Research cDepartment of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
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22
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Hypertensive patients with left ventricular hypertrophy have global left atrial dysfunction and impaired atrio-ventricular coupling. J Hypertens 2017; 34:1615-20. [PMID: 27219488 DOI: 10.1097/hjh.0000000000000971] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to comprehensively investigate left atrial (LA) reservoir, conduit, and booster pump functions, as well as their predictors in patients with primary systemic arterial hypertension (HTN) and left ventricular (LV) hypertrophy. METHODS Thirty patients with HTN and LV hypertrophy, but no history of atrial arrhythmia or heart failure, were compared with 29 normotensive controls. Speckle-tracking echocardiography of the LA wall was used to measure systolic and diastolic strains and strain rates. Early diastolic velocity of transmitral flow/early diastolic mitral annular motion velocity (E/E')/peak systolic LA strain (S-LAs) was used as an index of LA stiffness. RESULTS HTN patients had higher LV mass index, impaired LV diastolic function, and higher LA volume index than controls. LA reservoir, conduit, and booster pump functions were significantly lower and LA stiffness was greater. Multiple regression analysis indicated that increased LV mass and LV filling pressures as well as reduced LV strain or E' were predictors for reduced atrial function. CONCLUSION HTN patients showed a significant impairment of the three components of LA function. These changes were correlated with LV hypertrophy and dysfunction, and presumably related to LA fibrotic changes, underlining the importance of LA-LV coupling. The prognostic value of these new speckle-tracking echocardiography-based LA strain indices needs to be evaluated by future studies.
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23
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Šmíd J, Rokyta R. Atrial fibrillation and its relation to cardiac diseases and sudden cardiac death. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Dzeshka MS, Shahid F, Shantsila A, Lip GYH. Hypertension and Atrial Fibrillation: An Intimate Association of Epidemiology, Pathophysiology, and Outcomes. Am J Hypertens 2017; 30:733-755. [PMID: 28338788 DOI: 10.1093/ajh/hpx013] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 01/18/2023] Open
Abstract
Atrial fibrillation (AF) is the most prevalent sustained arrhythmia found in clinical practice. AF rarely exists as a single entity but rather as part of a diverse clinical spectrum of cardiovascular diseases, related to structural and electrical remodeling within the left atrium, leading to AF onset, perpetuation, and progression. Due to the high overall prevalence within the AF population arterial hypertension plays a significant role in the pathogenesis of AF and its complications. Fibroblast proliferation, apoptosis of cardiomyocytes, gap junction remodeling, accumulation of collagen both in atrial and ventricular myocardium all accompany ageing-related structural remodeling with impact on electrical activity. The presence of hypertension also stimulates oxidative stress, systemic inflammation, rennin-angiotensin-aldosterone and sympathetic activation, which further drives the remodeling process in AF. Importantly, both hypertension and AF independently increase the risk of cardiovascular and cerebrovascular events, e.g., stroke and myocardial infarction. Given that both AF and hypertension often present with limited on patient wellbeing, treatment may be delayed resulting in development of complications as the first clinical manifestation of the disease. Antithrombotic prevention in AF combined with strict blood pressure control is of primary importance, since stroke risk and bleeding risk are both greater with underlying hypertension.
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Affiliation(s)
- Mikhail S Dzeshka
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
- Grodno State Medical University, Grodno, Belarus
| | - Farhan Shahid
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Alena Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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25
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Erne P, Müller A, Rossi GP, Seifert B, Stehlin F, Redondo M, Bauer PT, Kobza R, Resink TJ, Radovanovic D. Aldosterone and renin in cardiac patients referred for catheterization. Medicine (Baltimore) 2017; 96:e7282. [PMID: 28640140 PMCID: PMC5484248 DOI: 10.1097/md.0000000000007282] [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: 11/26/2022] Open
Abstract
Little is known regarding alterations of the renin-angiotensin system in patients referred for cardiac catheterization. Here, we measured plasma levels of active renin and aldosterone in patients referred for cardiac catheterization in order to determine the prevalence of elevated renin, aldosterone, and the aldosterone-renin ratio.A chemiluminescence assay was used to measure plasma aldosterone concentration (PAC) and active renin levels in 833 consecutive patients, after an overnight fasting and without any medication for least 12 hours. We evaluated associations of the hormonal elevations in relation to hypertension, atrial fibrillation (AF), hypertensive cardiomyopathy, coronary artery disease (CAD), valvular disease, impaired left ventricular ejection fraction (LVEF < 35%), and pulmonary hypertension (arterial pulmonary mean pressure >25 mm Hg).Hyperaldosteronism occurred in around one-third of all examined patients, without significant differences between patients with or without the named cardiac diseases. In a comparison between patients with or without any given cardiac disease condition, renin was significantly elevated in patients with either hypertension (36.4% vs 15.9%), CAD (33.9% vs 22.1%), or impaired LVEF (47.3% vs 24.8%). The angiotensin-renin ratio was elevated in AF patients and in patients with hypertensive cardiomyopathy. Patients with AF and coexisting hypertension had elevated renin more frequently than AF patients without coexisting hypertension (35.3% vs 16.5%; P = .005). Patients with persistent/permanent AF more frequently had elevated renin than patients with paroxysmal AF (34.1% vs 15.8%; P = .007).This prospective study of consecutive cardiac disease patients referred for cardiac catheterization has revealed distinct cardiac disease condition-associated differences in the frequencies of elevations in plasma renin, PAC, and the aldosterone-renin ratio.
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Affiliation(s)
- Paul Erne
- Laboratory of Signal Transduction, Department of Biomedicine, University Hospital Basel, Hebelstrasse, Basel
| | - Andrea Müller
- Department of Cardiology, Luzerner Kantonsspital, Spitalstrasse, Luzern
| | - Gian Paolo Rossi
- Clinica dell’Ipertensione Arteriosa, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Burkhardt Seifert
- Division of Biostatistics, University of Zurich, EBPI, Hirschengraben, Zürich
| | | | | | - Peter T. Bauer
- Inovise Medical, Inc., Creekside Corporate Park, Nimbus Ave D, Beaverton, OR
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Spitalstrasse, Luzern
| | - Therese J. Resink
- Laboratory of Signal Transduction, Department of Biomedicine, University Hospital Basel, Hebelstrasse, Basel
| | - Dragana Radovanovic
- AMIS Plus Data Center, University of Zurich, EBPI, Hirschengraben, Zurich, Switzerland
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26
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Müssigbrodt A, Weber A, Mandrola J, van Belle Y, Richter S, Döring M, Arya A, Sommer P, Bollmann A, Hindricks G. Excess of exercise increases the risk of atrial fibrillation. Scand J Med Sci Sports 2017; 27:910-917. [PMID: 28090681 DOI: 10.1111/sms.12830] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 01/02/2023]
Abstract
An interesting and still not well-understood example for old medical wisdom "Sola dosis facit venenum" is the increased prevalence of atrial fibrillation (AF) in athletes. Numerous studies have shown a fourfold to eightfold increased risk of AF in athletes compared to the normal population. Analysis of the existing data suggests a dose-dependent effect of exercise. Moderate exercise seems to have a protective effect and decreases the risk of AF, whereas excessive exercise seems to increase the risk of AF. The described cases illustrate clinical manifestations within the spectrum of AF in elderly athletes, that is, exercise-induced AF, vagal AF, chronic AF, and atrial flutter. As the arrhythmia worsened quality of life and exercise capacity in all patients, recovery of sinus rhythm was desired in all described cases. As the atrial disease was advanced on different levels, different treatment regimes were applied. Lifestyle modification and temporary anti-arrhythmic drug therapy could stabilize sinus rhythm in one patient, whereas others needed radiofrequency ablation to achieve a stable sinus rhythm. The patient with the most advanced atrial disease necessitated anti-arrhythmic drug therapy and another left atrial ablation. All described patients remained in sinus rhythm during the long-term follow-up.
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Affiliation(s)
- A Müssigbrodt
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - A Weber
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - J Mandrola
- Baptist Health Louisville, Louisville, KY, USA
| | - Y van Belle
- Centre Hospitalier Universitaire, Liège, Belgium
| | - S Richter
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - M Döring
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - A Arya
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - P Sommer
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - A Bollmann
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - G Hindricks
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
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Meng L, Yang Y, Zhang Z, Li G, Liu T. Predictive value of circulating fibroblast growth factor-23 on atrial fibrillation: A meta-analysis. Int J Cardiol 2016; 210:68-71. [PMID: 26942328 DOI: 10.1016/j.ijcard.2016.02.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/14/2016] [Indexed: 12/01/2022]
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