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Masson W, Barbagelata L, Lobo M, Corral P, Nogueira JP, Lucas L. Dyslipidemia in adults with congenital heart disease: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2024; 34:19-32. [PMID: 37949709 DOI: 10.1016/j.numecd.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/18/2023] [Accepted: 09/12/2023] [Indexed: 11/12/2023]
Abstract
AIMS Several particular characteristics of patients with congenital heart disease could affect lipid levels. The objectives of this study were: a) to analyze the prevalence of dyslipidemia in congenital heart disease patients; 2) to compare lipid levels between congenital heart disease patients and a control group. DATA SYNTHESIS This systematic review and meta-analysis was performed according to PRISMA guidelines (PROSPERO CRD42023432041). A literature search was performed to detect studies that have reported lipid levels or the prevalence of dyslipidemia in congenital heart disease patients. We performed a qualitative analysis (studies that reported dyslipidemia prevalence) and quantitative analysis (studies that compared lipid values between congenital heart disease patients and controls). In total, 29 observational studies involving 22,914 patients with congenital heart disease and 641,086 controls were eligible for this review. The reported presence of "hyperlipidemia" or "dyslipidemia" ranged from 14.3% to 69.9%. When studies analyzed lipid variables dichotomously between congenital heart disease patients and controls, the results were conflicting. The quantitative analysis showed that patients with congenital heart disease have lower levels of total cholesterol (MD: -18.9 [95% CI: -22.2 to -15.7]; I2 = 93%), LDL-C (MD: -10.7 [95% CI: -13.1 to -8.3]; I2 = 90%) and HDL-C (MD: -6.3 [95% CI: -7.7 to -4.9]; I2 = 95%) compared to controls. CONCLUSIONS The qualitative analysis showed some concerns, but the quantitative analysis indicates that congenital heart disease patients showed lower levels of total cholesterol, LDL-C, and HDL-C compared to controls. New research should be developed to clarify this relevant topic.
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Affiliation(s)
- Walter Masson
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Leandro Barbagelata
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martín Lobo
- Cardiology Department, Hospital Militar Campo de Mayo, Buenos Aires, Argentina
| | - Pablo Corral
- Facultad de Medicina, Universidad FASTA. Mar del Plata, Argentina
| | - Juan P Nogueira
- Universidad Internacional de las Américas, San José, Costa Rica; Centro de Investigación en Endocrinología, Nutrición y Metabolismo (CIENM), Facultad de Ciencias de la Salud, Universidad Nacional de Formosa, Argentina
| | - Luciano Lucas
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Lawless L, Xie L, Zhang K. The inter- and multi- generational epigenetic alterations induced by maternal cadmium exposure. Front Cell Dev Biol 2023; 11:1148906. [PMID: 37152287 PMCID: PMC10157395 DOI: 10.3389/fcell.2023.1148906] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023] Open
Abstract
Exposure to cadmium during pregnancy, from environmental or lifestyle factors, has been shown to have detrimental fetal and placental developmental effects, along with negatively impacting maternal health during gestation. Additionally, prenatal cadmium exposure places the offspring at risk for developing diseases in infancy, adolescence, and adulthood. Although given much attention, the underlying mechanisms of cadmium-induced teratogenicity and disease development remain largely unknown. Epigenetic changes in DNA, RNA and protein modifications have been observed during cadmium exposure, which implies a scientific premise as a conceivable mode of cadmium toxicity for developmental origins of health and disease (DOHaD). This review aims to examine the literature and provide a comprehensive overview of epigenetic alterations induced by prenatal cadmium exposure, within the developing fetus and placenta, and the continued effects observed in childhood and across generations.
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Affiliation(s)
- Lauren Lawless
- Institute of Bioscience and Technology, Texas A&M University, Houston, TX, United States
- Department of Nutrition, Texas A&M University, College Station, TX, United States
| | - Linglin Xie
- Department of Nutrition, Texas A&M University, College Station, TX, United States
| | - Ke Zhang
- Institute of Bioscience and Technology, Texas A&M University, Houston, TX, United States
- Department of Nutrition, Texas A&M University, College Station, TX, United States
- *Correspondence: Ke Zhang,
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3
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Levene J, Cambron C, McGrath L, Garcia IC, Broberg C, Ramsey K, Khan A. Prevalence of traditional and non-traditional cardiovascular risk factors in adults with congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Murakami T. Vascular aging in adult congenital heart disease-a narrative review. Cardiovasc Diagn Ther 2022; 12:521-530. [PMID: 36033223 PMCID: PMC9412215 DOI: 10.21037/cdt-22-218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective Many studies about the high prevalence of cardiovascular disease in adults with congenital heart disease (CHD) have been published in response to the growing number of adult patients with CHD. The aging process leads to hypertension and cardiovascular disease, which is caused by a degenerative change in the systemic arterial system characterized by the stiffening of elastic arteries (known as arteriosclerosis) and the enlargement of aorta. In patients with CHD, aortic dilatation (so-called aortopathy) is one of the most frequent complications. It is well known the anatomical and histological changes in aortopathy are similar to those in aging process. The increase of pulse wave velocity (PWV) enhances pressure wave reflection, and it augments left ventricular afterload and impairs the coronary supply-workload balance in aging. This article reviews the aortic function in patients with CHD, aiming to provide a new direction for the management of their cardiovascular aging process. Methods Papers on vascular physiology in CHD were retrieved. I searched all original papers and reviews about the vascular physiology in CHD using PubMed, published from January 1, 1973 to June 30, 2022, in English. Key Content and Findings Enhancement of pressure wave reflection has been reported in many CHDs. Although PWV in whole aorta is not necessarily elevated, the abnormal arterial stiffness gradient is common in patients with CHD. Conclusions Many reports concerning functional abnormalities of the aorta have been reported. The abnormalities can result in cardiovascular disease and organ damage. The practitioners should carefully treat patients with CHD while paying attention to their aging process.
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Affiliation(s)
- Tomoaki Murakami
- Department of Pediatrics, Sapporo Tokushukai Hospital, Sapporo, Japan
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Giannakoulas G, Papazoglou AS. Atherosclerosis in Congenital Heart Disease: Let's Not Miss the Forest for the Trees. JACC. ADVANCES 2022; 1:100035. [PMID: 38939307 PMCID: PMC11198704 DOI: 10.1016/j.jacadv.2022.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- George Giannakoulas
- First Department of Cardiology, General University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Egbe AC, Miranda WR, Lopez-Jimenez F, Connolly HM. Atherosclerotic Cardiovascular Disease in Adults With Congenital Heart Disease. JACC. ADVANCES 2022; 1:100026. [PMID: 38939323 PMCID: PMC11198194 DOI: 10.1016/j.jacadv.2022.100026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 06/29/2024]
Abstract
Background The effect of atherosclerotic cardiovascular disease (ASCVD) on cardiovascular death in adults with congenital heart disease (CHD) is not well understood. Objectives The purpose of this study was to determine the prevalence and prognostic implications of ASCVD risk factors in adults with CHD. We hypothesized that ASCVD risk factors were associated with cardiovascular events defined as heart failure hospitalization, heart transplant, and cardiovascular death. Methods This is a retrospective cohort study of adults with CHD at the Mayo Clinic (2003-2019). Patients with a history of coronary artery disease (CAD) were excluded. ASCVD risk factors were defined as hypertension, hyperlipidemia, diabetes, obesity, smoking, and family history of premature CAD. Results There were 5,025 patients without a prior history of CAD. The mean age was 35 (23-45) years, and 2,558 (51%) were males. Of 5,025 patients, 2,382 (47%) had ≥1 ASCVD risk factors at baseline, and 16% developed additional ASCVD risk factors within 5 years (new-onset ASCVD risk). ASCVD risk factors at baseline (hazard ratio 1.27, 95% confidence interval 1.06-1.38) and new-onset ASCVD risk factors during follow-up (hazard ratio 1.06, 95% confidence interval 1.02-1.11) were associated with cardiovascular events. Conclusions ASCVD factors were associated with cardiovascular events in adults with CHD. Since interventions that modify ASCVD risk have been shown to decrease cardiovascular death in the general population, it is logical to expect that such interventions would also improve clinical outcomes in the CHD population.
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Affiliation(s)
- Alexander C. Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William R. Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Heidi M. Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Diminished Endothelial Function but Normal Vascular Structure in Adults with Tetralogy of Fallot. J Clin Med 2022; 11:jcm11030493. [PMID: 35159945 PMCID: PMC8836741 DOI: 10.3390/jcm11030493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/01/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023] Open
Abstract
The life expectancy of patients with Tetralogy of Fallot (ToF) has increased in recent years. As a result, other risk factors with later onset in life are in the focus of patient care. Endothelial function is an early indicator of cardiovascular risk and was investigated along further structural vessel properties. A total of 17 patients (41.7 ± 7.1 years, 8 women) with Tetralogy of Fallot were 1:2 matched for sex with 34 (38.9 ± 8.1 years, 16 women) healthy volunteers. Participants received an assessment of their endothelial function and a structural assessment of the aorta. Patients with ToF showed a reduced endothelial function determined by reactive hyperaemia index after adjusting for age, weight and height (ToF: 1.55 ± 0.31 vs. controls: 1.84 ± 0.47; p = 0.023). No differences in carotid intima-media thickness (cIMT) between the ToF and healthy controls (ToF: 0.542 ± 0.063 mm vs. controls: 0.521 ± 0.164 mm; p = 0.319) were found. Patients with ToF had reduced vascular function compared to healthy subjects. As the structural component is not affected, endothelial dysfunction seems not to have yet manifested itself as a morphological change. Nevertheless, long-term management of these patients should include vascular parameters.
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Adlakha H, Malik P, Donthula R, Rajagopal H, Kan A, Srivastava S, Karnik R, Shenoy RU. Systemic ventricular strain is abnormal with elevated BMI in adults with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rapetto F, Bruno VD, Rajakaruna C, Bryan AJ, Parry AJ, Caputo M, Stoica SC. Adult coronary artery bypass grafting by congenital surgeons-a propensity matched analysis. Eur J Cardiothorac Surg 2021; 60:354-360. [PMID: 33585898 PMCID: PMC8573332 DOI: 10.1093/ejcts/ezab081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Surgical myocardial revascularization will be increasingly needed in adult patients with congenital heart disease. We investigated the results of coronary artery bypass grafting (CABG) performed on adults by congenital cardiac surgeons at our institution. METHODS We conducted a retrospective, single-centre study. Adults undergoing isolated or combined CABG from 2004 to 2017 were included. Early and late outcomes were analyzed for the whole cohort. Furthermore, a propensity matched analysis was conducted comparing the results of isolated CABG between congenital and adult surgeons. RESULTS A total of 514 and 113 patients had isolated and combined CABG for acquired heart disease, respectively. A total of 33 patients had myocardial revascularization at the time of surgery for congenital heart disease. Overall early mortality was 1.2%, the rate of re-exploration for bleeding was 4.5%, and an internal mammary artery to left anterior descending artery graft was used in 85.6% patients. One-year survival was 97.5% (96.2-98.8%), and 5-year survival was 88.0% (84.8-91.3%). After propensity matching (468 pairs), early mortality (0.6% vs 1.2%, P = 0.51), re-exploration for bleeding (3.6% vs 3.0%, P = 0.72), use of internal mammary artery to left anterior descending artery graft (92.7% vs 91.9%, P = 0.70) and late survival did not differ between congenital surgeons and adult surgeons, respectively. CONCLUSIONS Surgical myocardial revascularization can be required for adult congenital patients in a broad spectrum of clinical situations. Despite lower volumes, congenital cardiac surgeons perform CABG safely and with results that are comparable to those of the adult surgeons at our centre.
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Affiliation(s)
- Filippo Rapetto
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Vito D Bruno
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Cha Rajakaruna
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Alan J Bryan
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Andrew J Parry
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Serban C Stoica
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
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10
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Early vascular aging in adult patients with congenital heart disease. Hypertens Res 2021; 44:1122-1128. [PMID: 33859395 DOI: 10.1038/s41440-021-00658-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 12/30/2022]
Abstract
Many studies have reported that adults with congenital heart disease suffer from hypertension and cardiovascular disease even at younger ages. Therefore, we analyzed early vascular aging, which is defined as pulse wave velocity values higher than the 95th percentile for age and sex, and clarified the relationship between early vascular aging and many parameters related to cardiovascular disorders in adults with congenital heart disease. We enrolled 72 adult patients with congenital heart disease and measured their brachial-ankle pulse wave velocity. Comparing the data between age- and sex-matched controls, patients with a pulse wave velocity higher than the 95th percentile for age and sex were defined as exhibiting early vascular aging. The parameters of patients with and without early vascular aging were compared. Early vascular aging was observed in 15.6% of the patients. Age, systolic blood pressure, diastolic blood pressure, pulse pressure, blood sugar, hemoglobin A1c, uric acid, low-density lipoprotein cholesterol, and triglyceride levels were positive determinants of early vascular aging. Logistic regression analysis proved that systolic blood pressure was a significant determinant of early vascular aging (odds ratio, 1.128, 95% confidence interval, 1.049-1.214; p = 0.001). The prevalence of early vascular aging is high in adult patients with congenital heart disease. Because early vascular aging can damage a patient's vulnerable heart, careful follow-up of blood pressure and pulse wave velocity is essential.
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Greenberg JH, McArthur E, Thiessen-Philbrook H, Zappitelli M, Wald R, Kaushal S, Ng DK, Everett AD, Chanchlani R, Garg AX, Parikh CR. Long-term Risk of Hypertension After Surgical Repair of Congenital Heart Disease in Children. JAMA Netw Open 2021; 4:e215237. [PMID: 33830227 PMCID: PMC8033439 DOI: 10.1001/jamanetworkopen.2021.5237] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE The long-term risk of hypertension in children after surgery for congenital heart disease (CHD) is unclear. OBJECTIVE To assess the incidence of hypertension after cardiac surgery in children with CHD. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective matched cohort study was conducted in Ontario, Canada, using administrative databases. A total of 3600 children with surgical repair of CHD were matched to 10 children (n = 36 000) from the general population without CHD on age, sex, index date, rurality, and neighborhood income. MAIN OUTCOMES AND MEASURES Diagnosis of hypertension over a median follow-up time of 9.8 years (interquartile range, 6.8-12.9 years) after surgery. The last follow-up was March 31, 2019. RESULTS Overall, in 3600 children with surgical repair of CHD, the median age at first surgery was 150 days (interquartile range, 40-252 days) and 2005 (55.7%) were boys. During follow-up, 445 (12.4%) children with surgical repair of CHD developed hypertension compared with 398 (1.1%) in the matched control group. The incidence rate of hypertension in children who received surgery for CHD was 141.3 (95% CI, 128.8-155.1) per 10 000 person-years compared with children in the matched control group, who had a rate of 11.1 (95% CI, 10.1-12.3) per 10 000 person-years. The risk of hypertension was higher in children with index surgical dates at an age of less 150 days compared with those who had surgical dates at an age of 150 days or older (P = .006 for interaction). The risk of hypertension was increased in children with more complex surgery, particularly children with hypoplastic left heart syndrome (49 of 140 [35.0%]), and in children who received dialysis (22 of 126 [17.5%]; hazard ratio, 1.67; 95% CI, 1.09-2.56) during the index cardiac surgery hospitalization. CONCLUSIONS AND RELEVANCE The incidence of long-term hypertension in this study was 12 times higher in children with surgical repair of CHD compared with children in the matched control group. The findings suggest that interventions aimed at reducing the long-term risk of hypertension after cardiac surgery in this population are needed.
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Affiliation(s)
- Jason H. Greenberg
- Division of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Michael Zappitelli
- Division of Pediatric Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ron Wald
- ICES, London, Ontario, Canada
- Division of Nephrology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sunjay Kaushal
- Department of Surgery, University of Maryland, Baltimore
| | - Derek K. Ng
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Allen D. Everett
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Amit X. Garg
- ICES, London, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
| | - Chirag R. Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Niwa K. Metabolic syndrome and coronary artery disease in adults with congenital heart disease. Cardiovasc Diagn Ther 2021; 11:563-576. [PMID: 33968634 DOI: 10.21037/cdt-20-781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In adults with congenital heart disease (ACHD), conditions acquired with aging, such as metabolic syndrome, hypertension, diabetes mellitus, and obesity, can negatively influence the original cardiovascular disease. Metabolic syndrome has a higher prevalence in ACHD than in the general population. In contrast, coronary artery disease shows a similar prevalence in adults with acyanotic CHD and the general population, while adults with cyanotic CHD, even after repair, have an even lower incidence of coronary artery disease than the general population/adults with acyanotic CHD. However, even in those with cyanotic CHD, coronary artery disease can develop when they have risk factors such as obesity, dyslipidemia, hypertension, diabetes mellitus, smoking habit, or limited exercise. The prevalence of risk factors for cardiovascular disease is similar between ACHD and the general population, but an increased risk of coronary atherosclerosis has been observed for congenital coronary artery anomalies, dextro-transposition of the great arteries after arterial switch operation, Ross procedure, and coarctation of the aorta. Aortopathy may be an additional risk factor for cardiovascular disease. As ACHD have other abnormalities that may make the heart more vulnerable to both the development of atherosclerosis and adverse cardiovascular sequelae, regular evaluation of their cardiovascular disease risk status is recommended. Metabolic syndrome is more common among ACHD than in the general population, and may therefore increase the future incidence of atherosclerotic coronary artery disease even in ACHD. Thus, ACHD should be screened for metabolic syndrome to eliminate risk factors for atherosclerotic coronary artery disease.
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Affiliation(s)
- Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St Luke's International Hospital, Tokyo 104-8560, Japan
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Maurer SJ, Bauer UMM, Baumgartner H, Uebing A, Walther C, Tutarel O. Acquired Comorbidities in Adults with Congenital Heart Disease: An Analysis of the German National Register for Congenital Heart Defects. J Clin Med 2021; 10:jcm10020314. [PMID: 33467024 PMCID: PMC7830982 DOI: 10.3390/jcm10020314] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/18/2022] Open
Abstract
Background: As adults with congenital heart disease (ACHD) are getting older, acquired comorbidities play an important role in morbidity and mortality. Data regarding their prevalence in ACHD that are representative on a population level are not available. Methods: The German National Register for Congenital Heart Defects was screened for ACHD. Underlying congenital heart disease (CHD), patient demographics, previous interventional/surgical interventions, and comorbidities were retrieved. Patients <40 years of age were compared to those ≥40 years. Results: A total of 4673 patients (mean age 33.6 ± 10.7 years, female 47.7%) was included. At least one comorbidity was present in 2882 patients (61.7%) altogether, and in 56.8% of patients below vs. 77.7% of patients over 40 years of age (p < 0.001). Number of comorbidities was higher in patients ≥40 years (2.1 ± 2.1) than in patients <40 years (1.2 ± 1.5, p < 0.001). On multivariable regression analysis, age and CHD complexity were significantly associated with the presence and number of comorbidities. Conclusions: At least one acquired comorbidity is present in approximately two-thirds of ACHD. Age and complexity of the CHD are significantly associated with the presence of comorbidities. These findings highlight the importance of addressing comorbidities in ACHD care to achieve optimal long-term outcomes.
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Affiliation(s)
- Susanne J. Maurer
- Department of Electrophysiology, German Heart Centre Munich, TUM School of Medicine—Technical University of Munich, 80636 Munich, Germany;
| | - Ulrike M. M. Bauer
- National Register for Congenital Heart Defects, Competence Network for Congenital Heart Defects, 13353 Berlin, Germany;
| | - Helmut Baumgartner
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany;
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany;
| | - Claudia Walther
- Department of Cardiology, University of Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Oktay Tutarel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine—Technical University of Munich, 80636 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80992 Munich, Germany
- Correspondence: or ; Tel.: +49-89-1218-2729
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Halling T, Akkermann S, Löffler F, Groh A, Heitland I, Haefeli WE, Bauersachs J, Kahl KG, Westhoff-Bleck M. Factors That Influence Adherence to Medication in Adults With Congenital Heart Disease (ACHD). Front Psychiatry 2021; 12:788013. [PMID: 34899440 PMCID: PMC8660073 DOI: 10.3389/fpsyt.2021.788013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Innovative operative and interventional procedures have improved survival in congenital heart disease (CHD), and today more than 90% of these children reach adulthood. Consequently, adherence and psychosocial issues are becoming increasingly important because non-adherence to treatment recommendations worsens morbidity and mortality. This study aimed to identify factors modifying adherence to medication in adult congenital heart disease (ACHD). Methods: This cross-sectional study included 451 outpatients (female 47.9%, average age ± SD: 37.9 ± 12 years) from the ACHD department, who completed a questionnaire assessing medication non-adherence and individual barriers to treatment. Further assessments included psychological well-being (Hospital Anxiety and Depression scale; HADS), childhood traumatization, sociodemographic, and clinical data. Binary logistic regression analysis calculated the impact of these factors on drug adherence. Results: Of the 451 patients 162 participants (35.9%) reported to be non-adherent. In univariate analysis non-adherence to treatment was associated with smoking (P = < 0.001) and internet addiction (P = 0.005). Further factors negatively influencing adherence were the presence of depressive symptoms (P = 0.002), anxiety (P = 0.004), and childhood traumatization (p = 0.002). Factors positively associated with adherence were older age (P = 0.003) and more advanced heart disease as indicated by NYHA class (P = 0.01), elevated NT-proBNP (P = 0.02), device therapy (P = 0.002) and intermittent arrhythmias (P = 0.01). In multivariate analysis especially psychopathological factors such as depression (P = 0.009), anxiety (P = 0.032) and childhood traumatization (P = 0.006) predicted non-adherence. Conclusion: Adherence is a critical issue in the long-term management of ACHD. Identifying modifiable factors that worsen adherence offers the opportunity for targeted interventions. Depressive symptoms, anxiety, and adverse childhood experiences are amenable to psychosocial interventions, as well as cigarette smoking. Our study suggests that a multimodal and interdisciplinary treatment concept for the long-term management of adults with congenital heart disease could be beneficial. Whether it will further improve morbidity and mortality, should be assessed in prospective interventions.
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Affiliation(s)
- Tim Halling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Steffen Akkermann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Ivo Heitland
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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Reich K, Moledina A, Kwan E, Keir M. Congenital Heart Disease (CHD) in Seniors: a Retrospective Study Defining a Brand New Cohort. Can Geriatr J 2020; 23:270-276. [PMID: 33282046 PMCID: PMC7704070 DOI: 10.5770/cgj.23.435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background With improved surgical techniques and medical therapy, patients with congenital heart disease (CHD) are now expected to achieve normal life expectancies. As a result, a new cohort of senior patients with adult congenital heart disease (ACHD) is emerging which has not been well characterized. Methods This study is a retrospective chart review of patients with moderate to complex CHD over the age of 60 years in Southern Alberta. We examined the number, length, and reasons for hospitalizations, and identified common adult comorbidities. Results A total of 84 patients with CHD who were 60 years or older were identified. The average age was 67.9 ± 6.6 years, with the majority of patients having moderate CHD. The most common cardiac comorbidities were arrhythmia, hypertension, and heart failure, which were also the most common reasons for hospital admission. There were 1.85 admissions per 10 patient-years, with a median length of stay of 6.0 (3.8-10.5) days. Conclusions With advanced age, the ACHD population is at risk of developing significant medical burden from acquired cardiac comorbidities, resulting in hospitalization. This analysis provides insight into disease characteristics of seniors with CHD. Further studies are needed to better understand this population and the association with geriatric syndromes.
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Affiliation(s)
- Krista Reich
- Department of Medicine, University of Calgary, Calgary
| | | | - Emily Kwan
- Department of Geriatric Medicine, University of Calgary, Calgary
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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The cardiovascular burden of congenital heart disease - not only in times of COVID-19. Int J Cardiol 2020; 316:106. [PMID: 32674839 PMCID: PMC7357463 DOI: 10.1016/j.ijcard.2020.05.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 11/29/2022]
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Systemic right ventricle in elderly patients with congenitally corrected transposition of the great arteries: Clinical profile, cardiac biomarkers, and echocardiographic parameters. Anatol J Cardiol 2020; 24:92-96. [PMID: 32749250 PMCID: PMC7460688 DOI: 10.14744/anatoljcardiol.2020.59689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The number of patients with congenitally corrected transposition of the great arteries (ccTGA) surviving to old age is increasing. This study therefore sought to characterize 'geriatric' systemic right ventricle (sRV) in terms of clinical profile, cardiac biomarkers, and echocardiography-derived function when compared with findings in younger patients. METHODS A single-center cross-sectional study of adults with ccTGA was performed. Patients underwent clinical assessment; transthoracic echocardiography; and venous blood sampling including N-terminal pro-B-type natriuretic peptide (NTproBNP), galectin-3, and soluble suppression of tumorgenicity 2 (sST2) measurements. In the echocardiographic study, the sRV function was assessed using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), systolic pulsed-wave Doppler velocity (s'), and longitudinal strain (LS). RESULTS Ten patients with ccTGA aged 60 years or older and 53 patients younger than 60 years of age were included. There were significantly more individuals with hypertension (40% vs. 5.7%), dyslipidaemia (50% vs. 5.7%), and atrial fibrillation (70% vs. 20.7%) in the older group; similarly, we found higher NTproBNP (2706 pg/mL vs. 784.7 pg/mL; p<0.001), and galectin-3 (10.15 ng/mL vs. 7.24 ng/mL; p=0.007) concentrations in elderly ccTGA individuals, while sST2 content did not vary significantly according to age. Upon echocardiographic assessment, lower sRV FAC (28.6% vs. 36.1%; p=0.028) and LS (-12% vs. -15.5%; p=0.017) values were observed in patients aged 60 years or older. TAPSE and s' did not differ between the age groups. CONCLUSION Careful screening for acquired comorbidities, particularly atrial fibrillation, in elderly ccTGA patients is warranted. Examining selected cardiac biomarkers and echocardiography-derived parameters are useful in the assessment of the aging sRV.
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Goldstein SA, D'Ottavio A, Spears T, Chiswell K, Hartman RJ, Krasuski RA, Kemper AR, Meyer RE, Hoffman TM, Walsh MJ, Sang CJ, Paolillo J, Li JS. Causes of Death and Cardiovascular Comorbidities in Adults With Congenital Heart Disease. J Am Heart Assoc 2020; 9:e016400. [PMID: 32654582 PMCID: PMC7660712 DOI: 10.1161/jaha.119.016400] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Little is known about the contemporary mortality experience among adults with congenital heart disease (CHD). The objectives of this study were to assess the age at death, presence of cardiovascular comorbidities, and most common causes of death among adults with CHD in a contemporary cohort within the United States. Methods and Results Patients with CHD who had a healthcare encounter between 2008 and 2013 at 1 of 5 comprehensive CHD centers in North Carolina were identified by International Classification of Diseases, Ninth Revision (ICD-9), code. Only patients who could be linked to a North Carolina death certificate between 2008 and 2016 and with age at death ≥20 years were included. Median age at death and underlying cause of death based on death certificate data were analyzed. The prevalence of acquired cardiovascular risk factors was determined from electronic medical record data. Among the 629 included patients, the median age at death was 64.2 years. Those with severe CHD (n=157, 25%), shunts (n=202, 32%), and valvular lesions (n=174, 28%) had a median age at death of 46.0, 65.0, and 73.3 years, respectively. Cardiovascular death was most common in adults with severe CHD (60%), with 40% of those deaths caused by CHD. Malignancy and ischemic heart disease were the most common causes of death in adults with nonsevere CHD. Hypertension and hyperlipidemia were common comorbidities among all CHD severity groups. Conclusions The most common underlying causes of death differed by lesion severity. Those with severe lesions most commonly died from underlying CHD, whereas those with nonsevere disease more commonly died from non-CHD causes.
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Affiliation(s)
- Sarah A Goldstein
- Duke University Medical Center Durham NC.,Duke Clinical Research Institute Durham NC
| | | | | | | | | | | | | | | | | | | | | | | | - Jennifer S Li
- Duke University Medical Center Durham NC.,Duke Clinical Research Institute Durham NC
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Hock J, Schwall L, Pujol C, Hager A, Oberhoffer R, Ewert P, Tutarel O. Tetralogy of Fallot or Pulmonary Atresia with Ventricular Septal Defect after the Age of 40 Years: A Single Center Study. J Clin Med 2020; 9:jcm9051533. [PMID: 32438748 PMCID: PMC7290291 DOI: 10.3390/jcm9051533] [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] [Received: 04/14/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The population of adults with tetralogy of Fallot (TOF) or pulmonary atresia with ventricular septal defect (PA/VSD) is growing and aging. Data regarding older patients are scarce. Prognostic outcome parameters in adults with TOF or PA/VSD ≥ 40 years were studied. Methods: This was a retrospective study of patients ≥ 40 years of age during the study period (January 2005–March 2018). Major adverse cardiac events (MACE) were a combined primary endpoint including death from any cause, prevented sudden cardiac death, pacemaker implantation, arrhythmia, and new-onset heart failure. Additionally, MACE II (secondary endpoint) was a combination of death from any cause and prevented sudden cardiac death. Results: 184 (58.7% female, mean age 45.3 ± 7.2 years) patients were included (159 (86.4%) TOF and 25 (13.6%) PA/VSD). During a median follow-up of 3.1 years (IQR: 0.6–6.5), MACE occurred in 35 and MACE II in 13 patients. On multivariable analysis, New York Heart Association class [HR: 2.1, 95% CI: 1.2–3.6, p = 0.009] emerged as an independent predictor for MACE, and age at corrective surgery [HR: 13.2, 95% CI: 1.6–107.1, p = 0.016] for MACE II. Conclusions: Adults with TOF or PA/VSD ≥ 40 years are burdened with significant morbidity and mortality. New York Heart Association class and age at corrective surgery were independent predictors of outcome.
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Affiliation(s)
- Julia Hock
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University of Munich, 80636 Munich, Germany; (J.H.); (L.S.); (C.P.); (A.H.); (P.E.)
- Institute of Preventive Paediatrics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany;
| | - Laurent Schwall
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University of Munich, 80636 Munich, Germany; (J.H.); (L.S.); (C.P.); (A.H.); (P.E.)
| | - Claudia Pujol
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University of Munich, 80636 Munich, Germany; (J.H.); (L.S.); (C.P.); (A.H.); (P.E.)
| | - Alfred Hager
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University of Munich, 80636 Munich, Germany; (J.H.); (L.S.); (C.P.); (A.H.); (P.E.)
| | - Renate Oberhoffer
- Institute of Preventive Paediatrics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany;
| | - Peter Ewert
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University of Munich, 80636 Munich, Germany; (J.H.); (L.S.); (C.P.); (A.H.); (P.E.)
| | - Oktay Tutarel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University of Munich, 80636 Munich, Germany; (J.H.); (L.S.); (C.P.); (A.H.); (P.E.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80992 Munich, Germany
- Correspondence: ; Tel.: +49–89–1218–2729
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Toyoda S, Sakuma M, Abe S, Nakajima T, Inoue T. Coronary artery disease in patients with adult congenital heart disease. Int J Cardiol 2020; 304:35-36. [DOI: 10.1016/j.ijcard.2020.01.011] [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: 12/17/2019] [Accepted: 01/08/2020] [Indexed: 11/16/2022]
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Neurocognition in Adult Congenital Heart Disease: How to Monitor and Prevent Progressive Decline. Can J Cardiol 2019; 35:1675-1685. [DOI: 10.1016/j.cjca.2019.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022] Open
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Shustak RJ, Cohen MS. What influences outcomes in pediatric and congenital cardiovascular disease?: A healthy lifestyle; obesity and overweight. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Martínez-Quintana E, Rodríguez-Hernández JL, Rodríguez-González F, Riaño-Ruiz M, Fraguela-Medina C, Girolimetti A, Jiménez-Rodríguez S. Cardiovascular risk factors and arterial thrombotic events in congenital heart disease patients. Int J Clin Pract 2019; 73:1-8. [PMID: 31141298 DOI: 10.1111/ijcp.13378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/26/2018] [Accepted: 05/25/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION As congenital patients get older, it can be hypothesised that cardiovascular risk factors increase. METHODS Retrospective study of congenital heart disease (CHD) patients attended between January 2008 and September 2018. Cardiovascular risk factors, myocardial infarction, stroke, peripheral vascular disease, and analytical data such as serum glucose and lipid profile were determined. RESULTS Eight hundred and eighteen CHD patients and 1955 control patients matched for age and sex were studied. CHD patients were distributed in simple (462 patients), moderate (228 patients) and great (128 patients) complexity. Median age in CHD patients was 33 (25-41) years old and 56% were male. CHD patients were significantly more hypertensive and diabetic but less dyslipidemic and smokers than patients in the control group. Twenty-seven (3.3%) CHD patients had an arterial thrombotic event: 3 coronary, 22 neurological and 2 peripheral vascular disease. No significant differences were seen in the incidence of myocardial infarction between the control and the CHD groups. However CHD patients had a significant higher incidence of arterial thrombotic events (coronary, neurological and peripheral vascular events) at the expense of strokes and transient ischaemic attacks (22 vs 2 events in CHD and control patients, respectively). Also, no significant differences were seen in age, sex, BMI, arterial hypertension, diabetes mellitus, dyslipidemia, smoking habit, serum glucose, total and LDL cholesterol, statin treatment, myocardial infarction and arterial thrombotic events according to CHD complexity. Being older and having arterial hypertension, diabetes mellitus, dyslipidemia and smoking habit were more frequent among CHD patients with arterial thrombosis. CONCLUSIONS Congenital heart diseases are more hypertensive and diabetic but less dyslipemic and smokers than patients in the control group. CHD patients have a higher incidence of neurological events but not of myocardial infarction in relation to the control population.
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Affiliation(s)
- Efrén Martínez-Quintana
- Cardiology Service, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Fayna Rodríguez-González
- Ophthalmology Service, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta Riaño-Ruiz
- Department of Biochemistry and Clinical Analyses, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Carla Fraguela-Medina
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Angela Girolimetti
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sara Jiménez-Rodríguez
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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