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Lu Y, Li Y, Xie Y, Bu J, Yuan R, Zhang X. Exploring Sirtuins: New Frontiers in Managing Heart Failure with Preserved Ejection Fraction. Int J Mol Sci 2024; 25:7740. [PMID: 39062982 PMCID: PMC11277469 DOI: 10.3390/ijms25147740] [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: 06/02/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
With increasing research, the sirtuin (SIRT) protein family has become increasingly understood. Studies have demonstrated that SIRTs can aid in metabolism and affect various physiological processes, such as atherosclerosis, heart failure (HF), hypertension, type 2 diabetes, and other related disorders. Although the pathogenesis of HF with preserved ejection fraction (HFpEF) has not yet been clarified, SIRTs have a role in its development. Therefore, SIRTs may offer a fresh approach to the diagnosis, treatment, and prevention of HFpEF as a novel therapeutic intervention target.
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Affiliation(s)
- Ying Lu
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou 730031, China; (Y.L.); (Y.X.); (J.B.); (R.Y.)
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou 730031, China;
| | - Yixin Xie
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou 730031, China; (Y.L.); (Y.X.); (J.B.); (R.Y.)
| | - Jiale Bu
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou 730031, China; (Y.L.); (Y.X.); (J.B.); (R.Y.)
| | - Ruowen Yuan
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou 730031, China; (Y.L.); (Y.X.); (J.B.); (R.Y.)
| | - Xiaowei Zhang
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou 730031, China; (Y.L.); (Y.X.); (J.B.); (R.Y.)
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Assayag E, Gurt I, Cohen-Kfir E, Stokar J, Zwas DR, Dresner-Pollak R. Cardiac Left Ventricular miRNA-26a Is Downregulated in Ovariectomized Mice, Upregulated upon 17-Beta Estradiol Replacement, and Inversely Correlated with Collagen Type 1 Gene Expression. Int J Mol Sci 2024; 25:5153. [PMID: 38791190 PMCID: PMC11121197 DOI: 10.3390/ijms25105153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is more prevalent in post- compared to pre-menopausal women. The underlying mechanisms are not fully understood. Data in humans is confounded by age and co-morbidities. We investigated the effects of ovariectomy and estrogen replacement on the left ventricular (LV) gene expression of pro-inflammatory and pro-fibrotic factors involved in HFpEF and putative regulating miRNAs. Nine-week-old C57BL/6 female mice were subjected to ovariectomy (OVX) or SHAM operation. OVX and SHAM groups were sacrificed 1-, 6-, and 12-weeks post-surgery (T1/SHAM; T1/OVX; T6/SHAM; T6/OVX, T12/SHAM). 17β-estradiol (E2) or vehicle (VEH) was then administered to the OVX groups for 6 weeks (T12/OVX/E2; T12/OVX/VEH). Another SHAM group was sacrificed 12-weeks post-surgery. RNA and miRNAs were extracted from the LV apex. An early 3-fold increase in the gene expression of IL-1α, IL-6, Mmp9, Mmp12, Col1α1, and Col3α1 was observed one-week post-surgery in T1/OVX vs. T1/SHAM, but not at later time points. miRNA-26a was lower in T1/OVX vs. T1/SHAM and was inversely correlated with Col1α1 and Col3α1 expression 1-week post-surgery (r = -0.79 p < 0.001; r = -0.6 p = 0.007). miRNAs-26a, 29b, and 133a were significantly higher, while Col1α1, Col3α1, IL-1α, IL-6, Tnfα, Mmp12, and FasL gene expression was significantly lower in E2- compared to vehicle-treated OVX mice. miRNA-26a was inversely correlated with Col3α1 in T12/OVX/ E2 (r = -0.56 p = 0.02). OVX triggered an early increase in the gene expression of pro-inflammatory and pro-fibrotic factors, highlighting the importance of the early phase post-cessation of ovarian function. E2 replacement therapy, even if it was not immediately initiated after OVX, reversed these unfavorable changes and upregulated cardiac miRNA-26a, previously unknown to be affected by menopausal status.
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Affiliation(s)
- Elishai Assayag
- Department of Endocrinology and Metabolism, Division of Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.A.); (I.G.); (E.C.-K.)
| | - Irina Gurt
- Department of Endocrinology and Metabolism, Division of Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.A.); (I.G.); (E.C.-K.)
| | - Einav Cohen-Kfir
- Department of Endocrinology and Metabolism, Division of Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.A.); (I.G.); (E.C.-K.)
| | - Joshua Stokar
- Department of Endocrinology and Metabolism, Division of Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.A.); (I.G.); (E.C.-K.)
| | - Donna R. Zwas
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Division of Cardiology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel;
| | - Rivka Dresner-Pollak
- Department of Endocrinology and Metabolism, Division of Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.A.); (I.G.); (E.C.-K.)
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Martin CM. Cardiomyopathies in Women. Methodist Debakey Cardiovasc J 2024; 20:59-69. [PMID: 38495661 PMCID: PMC10941701 DOI: 10.14797/mdcvj.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Heart failure affects over 2.6 million people in the United States. While women have better overall survival rates, they also suffer from higher morbidity as shown by higher rates of hospitalization and worse quality of life. Several anatomical differences in women's hearts affect both systolic and diastolic cardiac physiology. Despite these findings, women are significantly underrepresented in clinical trials, necessitating extrapolation of data from males. Because women have sex-specific etiologies of heart failure and unique manifestations in genetic-related cardiomyopathies, meaningful sex-related differences affect heart failure outcomes as well as access to and outcomes in advanced heart failure therapies in women. This review explores these gender-specific differences and potential solutions to balance care between women and men.
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Affiliation(s)
- Cindy M. Martin
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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Wang L, Lv XB, Yuan YT, Wang N, Yao HY, Zhang WC, Yin PF, Liu XH. Relationship between β1-AA and AT1-AA and Cardiac Function in Patients with Hypertension Complicated with Left Ventricular Diastolic Function Limitation. Cardiovasc Ther 2023; 2023:7611819. [PMID: 38125703 PMCID: PMC10733052 DOI: 10.1155/2023/7611819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/09/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Objective To investigate the association between β1 adrenergic receptor autoantibodies (β1-AA) and angiotensin II type-1 receptor autoantibodies (AT1-AA) and cardiac function in patients with hypertension complicated with left ventricular diastolic function limitation. Methods A total of 120 patients with essential hypertension who were not taking drug treatment and were hospitalised in the Department of Cardiology at the authors' hospital from April 2018 to December 2018 were enrolled in this study and divided into a diastolic dysfunction group (65 cases) and a normal diastolic group (55 cases) according to their left ventricular diastolic function. The levels of cardiac parameters, β1-AA, AT1-AA, and other indicators were compared. Logistic regression analysis was used to analyse the related factors affecting left ventricular diastolic dysfunction (LVDD). The diagnostic efficacy of related factors in the diagnosis of diastolic dysfunction was evaluated. Results Univariate analysis demonstrated that the left ventricular posterior wall diameter (10.29 ± 1.23 vs. 9.12 ± 1.53), left ventricular systolic dysfunction (10.56 ± 1.37 vs. 9.43 ± 1.44), systolic blood pressure (152.37 ± 10.24 vs. 140.33 ± 5.99), diastolic blood pressure (95.66 ± 6.34 vs. 87.33 ± 7.28), β1-AA (33 vs. 9 cases), and AT1-AA (35 cases vs. 12 cases) were higher in the dysfunction group than in the control group (all P < 0.05). Multivariate regression analysis showed that β1-AA (odds ratio (OR) = 1.96, 95% confidence interval (CI): 1.369-4.345) and AT1-AA (OR = 2.02, 95% CI: 1.332-6.720) were independent risk factors for cardiac diastolic dysfunction (P < 0.05). Both autoimmune antibodies had a certain predictive value, and the combined prediction value of the two was the highest, with an area under the curve of 0.942 (95% CI: 0.881~0.985). Conclusion The positive rate of β1-AA and AT1-AA in essential hypertension patients with LVDD was higher than that in the normal group. Both β1-AA and AT1-AA could be used as early markers of LVDD in essential hypertension patients.
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Affiliation(s)
- Liang Wang
- Department of Cardiology, Peking University International Hospital, Beijing 102206, China
| | - Xue-Bai Lv
- Third Medical Center, The General Hospital of the People's Liberation Army, Beijing 100039, China
| | - Yu-Ting Yuan
- Department of Cardiology, Peking University International Hospital, Beijing 102206, China
| | - Ning Wang
- Department of Cardiology, Peking University International Hospital, Beijing 102206, China
| | - Hong-Ying Yao
- Department of Cardiology, Peking University International Hospital, Beijing 102206, China
| | - Wen-Chao Zhang
- Department of Cardiology, Peking University International Hospital, Beijing 102206, China
| | - Peng-Fei Yin
- Department of Cardiology, Peking University International Hospital, Beijing 102206, China
| | - Xiao-Hui Liu
- Department of Cardiology, Peking University International Hospital, Beijing 102206, China
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Pappritz K, Puhl SL, Matz I, Brauer E, Shia YX, El-Shafeey M, Koch SE, Miteva K, Mucha C, Duda GN, Petersen A, Steffens S, Tschöpe C, Van Linthout S. Sex- and age-related differences in the inflammatory properties of cardiac fibroblasts: impact on the cardiosplenic axis and cardiac fibrosis. Front Cardiovasc Med 2023; 10:1117419. [PMID: 38054090 PMCID: PMC10694208 DOI: 10.3389/fcvm.2023.1117419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/20/2023] [Indexed: 12/07/2023] Open
Abstract
Background Age and sex are prominent risk factors for heart failure and determinants of structural and functional changes of the heart. Cardiac fibroblasts (cFB) are beyond their task as extracellular matrix-producing cells further recognized as inflammation-supporting cells. The present study aimed to evaluate the impact of sex and age on the inflammatory potential of cFB and its impact on the cardiosplenic axis and cardiac fibrosis. Materials Left ventricles (LV) of 3- and 12-months old male and female C57BL/6J mice were harvested for immunohistochemistry, immunofluorescence and cFB outgrowth culture and the spleen for flow cytometry. LV-derived cFB and respective supernatants were characterized. Results LV-derived cFB from 3-months old male mice exhibited a higher inflammatory capacity, as indicated by a higher gene expression of CC-chemokine ligand (CCL) 2, and CCL7 compared to cFB derived from 3-months old female mice. The resulting higher CCL2/chemokine C-X3-C motif ligand (Cx3CL1) and CCL7/Cx3CL1 protein ratio in cell culture supernatants of 3-months old male vs. female cFB was reflected by a higher migration of Ly6Chigh monocytes towards supernatant from 3-months old male vs. female cFB. In vivo a lower ratio of splenic pro-inflammatory Ly6Chigh to anti-inflammatory Ly6Clow monocytes was found in 3-months old male vs. female mice, suggesting a higher attraction of Ly6Chigh compared to Ly6Clow monocytes towards the heart in male vs. female mice. In agreement, the percentage of pro-inflammatory CD68+ CD206- macrophages was higher in the LV of male vs. female mice at this age, whereas the percentage of anti-inflammatory CD68+ CD206+ macrophages was higher in the LV of 3-months old female mice compared to age-matched male animals. In parallel, the percentage of splenic TGF-β+ cells was higher in both 3- and 12-months old female vs. male mice, as further reflected by the higher pro-fibrotic potential of female vs. male splenocytes at both ages. In addition, female mice displayed a higher total LV collagen content compared to age-matched male mice, whereby collagen content of female cFB was higher compared to male cFB at the age of 12-months. Conclusion Age- and sex-dependent differences in cardiac fibrosis and inflammation are related to age- and sex-dependent variations in the inflammatory properties of cardiac fibroblasts.
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Affiliation(s)
- Kathleen Pappritz
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Sarah-Lena Puhl
- Comprehensive Heart Failure Center, Universitätsklinikum Würzburg, Würzburg, Germany
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Isabel Matz
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Erik Brauer
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Yi Xuan Shia
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Muhammad El-Shafeey
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Medical Biotechnology Research Department, Genetic Engineering and Biotechnology Research Institute (GEBRI), City of Scientific Research and Technological Applications, Alexandria, Egypt
| | - Suzanne E. Koch
- Berlin-Brandenburg Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Kapka Miteva
- Berlin-Brandenburg Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
- Division of Cardiology, Foundation for Medical Research, Department of Medicine Specialized Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christin Mucha
- Berlin-Brandenburg Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Ansgar Petersen
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Sabine Steffens
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance (MHA), Munich, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department Cardiology, Angiology, and Intensive Medicine (CVK) at the German Heart Center of the Charite (DHZC), Charité—Universitätsmedizin Berlin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Sophie Van Linthout
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
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Zhazykbayeva S, Hassoun R, Herwig M, Budde H, Kovács Á, Mannherz HG, El-Battrawy I, Tóth A, Schmidt WE, Mügge A, Hamdani N. Oxidative stress and inflammation distinctly drive molecular mechanisms of diastolic dysfunction and remodeling in female and male heart failure with preserved ejection fraction rats. Front Cardiovasc Med 2023; 10:1157398. [PMID: 37363100 PMCID: PMC10285478 DOI: 10.3389/fcvm.2023.1157398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex cardiovascular insufficiency syndrome presenting with an ejection fraction (EF) of greater than 50% along with different proinflammatory and metabolic co-morbidities. Despite previous work provided key insights into our understanding of HFpEF, effective treatments are still limited. In the current study we attempted to unravel the molecular basis of sex-dependent differences in HFpEF pathology. We analyzed left ventricular samples from 1-year-old female and male transgenic (TG) rats homozygous for the rat Ren-2 renin gene (mRen2) characterized with hypertension and diastolic dysfunction and compared it to age-matched female and male wild type rats (WT) served as control. Cardiomyocytes from female and male TG rats exhibited an elevated titin-based stiffness (Fpassive), which was corrected to control level upon treatment with reduced glutathione indicating titin oxidation. This was accompanied with high levels of oxidative stress in TG rats with more prominent effects in female group. In vitro supplementation with heat shock proteins (HSPs) reversed the elevated Fpassive indicating restoration of their cytoprotective function. Furthermore, the TG group exhibited high levels of proinflammatory cytokines with significant alterations in apoptotic and autophagy pathways in both sexes. Distinct alterations in the expression of several proteins between both sexes suggest their differential impact on disease development and necessitate distinct treatment options. Hence, our data suggested that oxidative stress and inflammation distinctly drive diastolic dysfunction and remodeling in female and male rats with HFpEF and that the sex-dependent mechanisms contribute to HF pathology.
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Affiliation(s)
- Saltanat Zhazykbayeva
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
| | - Roua Hassoun
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
| | - Melissa Herwig
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
| | - Heidi Budde
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
| | - Árpád Kovács
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
| | - Hans Georg Mannherz
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Anatomy and Molecular Embryology, Ruhr University Bochum, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, UK RUB, Ruhr University of Bochum, Bochum, Germany
| | - Attila Tóth
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Research Centre for Molecular Medicine, University of Debrecen, Debrecen, Hungary
| | - Wolfgang E. Schmidt
- Department of Medicine I, St. Josef Hospital, UK RUB, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Mügge
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, UK RUB, Ruhr University of Bochum, Bochum, Germany
| | - Nazha Hamdani
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, Bochum, Germany
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7
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Liu Z, Zhu Y, Chen S, Wu M, Huang H, Peng K, Zhang L, Zhao W, Peng X, Li N, Zhang H, Zhou Y, Peng Y, Fan J, Zeng J. Sex differences in patients with heart failure and mildly reduced left ventricular ejection fraction. Sci Rep 2023; 13:6832. [PMID: 37100821 PMCID: PMC10133291 DOI: 10.1038/s41598-023-33733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
Clinical studies on heart failure with mildly reduced left ventricular ejection fraction (HFmrEF) have gradually increased. However, studies on the prognostic differences between men and women among patients with HFmrEF are few, and no evidence on sex differences in such patients exists. Therefore, we retrospectively assessed the data of patients with HFmrEF using propensity score-matched analysis (PSMA). A total of 1691 patients with HFmrEF were enrolled in the Outcome of Discharged HFmrEF Patients study (OUDI-HF study), which included 1095 men and 596 women. After propensity score matching, we compared the difference in cardiovascular (CV) events (cardiovascular death or heart failure readmission) and all-cause mortality at 90 days and 1 year after discharge between men and women using Kaplan-Meier analysis and Cox regression. After PSMA, men with HFmrEF were 2.2 times more likely to die at 90 days than women with HFmrEF [hazard ratio (HR) 1.88; 95% confidence interval (95% CI) 1.03-3.46; P = 0.041]. However, there was no difference in the 90-day CV events (HR 0.96; 95% CI 0.75-1.22; P = 0.718). Similarly, there was no difference in all-cause mortality (HR 1.16; 95% CI 0.81-1.65; P = 0.417) and CV events (HR 0.98; 95% CI 0.83-1.16; P = 0.817) between men and women after 1 year. Among the patients with HFmrEF, men had a higher 90-day risk of all-cause mortality than women after hospital discharge, and this risk disappeared after 1 year.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT05240118 (ESC Heart Failure. (2022). doi: https://doi.org/10.1002/ehf2.14044 ).
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Affiliation(s)
- Zhican Liu
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Yunlong Zhu
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Sihao Chen
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Mingxin Wu
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Haobo Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Ke Peng
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Lingling Zhang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Wenjiao Zhao
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Xin Peng
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Na Li
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Hui Zhang
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Yuying Zhou
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Yiqun Peng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Jie Fan
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Jianping Zeng
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China.
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8
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Regitz-Zagrosek V, Gebhard C. Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes. Nat Rev Cardiol 2023; 20:236-247. [PMID: 36316574 PMCID: PMC9628527 DOI: 10.1038/s41569-022-00797-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
Despite a growing body of evidence, the distinct contributions of biological sex and the sociocultural dimension of gender to the manifestations and outcomes of ischaemic heart disease and heart failure remain unknown. The intertwining of sex-based differences in genetic and hormonal mechanisms with the complex dimension of gender and its different components and determinants that result in different disease phenotypes in women and men needs to be elucidated. The relative contribution of purely biological factors, such as genes and hormones, to cardiovascular phenotypes and outcomes is not yet fully understood. Increasing awareness of the effects of gender has led to efforts to measure gender in retrospective and prospective clinical studies and the development of gender scores. However, the synergistic or opposing effects of sex and gender on cardiovascular traits and on ischaemic heart disease and heart failure mechanisms have not yet been systematically described. Furthermore, specific considerations of sex-related and gender-related factors in gender dysphoria or in heart-brain interactions and their association with cardiovascular disease are still lacking. In this Review, we summarize contemporary evidence on the distinct effects of sex and gender as well as of their interactions on cardiovascular disease and how they favourably or unfavourably influence the pathogenesis, clinical manifestations and treatment responses in patients with ischaemic heart disease or heart failure.
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Affiliation(s)
- Vera Regitz-Zagrosek
- Institute for Gender in Medicine, Charité University Medicine Berlin, Berlin, Germany.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Cardiology, Inselspital Bern University Hospital, Bern, Switzerland
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9
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Zhang S, Ma J, Wang X, Zhao D, Zhang J, Jiang L, Duan W, Wang X, Hong Z, Li Z, Liu J. GPR30 Alleviates Pressure Overload-Induced Myocardial Hypertrophy in Ovariectomized Mice by Regulating Autophagy. Int J Mol Sci 2023; 24:ijms24020904. [PMID: 36674423 PMCID: PMC9867279 DOI: 10.3390/ijms24020904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
The incidence of heart failure mainly resulting from cardiac hypertrophy and fibrosis increases sharply in post-menopausal women compared with men at the same age, which indicates a cardioprotective role of estrogen. Previous studies in our group have shown that the novel estrogen receptor G Protein Coupled Receptor 30 (GPR30) could attenuate myocardial fibrosis caused by ischemic heart disease. However, the role of GPR30 in myocardial hypertrophy in ovariectomized mice has not been investigated yet. In this study, female mice with bilateral ovariectomy or sham surgery underwent transverse aortic constriction (TAC) surgery. After 8 weeks, mice in the OVX + TAC group exhibited more severe myocardial hypertrophy and fibrosis than mice in the TAC group. G1, the specific agonist of GPR30, could attenuate myocardial hypertrophy and fibrosis of mice in the OVX + TAC group. Furthermore, the expression of LC3II was significantly higher in the OVX + TAC group than in the OVX + TAC + G1 group, which indicates that autophagy might play an important role in this process. An in vitro study showed that G1 alleviated AngiotensionII (AngII)-induced hypertrophy and reduced the autophagy level of H9c2 cells, as revealed by LC3II expression and tandem mRFP-GFP-LC3 fluorescence analysis. Additionally, Western blot results showed that the AKT/mTOR pathway was inhibited in the AngII group, whereas it was restored in the AngII + G1 group. To further verify the mechanism, PI3K inhibitor LY294002 or autophagy activator rapamycin was added in the AngII + G1 group, and the antihypertrophy effect of G1 on H9c2 cells was blocked by LY294002 or rapamycin. In summary, our results demonstrate that G1 can attenuate cardiac hypertrophy and fibrosis and improve the cardiac function of mice in the OVX + TAC group through AKT/mTOR mediated inhibition of autophagy. Thus, this study demonstrates a potential option for the drug treatment of pressure overload-induced cardiac hypertrophy in postmenopausal women.
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10
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Gu F, Wu H, Jin X, Kong C, Zhao W. Association of red cell distribution width with the risk of 3-month readmission in patients with heart failure: A retrospective cohort study. Front Cardiovasc Med 2023; 10:1123905. [PMID: 36960473 PMCID: PMC10028279 DOI: 10.3389/fcvm.2023.1123905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
Background In recent years, red cell distribution width (RDW) has been found to be associated with the prognosis of patients with heart failure (HF) in Western countries. However, evidence from Asia is limited. We aimed to investigate the relationship between RDW and the risk of 3-month readmission in hospitalized Chinese HF patients. Methods We retrospectively analyzed HF data from the Fourth Hospital of Zigong, Sichuan, China, involving 1,978 patients admitted for HF between December 2016 and June 2019. The independent variable in our study was RDW, and the endpoint was the risk of readmission within 3 months. This study mainly used a multivariable Cox proportional hazards regression analysis. Smoothed curve fitting was then used to assess the dose-response relationship between RDW and the risk of 3-month readmission. Results In the original cohort of 1,978 patients with HF (42% male and 73.1% aged ≥70 years), 495 patients (25.0%) were readmitted within 3 months after discharge. Smoothed curve fitting showed a linear correlation between RDW and the risk of readmission within 3 months. In the multivariable-adjusted model, every 1% increase in RDW was associated with a 9% increased risk of readmission within 3 months (hazard ratio = 1.09, 95% confidence interval: 1.00-1.15; P < 0.005). Conclusions A higher RDW value was significantly associated with a greater risk of 3-months readmission in hospitalized patients with HF.
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Affiliation(s)
- Fang Gu
- Center for Reproductive Medicine, Department of Pediatrics, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Han Wu
- Department of Clinical Laboratory Medicine, Sir Run Run Shaw Hospital Xiasha Campus, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoli Jin
- Center for Reproductive Medicine, Department of Pediatrics, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Cheng Kong
- Department of Neurosurgery, People’s Hospital of Pan’an County, Jinhua, China
- Correspondence: Wenyan Zhao Cheng Kong
| | - Wenyan Zhao
- Center for General Practice Medicine, Department of General Practice Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
- Correspondence: Wenyan Zhao Cheng Kong
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11
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Puntmann VO, Martin S, Shchendrygina A, Hoffmann J, Ka MM, Giokoglu E, Vanchin B, Holm N, Karyou A, Laux GS, Arendt C, De Leuw P, Zacharowski K, Khodamoradi Y, Vehreschild MJGT, Rohde G, Zeiher AM, Vogl TJ, Schwenke C, Nagel E. Long-term cardiac pathology in individuals with mild initial COVID-19 illness. Nat Med 2022; 28:2117-2123. [PMID: 36064600 PMCID: PMC9556300 DOI: 10.1038/s41591-022-02000-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/08/2022] [Indexed: 01/03/2023]
Abstract
Cardiac symptoms are increasingly recognized as late complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in previously well individuals with mild initial illness, but the underlying pathophysiology leading to long-term cardiac symptoms remains unclear. In this study, we conducted serial cardiac assessments in a selected population of individuals with Coronavirus Disease 2019 (COVID-19) with no previous cardiac disease or notable comorbidities by measuring blood biomarkers of heart injury or dysfunction and by performing magnetic resonance imaging. Baseline measurements from 346 individuals with COVID-19 (52% females) were obtained at a median of 109 days (interquartile range (IQR), 77-177 days) after infection, when 73% of participants reported cardiac symptoms, such as exertional dyspnea (62%), palpitations (28%), atypical chest pain (27%) and syncope (3%). Symptomatic individuals had higher heart rates and higher imaging values or contrast agent accumulation, denoting inflammatory cardiac involvement, compared to asymptomatic individuals. Structural heart disease or high levels of biomarkers of cardiac injury or dysfunction were rare in symptomatic individuals. At follow-up (329 days (IQR, 274-383 days) after infection), 57% of participants had persistent cardiac symptoms. Diffuse myocardial edema was more pronounced in participants who remained symptomatic at follow-up as compared to those who improved. Female gender and diffuse myocardial involvement on baseline imaging independently predicted the presence of cardiac symptoms at follow-up. Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness.
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Affiliation(s)
- Valentina O Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Simon Martin
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anastasia Shchendrygina
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jedrzej Hoffmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Mame Madjiguène Ka
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eleni Giokoglu
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Byambasuren Vanchin
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Niels Holm
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Argyro Karyou
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Gerald S Laux
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christophe Arendt
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine & Pain Therapy; Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gernot Rohde
- Department of Internal Medicine, Respiratory Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Institute of Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
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12
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Cheng L, Maboh RN, Wang H, Mao GW, Wu XY, Chen H. Naoxintong Capsule Activates the Nrf2/HO-1 Signaling Pathway and Suppresses the p38α Signaling Pathway Via Estrogen Receptors to Ameliorate Heart Remodeling in Female Mice With Postmenopausal Hypertension. J Cardiovasc Pharmacol 2022; 80:158-170. [PMID: 35500215 DOI: 10.1097/fjc.0000000000001285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Limited treatments are available for alleviating heart remodeling in postmenopausal hypertension. The cardioprotective effect of naoxintong (NXT) has been widely accepted. This study aimed to explore the effects of NXT on pathological heart remodeling in a postmenopausal hypertension mouse model in vivo and H9c2 cardiomyocytes in vitro. In vivo, ovariectomy combined with chronic angiotensin II infusion was used to establish the postmenopausal hypertension animal model. NXT significantly ameliorated cardiac remodeling as indicated by a reduced ratio of heart weight/body weight and left ventricle weight/body weight, left ventricular wall thickness, diameter of cardiomyocytes, and collagen deposition in the heart. NXT also significantly increased the expression of estrogen receptors (ERs) and downregulated the expression of nicotinamide adenine dinucleotide phosphate oxidase 2 (Nox2). In vitro, NXT treatment greatly suppressed angiotensin II-induced cardiac hypertrophy, cardiac fibrosis, and excessive oxidative stress as proven by reducing the diameter of H9c2 cardiomyocytes, expression of hypertrophy and fibrosis markers, intracellular reactive oxygen species, and oxidative enzymes. Mechanistically, NXT significantly upregulated the expression of ERs, which activated the Nrf2/HO-1 signaling pathway and inhibited the phosphorylation of the p38α pathway. Collectively, the results indicated that NXT administration might attenuate cardiac remodeling through upregulating the expression of ERs, which activated the Nrf2/HO-1 signaling pathway, inhibited the phosphorylation of the p38α signaling pathway, and reduced oxidative stress.
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Affiliation(s)
- Lan Cheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ; and
| | - Rene Nfornah Maboh
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ; and
| | - Huan Wang
- Hypertension Laboratory, Fujian Provincial Cardiovascular Disease Institute, Fujian Provincial Hospital, Fuzhou, China
| | - Gao-Wei Mao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ; and
| | - Xiao-Ying Wu
- Hypertension Laboratory, Fujian Provincial Cardiovascular Disease Institute, Fujian Provincial Hospital, Fuzhou, China
| | - Hui Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ; and.,Hypertension Laboratory, Fujian Provincial Cardiovascular Disease Institute, Fujian Provincial Hospital, Fuzhou, China
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13
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Bilu C, Kronfeld-Schor N, Zimmet P, Einat H. Sex differences in the response to circadian disruption in diurnal sand rats. Chronobiol Int 2021; 39:169-185. [PMID: 34711113 DOI: 10.1080/07420528.2021.1989448] [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: 12/25/2022]
Abstract
Most animal model studies on physiological functions and pathologies are conducted in males. However, diseases such as depression, type 2 diabetes (T2DM) and cardiovascular disease, all show different prevalence and characteristics in females and males. Moreover, most mammal studies are conducted in nocturnal mice and rats, while modelling diurnal humans. We therefore used male and female fat sand rats (Psammomys obesus), which are diurnal in the wild, as an animal model for T2DM, to explore the effects of mild circadian disruption on behavior, glucose tolerance, cholesterol and heart weight. We found significant differences between the sexes: on average, in response to short photoperiods (SP) acclimation, males showed higher levels of depression-like behavior, lower glucose tolerance, and increased plasma cholesterol levels compared with females, with no effect on heart/body weight ratio. Females, however did show an increase in heart/body weight ratio in response to SP acclimation. We also found that regardless of sex, arrhythmic animals showed higher blood glucose levels, cholesterol levels, heart/body weight ratio, and depressive-like behavior compared with rhythmic animals. Hence, we suggest that the expression of the Circadian Syndrome could be different between males and females. Additional work with females is required to clearly delineate the specific effects in both sexes, and promote sex-based health care, prevention measures and therapies.
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Affiliation(s)
- Carmel Bilu
- School of Zoology, Tel-Aviv University, Tel Aviv, Israel
| | - Noga Kronfeld-Schor
- School of Zoology, Tel-Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | - Paul Zimmet
- Department of Medicine, Monash University, Melbourne, Australia
| | - Haim Einat
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel-Aviv, Israel
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14
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Withaar C, Lam CSP, Schiattarella GG, de Boer RA, Meems LMG. Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models. Eur Heart J 2021; 42:4420-4430. [PMID: 34414416 PMCID: PMC8599003 DOI: 10.1093/eurheartj/ehab389] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/15/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a multifactorial disease accounting for a large and increasing proportion of all clinical HF presentations. As a clinical syndrome, HFpEF is characterized by typical signs and symptoms of HF, a distinct cardiac phenotype and raised natriuretic peptides. Non-cardiac comorbidities frequently co-exist and contribute to the pathophysiology of HFpEF. To date, no therapy has proven to improve outcomes in HFpEF, with drug development hampered, at least partly, by lack of consensus on appropriate standards for pre-clinical HFpEF models. Recently, two clinical algorithms (HFA-PEFF and H2FPEF scores) have been developed to improve and standardize the diagnosis of HFpEF. In this review, we evaluate the translational utility of HFpEF mouse models in the context of these HFpEF scores. We systematically recorded evidence of symptoms and signs of HF or clinical HFpEF features and included several cardiac and extra-cardiac parameters as well as age and sex for each HFpEF mouse model. We found that most of the pre-clinical HFpEF models do not meet the HFpEF clinical criteria, although some multifactorial models resemble human HFpEF to a reasonable extent. We therefore conclude that to optimize the translational value of mouse models to human HFpEF, a novel approach for the development of pre-clinical HFpEF models is needed, taking into account the complex HFpEF pathophysiology in humans.
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Affiliation(s)
- Coenraad Withaar
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Carolyn S P Lam
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.,National University Heart Centre, Singapore and Duke-National University of Singapore
| | - Gabriele G Schiattarella
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Department of Cardiology, Center for Cardiovascular Research (CCR), Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Department of Internal Medicine (Cardiology), University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Laura M G Meems
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
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15
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Hamdani N, Costantino S, Mügge A, Lebeche D, Tschöpe C, Thum T, Paneni F. Leveraging clinical epigenetics in heart failure with preserved ejection fraction: a call for individualized therapies. Eur Heart J 2021; 42:1940-1958. [PMID: 36282124 DOI: 10.1093/eurheartj/ehab197] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Described as the 'single largest unmet need in cardiovascular medicine', heart failure with preserved ejection fraction (HFpEF) remains an untreatable disease currently representing 65% of new heart failure diagnoses. HFpEF is more frequent among women and associates with a poor prognosis and unsustainable healthcare costs. Moreover, the variability in HFpEF phenotypes amplifies complexity and difficulties in the approach. In this perspective, unveiling novel molecular targets is imperative. Epigenetic modifications-defined as changes of DNA, histones, and non-coding RNAs (ncRNAs)-represent a molecular framework through which the environment modulates gene expression. Epigenetic signals acquired over the lifetime lead to chromatin remodelling and affect transcriptional programmes underlying oxidative stress, inflammation, dysmetabolism, and maladaptive left ventricular remodelling, all conditions predisposing to HFpEF. The strong involvement of epigenetic signalling in this setting makes the epigenetic information relevant for diagnostic and therapeutic purposes in patients with HFpEF. The recent advances in high-throughput sequencing, computational epigenetics, and machine learning have enabled the identification of reliable epigenetic biomarkers in cardiovascular patients. Contrary to genetic tools, epigenetic biomarkers mirror the contribution of environmental cues and lifestyle changes and their reversible nature offers a promising opportunity to monitor disease states. The growing understanding of chromatin and ncRNAs biology has led to the development of several Food and Drug Administration approved 'epidrugs' (chromatin modifiers, mimics, anti-miRs) able to prevent transcriptional alterations underpinning left ventricular remodelling and HFpEF. In the present review, we discuss the importance of clinical epigenetics as a new tool to be employed for a personalized management of HFpEF.
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Affiliation(s)
- Nazha Hamdani
- Institute of Physiology, Ruhr University, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr University, Bochum, Germany.,Department of Cardiology, St-Josef Hospital, Ruhr University, Bochum, Germany.,Clinical Pharmacology, Ruhr University, Bochum, Germany
| | - Sarah Costantino
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, Schlieren CH-8952, Switzerland
| | - Andreas Mügge
- Molecular and Experimental Cardiology, Ruhr University, Bochum, Germany.,Department of Cardiology, St-Josef Hospital, Ruhr University, Bochum, Germany
| | - Djamel Lebeche
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Cardiovascular Research Institute, New York, NY 10029, USA.,Department of Medicine, Diabetes, Obesity and Metabolism Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,Department of Medicine, Graduate School of Biological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Carsten Tschöpe
- Berlin Institute of Health Center for Regenerative Therapies and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany.,REBIRTH Center for Translational Regenerative Medicine, Hannover Medical School, Hannover, Germany.,Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover 30625, Germany
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, Schlieren CH-8952, Switzerland.,University Heart Center, Cardiology, University Hospital Zurich, Zürich, Switzerland.,Department of Research and Education, University Hospital Zurich, Zürich, Switzerland
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16
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Koniari I, Artopoulou E, Velissaris D, Kounis N, Tsigkas G. Atrial fibrillation in patients with systolic heart failure: pathophysiology mechanisms and management. J Geriatr Cardiol 2021; 18:376-397. [PMID: 34149826 PMCID: PMC8185445 DOI: 10.11909/j.issn.1671-5411.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Heart failure (HF) and atrial fibrillation (AF) demonstrate a constantly increasing prevalence during the 21st century worldwide, as a result of the aging population and the successful interventions of the clinical practice in the deterioration of adverse cardiovascular outcomes. HF and AF share common risk factors and pathophysiological mechanisms, creating the base of a constant interrelation. AF impairs systolic and diastolic function, resulting in the increasing incidence of HF, whereas the structural and neurohormonal changes in HF with preserved or reduced ejection fraction increase the possibility of the AF development. The temporal relationship of the development of either condition affects the diagnostic algorithms, the prognosis and the ideal therapeutic strategy that leads to euvolaemia, management of non-cardiovascular comorbidities, control of heart rate or restoration of sinus rate, ventricular synchronization, prevention of sudden death, stroke, embolism, or major bleeding and maintenance of a sustainable quality of life. The indicated treatment for the concomitant HF and AF includes rate or/and rhythm control as well as thromboembolism prophylaxis, while the progress in the understanding of their pathophysiological interdependence and the introduction of the genetic profiling, create new paths in the diagnosis, the prognosis and the prevention of these diseases.
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Affiliation(s)
- Ioanna Koniari
- Manchester Heart Institute, Manchester University Foundation Trust, Manchester, United Kingdom
| | - Eleni Artopoulou
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | | | - Nicholas Kounis
- Department of Cardiology, University Hospital of Patras, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, Patras, Greece
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17
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Maas AHEM, Rosano G, Cifkova R, Chieffo A, van Dijken D, Hamoda H, Kunadian V, Laan E, Lambrinoudaki I, Maclaran K, Panay N, Stevenson JC, van Trotsenburg M, Collins P. Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists. Eur Heart J 2021; 42:967-984. [PMID: 33495787 PMCID: PMC7947184 DOI: 10.1093/eurheartj/ehaa1044] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman’s risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).
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Affiliation(s)
- Angela H E M Maas
- Department of Cardiology, Director Women's Cardiac Health Program, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Route 616, 6525GA Nijmegen, The Netherlands
| | - Giuseppe Rosano
- St George's Hospitals NHS Trust University of London, Cranmer Terrace, London SW17 0RE, UK.,Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235 Rome, Italy
| | - Renata Cifkova
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Vídeňská 800, 140 59 Prague 4, Czech Republic.,Department of Internal Cardiovascular Medicine, First Medical Faculty, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Olgettina Street, 60 - 20132 Milan (Milan), Italy
| | - Dorenda van Dijken
- Department of Obstetrics and Gynaecology, OLVG location West, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands
| | - Haitham Hamoda
- Department Gynaecology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, M4:146 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
| | - Ellen Laan
- Department of Sexology and Psychosomatic Gynaecology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Irene Lambrinoudaki
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, 30 Panepistimiou Str., 10679 Athens, Greece
| | - Kate Maclaran
- Department Gynaecology, Chelsea and Westminster Hospital, NHS Foundation Trust, 69 Fulham Road London SW10 9NH, UK
| | - Nick Panay
- Department of Gynaecology, Queen Charlotte's & Chelsea and Westminster Hospitals, Imperial College, Du Cane Road, London W12 0HS, UK
| | - John C Stevenson
- Department of Cardiology, National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Mick van Trotsenburg
- Bureau Gender PRO Vienna and Department of Obstetrics and Gynaecology, University Hospital St. Poelten-Lilienfeld, Probst Führer Straße 4 · 3100 St. Pölten, Austria
| | - Peter Collins
- Department of Cardiology, National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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18
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Motiejūnaitė J, Akiyama E, Cohen-Solal A, Maggioni AP, Mueller C, Choi DJ, Kavoliūnienė A, Čelutkienė J, Parenica J, Lassus J, Kajimoto K, Sato N, Miró Ò, Peacock WF, Matsue Y, Voors AA, Lam CSP, Ezekowitz JA, Ahmed A, Fonarow GC, Gayat E, Regitz-Zagrosek V, Mebazaa A. The association of long-term outcome and biological sex in patients with acute heart failure from different geographic regions. Eur Heart J 2021; 41:1357-1364. [PMID: 32125360 DOI: 10.1093/eurheartj/ehaa071] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/11/2019] [Accepted: 02/03/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Recent data from national registries suggest that acute heart failure (AHF) outcomes might vary in men and women, however, it is not known whether this observation is universal. The aim of this study was to evaluate the association of biological sex and 1-year all-cause mortality in patients with AHF in various regions of the world. METHODS AND RESULTS We analysed several AHF cohorts including GREAT registry (22 523 patients, mostly from Europe and Asia) and OPTIMIZE-HF (26 376 patients from the USA). Clinical characteristics and medication use at discharge were collected. Hazard ratios (HRs) for 1-year mortality according to biological sex were calculated using a Cox proportional hazards regression model with adjustment for baseline characteristics (e.g. age, comorbidities, clinical and laboratory parameters at admission, left ventricular ejection fraction). In the GREAT registry, women had a lower risk of death in the year following AHF [HR 0.86 (0.79-0.94), P < 0.001 after adjustment]. This was mostly driven by northeast Asia [n = 9135, HR 0.76 (0.67-0.87), P < 0.001], while no significant differences were seen in other countries. In the OPTIMIZE-HF registry, women also had a lower risk of 1-year death [HR 0.93 (0.89-0.97), P < 0.001]. In the GREAT registry, women were less often prescribed with a combination of angiotensin-converting enzyme inhibitors and beta-blockers at discharge (50% vs. 57%, P = 0.001). CONCLUSION Globally women with AHF have a lower 1-year mortality and less evidenced-based treatment than men. Differences among countries need further investigation. Our findings merit consideration when designing future global clinical trials in AHF.
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Affiliation(s)
- Justina Motiejūnaitė
- Inserm UMR-S 942 MASCOT, Hôpital Lariboisière - Bâtiment Viggo Petersen 41, boulevard de la Chapelle, 75475 Paris Cedex 10, France.,Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010 Paris, France.,Department of Cardiology, Lithuanian University of Health Sciences Kaunas Clinics, 2 Eivenių street 2 LT-50009 Kaunas, Lithuania
| | - Eiichi Akiyama
- Inserm UMR-S 942 MASCOT, Hôpital Lariboisière - Bâtiment Viggo Petersen 41, boulevard de la Chapelle, 75475 Paris Cedex 10, France.,Division of Cardiology, Yokohama City University Medical Center, 4 Chome-57, 〒 232-0024 Kanagawa, Yokohama, Minami Ward, Urafunecho, Japan
| | - Alain Cohen-Solal
- Inserm UMR-S 942 MASCOT, Hôpital Lariboisière - Bâtiment Viggo Petersen 41, boulevard de la Chapelle, 75475 Paris Cedex 10, France.,Department of Cardiology, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010 Paris, France.,Université de Paris, 16 Rue Henri Huchard, 75018 Paris, France
| | | | - Christian Mueller
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Dong-Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea
| | - Aušra Kavoliūnienė
- Department of Cardiology, Lithuanian University of Health Sciences Kaunas Clinics, 2 Eivenių street 2 LT-50009 Kaunas, Lithuania
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, 2 Santariskiu Street, LT-08661 Bilnius, Lithuania
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno and Medical Faculty, Masaryk University, Kamenice 5, 625 00 Bohunice, Czech Republic
| | - Johan Lassus
- Cardiology, Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki University, Haartmaninkatu 4 Rakennus 1, 00290 Helsinki, Finland
| | - Katsuya Kajimoto
- Division of Cardiology, Sekikawa Hospital, 1 Chome-4-1 Nishinippori, Arakawa City, Tokyo 116-0013, Japan
| | - Naoki Sato
- Division of Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, 1 Chome-396 Kosugimachi, Nakahara Ward, Kawasaki, Kanagawa 211-8533, Japan
| | - Òscar Miró
- Emergency Department, Hospital Clinic and "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, Carrer del Rosselló, 149, 08036 Barcelona, Spain.,University of Barcelona, Gran Via de les Corts Catalanes, 585 08007 Barcelona, Spain
| | - W Frank Peacock
- Emergency Department, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Yuya Matsue
- Department of Cardiovascular Medicine, Juntendo University, 3 Chome-1-3 Hongo, Bunkyo City, Tokyo 113-8431, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 3 Chome-1-3 Hongo, Bunkyo City, Tokyo 113-8431, Japan
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Carolyn S P Lam
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.,National Heart Centre, 5 Hospital Dr, Singapore 169609, Singapore.,Duke-National University of Singapore, 8 College Rd, Singapore 169857, Singapore
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, Katz Group Centre for Pharmacy and Health Research, University of Alberta, 4-120, Edmonton, AB T6G, Canada
| | - Ali Ahmed
- Department of Medicine, Center for Health and Aging, Veterans Affairs Medical Center, George Washington University, 2121 I St NW, Washington, DC 20052, USA
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, 100 Medical Plaza Driveway, Los Angeles, CA 90095, USA
| | - Etienne Gayat
- Inserm UMR-S 942 MASCOT, Hôpital Lariboisière - Bâtiment Viggo Petersen 41, boulevard de la Chapelle, 75475 Paris Cedex 10, France.,Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010 Paris, France.,Université de Paris, 16 Rue Henri Huchard, 75018 Paris, France
| | - Vera Regitz-Zagrosek
- Center for Gender in Medicine (GIM), Center for Cardiovascular Research, (CCR), Charite - Universitaetsmedizin Berlin, DZHK Partner Site Berlin, Charitépl. 1, 10117 Berlin, Germany
| | - Alexandre Mebazaa
- Inserm UMR-S 942 MASCOT, Hôpital Lariboisière - Bâtiment Viggo Petersen 41, boulevard de la Chapelle, 75475 Paris Cedex 10, France.,Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010 Paris, France.,Université de Paris, 16 Rue Henri Huchard, 75018 Paris, France
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19
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Pan Y, Xu L, Yang X, Chen M, Gao Y. The common characteristics and mutual effects of heart failure and atrial fibrillation: initiation, progression, and outcome of the two aging-related heart diseases. Heart Fail Rev 2021; 27:837-847. [PMID: 33768377 DOI: 10.1007/s10741-021-10095-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation (AF) and heart failure (HF) are common chronic diseases noted in humans. AF and HF share several risk factors, such as age, hypertension, obesity, diabetes, and dyslipidemia. They can interact with each other, while both their morbidity and mortality have been considerably increased. And AF and HF often occur together, suggesting a strong association between the two. However, the underlying mechanism behind this association is not well understood. Among them, aging is the most significant common risk factor, which represents an aging heart and is characterized by fibrosis and decreased number of cardiomyocytes, known as senescence-related cardiac remodeling for both atria and ventricles. Finally, it is proposed that cardiac remodeling is the key link between AF and HF.
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Affiliation(s)
- Yuxia Pan
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Li Xu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xinchun Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Mulei Chen
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Yuanfeng Gao
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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20
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Abstract
Cardiovascular diseases show many sex-related differences in prevalence, etiology, phenotype expression, and outcomes. Complex molecular mechanisms underlie this diverse pathological manifestation, from sex-determined differential gene expression to sex hormones interaction with their specific receptors in different tissues. More recently, differential non-coding RNAs regulation also turned out to be an involved mechanism. This review focuses on sex impact on the various heart failure syndromes, including coronary artery disease, heart failure with preserved ejection fraction and with reduced ejection fraction, with particular attention to dilated cardiomyopathy. Despite similar genetic predisposition in terms of identified causative mutations, other causes, such as cardiotoxic drugs exposure or stress-induced cardiomyopathy, are more prevalent in women. Beyond this, differences in disease presentation and natural history reveal a more severe clinical onset with otherwise better long-term outcomes in women compared to men. Understanding the varying characteristics of disease manifestation and outcomes is warranted for a prompt and tailored treatment for both men and women. This is a mandatory step in the road to the personalized medicine. Moreover, despite a higher enrollment in the last years, the under-representation of females in clinical trials is the first obstacle to overcome in the long way to develop appropriate sex-based therapy approach.
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21
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Boudagh S, Alizadehasl A, Bakhshandeh H, Sadeghipour P, Mohebbi B, Baay M, Alemzadeh-Ansari M, Hosseini Z, Norouzi Z, Maleki M, Noohi F, Khalili Y, Naderi N, Pouraliakbar H, Ghadrdoost B, Arabian M, Khaleghparast S. Normal values of echocardiographic parameters and incidence of valvular heart findings in 2229 iranian peaple: Results from the “HAMRAH survey”. Res Cardiovasc Med 2021. [DOI: 10.4103/rcm.rcm_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Florea V, Rieger AC, Natsumeda M, Tompkins BA, Banerjee MN, Schulman IH, Premer C, Khan A, Valasaki K, Heidecker B, Mantero A, Balkan W, Mitrani RD, Hare JM. The impact of patient sex on the response to intramyocardial mesenchymal stem cell administration in patients with non-ischaemic dilated cardiomyopathy. Cardiovasc Res 2020; 116:2131-2141. [PMID: 32053144 PMCID: PMC7584465 DOI: 10.1093/cvr/cvaa004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 10/31/2019] [Accepted: 02/05/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Sex differences impact the occurrence, presentation, prognosis, and response to therapy in heart disease. Particularly, the phenotypic presentation of patients with non-ischaemic dilated cardiomyopathy (NIDCM) differs between men and women. However, whether the response to mesenchymal stem cell (MSC) therapy is influenced by sex remains unknown. We hypothesize that males and females with NIDCM respond similarly to MSC therapy. METHODS AND RESULTS Male (n = 24) and female (n = 10) patients from the POSEIDON-DCM trial who received MSCs via transendocardial injections were evaluated over 12 months. Endothelial function was measured at baseline and 3 months post-transendocardial stem cell injection (TESI). At baseline, ejection fraction (EF) was lower (P = 0.004) and end-diastolic volume (EDV; P = 0.0002) and end-systolic volume (ESV; P = 0.0002) were higher in males vs. females. In contrast, baseline demographic characteristics, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and 6-min walk test (6MWT) were similar between groups. EF improved in males by 6.2 units (P = 0.04) and in females by 8.6 units (P = 0.04; males vs. females, P = 0.57). EDV and ESV were unchanged over time. The MLHFQ score, New York Heart Association (NYHA) class, endothelial progenitor cell-colony forming units, and serum tumour necrosis factor alpha improved similarly in both groups. CONCLUSION Despite major differences in phenotypic presentation of NIDCM in males and females, this study is the first of its kind to demonstrate that MSC therapy improves a variety of parameters in NIDCM irrespective of patient sex. These findings have important clinical and pathophysiologic implications regarding the impact of sex on responses to cell-based therapy for NIDCM.
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Affiliation(s)
- Victoria Florea
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Angela C Rieger
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Makoto Natsumeda
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Bryon A Tompkins
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Monisha N Banerjee
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ivonne H Schulman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Courtney Premer
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Krystalenia Valasaki
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
| | - Bettina Heidecker
- Department of Cardiology, Charite Berlin University of Medicine, Berlin, Germany
| | - Alejandro Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Wayne Balkan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Raul D Mitrani
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Biomedical Research Building - 9th Floor 1501 NW 10th Ave, Miami, FL 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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23
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O’Kelly AC, Honigberg MC. Sex Differences in Cardiovascular Disease and Unique Pregnancy-Associated Risk Factors in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00860-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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24
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Sex and Gender Differences in Heart Failure. ACTA ACUST UNITED AC 2020; 2:157-181. [PMID: 36262368 PMCID: PMC9536682 DOI: 10.36628/ijhf.2020.0004] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 01/04/2023]
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25
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Merrill M, Sweitzer NK, Lindenfeld J, Kao DP. Sex Differences in Outcomes and Responses to Spironolactone in Heart Failure With Preserved Ejection Fraction: A Secondary Analysis of TOPCAT Trial. JACC. HEART FAILURE 2019; 7:228-238. [PMID: 30819379 PMCID: PMC6817333 DOI: 10.1016/j.jchf.2019.01.003] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/11/2019] [Accepted: 01/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to investigate sex differences in outcomes and responses to spironolactone in patients with heart failure with preserved ejection fraction (HFpEF). BACKGROUND HFpEF affects women more frequently than men. Sex differences in responses to effects of mineralocorticoid antagonists have not been reported. METHODS This was an exploratory, post hoc, non-pre-specified analysis of the TOPCAT (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function) trial. Subjects with symptomatic HF and a left ventricular ejection fraction ≥45% were randomized to spironolactone or placebo therapy. Subjects enrolled from the Americas were analyzed. The primary outcome was a composite of cardiovascular (CV) death, cardiac arrest, or HF hospitalization. Secondary outcomes included all-cause mortality, CV, and non-CV mortality and CV, HF, and non-CV hospitalization. Sex differences in outcomes and treatment effects were determined using time-to-event analysis. RESULTS In total, 882 of 1,767 subjects (49.9%) were women. Women were older with fewer comorbidities but worse patient-reported outcomes. There were no sex differences in outcomes in the placebo arm or in response to spironolactone for the primary outcome or its components. Spironolactone therapy was associated with reduced all-cause mortality in women (hazard ratio: 0.66; p = 0.01) but not in men (pinteraction = 0.02). CONCLUSIONS In TOPCAT, women and men presented with different clinical profiles and similar clinical outcomes. The interaction between spironolactone and sex in TOPCAT overall and in the present analysis was nonsignificant for the primary outcome, but there was a reduction in all-cause mortality associated with spironolactone therapy in women, with a significant interaction between sex and treatment arm. Prospective evaluation is needed to determine whether spironolactone therapy may be effective for treatment of HFpEF in women. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302).
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Affiliation(s)
- Miranda Merrill
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Nancy K Sweitzer
- Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
| | - David P Kao
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.
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26
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Abstract
Atrial fibrillation often occurs as a cause or consequence of heart failure. Clinical outcomes are worse when atrial fibrillation and heart failure coexist. There are important sex-related differences in the incidence, prevalence, pathophysiology, treatment, and outcomes of these patients. Women with heart failure are at greater risk of developing atrial fibrillation than men, and more women with atrial fibrillation develop heart failure. More women die of atrial fibrillation-related strokes. Despite significant morbidity and mortality, current treatments for women are inadequate. This review explores sex differences in atrial fibrillation and heart failure, emphasizing risk stratification and treatments to improve clinical outcomes.
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Affiliation(s)
- Nidhi Madan
- Department of Medicine, Cardiology Division, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Dipti Itchhaporia
- Department of Medicine, Cardiology Division, Hoag Memorial Hospital, University of California, Irvine, 520 Superior Avenue, Newport Beach, CA 92663, USA
| | - Christine M Albert
- Department of Medicine, Cardiology Division, Brigham and Women's Medical Center, 75 Francis Street Towers 3a, Boston, MA 02115, USA
| | - Neelum T Aggarwal
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison, Suite 1000, Chicago, IL 60612, USA
| | - Annabelle Santos Volgman
- Department of Medicine, Cardiology Division, Rush University Medical Center, 1725 W. Harrison Street, Room 1159, Chicago, IL 60612, USA.
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27
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Chaudhari S, Cushen SC, Osikoya O, Jaini PA, Posey R, Mathis KW, Goulopoulou S. Mechanisms of Sex Disparities in Cardiovascular Function and Remodeling. Compr Physiol 2018; 9:375-411. [PMID: 30549017 DOI: 10.1002/cphy.c180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies demonstrate disparities between men and women in cardiovascular disease prevalence, clinical symptoms, treatments, and outcomes. Enrollment of women in clinical trials is lower than men, and experimental studies investigating molecular mechanisms and efficacy of certain therapeutics in cardiovascular disease have been primarily conducted in male animals. These practices bias data interpretation and limit the implication of research findings in female clinical populations. This review will focus on the biological origins of sex differences in cardiovascular physiology, health, and disease, with an emphasis on the sex hormones, estrogen and testosterone. First, we will briefly discuss epidemiological evidence of sex disparities in cardiovascular disease prevalence and clinical manifestation. Second, we will describe studies suggesting sexual dimorphism in normal cardiovascular function from fetal life to older age. Third, we will summarize and critically discuss the current literature regarding the molecular mechanisms underlying the effects of estrogens and androgens on cardiac and vascular physiology and the contribution of these hormones to sex differences in cardiovascular disease. Fourth, we will present cardiovascular disease risk factors that are positively associated with the female sex, and thus, contributing to increased cardiovascular risk in women. We conclude that inclusion of both men and women in the investigation of the role of estrogens and androgens in cardiovascular physiology will advance our understanding of the mechanisms underlying sex differences in cardiovascular disease. In addition, investigating the role of sex-specific factors in the development of cardiovascular disease will reduce sex and gender disparities in the treatment and diagnosis of cardiovascular disease. © 2019 American Physiological Society. Compr Physiol 9:375-411, 2019.
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Affiliation(s)
- Sarika Chaudhari
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Paresh A Jaini
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rachel Posey
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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28
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Galati A, Piccoli M, Tourkmani N, Sgorbini L, Rossetti A, Cugusi L, Bellotto F, Mercuro G, Abreu A, D’Ascenzi F. Cardiac rehabilitation in women. J Cardiovasc Med (Hagerstown) 2018; 19:689-697. [DOI: 10.2459/jcm.0000000000000730] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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29
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Pai P, Shibu MA, Chang RL, Yang JJ, Su CC, Lai CH, Liao HE, Viswanadha VP, Kuo WW, Huang CY. ERβ targets ZAK and attenuates cellular hypertrophy via SUMO-1 modification in H9c2 cells. J Cell Biochem 2018; 119:7855-7864. [PMID: 29932238 DOI: 10.1002/jcb.27199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/24/2018] [Indexed: 11/11/2022]
Abstract
Aberrant expression of leucine zipper- and sterile ɑ motif-containing kinase (ZAK) observed in pathological human myocardial tissue is associated with the progression and elevation of hypertrophy. Our previous reports have correlated high levels of estrogen (E2) and abundant estrogen receptor (ER) α with a low incidence of pathological cardiac-hypertrophy and heart failure in the premenopause female population. However, the effect of elevated ERβ expression is not well known yet. Therefore, in this study, we have analyzed the cardioprotective effects and mechanisms of E2 and/or ERβ against ZAK overexpression-induced cellular hypertrophy. We have used transient transfection to overexpress ERβ into the ZAK tet-on H9c2 cells that harbor the doxycycline-inducible ZAK plasmid. The results show that ZAK overexpression in H9c2 cells resulted in hypertrophic effects, which was correlated with the upregulation of p-JNK and p-p38 MAPKs and their downstream transcription factors c-Jun and GATA-4. However, ERβ and E2 with ERβ overexpressions totally suppressed the effects of ZAK overexpression and inhibited the levels of p-JNK, p-p38, c-Jun, and GATA-4 effectively. Our results further reveal that ERβ directly binds with ZAK under normal conditions; however, ZAK overexpression reduced the association of ZAK-ERβ. Interestingly, increase in ERβ and E2 along with ERβ overexpression both enhanced the binding strengths of ERβ and ZAK and reduced the ZAK protein level. ERβ overexpression also suppressed the E3 ligase-casitas B-lineage lymphoma (CBL) and attenuated CBL-phosphoinositide 3-kinase (PI3K) protein association to prevent PI3K protein degradation. Moreover, ERβ and/or E2 blocked ZAK nuclear translocation via the inhibition of small ubiquitin-like modifier (SUMO)-1 modification. Taken together, our results further suggest that ERβ overexpression strongly suppresses ZAK-induced cellular hypertrophy and myocardial damage.
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Affiliation(s)
- Peiying Pai
- Division of Cardiology, China Medical University Hospital, Taichung, Taiwan
| | | | - Ruey-Lin Chang
- College of Chinese Medicine, School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Jaw-Ji Yang
- Institute of Medicine, School of Dentistry, Chung-Shan Medical University, Taichung, Taiwan
| | - Chia-Chi Su
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Chao-Hung Lai
- Division of Cardiology, Department of Internal Medicine, Taichung Armed Force General Hospital, Taichung, Taiwan
| | - Hung-En Liao
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | | | - Wei-Wen Kuo
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Chih-Yang Huang
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan.,Department of Biotechnology, Asia University, Taichung, Taiwan.,Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan
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Cífková R. Left ventricular hypertrophy in females with hypertension is associated with a poor prognosis. Int J Cardiol 2018; 258:277-278. [PMID: 29544943 DOI: 10.1016/j.ijcard.2018.01.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/22/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic; Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Czech Republic.
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Kim MN, Shim JM, Choi JI, Park SM, Kim YH, Shim WJ. Evaluation of sex differences in the relationship between diastolic dysfunction and thromboembolism using propensity score analysis. Echocardiography 2018; 35:817-826. [PMID: 29460490 DOI: 10.1111/echo.13843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Female sex is a risk factor for thromboembolism (TE) in atrial fibrillation (AF); however, the underlying mechanisms are unclear. We postulated that left ventricular (LV) diastolic dysfunction (LVDD) could be associated with increased thromboembolic risk in women. METHODS From a retrospective cohort, 158 patients (female : male = 79:79) with nonvalvular AF were propensity score-matched for age, presence of diabetes, hypertension, coronary artery disease, congestive heart failure, embolic history, AF type, and AF duration. Cardiac size and function and central aortic stiffness parameters were evaluated. Diastolic function was classified as normal, indeterminate, and LVDD according to recent guidelines. Surrogate markers for thromboembolism (dense spontaneous echo contrast and thrombus) were evaluated using transesophageal echocardiography. RESULTS Surrogate markers for TE showed a trend to be more frequent in women than in men (21.5% vs 11.4%, P = .086). LVDD was more prevalent in women than in men (22.8% vs 2.5%, P < .001); however, the prevalence of indeterminate diastolic function was not different between sexes (26.6% vs 20.3%, P = .453). Surrogate markers for TE were detected mostly in women with LVDD. LV diastolic parameters showed a restrictive pattern, and aortic stiffness parameters were worse in women than in men. Women with LVDD had increased aortic stiffness compared to women with indeterminate and normal function, whereas aortic stiffness did not differ among men in all groups. Significant relations between LV diastolic function and aortic stiffness parameters were observed only in women. CONCLUSION LVDD due to increased aortic stiffness could be related to a higher thromboembolic risk in women with AF.
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Affiliation(s)
- Mi-Na Kim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Jae-Min Shim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Young Hoon Kim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Wan Joo Shim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
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Hong S, Lee JH, Kim KM, Lee JW, Youn YJ, Ahn MS, Ahn SG, Lee SH, Yoon J, Choe KH, Yoo BS. Is There a Sex-Related Difference in the Obesity Paradox in Systolic Heart Failure? Sex-Related Difference in the Obesity Paradox. Yonsei Med J 2018; 59:57-62. [PMID: 29214777 PMCID: PMC5725365 DOI: 10.3349/ymj.2018.59.1.57] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/11/2017] [Accepted: 09/09/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Obesity is often associated with better clinical outcomes in heart failure (HF). This so-called obesity paradox remains controversial. The aim of present study was to investigate the prognostic value of obesity in patients hospitalized for systolic HF. MATERIALS AND METHODS We performed a pooled analysis of data from two multicenter, observational HF studies. Patients hospitalized for systolic HF were eligible for the present study. We divided the subjects into two groups, a normal body mass index (BMI) group and a high BMI group. Study endpoints included all-cause mortality and any re-hospitalization within 1 year. RESULTS We enrolled 3145 patients (male, 1824; female, 1321). The high BMI group was significantly associated with lower 1-year mortality rate [odds ratio (OR), 0.543; 95% confidence interval (CI), 0.355-0.832] after adjusting for age, hypertension, diabetes, ischemic HF, previous myocardial infarction, serum creatinine level, anemia, and ejection fraction in men. After adjustment for clinical characteristics, high BMI was not significantly associated with 1-year mortality (OR, 0.739; 95% CI, 0.450-1.216) or 1-year re-hospitalization (OR, 0.958; 95% CI, 0.696-1.319) in women. CONCLUSION In pooled analysis of data from two Korean HF registries, the high BMI group was independently associated with lower 1-year mortality rate from systolic HF, especially in men.
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Affiliation(s)
- Soonchang Hong
- Department of Thoracic and Cardiovascular Surgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Ji Hyun Lee
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kyung Min Kim
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jun Won Lee
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Young Jin Youn
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Min Soo Ahn
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sung Gyun Ahn
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Seung Hwan Lee
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Junghan Yoon
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kyung Hoon Choe
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Byung Su Yoo
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea.
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Hosseinsabet A, Mohseni-Badalabadi R, Jalali A. Two-dimensional speckle-tracking echocardiography evaluation of left atrial function according to glycemic state in patients with coronary artery disease. Cardiovasc Endocrinol 2017; 6:101-108. [PMID: 31646126 PMCID: PMC6768513 DOI: 10.1097/xce.0000000000000127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/23/2017] [Indexed: 11/26/2022] Open
Abstract
Prediabetes and diabetes are dysglycemic conditions associated with increased cardiovascular risks and subtle myocardial injuries. The aim of our study was to evaluate left atrial (LA) function by two-dimensional speckle-tracking echocardiography in prediabetic and diabetic patients with coronary artery disease (CAD) and compare the results with those in euglycemic patients with CAD. METHODS The study population comprised 205 consecutive patients with CAD: 104 diabetic, 51 prediabetic, and 50 euglycemic patients. LA function was evaluated with two-dimensional speckle-tracking echocardiography and the longitudinal deformation indices of the LA were measured. RESULTS Our results showed that early diastolic strain was lower in the diabetic patients than in the prediabetic and euglycemic patients. The absolute value of early diastolic strain rate was reduced in the diabetic patients compared with the euglycemic patients. Late diastolic strain was increased in the diabetic patients compared with the prediabetic and euglycemic patients. The multivariate analysis showed that diabetes was a determinant of early diastolic strain and strain rate, but not late diastolic strain. CONCLUSION LA conduit function, as evaluated in terms of early diastolic strain and strain rate, was impaired in the diabetic CAD patients compared with the prediabetic and euglycemic CAD patients.
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Affiliation(s)
| | | | - Arash Jalali
- Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Hoshida S, Shinoda Y, Ikeoka K, Minamisaka T, Fukuoka H, Inui H, Watanabe T. Fluctuation of Dynamic Diastolic Function Relative to Static Cardiac Structure - New Insights Into the Underlying Mechanism of Heart Failure With Preserved Ejection Fraction in Elderly Patients. Circ J 2017; 81:755-758. [PMID: 28132965 DOI: 10.1253/circj.cj-16-1126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The mechanisms of heart failure with preserved ejection fraction (HFpEF) need to be clarified immediately.Methods and Results:We examined diastolic function relative to arterial elasticity among hypertensive patients with preserved EF. Diastolic elastance (EdI)/effective arterial elastance (EaI), EdI/EaI=E/e'/(0.9×systolic blood pressure [SBP]) was significantly more impaired in women than in men among patients ≥75 years. The higher EdI/EaI value in elderly women implies they are intermittently exposed to higher left ventricular filling pressure relative to SBP during daily life. CONCLUSIONS Highly fluctuating impairment of diastolic function relative to arterial elasticity may predispose elderly women to pulmonary edema.
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Affiliation(s)
- Shiro Hoshida
- Department of Cardiovascular Medicine, Yao Municipal Hospital
| | | | - Kuniyasu Ikeoka
- Department of Cardiovascular Medicine, Yao Municipal Hospital
| | | | | | - Hirooki Inui
- Department of Cardiovascular Medicine, Yao Municipal Hospital
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Heo S, Moser DK, Pressler SJ, Dunbar SB, Lee KS, Kim J, Lennie TA. Association between obesity and heart failure symptoms in male and female patients. Clin Obes 2017; 7:77-85. [PMID: 28117927 PMCID: PMC6106864 DOI: 10.1111/cob.12179] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/14/2016] [Accepted: 09/18/2016] [Indexed: 11/30/2022]
Abstract
In patients with heart failure (HF), higher body mass index (BMI) has been associated with lower rates of hospitalization and mortality (obesity paradox). Symptoms are antecedents of hospitalizations, but little is known about the relationship between BMI and symptoms and gender differences. To examine the association of BMI with symptoms in male and female patients with HF, controlling for covariates (sample characteristics, depressive symptoms and sodium intake). In this cross-sectional correlational study, patients (N = 247) provided data on BMI, symptoms and covariates. BMI was categorized into four groups: normal/underweight (<25 kg/m2 ), overweight (25-29.9 kg/m2 ), obese I (30-34.9 kg/m2 ) and obese II/III (≥35 kg/m2 ). General linear regression was used to analyse the data. The Obese II/III group had more severe HF symptoms than other groups only in male patients. In male patients, older age, Caucasian race, more comorbidities and more severe depressive symptoms were also associated with more severe symptoms. In female patients, more severe depressive symptoms, more comorbidities and higher sodium intake were associated with more severe symptoms. The obesity paradox does not fully extend to symptoms, and gender has a role in the relationship between obesity and symptoms.
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Affiliation(s)
- S Heo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - D K Moser
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - S J Pressler
- School of Nursing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - S B Dunbar
- School of Nursing, Emory University, Atlanta, GA, USA
| | - K S Lee
- College of Nursing, Chungnam National University, Dea Jeon, South Korea
| | - J Kim
- Gachon University, College of Nursing, Incheon, South Korea
| | - T A Lennie
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Regitz-Zagrosek V, Kararigas G. Mechanistic Pathways of Sex Differences in Cardiovascular Disease. Physiol Rev 2017; 97:1-37. [PMID: 27807199 DOI: 10.1152/physrev.00021.2015] [Citation(s) in RCA: 395] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Major differences between men and women exist in epidemiology, manifestation, pathophysiology, treatment, and outcome of cardiovascular diseases (CVD), such as coronary artery disease, pressure overload, hypertension, cardiomyopathy, and heart failure. Corresponding sex differences have been studied in a number of animal models, and mechanistic investigations have been undertaken to analyze the observed sex differences. We summarize the biological mechanisms of sex differences in CVD focusing on three main areas, i.e., genetic mechanisms, epigenetic mechanisms, as well as sex hormones and their receptors. We discuss relevant subtypes of sex hormone receptors, as well as genomic and nongenomic, activational and organizational effects of sex hormones. We describe the interaction of sex hormones with intracellular signaling relevant for cardiovascular cells and the cardiovascular system. Sex, sex hormones, and their receptors may affect a number of cellular processes by their synergistic action on multiple targets. We discuss in detail sex differences in organelle function and in biological processes. We conclude that there is a need for a more detailed understanding of sex differences and their underlying mechanisms, which holds the potential to design new drugs that target sex-specific cardiovascular mechanisms and affect phenotypes. The comparison of both sexes may lead to the identification of protective or maladaptive mechanisms in one sex that could serve as a novel therapeutic target in one sex or in both.
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Affiliation(s)
- Vera Regitz-Zagrosek
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Georgios Kararigas
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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Alma LJ, Bokslag A, Maas AHEM, Franx A, Paulus WJ, de Groot CJM. Shared biomarkers between female diastolic heart failure and pre-eclampsia: a systematic review and meta-analysis. ESC Heart Fail 2017; 4:88-98. [PMID: 28451444 PMCID: PMC5396047 DOI: 10.1002/ehf2.12129] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/25/2016] [Accepted: 11/15/2016] [Indexed: 12/11/2022] Open
Abstract
Evidence accumulates for associations between hypertensive pregnancy disorders and increased cardiovascular risk later. The main goal of this study was to explore shared biomarkers representing common pathogenic pathways between heart failure with preserved ejection fraction (HFpEF) and pre‐eclampsia where these biomarkers might be potentially eligible for cardiovascular risk stratification in women after hypertensive pregnancy disorders. We sought for blood markers in women with diastolic dysfunction in a first literature search, and through a second search, we investigated whether these same biochemical markers were present in pre‐eclampsia.This systematic review and meta‐analysis presents two subsequent systematic searches in PubMed and EMBASE. Search I yielded 3014 studies on biomarkers discriminating women with HFpEF from female controls, of which 13 studies on 11 biochemical markers were included. Cases had HFpEF, and controls had no heart failure. The second search was for studies discriminating women with pre‐eclampsia from women with non‐hypertensive pregnancies with at least one of the biomarkers found in Search I. Search II yielded 1869 studies, of which 51 studies on seven biomarkers were included in meta‐analyses and 79 studies on 12 biomarkers in systematic review.Eleven biological markers differentiated women with diastolic dysfunction from controls, of which the following 10 markers differentiated women with pre‐eclampsia from controls as well: C‐reactive protein, HDL, insulin, fatty acid‐binding protein 4, brain natriuretic peptide, N terminal pro brain natriuretic peptide, adrenomedullin, mid‐region pro adrenomedullin, cardiac troponin I, and cancer antigen 125.Our study supports the hypothesis that HFpEF in women shares a common pathogenic background with pre‐eclampsia. The biomarkers representing inflammatory state, disturbances in myocardial function/structure, and unfavourable lipid metabolism may possibly be eligible for future prognostic tools.
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Affiliation(s)
- Lisa J Alma
- Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands
| | - Anouk Bokslag
- Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands
| | - Angela H E M Maas
- Department of CardiologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
| | - Arie Franx
- Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Walter J Paulus
- Department of PhysiologyVU University Medical CenterAmsterdamThe Netherlands
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Hosseinsabet A, Mohseni-Badalabadi R, Moinfar A. Impaired Left Atrial Conduit Function in Coronary Artery Disease Patients With Poorly Controlled Diabetes: Two-Dimensional Speckle-Tracking Echocardiographic Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:13-23. [PMID: 27925659 DOI: 10.7863/ultra.15.12065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/03/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The myocardium can be affected by diabetes mellitus. The effects of blood glucose control on some organs such as the kidney and eye have been previously reported. The aim of our study was to evaluate left atrial function via 2-dimensional (2D) speckle-tracking echocardiography in a group of coronary artery disease (CAD) patients with well-controlled diabetes (hemoglobin A1c [HbA1c] < 7%) and to compare it with that in a group of CAD patients with poorly controlled diabetes. METHODS This cross-sectional study included 110 CAD patients, comprising 44 euglycemic control patients, 33 patients with well-controlled diabetes (HbA1c < 7%), and 33 patients with poorly controlled diabetes. The study population thereafter underwent 2D speckle-tracking echocardiography for an evaluation of their left atrial function. RESULTS Our findings showed that the absolute values of early diastolic strain and early diastolic strain rate were lower in the CAD patients with poorly controlled diabetes than in the euglycemic control patients with CAD. Moreover, early diastolic strain in the CAD patients with poorly controlled diabetes was lower than that in the CAD patients with well-controlled diabetes. Multivariable analysis revealed that poorly controlled diabetes was an independent determinant of early diastolic strain and strain rate. CONCLUSIONS The conduit function of the left atrium was impaired in the CAD patients with poorly controlled diabetes compared with that in the euglycemic control patients with CAD and the CAD patients with well-controlled diabetes.
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Affiliation(s)
- Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran
| | - Reza Mohseni-Badalabadi
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran
| | - Ali Moinfar
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran
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Role of mineralocorticoid receptor activation in cardiac diastolic dysfunction. Biochim Biophys Acta Mol Basis Dis 2016; 1863:2012-2018. [PMID: 27989961 DOI: 10.1016/j.bbadis.2016.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/29/2016] [Accepted: 10/26/2016] [Indexed: 02/07/2023]
Abstract
The prevalence of cardiac diastolic dysfunction and heart failure with preserved ejection, a major cause of morbidity and mortality in the western world, is increasing due, in part, to increases in obesity and type 2 diabetes. Characteristics of cardiac diastolic dysfunction include increased myocardial stiffness and impaired left ventricular (LV) relaxation that is characterized by prolonged isovolumic LV relaxation and slow LV filling. Obesity, insulin resistance and type 2 diabetes, especially in females promote activation of mineralocorticoid receptor (MR) signaling with resultant increases in oxidative stress, maladaptive immune responses, inflammation, and impairment of coronary blood flow and cardiac interstitial fibrosis. This review highlights findings from the recent surge in cardiac diastolic dysfunction research. To this end it highlights our contemporary understanding of molecular mechanisms of MR regulation by genetic, epigenetic and posttranslational modifications and resultant cardiac diastolic dysfunction associated with insulin resistance, obesity and type 2 diabetes. This review also explores potential preventative and therapeutic strategies directed in the prevention of cardiac diastolic dysfunction and heart failure with preserved ejection. This article is part of a Special Issue entitled: Genetic and epigenetic control of heart failure edited by Dr. Jun Ren & Yingmei Zhang.
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Cardiovascular Disease Risk Factors in Ghana during the Rural-to-Urban Transition: A Cross-Sectional Study. PLoS One 2016; 11:e0162753. [PMID: 27732601 PMCID: PMC5061429 DOI: 10.1371/journal.pone.0162753] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/26/2016] [Indexed: 12/28/2022] Open
Abstract
Populations in sub-Saharan Africa are shifting from rural to increasingly urban. Although the burden of cardiovascular disease is expected to increase with this changing landscape, few large studies have assessed a wide range of risk factors in urban and rural populations, particularly in West Africa. We conducted a cross-sectional, population-based survey of 3317 participants from Ghana (≥18 years old), of whom 2265 (57% female) were from a mid-sized city (Sunyani, population ~250,000) and 1052 (55% female) were from surrounding villages (populations <5000). We measured canonical cardiovascular disease risk factors (BMI, blood pressure, fasting glucose, lipids) and fibrinolytic markers (PAI-1 and t-PA), and assessed how their distributions and related clinical outcomes (including obesity, hypertension and diabetes) varied with urban residence and sex. Urban residence was strongly associated with obesity (OR: 7.8, 95% CI: 5.3–11.3), diabetes (OR 3.6, 95% CI: 2.3–5.7), and hypertension (OR 3.2, 95% CI: 2.6–4.0). Among the quantitative measures, most affected were total cholesterol (+0.81 standard deviations, 95% CI 0.73–0.88), LDL cholesterol (+0.89, 95% CI: 0.79–0.99), and t-PA (+0.56, 95% CI: 0.48–0.63). Triglycerides and HDL cholesterol profiles were similarly poor in both urban and rural environments, but significantly worse among rural participants after BMI-adjustment. For most of the risk factors, the strength of the association with urban residence did not vary with sex. Obesity was a major exception, with urban women at particularly high risk (26% age-standardized prevalence) compared to urban men (7%). Overall, urban residents had substantially worse cardiovascular risk profiles, with some risk factors at levels typically seen in the developed world.
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Abstract
BACKGROUND There are several gender differences that may help explain the link between biology and symptoms in heart failure (HF). OBJECTIVE The aim of this study was to examine gender-specific relationships between objective measures of HF severity and physical symptoms. METHODS Detailed clinical data, including left ventricular ejection fraction and left ventricular internal end-diastolic diameter, and HF-specific physical symptoms were collected as part of a prospective cohort study. Gender interaction terms were tested in linear regression models of physical symptoms. RESULTS The sample (101 women and 101 men) averaged 57 years of age and most participants (60%) had class III/IV HF. Larger left ventricle size was associated with better physical symptoms for women and worse physical symptoms for men. CONCLUSION Decreased ventricular compliance may result in worse physical HF symptoms for women and dilation of the ventricle may be a greater progenitor of symptoms for men with HF.
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Pasipoularides A. Calcific Aortic Valve Disease: Part 2-Morphomechanical Abnormalities, Gene Reexpression, and Gender Effects on Ventricular Hypertrophy and Its Reversibility. J Cardiovasc Transl Res 2016; 9:374-99. [PMID: 27184804 PMCID: PMC4992466 DOI: 10.1007/s12265-016-9695-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/03/2016] [Indexed: 02/07/2023]
Abstract
In part 1, we considered cytomolecular mechanisms underlying calcific aortic valve disease (CAVD), hemodynamics, and adaptive feedbacks controlling pathological left ventricular hypertrophy provoked by ensuing aortic valvular stenosis (AVS). In part 2, we survey diverse signal transduction pathways that precede cellular/molecular mechanisms controlling hypertrophic gene expression by activation of specific transcription factors that induce sarcomere replication in-parallel. Such signaling pathways represent potential targets for therapeutic intervention and prevention of decompensation/failure. Hypertrophy provoking signals, in the form of dynamic stresses and ligand/effector molecules that bind to specific receptors to initiate the hypertrophy, are transcribed across the sarcolemma by several second messengers. They comprise intricate feedback mechanisms involving gene network cascades, specific signaling molecules encompassing G protein-coupled receptors and mechanotransducers, and myocardial stresses. Future multidisciplinary studies will characterize the adaptive/maladaptive nature of the AVS-induced hypertrophy, its gender- and individual patient-dependent peculiarities, and its response to surgical/medical interventions. They will herald more effective, precision medicine treatments.
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Affiliation(s)
- Ares Pasipoularides
- Duke University School of Medicine, Durham, NC, USA.
- Duke/NSF Research Center for Emerging Cardiovascular Technologies, Duke University, Durham, NC, 27710, USA.
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Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev 2016; 37:278-316. [PMID: 27159875 PMCID: PMC4890267 DOI: 10.1210/er.2015-1137] [Citation(s) in RCA: 1044] [Impact Index Per Article: 130.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The steep rise of type 2 diabetes mellitus (T2DM) and associated complications go along with mounting evidence of clinically important sex and gender differences. T2DM is more frequently diagnosed at lower age and body mass index in men; however, the most prominent risk factor, which is obesity, is more common in women. Generally, large sex-ratio differences across countries are observed. Diversities in biology, culture, lifestyle, environment, and socioeconomic status impact differences between males and females in predisposition, development, and clinical presentation. Genetic effects and epigenetic mechanisms, nutritional factors and sedentary lifestyle affect risk and complications differently in both sexes. Furthermore, sex hormones have a great impact on energy metabolism, body composition, vascular function, and inflammatory responses. Thus, endocrine imbalances relate to unfavorable cardiometabolic traits, observable in women with androgen excess or men with hypogonadism. Both biological and psychosocial factors are responsible for sex and gender differences in diabetes risk and outcome. Overall, psychosocial stress appears to have greater impact on women rather than on men. In addition, women have greater increases of cardiovascular risk, myocardial infarction, and stroke mortality than men, compared with nondiabetic subjects. However, when dialysis therapy is initiated, mortality is comparable in both males and females. Diabetes appears to attenuate the protective effect of the female sex in the development of cardiac diseases and nephropathy. Endocrine and behavioral factors are involved in gender inequalities and affect the outcome. More research regarding sex-dimorphic pathophysiological mechanisms of T2DM and its complications could contribute to more personalized diabetes care in the future and would thus promote more awareness in terms of sex- and gender-specific risk factors.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
| | - Jürgen Harreiter
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
| | - Giovanni Pacini
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
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Ouyang P, Wenger NK, Taylor D, Rich-Edwards JW, Steiner M, Shaw LJ, Berga SL, Miller VM, Merz NB. Strategies and methods to study female-specific cardiovascular health and disease: a guide for clinical scientists. Biol Sex Differ 2016; 7:19. [PMID: 27034774 PMCID: PMC4815158 DOI: 10.1186/s13293-016-0073-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/21/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In 2001, the Institute of Medicine's (IOM) report, "Exploring the Biological Contributions to Human Health: Does Sex Matter?" advocated for better understanding of the differences in human diseases between the sexes, with translation of these differences into clinical practice. Sex differences are well documented in the prevalence of cardiovascular (CV) risk factors, the clinical manifestation and incidence of cardiovascular disease (CVD), and the impact of risk factors on outcomes. There are also physiologic and psychosocial factors unique to women that may affect CVD risk, such as issues related to reproduction. METHODS The Society for Women's Health Research (SWHR) CV Network compiled an inventory of sex-specific strategies and methods for the study of women and CV health and disease across the lifespan. References for methods and strategy details are provided to gather and evaluate this information. Some items comprise robust measures; others are in development. RESULTS To address female-specific CV health and disease in population, physiology, and clinical trial research, data should be collected on reproductive history, psychosocial variables, and other factors that disproportionately affect CVD in women. Variables related to reproductive health include the following: age of menarche, menstrual cycle regularity, hormone levels, oral contraceptive use, pregnancy history/complications, polycystic ovary syndrome (PCOS) components, menopause age, and use and type of menopausal hormone therapy. Other factors that differentially affect women's CV risk include diabetes mellitus, autoimmune inflammatory disease, and autonomic vasomotor control. Sex differences in aging as well as psychosocial variables such as depression and stress should also be considered. Women are frequently not included/enrolled in mixed-sex CVD studies; when they are included, information on these variables is generally not collected. These omissions limit the ability to determine the role of sex-specific contributors to CV health and disease. Lack of sex-specific knowledge contributes to the CVD health disparities that women face. CONCLUSIONS The purpose of this review is to encourage investigators to consider ways to increase the usefulness of physiological and psychosocial data obtained from clinical populations, in an effort to improve the understanding of sex differences in clinical CVD research and health-care delivery for women and men.
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Affiliation(s)
- Pamela Ouyang
- />Johns Hopkins University, Baltimore, MD USA
- />Division of Cardiology, Johns Hopkins Bayview Medical Center, 301 Building, Suite 2400, 4940 Eastern Ave, Baltimore, MD 21224 USA
| | | | | | | | | | | | | | | | - Noel Bairey Merz
- />Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA USA
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Women and heart disease, the underrecognized burden: sex differences, biases, and unmet clinical and research challenges. Clin Sci (Lond) 2016; 130:551-63. [DOI: 10.1042/cs20150586] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For many years the significance of heart disease in women was vastly underappreciated, and women were significantly underrepresented in cardiovascular clinical research. We now know that cardiovascular disease is the leading cause of death for women. Women and men share many similarities in the pathophysiology and manifestations of heart disease. However, as research advances with the continued inclusion of more women, knowledge about gender differences between the female and male heart, both on a physiological and pathophysiological basis, grows. These differences can be found in all domains of cardiovascular health and disease, including heart rhythm, heart failure, coronary disease and valvular disease. Further understanding of gender differences in the heart is crucial for advancing our ability to maintain a healthy population and identify and treat heart disease in both women and men. Specific examples within the spectrum of heart disease will be discussed in this review paper, and areas for further research will be proposed.
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Kiczak L, Tomaszek A, Pasławska U, Bania J, Noszczyk-Nowak A, Skrzypczak P, Pasławski R, Zacharski M, Janiszewski A, Kuropka P, Ponikowski P, Jankowska EA. Sex differences in porcine left ventricular myocardial remodeling due to right ventricular pacing. Biol Sex Differ 2015; 6:32. [PMID: 26693003 PMCID: PMC4676102 DOI: 10.1186/s13293-015-0048-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/22/2015] [Indexed: 12/25/2022] Open
Abstract
Background Although sex differences in heart failure (HF) prevalence and severity have been recognized, its molecular mechanisms are poorly understood. We used a tachycardia-induced cardiomyopathy model to determine the sex specific remodeling pattern in male and female adult pigs. Methods We compared the echocardiographic and molecular measures of myocardial remodeling in 19 male and 12 female pigs with chronic symptomatic systolic HF due to right ventricle (RV) pacing (170 bpm) and 6 male and 5 female sham-operated controls. Males achieved subsequent HF stages earlier than females. Results The progression of symptomatic HF was associated with the reduction of the left ventricle (LV) ejection fraction in both sexes (all p < 0.05). A significant LV dilatation occurred only in males (p < 0.001). The HF development was accompanied by an increased pro-hypertrophic factor GATA4 and TGF-β1 messenger RNA (mRNA) expression in the LV only in male pigs (all p < 0.01). The total gelatinolytic activity in LV was higher in males than females (irrespective of HF, p < 0.05), and the HF progression was associated with a reduced total gelatinolytic activity (p < 0.05) in the LV only in males. No differences in LV myocardial collagen content were found between HF groups and sexes. Cardiomyocyte cross-sectional diameter was significantly smaller in male hearts as compared to female (p < 0.05). Conclusions Male and female porcine hearts respond differently to RV pacing. Males, most likely due to a higher extracellular matrix turnover, demonstrated a significant LV dilatation, followed by a strong induction of pro-hypertrophic program, and an earlier development of symptomatic HF. Electronic supplementary material The online version of this article (doi:10.1186/s13293-015-0048-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liliana Kiczak
- Research and Development Centre, Regional Specialist Hospital in Wroclaw, Kamienskiego Street 73a, 51-124 Wroclaw, Poland ; Department of Biochemistry, Pharmacology and Toxicology, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Norwida Street 31, 50-375 Wroclaw, Poland
| | - Alicja Tomaszek
- Research and Development Centre, Regional Specialist Hospital in Wroclaw, Kamienskiego Street 73a, 51-124 Wroclaw, Poland ; Department of Heart Diseases, Wroclaw Medical University, Weigla Street 5, 50-981 Wroclaw, Poland
| | - Urszula Pasławska
- Research and Development Centre, Regional Specialist Hospital in Wroclaw, Kamienskiego Street 73a, 51-124 Wroclaw, Poland ; Department of Internal Diseases and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Grunwaldzki Sq. 47, 50-366 Wroclaw, Poland
| | - Jacek Bania
- Research and Development Centre, Regional Specialist Hospital in Wroclaw, Kamienskiego Street 73a, 51-124 Wroclaw, Poland ; Department of Food Hygiene and Consumer Health Protection, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Norwida Street 31, 50-375 Wroclaw, Poland
| | - Agnieszka Noszczyk-Nowak
- Research and Development Centre, Regional Specialist Hospital in Wroclaw, Kamienskiego Street 73a, 51-124 Wroclaw, Poland ; Department of Internal Diseases and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Grunwaldzki Sq. 47, 50-366 Wroclaw, Poland
| | - Piotr Skrzypczak
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Grunwaldzki Sq. 51, 50-366 Wroclaw, Poland
| | - Robert Pasławski
- Research and Development Centre, Regional Specialist Hospital in Wroclaw, Kamienskiego Street 73a, 51-124 Wroclaw, Poland ; Department and Clinic of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Maciej Zacharski
- Research and Development Centre, Regional Specialist Hospital in Wroclaw, Kamienskiego Street 73a, 51-124 Wroclaw, Poland ; Department of Biochemistry, Pharmacology and Toxicology, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Norwida Street 31, 50-375 Wroclaw, Poland
| | - Adrian Janiszewski
- Research and Development Centre, Regional Specialist Hospital in Wroclaw, Kamienskiego Street 73a, 51-124 Wroclaw, Poland ; Department of Internal Diseases and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Grunwaldzki Sq. 47, 50-366 Wroclaw, Poland
| | - Piotr Kuropka
- Department of Animal Physiology and Biostructure, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Piotr Ponikowski
- Research and Development Centre, Regional Specialist Hospital in Wroclaw, Kamienskiego Street 73a, 51-124 Wroclaw, Poland ; Department of Heart Diseases, Wroclaw Medical University, Weigla Street 5, 50-981 Wroclaw, Poland
| | - Ewa A Jankowska
- Research and Development Centre, Regional Specialist Hospital in Wroclaw, Kamienskiego Street 73a, 51-124 Wroclaw, Poland ; Department of Heart Diseases, Wroclaw Medical University, Weigla Street 5, 50-981 Wroclaw, Poland
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Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A, Maas AHEM, Kautzky-Willer A, Knappe-Wegner D, Kintscher U, Ladwig KH, Schenck-Gustafsson K, Stangl V. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J 2015; 37:24-34. [PMID: 26530104 DOI: 10.1093/eurheartj/ehv598] [Citation(s) in RCA: 422] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Sabine Oertelt-Prigione
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Eva Prescott
- Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Flavia Franconi
- International Society for Gender Medicine Dep Scienze Biomediche, Regione Basilicata and National Laboratory of Gender Medicine, Consorzio Interuniversitario INBB, University of Sassari, Via Muroni 23a, 07100 Sassari, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Anna Foryst-Ludwig
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Route 616, 6525 GA Nijmegen, The Netherlands
| | - Alexandra Kautzky-Willer
- International Society for Gender Medicine Gender Medicine Unit, Internal Medicine III, Endocrinology, Medical University of Vienna, International Society for Gender Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Dorit Knappe-Wegner
- International Society for Gender Medicine University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulrich Kintscher
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Karl Heinz Ladwig
- Helmholtz Center Munich, Institute of Epidemiology II, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Karin Schenck-Gustafsson
- International Society for Gender Medicine Karolinska Institutet Stockholm, Centre for Gender Medicine, Thorax N3:05, International Society for Gender Medicine, 17176 Stockholm, Sweden
| | - Verena Stangl
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Clinic for Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Samai AA, Martin-Schild S. Sex differences in predictors of ischemic stroke: current perspectives. Vasc Health Risk Manag 2015; 11:427-36. [PMID: 26251609 PMCID: PMC4524454 DOI: 10.2147/vhrm.s65886] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Globally, stroke is a significant public health concern affecting more than 33 million individuals. Of growing importance are the differences between males and females in the predictors and overall risk of stroke. Given that women have a higher lifetime risk for stoke and account for more than half of all stroke deaths, sex-specific stroke risk factors merit investigation and may help target public health interventions. This review aims to discuss the current body of knowledge regarding sex-specific predictors of ischemic stroke including both modifiable and non-modifiable risk factors, as well as specific pathologies known to increase stroke risk.
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Affiliation(s)
- Alyana A Samai
- Department of Neurology, Stroke Program, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Sheryl Martin-Schild
- Department of Neurology, Stroke Program, Tulane University School of Medicine, New Orleans, LA, USA
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Left ventricular remodeling and fibrosis: Sex differences and relationship with diastolic function in hypertrophic cardiomyopathy. Eur J Radiol 2015; 84:1487-1492. [PMID: 26001434 DOI: 10.1016/j.ejrad.2015.04.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 04/01/2015] [Accepted: 04/27/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVES We investigated sex differences in left ventricular (LV) remodeling and fibrosis and their relationship with LV diastolic dysfunction by cardiovascular magnetic resonance (CMR). METHODS CMR imaging was performed simultaneously in 152 age-matched patients (76 men, 76 women; mean age: 49±9 years) without LV systolic dysfunction. LV remodeling index (LVRI) was calculated as the ratio of LV mass and end-diastolic volume. Diastolic function indexes including peak filling rate (PFR) and time to PFR (tPFR) were evaluated. Extent of late gadolinium enhancement (LGE) was measured. RESULTS LVRI and extent of LGE were greater in women compared with men (1.48±0.22 vs. 1.36±0.28g/ml; 13.15±2.48 vs. 11.35±2.34g, respectively, both P<0.001). Women had lower PFR and higher tPFR (both P<0.001) than men. LVRI and the extent of LGE showed significant relationships with parameters of diastolic function in both sex. In a multivariate analysis, LVRI remained a strong independent predictor of PFR and TPFR in women (β=-0.272, P=0.032; β=0.348, P=0.016, respectively), and in men (β=-0.374, P<0.001; β=0.660, P<0.001, respectively). Furthermore, the extent of LGE also remained an independent predictor of PFR in women (β=-0.283, P=0.033) and men (β=-0.492, P<0.001). CONCLUSIONS There are prominent sex differences in LV remodeling and myocardial fibrosis. We suggest that the effects of LV remodeling and fibrosis may lead to diastolic dysfunction with greater susceptibility to worse clinical outcome in women.
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