1
|
Fernandez C, Rysä J, Ström K, Nilsson J, Engström G, Orho-Melander M, Ruskoaho H, Melander O. Circulating protein biomarkers predict incident hypertensive heart failure independently of N-terminal pro-B-type natriuretic peptide levels. ESC Heart Fail 2020; 7:1891-1899. [PMID: 32410391 PMCID: PMC7373917 DOI: 10.1002/ehf2.12757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Hypertension is the leading cause for the development of heart failure (HF). Here, we aimed to identify cardiomyocyte stretch‐induced circulating biomarkers for predicting hypertension‐associated HF. Methods and results Circulating levels of 149 proteins were measured by proximity extension assay at baseline examination in 4742 individuals from the Malmö Diet and Cancer study. Protein levels were compared with stretch‐activated gene expression changes in cultured neonatal rat ventricular myocytes (NRVMs) in response to 1–48 h of mechanical stretch. We also studied the association between protein levels and hypertension and HF incidence using respectively binary logistic and Cox regressions. Levels of 35 proteins were differentially expressed after Bonferroni correction in incident HF vs. control (P < 3.4E−4). Growth differentiation factor‐15 (GDF‐15), interleukin‐6 (IL‐6), IL‐1 receptor type 1, and urokinase plasminogen activator surface receptor had corresponding mRNA levels up‐regulated by stretch in NRVMs at all time points (P < 0.05). These four proteins were individually associated with increased risk of HF after age and sex adjustment [hazard ratio (HR) per standard deviation: 1.19 ≤ HR ≤ 1.49, P ≤ 4.90E−3]. GDF‐15 and IL‐6 were associated with HF independently of each other (1.22 ≤ HR ≤ 1.33, P ≤ 0.001). In subjects with hypertension, these associations remained significant after further adjustment for N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) levels (1.23 ≤ HR ≤ 1.45, P ≤ 0.001). A higher fasting value of a GDF‐15, IL‐6 score aggregate was associated with increased risk of hypertensive HF after adjustment for all traditional risk factors for HF and NT‐proBNP (HR = 1.31, P = 2.19E−4). Conclusions Cardiomyocyte mRNA levels of GDF‐15 and IL‐6 are consistently up‐regulated by stretch, and their circulating protein levels predict HF in hypertensive subjects independently of NT‐proBNP during long‐term follow‐up. Our results encourage further studies on lower blood pressure goals in hypertensive subjects with high GDF‐15 and IL‐6, and interventions targeted at stretch‐induced cardiomyocyte expressed biomarkers.
Collapse
Affiliation(s)
- Celine Fernandez
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Jaana Rysä
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kristoffer Ström
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | | | - Heikki Ruskoaho
- Drug Research Program, Division of Pharmacology and Pharmacotherapy, University of Helsinki, Helsinki, Finland
| | - Olle Melander
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| |
Collapse
|
2
|
El-Menyar A, Shabana A, Arabi A, Al-Thani H, Asaad N, AlBinALi H, Singh R, Gomaa M, Gehani A. Congestive Heart Failure With Apparently Preserved Left Ventricular Systolic Function: A 10-Year Observational Study. Angiology 2014; 66:738-44. [PMID: 25248442 DOI: 10.1177/0003319714551198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We analyzed the clinical presentation and outcomes (from 2003 to 2013) of heart failure (HF) with apparently normal systolic function (HFPEF). Based on the echocardiographic left ventricular ejection fraction (LVEF), patients were divided into 2 groups, group 1 (<50%) and group 2 (≥50%). Of 2212 patients with HF, 20% were in group 2. Patients in group 2 were more likely to be older, females, Arabs, hypertensive, and obese (P = .001). Patients in group 1 were mostly Asians and had more troponin-T positivity (P = .001). Inhospital cardiac arrest, shock, and deaths were significantly greater in group 1. On multivariate analysis, age, ST-segment elevation myocardial infarction, lack of on-admission β-blockers, and angiotensin-converting enzyme inhibitors use were independent predictors of mortality. HFPEF is associated with less mortality compared to those who presented with reduced LVEF. On admission, use of evidence-based medications could in part predict this difference in the hospital outcome.
Collapse
Affiliation(s)
- Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar Clinical Research, Trauma Section, Hamad Medical Corporation (HMC), Doha, Qatar Internal Medicine, Cardiology Section, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Adel Shabana
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdulrahman Arabi
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Hassan Al-Thani
- Vascular Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Nidal Asaad
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Hajar AlBinALi
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rajvir Singh
- Cardiovascular Research, Heart Hospital, HMC, Doha, Qatar
| | - Mohammed Gomaa
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - A Gehani
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| |
Collapse
|
3
|
Ely JJ, Zavaskis T, Lammey ML. Hypertension increases with aging and obesity in chimpanzees (Pan troglodytes). Zoo Biol 2013; 32:79-87. [PMID: 22968757 PMCID: PMC3537917 DOI: 10.1002/zoo.21044] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 08/10/2012] [Accepted: 08/10/2012] [Indexed: 12/17/2022]
Abstract
Cardiovascular disease is a primary cause of morbidity and mortality in captive chimpanzees. Four years of blood pressure (BP) data were analyzed from a captive former laboratory population of 201 healthy adult chimpanzees with assessment of age and obesity on elevated BP. Five different measures of obesity were compared: abdominal girth, basal metabolic rate, body-mass index (BMI), body weight, and surface area. Systolic BP varied by sex. Obesity did not influence male BP. For females, obesity was a significant determinant of BP. The best measure of female obesity was basal metabolic rate and the worst was BMI. Median systolic BP of healthy weight females (<54.5 kg) was significantly lower (128 mmHg) than overweight or obese females (140 mmHg), but both were lower than all males (147 mmHg). For diastolic BP, neither sex nor any of the five obesity measures was significant. But age was highly significant, with geriatric chimpanzees (>30 years) having higher median diastolic BP (74 mmHg) than young adults of 10-29 years of age (65 mmHg). By these criteria, 80% of this population is normotensive, 7% prehypertensive, and 13% hypertensive. In summary, systolic BP intervals required adjustment for obesity among females but not males. Diastolic BP required adjustment for advanced age (≥30 years). Use of these reference intervals can facilitate timely clinical care of captive chimpanzees.
Collapse
Affiliation(s)
- John J Ely
- Alamogordo Primate Facility, Holloman AFB, Alamogordo, New Mexico, USA.
| | | | | |
Collapse
|
4
|
Kurtz B, Thibault HB, Raher MJ, Popovich JR, Cawley S, Atochin DN, Hayton S, Shakartzi HR, Huang PL, Bloch KD, Buys E, Scherrer-Crosbie M. Nitric oxide synthase 3 deficiency limits adverse ventricular remodeling after pressure overload in insulin resistance. Am J Physiol Heart Circ Physiol 2011; 301:H2093-101. [PMID: 21856905 DOI: 10.1152/ajpheart.00744.2010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Insulin resistance (IR) and systemic hypertension are independently associated with heart failure. We reported previously that nitric oxide synthase 3 (NOS3) has a beneficial effect on left ventricular (LV) remodeling and function after pressure-overload in mice. The aim of our study was to investigate the interaction of IR and NOS3 in pressure-overload-induced LV remodeling and dysfunction. Wild-type (WT) and NOS3-deficient (NOS3(-/-)) mice were fed either a standard diet (SD) or a high-fat diet (HFD) to induce IR. After 9 days of diet, mice underwent transverse aortic constriction (TAC). LV structure and function were assessed serially using echocardiography. Cardiomyocytes were isolated, and levels of oxidative stress were evaluated using 2',7'-dichlorodihydrofluorescein diacetate. Cardiac mitochondria were isolated, and mitochondrial respiration and ATP production were measured. TAC induced LV remodeling and dysfunction in all mice. The TAC-induced decrease in LV function was greater in SD-fed NOS3(-/-) mice than in SD-fed WT mice. In contrast, HFD-fed NOS3(-/-) developed less LV remodeling and dysfunction and had better survival than did HFD-fed WT mice. Seven days after TAC, oxidative stress levels were lower in cardiomyocytes from HFD-fed NOS3(-/-) than in those from HFD-fed WT. N(ω)-nitro-L-arginine methyl ester and mitochondrial inhibitors (rotenone and 2-thenoyltrifluoroacetone) decreased oxidative stress levels in cardiomyocytes from HFD-fed WT mice. Mitochondrial respiration was altered in NOS3(-/-) mice but did not worsen after HFD and TAC. In contrast with its protective role in SD, NOS3 increases LV adverse remodeling after pressure overload in HFD-fed, insulin resistant mice. Interactions between NOS3 and mitochondria may be responsible for increased oxidative stress levels in HFD-fed WT mice hearts.
Collapse
Affiliation(s)
- Baptiste Kurtz
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Ely J, Zavaskis T, Lammey M, Rick Lee D. Blood pressure reference intervals for healthy adult chimpanzees (Pan troglodytes). J Med Primatol 2011; 40:171-80. [DOI: 10.1111/j.1600-0684.2011.00467.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Shinde AA, Anderson AS. Treatment of hypertension in heart failure with preserved ejection fraction: role of the kidney. Heart Fail Clin 2008; 4:479-503. [PMID: 18760759 DOI: 10.1016/j.hfc.2008.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Heart failure can present clinically as primarily diastolic or systolic dysfunction or both. There is an increasing awareness that heart failure can occur in the presence of a normal left ventricular ejection fraction. Heart failure with normal left ventricular ejection fraction is frequently referred to as diastolic heart failure because of the presence of diastolic left ventricular dysfunction evident from impaired left ventricular relaxation. This article focuses on the treatment of hypertension and the role the kidney plays in selecting appropriate agents.
Collapse
Affiliation(s)
- Abhijit A Shinde
- University of Chicago, Department of Medicine, Chicago, IL 60637, USA.
| | | |
Collapse
|
7
|
Drager LF, Bortolotto LA, Figueiredo AC, Silva BC, Krieger EM, Lorenzi-Filho G. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest 2007; 131:1379-86. [PMID: 17494787 DOI: 10.1378/chest.06-2703] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) and hypertension are independently associated with increased stiffness of large arteries that may contribute to left ventricular (LV) remodeling. We sought to investigate the impact of OSA, hypertension, and their association with arterial stiffness and heart structure. DESIGN We studied 60 middle-aged subjects classified into four groups according to the absence or presence of severe OSA with and without hypertension. All participants were free of other comorbidities. The groups were matched for age, sex, and body mass index. MEASUREMENTS AND RESULTS Full polysomnography, pulse-wave velocity (PWV), and transthoracic echocardiography were performed in all participants. Compared with normotensive subjects without OSA, PWV, left atrial diameter, interventricular septal thickness, LV posterior wall thickness, LV mass index, and percentage of LV hypertrophy had similar increases in normotensive OSA and patients with hypertension and no OSA (p < 0.05 for all comparisons), with a significant further increase in PWV, LV mass index, and percentage of LV hypertrophy in subjects with OSA and hypertension. Multivariate regression analysis showed that PWV was associated with systolic BP (p < 0.001) and apnea-hypopnea index (p = 0.002). The only independent variable associated with LV mass index was PWV (p < 0.0001). CONCLUSIONS Severe OSA and hypertension are associated with arterial stiffness and heart structure abnormalities of similar magnitude, with additive effects when both conditions coexist. Increased large arterial stiffness contributes to ventricular afterload and may help to explain heart remodeling in both OSA and hypertension.
Collapse
Affiliation(s)
- Luciano F Drager
- Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr Enéas Carvalho de Aguiar 44, CEP 05403-904, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
8
|
Perez-Fernandez R, Mariño AF, Cadarso-Suarez C, Botana MA, Tome MA, Solache I, Rego-Iraeta A, Mato AJ. Prevalence, awareness, treatment and control of hypertension in Galicia (Spain) and association with related diseases. J Hum Hypertens 2007; 21:366-73. [PMID: 17301825 DOI: 10.1038/sj.jhh.1002158] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The present study evaluated the prevalence of hypertension (HT) and its possible relationships with various risk factors in a representative sample (n=2884) of the adult population (>18 years old) of Galicia, a region of Spain. Subjects were selected by a two-step cluster sampling procedure from the Galician public health service database, which covers more than 95% of the population (2.7 million inhabitants). The overall prevalence of HT, defined as BP >140/90 mm Hg and/or current treatment with antihypertensive medication, was 25.5%, higher in men (31.1%) than in women (20.7%). Of the hypertensive subjects 50.6% were aware of the HT; of these, 72.0% were receiving treatment and 36.4% were treated and controlled. The prevalence of HT increased with age and was higher in subjects from urban areas than rural areas and higher in subjects with low educational level. Surprisingly, people with low educational level more frequently showed awareness of HT than people with high education level. Increased body mass index was related to increased prevalence of HT and close associations were observed between HT and cardiovascular diseases. Our data also show a linear upward trend in blood pressure from normal glucose metabolism to diabetes mellitus. Surprisingly, the prevalence of HT among people with known diabetes was higher than among people with undetected diabetes, which may indicate poor control of HT in diabetic subjects.
Collapse
Affiliation(s)
- R Perez-Fernandez
- Department of Physiology, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Völzke H, Warnke C, Dörr M, Kramer A, Guertler L, Hoffmann W, Kors JA, John U, Felix SB. Association between cardiac disorders and a decades-previous history of diphtheria. Eur J Clin Microbiol Infect Dis 2006; 25:651-6. [PMID: 17047906 DOI: 10.1007/s10096-006-0185-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A long, prior history of diphtheria is common among middle-aged and elder European adults. The aim of the present study was to determine whether the risk of reduced ventricular function and impaired intraventricular conduction is increased in individuals with a history of diphtheria. A study population of 2,480 subjects (1,222 women) aged 45 years or older who were recruited for the Study of Health in Pomerania were available for the present analyses. Left ventricular function was assessed by echocardiography. Intraventricular conduction blocks were diagnosed using electrocardiograms. Multivariable analyses revealed that individuals with a history of diphtheria had neither an increased odds for reduced fractional shortening (OR 1.21, 95% CI 0.69-2.11; p=0.51) nor an increased odds for intraventricular conduction blocks (OR 0.90, 95% CI 0.55-1.46; p=0.67). However, regression models revealed two-way interactions between the exposure variable and hypertension with respect to both endpoints. A history of diphtheria increased the odds for both endpoints in normotensive but not in hypertensive individuals. The findings show that a history of diphtheria several decades previously in a patient is a risk marker for reduced cardiac function and impaired intraventricular conduction in individuals at low risk for these disorders.
Collapse
Affiliation(s)
- H Völzke
- Institute of Epidemiology and Social Medicine, Ernst Moritz Arndt University, Walther Rathenau Strasse 48, 17487, Greifswald, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Kakar P, Lip GYH. Towards improving the clinical assessment and management of human hypertension: an overview from this Journal. J Hum Hypertens 2006; 20:913-6. [PMID: 16929339 DOI: 10.1038/sj.jhh.1002083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- P Kakar
- University Department of Medicine, City Hospital, Birmingham, UK
| | | |
Collapse
|
11
|
Kakar P, Lip GYH. Towards understanding the aetiology and pathophysiology of human hypertension: where are we now? J Hum Hypertens 2006; 20:833-6. [PMID: 16929340 DOI: 10.1038/sj.jhh.1002082] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P Kakar
- Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
| | | |
Collapse
|
12
|
Saadi HF, Kazzam E, Ghurbana BA, Nicholls MG. Hypothesis: Correction of low vitamin D status among Arab women will prevent heart failure and improve cardiac function in established heart failure. Eur J Heart Fail 2006; 8:694-6. [PMID: 16828339 DOI: 10.1016/j.ejheart.2006.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 04/05/2006] [Accepted: 05/10/2006] [Indexed: 11/21/2022] Open
Abstract
Vitamin D deficiency is common in Arab countries particularly among women. This is the result of a low dietary intake of the vitamin, limited exposure to sunlight (a paradox in view of the high sunshine figures), skin colour, obesity and high parity. Apart from its adverse effects on bone in women and their offspring, vitamin D deficiency has the potential to cause or exacerbate heart failure through a number of mechanisms including activation of the renin-angiotensin system and increased arterial pressure. Accordingly, we propose that ensuring adequate vitamin D levels in Arab women will have a much greater impact on health than just the prevention of bone disease. In particular, we suggest that prevention and correction of vitamin D deficiency will reduce the incidence of heart failure and, for Arab women with established heart failure and vitamin D deficiency, improve cardiac function.
Collapse
Affiliation(s)
- Hussein F Saadi
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | | | | | | |
Collapse
|
13
|
Gustafsson F, Torp-Pedersen C, Seibaek M, Burchardt H, Nielsen OW, Køber L. A history of arterial hypertension does not affect mortality in patients hospitalised with congestive heart failure. Heart 2006; 92:1430-3. [PMID: 16621877 PMCID: PMC1861024 DOI: 10.1136/hrt.2005.080572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the importance of a history of hypertension on long-term mortality in a large cohort of patients hospitalised with congestive heart failure (CHF). DESIGN Retrospective analysis of 5491 consecutive patients, of whom 24% had a history of hypertension. 60% of the patients had non-systolic CHF, and 57% had ischaemic heart disease. SETTING 38 primary, secondary and tertiary hospitals in Denmark. MAIN OUTCOME MEASURES Total mortality 5-8 years after inclusion in the registry. RESULTS Female sex and preserved left ventricular systolic function was more common among patients with a history of hypertension. 72% of the patients died during follow up. A hypertension history did not affect mortality risk (hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.92 to 1.07). Correction for differences between the normotensive and hypertensive groups at baseline in a multivariate model did not alter this result (HR 1.08, 95% CI 1.00 to 1.17, p = 0.06). The hazard ratio was similar in patients with and without a history of ischaemic heart disease. Hence, a specific effect of hypertension in the group of patients with CHF with ischaemic heart disease, as suggested in earlier studies, could not be confirmed. CONCLUSION A history of arterial hypertension did not affect mortality in patients hospitalised with CHF.
Collapse
Affiliation(s)
- F Gustafsson
- Department of Cardiology B, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | | | |
Collapse
|
14
|
MacFadyen RJ, Goyal D, Lip GYH. How far can population epidemiology contribute to defining the relationship between hypertension and left ventricular systolic dysfunction? J Hum Hypertens 2005; 19:919-22. [PMID: 16195708 DOI: 10.1038/sj.jhh.1001927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- R J MacFadyen
- University Department of Medicine, City Hospital, Birmingham, UK.
| | | | | |
Collapse
|