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Marcozzi S, Bigossi G, Giuliani ME, Giacconi R, Piacenza F, Cardelli M, Brunetti D, Segala A, Valerio A, Nisoli E, Lattanzio F, Provinciali M, Malavolta M. Cellular senescence and frailty: a comprehensive insight into the causal links. GeroScience 2023; 45:3267-3305. [PMID: 37792158 PMCID: PMC10643740 DOI: 10.1007/s11357-023-00960-w] [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: 08/03/2023] [Accepted: 09/24/2023] [Indexed: 10/05/2023] Open
Abstract
Senescent cells may have a prominent role in driving inflammation and frailty. The impact of cellular senescence on frailty varies depending on the assessment tool used, as it is influenced by the criteria or items predominantly affected by senescent cells and the varying weights assigned to these items across different health domains. To address this challenge, we undertook a thorough review of all available studies involving gain- or loss-of-function experiments as well as interventions targeting senescent cells, focusing our attention on those studies that examined outcomes based on the individual frailty phenotype criteria or specific items used to calculate two humans (35 and 70 items) and one mouse (31 items) frailty indexes. Based on the calculation of a simple "evidence score," we found that the burden of senescent cells related to musculoskeletal and cerebral health has the strongest causal link to frailty. We deem that insight into these mechanisms may not only contribute to clarifying the role of cellular senescence in frailty but could additionally provide multiple therapeutic opportunities to help the future development of a desirable personalized therapy in these extremely heterogeneous patients.
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Affiliation(s)
- Serena Marcozzi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
- Scientific Direction, IRCCS INRCA, 60124, Ancona, Italy
| | - Giorgia Bigossi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Maria Elisa Giuliani
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Robertina Giacconi
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Francesco Piacenza
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Maurizio Cardelli
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Dario Brunetti
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20126, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20129, Milan, Italy
| | - Agnese Segala
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa, 11, 25123, Brescia, Italy
| | - Alessandra Valerio
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa, 11, 25123, Brescia, Italy
| | - Enzo Nisoli
- Center for Study and Research On Obesity, Department of Medical Biotechnology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20129, Milan, Italy
| | | | - Mauro Provinciali
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy
| | - Marco Malavolta
- Advanced Technology Center for Aging Research and Geriatric Mouse Clinic, IRCCS INRCA, 60121, Ancona, Italy.
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van Poelgeest EP, Handoko ML, Muller M, van der Velde N. Diuretics, SGLT2 inhibitors and falls in older heart failure patients: to prescribe or to deprescribe? A clinical review. Eur Geriatr Med 2023; 14:659-674. [PMID: 36732414 PMCID: PMC10447274 DOI: 10.1007/s41999-023-00752-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Both heart failure and its treatment with diuretics or SGLT2 inhibitors increase fall risk in older adults. Therefore, decisions to continue or deprescribe diuretics or SGLT2 inhibitors in older heart failure patients who have fallen are generally highly complex and challenging for clinicians. However, a comprehensive overview of information required for rationale and safe decision-making is lacking. The aim of this clinical review was to assist clinicians in safe (de)prescribing of these drug classes in older heart failure patients. METHODS We comprehensively searched and summarized published literature and international guidelines on the efficacy, fall-related safety issues, and deprescribing of the commonly prescribed diuretics and SGLT2 inhibitors in older adults. RESULTS Both diuretics and SGLT2 inhibitors potentially cause various fall-related adverse effects. Their fall-related side effect profiles partly overlap (e.g., tendency to cause hypotension), but there are also important differences; based on the currently available evidence of this relatively new drug class, SGLT2 inhibitors seem to have a favorable fall-related adverse effect profile compared to diuretics (e.g., low/absent tendency to cause hyperglycemia or electrolyte abnormalities, low risk of worsening chronic kidney disease). In addition, SGLT2 inhibitors have potential beneficial effects (e.g., disease-modifying effects in heart failure, renoprotective effects), whereas diuretic effects are merely symptomatic. CONCLUSION (De)prescribing diuretics and SGLT2 inhibitors in older heart failure patients who have fallen is often highly challenging, but this clinical review paper assists clinicians in individualized and patient-centered rational clinical decision-making: we provide a summary of available literature on efficacy and (subclass-specific) safety profiles of diuretics and SGLT2 inhibitors, and practical guidance on safe (de)prescribing of these drugs (e.g. a clinical decision tree for deprescribing diuretics in older adults who have fallen).
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Affiliation(s)
- Eveline P van Poelgeest
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands.
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Centers, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands
| | - Majon Muller
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
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Ho VS, Cenzer IS, Nguyen BT, Lee SJ. Time to benefit for stroke reduction after blood pressure treatment in older adults: A meta-analysis. J Am Geriatr Soc 2022; 70:1558-1568. [PMID: 35137952 PMCID: PMC9106841 DOI: 10.1111/jgs.17684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/24/2021] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
Abstract
Background Hypertension treatment in older adults can decrease mortality, cardiovascular events, including heart failure, cognitive impairment, and stroke risk, but may also lead to harms such as syncope and falls. Guidelines recommend targeting preventive interventions with immediate harms and delayed benefits to patients whose life expectancy exceeds the intervention's time to benefit (TTB). Our objective was to estimate a meta‐analyzed TTB for stroke prevention after initiation of more intensive hypertension treatment in adults aged ≥65 years. Methods Studies were identified from two Cochrane systematic reviews and a search of MEDLINE and Google Scholar for subsequent publications until August 31, 2021. We abstracted data from randomized controlled trials comparing standard (untreated, placebo, or less intensive treatment) to more intensive treatment groups in older adults (mean age ≥ 65 years). We fit Weibull survival curves and used a random‐effects model to estimate the pooled annual absolute risk reduction (ARR) between control and intervention groups. We applied Markov chain Monte Carlo methods to determine the time to ARR thresholds (0.002, 0.005, and 0.01) for a first stroke. Results Nine trials (n = 38,779) were identified. The mean age ranged from 66 to 84 years and study follow‐up times ranged from 2.0 to 5.8 years. We determined that 1.7 (95%CI: 1.0–2.9) years were required to prevent 1 stroke for 200 persons (ARR = 0.005) receiving more intensive hypertensive treatment. Heterogeneity was found across studies, with those focusing on tighter systolic blood pressure control (SBP < 150 mmHg) showing longer TTB. For example, in the SPRINT study (baseline SBP = 140 mmHg, achieved SBP = 121 mmHg), the TTB to avoid 1 stroke for 200 patients treated was 5.9 years (95%CI: 2.2–13.0). Conclusions More intensive hypertension treatment in 200 older adults prevents 1 stroke after 1.7 years. Given the heterogeneity across studies, the TTB estimates from individual studies may be more relevant for clinical decision‐making than our summary estimate. See related Editorial by Mark A. Supiano in this issue.
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Affiliation(s)
- Vanessa S Ho
- College of Medicine, California Northstate University, Elk Grove, California, USA.,Medical Student Training in Aging Research (MSTAR) Program, Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Irena S Cenzer
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Brian T Nguyen
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Northern California Institute for Research and Education, San Francisco, California, USA
| | - Sei J Lee
- Medical Student Training in Aging Research (MSTAR) Program, Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Bryniarski P, Nazimek K, Marcinkiewicz J. Immunomodulatory properties of antihypertensive drugs and digitalis glycosides. Expert Rev Cardiovasc Ther 2022; 20:111-121. [PMID: 35130796 DOI: 10.1080/14779072.2022.2039627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The role of chronic inflammatory process in the pathogenesis or exacerbation of hypertension has been already acknowledged. AREAS COVERED Therefore, one can speculate that hypotensive drugs may exert some of their therapeutic effects due to immunomodulatory properties. So far, this assumption has been tested in different studies, and the resulting knowledge is summarized in the current review article that is dedicated to different groups of antihypertensives, namely calcium channel blockers, beta blockers, as well as other less commonly used medications, such as hydralazine, agonists of alfa-2 receptor, diazoxide, doxazosin, aliskiren, and sodium nitroprusside. Articles were found in the Pubmed database by entering the name of a specific drug (or group of drugs) together with the words: immunology, cellular response, humoral response, inflammation, interleukin. The 2000-2021 range was used to search for all drugs except propranolol (1980-2021) and calcium blockers (1990-2021). EXPERT OPINION Observed decrease in serum/plasma concentration of proinflammatory cytokines, and CRP along with lower expression of adhesion molecules on immune cells strongly suggest that these drugs possess immunomodulatory properties, which seems to be crucial in the medical practice, especially in the therapy of hypertensive patients with other accompanying inflammatory-based diseases, such as type II diabetes, developed metabolic syndrome, allergies or autoimmunity.
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Affiliation(s)
- Paweł Bryniarski
- Department of Immunology, Jagiellonian University in Kraków Medical College Ringgold standard institution, Krakow, Poland
| | - Katarzyna Nazimek
- Department of Immunology, Jagiellonian University in Kraków Medical College Ringgold standard institution, Krakow, Poland
| | - Janusz Marcinkiewicz
- Department of Immunology, Jagiellonian University in Kraków Medical College Ringgold standard institution, Krakow, Poland
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Soares MM, Guedes GR, Rodrigues SM, Dias CA. [Interactions between drug treatment adherence, blood pressure targets, and depression in hypertensive individuals receiving care in the Family Health Strategy]. CAD SAUDE PUBLICA 2021; 37:e00061120. [PMID: 34495089 DOI: 10.1590/0102-311x00061120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
The study analyzes interactions between drug treatment adherence, blood pressure targets, and depression in a probabilistic sample of hypertensive individuals treated in the Family Health Strategy in Governador Valadares, Minas Gerais State, Brazil. This is a cross-sectional study with 641 hypertensive individuals 40 years or older, residing in the urban area of Governador Valadares. Structured scripts were used to collect data in home interviews, with a focus on the following indicators: Medication Assessment Questionnaire (MAQ), Beck Depression Inventory (BDI), and blood pressure measurement. Due to the simultaneity of the target events (depression, blood pressure target, and adherence), we applied a system of recursive and simultaneous nonlinear equations. The results suggest that the odds of meeting the blood pressure target increase significantly with adherence to treatment; they also suggest that individuals that meet the blood pressure target show 2.6 higher odds of treatment adherence. Adherence has a protective effect against depression: individuals with minimal adherence show 8.4 higher odds of developing depressive symptoms when compared to those with maximum adherence. Drug treatment adherence is related simultaneously to blood pressure control and lower levels of depression. Promoting drug treatment adherence is essential for ensuring that individuals remain normotensive, with the potential for reducing levels of depression. These positive externalities can reduce pressure on the health system, with simultaneous gains in quality of life for hypertensive individuals.
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Affiliation(s)
| | | | | | - Carlos Alberto Dias
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Teófilo Otoni, Brasil
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Rea F, Cantarutti A, Merlino L, Ungar A, Corrao G, Mancia G. Antihypertensive Treatment in Elderly Frail Patients: Evidence From a Large Italian Database. Hypertension 2020; 76:442-449. [PMID: 32507038 DOI: 10.1161/hypertensionaha.120.14683] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim of our study was to assess the relationship between adherence with antihypertensive drugs and the risk of death in frail versus nonfrail old individuals. Using the database of the Lombardy Region (Italy), we identified 1 283 602 residents aged ≥65 years (mean age 76) who had ≥3 prescriptions of antihypertensive drugs between 2011 and 2012. A nested case-control design was applied, with cases being the cohort members who died during the observation period (7 years). Logistic regression was used to model the association of interest, with adjustment for potential confounders. Adherence was measured by the proportion of the follow-up covered by prescriptions, and the analysis was separately performed in patients with a good, medium, poor, and very poor clinical status, as assessed by a score that has been shown to be a sensitive predictor of death in the Italian population. The 7-year death probability increased from 16% (good) to 64% (very poor) clinical status. Compared with patients with very low adherence with antihypertensive treatment (<25% of follow-up time covered by prescriptions), those with high adherence (>75% of time covered by prescriptions) exhibited a lower risk of all-cause mortality in each group, the difference decreasing progressively (-44%, -43%, -40%, and -33%) from the good to the very poor clinical status. Adherence with antihypertensive drug treatment was also associated with a lower risk of cardiovascular mortality. Adherence with antihypertensive appears to be protective in frail old patients, but the benefit is less marked than in patients with a good clinical status.
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Affiliation(s)
- Federico Rea
- From the National Centre for Healthcare Research & Pharmacoepidemiology (F.R., A.C., L.M., G.C.), University of Milano-Bicocca Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (F.R., A.C., G.C.), University of Milano-Bicocca Milan, Italy
| | - Anna Cantarutti
- From the National Centre for Healthcare Research & Pharmacoepidemiology (F.R., A.C., L.M., G.C.), University of Milano-Bicocca Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (F.R., A.C., G.C.), University of Milano-Bicocca Milan, Italy
| | - Luca Merlino
- From the National Centre for Healthcare Research & Pharmacoepidemiology (F.R., A.C., L.M., G.C.), University of Milano-Bicocca Milan, Italy.,Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy (L.M.)
| | - Andrea Ungar
- Geriatric Intensive Care Medicine, University of Florence, Italy (A.U.)
| | - Giovanni Corrao
- From the National Centre for Healthcare Research & Pharmacoepidemiology (F.R., A.C., L.M., G.C.), University of Milano-Bicocca Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (F.R., A.C., G.C.), University of Milano-Bicocca Milan, Italy
| | - Giuseppe Mancia
- University of Milano-Bicocca (Emeritus Professor), Milan, Italy (G.M.)
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Liu J, Liu L, Jia Q, Zhang X, Jin X, Shen H. Effects of Excessive Iodine Intake on Blood Glucose, Blood Pressure, and Blood Lipids in Adults. Biol Trace Elem Res 2019; 192:136-144. [PMID: 30798477 DOI: 10.1007/s12011-019-01668-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/06/2019] [Indexed: 01/18/2023]
Abstract
To understand the effects of excess iodine intake on blood glucose, blood pressure, and blood lipids in adults. We selected three villages from Shanxi Province to conduct cross-sectional survey: Maxi [median water iodine concentration (MWIC) 6.3 μg/L, median urinary iodine concentration (MUIC) 126.6 μg/L, 320 adults]; Xiwenzhuang (MWIC 79.8 μg/L, MUIC 221.2 μg/L, 264 adults); and Gaoche (MWIC 506.0 μg/L, MUIC 421.3 μg/L, 241 adults). According to the urinary iodine levels in adults, the three villages were defined as iodine-adequate, iodine-sufficient, and iodine-excess. Urinary iodine, water iodine, thyroid function, blood glucose, blood pressure, and blood lipids were measured. Compared with the iodine-adequate area, blood glucose and systolic and diastolic pressure of adults in iodine-sufficient and iodine-excess areas increased and high-density lipoprotein-cholesterol decreased (all P < 0.001). Urinary iodine, thyroid-stimulating hormone, and free thyroxine have a nonlinear correlation with blood glucose (R2 = 0.8174, 0.8264, and 0.8520, respectively). Excessive iodine intake may result in elevated blood glucose and blood pressure and has some influence on blood lipids, and may increase the risk of hypertension and diabetes.
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Affiliation(s)
- Jiwei Liu
- Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lixiang Liu
- Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qingzhen Jia
- Institute for Endemic Disease Prevention and Treatment of Shanxi Province, Linfen, Shanxi, China
| | - Xiangdong Zhang
- Institute for Endemic Disease Prevention and Treatment of Shanxi Province, Linfen, Shanxi, China
| | - Xing Jin
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian, China
| | - Hongmei Shen
- Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China.
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