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Tan JS, Yang Y, Wang J, Wang Y, Lv T, Shu Y, Xu W, Chong L. Diabetes mellitus, glycemic traits, SGLT2 inhibition, and risk of pulmonary arterial hypertension: A Mendelian randomization study. Biosci Trends 2024; 18:94-104. [PMID: 38325821 DOI: 10.5582/bst.2024.01006] [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] [Indexed: 02/09/2024]
Abstract
This study aimed to investigate the causal role of diabetes mellitus (DM), glycemic traits, and sodium-glucose cotransporter 2 (SGLT2) inhibition in pulmonary arterial hypertension (PAH). Utilizing a two-sample two-step Mendelian randomization (MR) approach, we determined the causal influence of DM and glycemic traits (including insulin resistance, glycated hemoglobin, and fasting insulin and glucose) on the risk of PAH. Moreover, we examined the causal effects of SGLT2 inhibition on the risk of PAH. Genetic proxies for SGLT2 inhibition were identified as variants in the SLC5A2 gene that were associated with both levels of gene expression and hemoglobin A1c. Results showed that genetically inferred DM demonstrated a causal correlation with an increased risk of PAH, exhibiting an odds ratio (OR) of 1.432, with a 95% confidence interval (CI) of 1.040-1.973, and a p-value of 0.028. The multivariate MR analysis revealed comparable outcomes after potential confounders (OR = 1.469, 95%CI = 1.021-2.115, p = 0.038). Moreover, genetically predicted SGLT2 inhibition was causally linked to a reduced risk of PAH (OR = 1.681*10-7, 95%CI = 7.059*10-12-0.004, p = 0.002). Therefore, our study identified the suggestively causal effect of DM on the risk of PAH, and SGLT2 inhibition may be a potential therapeutic target in patients with PAH.
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Affiliation(s)
- Jiang-Shan Tan
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanmin Yang
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingyang Wang
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yimeng Wang
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tingting Lv
- Key Laboratory of Pulmonary Vascular Medicine, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuyuan Shu
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Xu
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingtao Chong
- Key Laboratory of Pulmonary Vascular Medicine, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Long C, Fan W, Liu Y, Hong K. Stress hyperglycemia is associated with poor outcome in critically ill patients with pulmonary hypertension. Front Endocrinol (Lausanne) 2024; 15:1302537. [PMID: 38464971 PMCID: PMC10924302 DOI: 10.3389/fendo.2024.1302537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
Background and objective Stress hyperglycemia is common in critically ill patients and is associated with poor prognosis. Whether this association exists in pulmonary hypertension (PH) patients is unknown. The present cohort study investigated the association of stress hyperglycemia with 90-day all-cause mortality in intensive care unit (ICU) patients with PH. Methods Data of the study population were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. A new index, the ratio of admission glucose to HbA1c (GAR), was used to evaluate stress hyperglycemia. The study population was divided into groups according to GAR quartiles (Q1-Q4). The outcome of interest was all-cause mortality within 90 days, which was considered a short-term prognosis. Result A total of 53,569 patients were screened. Ultimately, 414 PH patients were enrolled; 44.2% were male, and 23.2% were admitted to the cardiac ICU. As the GAR increased from Q2 to Q4, the groups had lower creatinine levels, longer ICU stays, and a higher proportion of renal disease. After adjusting for confounding factors such as demographics, vital signs, and comorbidities, an elevated GAR was associated with an increased risk of 90-day mortality. Conclusion Stress hyperglycemia assessed by the GAR was associated with increased 90-day mortality in ICU patients with PH.
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Affiliation(s)
- Chuyan Long
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weiguo Fan
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yang Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Kui Hong
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Genetic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Key Laboratory of Molecular Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Jonas K, Kurzyna M, Mroczek E, Chrzanowski Ł, Mularek-Kubzdela T, Skoczylas I, Błaszczak P, Grześk G, Mizia-Stec K, Kuśmierczyk B, Kamiński K, Lewicka E, Peregud-Pogorzelska M, Tomaszewski M, Jacheć W, Gąsior Z, Pawlak A, Ryczek R, Pruszczyk P, Doboszyńska A, Widejko-Pietkiewicz K, Zabłocka W, Waligóra M, Kopeć G. Impact of diabetes mellitus on disease severity and patient survival in idiopathic pulmonary arterial hypertension: data from the Polish multicentre registry (BNP-PL). Cardiovasc Diabetol 2023; 22:177. [PMID: 37443009 PMCID: PMC10347845 DOI: 10.1186/s12933-023-01885-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Recent studies revealed that alterations in glucose and lipid metabolism in idiopathic pulmonary arterial hypertension (IPAH) are associated with disease severity and poor survival. However, data regarding the impact of diabetes mellitus (DM) on the prognosis of patients with IPAH remain scarce. The aim of our study was to determine that impact using data from a national multicentre prospective pulmonary hypertension registry. METHODS We analysed data of adult patients with IPAH from the Database of Pulmonary Hypertension in the Polish population (BNP‑PL) between March 1, 2018 and August 31, 2020. Upon admission, clinical, echocardiographic, and haemodynamic data were collected at 21 Polish IPAH reference centres. The all-cause mortality was assessed during a 30-month follow-up period. To adjust for differences in age, body mass index (BMI), and comorbidities between patients with and without DM, a 2-group propensity score matching was performed using a 1:1 pairing algorithm. RESULTS A total of 532 patients with IPAH were included in the study and 25.6% were diagnosed with DM. Further matched analysis was performed in 136 patients with DM and 136 without DM. DM was associated with older age, higher BMI, more advanced exertional dyspnea, increased levels of N-terminal pro-brain natriuretic peptide, larger right atrial area, increased mean right atrial pressure, mean pulmonary artery pressure, pulmonary vascular resistance, and all-cause mortality compared with no DM. CONCLUSIONS Patients with IPAH and DM present with more advanced pulmonary vascular disease and worse survival than counterparts without DM independently of age, BMI, and cardiovascular comorbidities.
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Affiliation(s)
- Kamil Jonas
- Department of Cardiac and Vascular Diseases, John Paul II Hospital in Krakow, Krakow, 31-202, Poland
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 31-008, Poland
- Center for Innovative Medical Education, Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 30-688, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Fryderyk Chopin Hospital in European Health Centre Otwock, Otwock, Poland
| | - Ewa Mroczek
- Clinic of Heart Diseases, Institute of Heart Diseases, University Clinical Hospital, Wrocław, Poland
| | | | | | - Ilona Skoczylas
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 41-800, Poland
| | - Piotr Błaszczak
- Department of Cardiology, Cardinal Wyszynski Hospital, Lublin, 20-718, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, 40-635, Poland
| | - Beata Kuśmierczyk
- Department of Congenital Heart Disease Institute of Cardiology, Warsaw, 04-628, Poland
| | - Karol Kamiński
- Department of Cardiology, Medical University of Bialystok, Bialystok, 15-276, Poland
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Bialystok, 15-269, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, 80-211, Poland
| | | | - Michał Tomaszewski
- Department of Cardiology, Medical University of Lublin, Lublin, 20-090, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia in Katowice, Zabrze, 41-800, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, School of Health Sciences, Medical University of Cardiology in Katowice, Katowice, 40-635, Poland
| | - Agnieszka Pawlak
- Department of Invasive Cardiology, Polish Academy of Sciences, Mossakowski Medical Research Centre, Central Clinical Hospital of the Ministry of Interior, Warsaw, 02-507, Poland
| | - Robert Ryczek
- Department of Cardiology and Internal Medicine, Military Institute of Medicine - National Research Institute, Warsaw, 04-141, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Warszawa, Poland
| | - Anna Doboszyńska
- Pulmonary Department, University of Warmia and Mazury, Olsztyn, 10-357, Poland
| | | | - Wiesława Zabłocka
- Department of Cardiology, Provincial Specialist Hospital in Szczecin, Szczecin, Poland
| | - Marcin Waligóra
- Department of Cardiac and Vascular Diseases, John Paul II Hospital in Krakow, Krakow, 31-202, Poland
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 31-008, Poland
- Center for Innovative Medical Education, Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 30-688, Poland
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, John Paul II Hospital in Krakow, Krakow, 31-202, Poland.
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 31-008, Poland.
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Kant S, Banerjee D, Sabe SA, Sellke F, Feng J. Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction. Front Med (Lausanne) 2023; 10:1110532. [PMID: 36865056 PMCID: PMC9971232 DOI: 10.3389/fmed.2023.1110532] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Despite significant advances in surgical technique and strategies for tissue/organ protection, cardiac surgery involving cardiopulmonary bypass is a profound stressor on the human body and is associated with numerous intraoperative and postoperative collateral effects across different tissues and organ systems. Of note, cardiopulmonary bypass has been shown to induce significant alterations in microvascular reactivity. This involves altered myogenic tone, altered microvascular responsiveness to many endogenous vasoactive agonists, and generalized endothelial dysfunction across multiple vascular beds. This review begins with a survey of in vitro studies that examine the cellular mechanisms of microvascular dysfunction following cardiac surgery involving cardiopulmonary bypass, with a focus on endothelial activation, weakened barrier integrity, altered cell surface receptor expression, and changes in the balance between vasoconstrictive and vasodilatory mediators. Microvascular dysfunction in turn influences postoperative organ dysfunction in complex, poorly understood ways. Hence the second part of this review will highlight in vivo studies examining the effects of cardiac surgery on critical organ systems, notably the heart, brain, renal system, and skin/peripheral tissue vasculature. Clinical implications and possible areas for intervention will be discussed throughout the review.
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Affiliation(s)
| | | | | | | | - Jun Feng
- Cardiothoracic Surgery Research Laboratory, Department of Cardiothoracic Surgery, Rhode Island Hospital, Lifespan, Providence, RI, United States
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5
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Kumar R, Aktay-Cetin Ö, Craddock V, Morales-Cano D, Kosanovic D, Cogolludo A, Perez-Vizcaino F, Avdeev S, Kumar A, Ram AK, Agarwal S, Chakraborty A, Savai R, de Jesus Perez V, Graham BB, Butrous G, Dhillon NK. Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: Multilayered cross-talks in the setting of coinfections and comorbidities. PLoS Pathog 2023; 19:e1011063. [PMID: 36634048 PMCID: PMC9836319 DOI: 10.1371/journal.ppat.1011063] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its sublineages pose a new challenge to healthcare systems worldwide due to its ability to efficiently spread in immunized populations and its resistance to currently available therapies. COVID-19, although targeting primarily the respiratory system, is also now well established that later affects every organ in the body. Most importantly, despite the available therapy and vaccine-elicited protection, the long-term consequences of viral infection in breakthrough and asymptomatic individuals are areas of concern. In the past two years, investigators accumulated evidence on how the virus triggers our immune system and the molecular signals involved in the cross-talk between immune cells and structural cells in the pulmonary vasculature to drive pathological lung complications such as endothelial dysfunction and thrombosis. In the review, we emphasize recent updates on the pathophysiological inflammatory and immune responses associated with SARS-CoV-2 infection and their potential long-term consequences that may consequently lead to the development of pulmonary vascular diseases.
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Affiliation(s)
- Rahul Kumar
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Öznur Aktay-Cetin
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany
- Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
| | - Vaughn Craddock
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Daniel Morales-Cano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Djuro Kosanovic
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Angel Cogolludo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | - Francisco Perez-Vizcaino
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | - Sergey Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ashok Kumar
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Anil Kumar Ram
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Stuti Agarwal
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University Medical Center, California, United States of America
| | - Ananya Chakraborty
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University Medical Center, California, United States of America
| | - Rajkumar Savai
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany
- Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
- Department of Internal Medicine, Justus Liebig University Giessen, Member of the DZL, Member of CPI, Giessen, Germany
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany
| | - Vinicio de Jesus Perez
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University Medical Center, California, United States of America
| | - Brian B. Graham
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Ghazwan Butrous
- Cardiopulmonary Sciences, University of Kent, Canterbury, United Kingdom
| | - Navneet K. Dhillon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
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Hendriks PM, Staal DP, van de Groep LD, van den Toorn LM, Chandoesing PP, Kauling RM, Mager H, van den Bosch AE, Post MC, Boomars KA. The evolution of survival of pulmonary arterial hypertension over 15 years. Pulm Circ 2022; 12:e12137. [PMID: 36268054 PMCID: PMC9579738 DOI: 10.1002/pul2.12137] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
The prognosis of pulmonary arterial hypertension (PAH) remains dismal. Over the years, multiple therapeutic advances have been introduced. This study evaluates the evolution of PAH survival over the past 15 years. We included 293 consecutive adult patients diagnosed with PAH between 2005 and 2019 (median age: 61.8 years, 70.3% female). Patients were divided into three cohorts based on the time of diagnosis: 2005-2009, 2010-2014, and 2015-2019 (2005-2009: n = 56; 2010-2014: n = 111; 2015-2019: n = 126). Transplant-free survival was measured from the date of right heart catheterization until patients reached the composite endpoint of lung transplant or death. Multivariable cox-pulmonary hypertension regression was used to study the effect of the time of diagnosis. The final cox model was fitted in both younger and older patients to evaluate the difference between these groups. During a median follow-up time of 4.1 (interquartile range: 2.2-7.3) years, 9 patients underwent lung transplantation and 151 patients died. The median overall transplant-free survival was 6.2 (5.5-8.0) years. Patients older than 56 years at baseline who were diagnosed in 2005-2009 showed better survival compared to patients diagnosed in 2010-2014 and 2015-2019 with an adjusted hazard ratio of, respectively, 2.12 (1.11-4.03) and 2.83 (1.41-5.69). Patients younger than 56 years showed neither an improved nor deteriorated survival over time. In conclusion, survival in patients with PAH did not improve over time, despite more available therapeutic options. This might be partly due to the changed demographic characteristics of the PAH patients and a still important diagnostic delay.
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Affiliation(s)
- Paul M. Hendriks
- Department of Respiratory MedicineErasmus University Medical CenterRotterdamThe Netherlands
- Department of CardiologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Diederik P. Staal
- Department of CardiologySt. Antonius HospitalNieuwegeinThe Netherlands
| | | | - Leon M. van den Toorn
- Department of Respiratory MedicineErasmus University Medical CenterRotterdamThe Netherlands
| | - Prewesh P. Chandoesing
- Department of Respiratory MedicineErasmus University Medical CenterRotterdamThe Netherlands
| | - Robert M. Kauling
- Department of CardiologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Hans‐Jurgen Mager
- Department of Respiratory MedicineSt. Antonius HospitalNieuwegeinThe Netherlands
| | | | - Marco C. Post
- Department of CardiologySt. Antonius HospitalNieuwegeinThe Netherlands
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Karin A. Boomars
- Department of Respiratory MedicineErasmus University Medical CenterRotterdamThe Netherlands
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Vrigkou E, Vassilatou E, Dima E, Langleben D, Kotanidou A, Tzanela M. The Role of Thyroid Disorders, Obesity, Diabetes Mellitus and Estrogen Exposure as Potential Modifiers for Pulmonary Hypertension. J Clin Med 2022; 11:jcm11040921. [PMID: 35207198 PMCID: PMC8874474 DOI: 10.3390/jcm11040921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/30/2022] [Accepted: 02/06/2022] [Indexed: 02/01/2023] Open
Abstract
Pulmonary hypertension (PH) is a progressive disorder characterized by a chronic in-crease in pulmonary arterial pressure, frequently resulting in right-sided heart failure and potentially death. Co-existing medical conditions are important factors in PH, since they not only result in the genesis of the disorder, but may also contribute to its progression. Various studies have assessed the impact of thyroid disorders and other endocrine conditions (namely estrogen exposure, obesity, and diabetes mellitus) on the progression of PH. The complex interactions that hormones may have with the cardiovascular system and pulmonary vascular bed can create several pathogenetic routes that could explain the effects of endocrine disorders on PH development and evolution. The aim of this review is to summarize current knowledge on the role of concomitant thyroid disorders, obesity, diabetes mellitus, and estrogen exposure as potential modifiers for PH, and especially for pulmonary arterial hypertension, and to discuss possible pathogenetic routes linking them with PH. This information could be valuable for practicing clinicians so as to better evaluate and/or treat concomitant endocrine conditions in the PH population.
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Affiliation(s)
- Eleni Vrigkou
- 1st Department of Critical Care and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (E.V.); (E.D.); (A.K.)
| | | | - Effrosyni Dima
- 1st Department of Critical Care and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (E.V.); (E.D.); (A.K.)
| | - David Langleben
- Center for Pulmonary Vascular Disease, Azrieli Heart Center, Jewish General Hospital and McGill University, Montreal, QC H3A 0G4, Canada;
| | - Anastasia Kotanidou
- 1st Department of Critical Care and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (E.V.); (E.D.); (A.K.)
| | - Marinella Tzanela
- Department of Endocrinology, Diabetes Center, Evangelismos Hospital, 10676 Athens, Greece
- Correspondence: ; Tel.: +30-694-4284-637
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8
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Colón F, Gutiérrez A, García AG, Jiménez L, Arbaje DE, Zayas N. [Pulmonary arterial hypertension and renal impairment in patients from the National Institute of Cardiology Dr. Ignacio Chávez, Mexico]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:240-246. [PMID: 37727668 PMCID: PMC10506565 DOI: 10.47487/apcyccv.v2i4.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/22/2021] [Indexed: 09/21/2023]
Abstract
Objective The objective of the study was to describe the clinical characteristics and the evolution of the severity of pulmonary arterial hypertension (PAH) and the degree of renal failure. Material and methods A retrospective observational study was carried out in which the physical and electronic medical records of 60 patients older than 18 years with a diagnosis of pulmonary arterial hypertension were analyzed. Results In our study, 11.4% of the severe PAH group worsened renal function at six months, and 13.6% of the participants worsened it at one year. In contrast, in the group with moderate PAH, 18.8% worsened at six months, and 12.5% worsened at one year. Also, the GFR at one year was 54.15 mL/min/1.73 m2 in the moderate PAH group and in the severe PAH group was 73.55 mL/min/1.73 m2. Conclusion The results of this research suggest that the deterioration of kidney function is related to the severity of pulmonary arterial hypertension.
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Affiliation(s)
- Franklyn Colón
- Departamento de Cardiología, Clínica Corominas. Santiago de los Caballeros, República Dominicana.Departamento de CardiologíaClínica CorominasSantiago de los CaballerosRepública Dominicana
| | - Anthony Gutiérrez
- Departamento de Medicina, Facultad de Ciencias de la Salud Pontificia Universidad Católica Madre y Maestra. Santiago de los Caballeros, República Dominicana.Pontificia Universidad Católica Madre y MaestraDepartamento de MedicinaFacultad de Ciencias de la SaludPontificia Universidad Católica Madre y MaestraSantiago de los CaballerosDominican Republic
| | - Annette G. García
- Departamento de Medicina, Facultad de Ciencias de la Salud Pontificia Universidad Católica Madre y Maestra. Santiago de los Caballeros, República Dominicana.Pontificia Universidad Católica Madre y MaestraDepartamento de MedicinaFacultad de Ciencias de la SaludPontificia Universidad Católica Madre y MaestraSantiago de los CaballerosDominican Republic
| | - Lorgis Jiménez
- Departamento de Medicina, Facultad de Ciencias de la Salud Pontificia Universidad Católica Madre y Maestra. Santiago de los Caballeros, República Dominicana.Pontificia Universidad Católica Madre y MaestraDepartamento de MedicinaFacultad de Ciencias de la SaludPontificia Universidad Católica Madre y MaestraSantiago de los CaballerosDominican Republic
| | - Diego E. Arbaje
- Departamento de Medicina, Facultad de Ciencias de la Salud Pontificia Universidad Católica Madre y Maestra. Santiago de los Caballeros, República Dominicana.Pontificia Universidad Católica Madre y MaestraDepartamento de MedicinaFacultad de Ciencias de la SaludPontificia Universidad Católica Madre y MaestraSantiago de los CaballerosDominican Republic
| | - Nayeli Zayas
- Departamento de Cardioneumología, Instituto Nacional de Cardiología Dr. Ignacio Chávez. Ciudad de México, México. Departamento de CardioneumologíaInstituto Nacional de Cardiología Dr. Ignacio ChávezCiudad de MéxicoMéxico
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Nundlall N, Playford D, Strange G, Davis TME, Davis WA. Prevalence, Incidence and Associates of Pulmonary Hypertension Complicating Type 2 Diabetes: Insights from the Fremantle Diabetes Study Phase 2 and National Echocardiographic Database of Australia. J Clin Med 2021; 10:jcm10194503. [PMID: 34640520 PMCID: PMC8509549 DOI: 10.3390/jcm10194503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
There is a paucity of epidemiologic data examining the relationship between pulmonary hypertension (PH) and diabetes. The aim of this study was to determine prevalence, incidence and associates of PH complicating type 2 diabetes. Data from 1430 participants (mean age 65.5 years, 51.5% males) in the Fremantle Diabetes Study Phase 2 (FDS2) were linked with the National Echocardiographic Database of Australia (NEDA) to ascertain the prevalence and incidence of PH (estimated right ventricular systolic pressure (eRVSP) >30 mmHg as a new suggested threshold or the conventional >40 mmHg) over a 12-year period. PH prevalence in FDS2 was compared with that in NEDA overall and a geographically close sub-population. Multivariable analyses identified associates of prevalent/incident PH in the FDS2 cohort. Of 275 FDS2 patients (19.2%) with pre-entry echocardiography, 90 had eRVSP >30 mmHg and 35 had eRVSP >40 mmHg (prevalences 32.7% (95% CI 27.3–38.7%) and 12.7% (9.1–17.4%), respectively), rates that are 35–50% greater than national/local NEDA general population estimates. Moreover, 70 (5.0%) and 123 (9.2%) FDS2 participants were identified with incident PH at the respective eRVSP thresholds (incidence (95% CI) 7.6 (6.0–9.7) and 14.2 (11.8–17.0)/1000 person-years), paralleling data from recognised high-risk conditions such as systemic sclerosis. The baseline plasma N-terminal pro-brain natriuretic peptide concentration was the strongest independent associate of prevalent/incident PH. Approximately 1 in 8 people with type 2 diabetes have PH using the eRVSP >40 mmHg threshold. Its presence should be considered as part of regular clinical assessment of individuals with type 2 diabetes.
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Affiliation(s)
- Nishant Nundlall
- School of Medicine, The University of Notre Dame, Fremantle, WA 6160, Australia; (N.N.); (D.P.); (G.S.)
| | - David Playford
- School of Medicine, The University of Notre Dame, Fremantle, WA 6160, Australia; (N.N.); (D.P.); (G.S.)
| | - Geoff Strange
- School of Medicine, The University of Notre Dame, Fremantle, WA 6160, Australia; (N.N.); (D.P.); (G.S.)
- The Heart Research Institute, Newtown, NSW 2042, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Timothy M. E. Davis
- Fremantle Hospital, Medical School, The University of Western Australia, Fremantle, WA 6160, Australia;
- Correspondence:
| | - Wendy A. Davis
- Fremantle Hospital, Medical School, The University of Western Australia, Fremantle, WA 6160, Australia;
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10
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Insulin Resistance Is Associated with Right Ventricular Dysfunction. Ann Am Thorac Soc 2021; 19:562-571. [PMID: 34499590 DOI: 10.1513/annalsats.202107-766oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The effect of insulin resistance on left ventricular function is well documented, however less is known regarding its effect on the right ventricle (RV). OBJECTIVES To evaluate the association between insulin resistance and RV function by echocardiography in a cohort of adults without baseline cardiovascular disease. METHODS We performed a retrospective cohort study in the Multi-Ethnic Study of Atherosclerosis (MESA). Linear regression was used to examine the association between overall insulin resistance measured by the mean triglyceride to HDL cholesterol ratio (TG:HDL), and change in TG:HDL over time for each participant with echocardiographic RV function. Logistic regression was used to calculate the odds ratios of RV systolic and diastolic dysfunction. RESULTS Among 3,032 participants, higher mean TG:HDL was associated with lower (worse) absolute RV longitudinal strain (β -0.38; 95%CI -0.64, -0.13; p<0.01), tricuspid annular plane systolic excursion (TAPSE; β -0.05; 95%CI -0.07, -0.04; p<0.001) and higher odds of abnormal RV strain (OR 1.26; 95%CI 1.08, 1.47; p<0.01) and abnormal TAPSE (OR 1.31; 95%CI 1.14, 1.51; p<0.001). TG:HDL was also associated with lower tricuspid E/A ratio (β -0.03; 95%CI -0.04, -0.01; p<0.01), higher E/e' ratio (β 0.15; 95%CI 0.07, 0.23; p<0.001), and higher odds of graded RV diastolic dysfunction (OR 1.19; 95%CI 1.03, 1.39; p<0.05). These associations remained following multivariable adjustment. CONCLUSIONS Insulin resistance was associated with decreased RV systolic and diastolic function after adjusting for alternative causes of RV dysfunction, suggesting that insulin resistant individuals are at risk for early RV dysfunction, even in the absence of cardiovascular disease.
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Sweatt AJ, Reddy R, Rahaghi FN, Al-Naamani N. What's new in pulmonary hypertension clinical research: lessons from the best abstracts at the 2020 American Thoracic Society International Conference. Pulm Circ 2021; 11:20458940211040713. [PMID: 34471517 PMCID: PMC8404658 DOI: 10.1177/20458940211040713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022] Open
Abstract
In this conference paper, we review the 2020 American Thoracic Society International Conference session titled, "What's New in Pulmonary Hypertension Clinical Research: Lessons from the Best Abstracts". This virtual mini-symposium took place on 21 October 2020, in lieu of the annual in-person ATS International Conference which was cancelled due to the COVID-19 pandemic. Seven clinical research abstracts were selected for presentation in the session, which encompassed five major themes: (1) standardizing diagnosis and management of pulmonary hypertension, (2) improving risk assessment in pulmonary arterial hypertension, (3) evaluating biomarkers of disease activity, (4) understanding metabolic dysregulation across the spectrum of pulmonary hypertension, and (5) advancing knowledge in chronic thromboembolic pulmonary hypertension. Focusing on these five thematic contexts, we review the current state of knowledge, summarize presented research abstracts, appraise their significance and limitations, and then discuss relevant future directions in pulmonary hypertension clinical research.
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Affiliation(s)
- Andrew J. Sweatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
| | - Raju Reddy
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Farbod N. Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nadine Al-Naamani
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - on behalf of the American Thoracic Society Pulmonary Circulation Assembly Early Career Working Group
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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12
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Nundlall N, Playford D, Davis TME, Davis WA. Relative incidence and predictors of pulmonary arterial hypertension complicating type 2 diabetes: The Fremantle Diabetes Study Phase I. J Diabetes Complications 2021; 35:107773. [PMID: 33144028 DOI: 10.1016/j.jdiacomp.2020.107773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 11/19/2022]
Abstract
AIMS To determine the relative incidence and predictors of pulmonary arterial hypertension (PAH) in type 2 diabetes. METHODS Hospitalizations for/with and death from/with PAH, and all-cause mortality, were ascertained from validated databases for participants from the longitudinal, community-based Fremantle Diabetes Study Phase I (FDS1; n = 1287) and age-, sex- and zip code-matched people without diabetes (n = 5153) between entry (1993-1996) and end-2017. Incidence rates (IRs) and IR ratios (IRRs) were calculated. Cox proportional hazards and competing risk models generated cause-specific (cs) and subdistribution (sd) hazard ratios (HRs) for incident PAH. RESULTS In the pooled cohort (mean age 64.0 years, 49% males), 49 (3.8%) of the type 2 diabetes participants and 133 (2.6%) of those without diabetes developed PAH during 106,556 person-years of follow-up (IRs (95% CI) 262 (194-346) and 151 (127-179) /100,000 person-years, respectively; IRR 1.73 (1.22-2.42), P = 0.001). Type 2 diabetes was associated with an unadjusted csHR of 1.97 (1.42-2.74) and sdHR of 1.44 (1.04-2.00) (P ≤ 0.03); after adjustment for age, sex, and co-morbidities, these were 1.43 (0.83-2.47) and 1.36 (0.97-1.91), respectively (P ≥ 0.07). CONCLUSIONS Type 2 diabetes is associated with an increased risk of PAH but this is no longer significant after adjustment for other explanatory variables and the competing risk of death.
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Affiliation(s)
| | - David Playford
- School of Medicine, The University of Notre Dame, Australia
| | - Timothy M E Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Wendy A Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
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13
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Kopf S, Kumar V, Kender Z, Han Z, Fleming T, Herzig S, Nawroth PP. Diabetic Pneumopathy-A New Diabetes-Associated Complication: Mechanisms, Consequences and Treatment Considerations. Front Endocrinol (Lausanne) 2021; 12:765201. [PMID: 34899603 PMCID: PMC8655305 DOI: 10.3389/fendo.2021.765201] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/22/2021] [Indexed: 01/04/2023] Open
Abstract
Patients with diabetes are over-represented among the total cases reported with "idiopathic" pulmonary fibrosis (IPF). This raises the question, whether this is an association only or whether diabetes itself can cause pulmonary fibrosis. Recent studies in mouse models of type 1 and type 2 diabetes demonstrated that diabetes causes pulmonary fibrosis. Both types of diabetes trigger a cascade, starting with increased DNA damage, an impaired DNA repair, and leading to persistent DNA damage signaling. This response, in turn, induces senescence, a senescence-associated-secretory phenotype (SASP), marked by the release of pro-inflammatory cytokines and growth factors, finally resulting in fibrosis. Restoring DNA repair drives fibrosis into remission, thus proving causality. These data can be translated clinically to patients with type 2 diabetes, characterized by long-term diabetes and albuminuria. Hence there are several arguments, to substitute the term "idiopathic" pulmonary fibrosis (IPF) in patients with diabetes (and exclusion of other causes of lung diseases) by the term "diabetes-induced pulmonary fibrosis" (DiPF). However, future studies are required to establish this term and to study whether patients with diabetes respond to the established therapies similar to non-diabetic patients.
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Affiliation(s)
- Stefan Kopf
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Varun Kumar
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- European Molecular Biology Laboratory, Advanced Light Microscopy Facility, Heidelberg, Germany
| | - Zoltan Kender
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Zhe Han
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Fleming
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Stephan Herzig
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Munich-Neuherberg, Germany
- Joint Heidelberg-Institute for Diabetes and Cancer (IDC) Translational Diabetes Programme, Helmholtz-Zentrum, Munich, Germany
| | - Peter P. Nawroth
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Joint Heidelberg-Institute for Diabetes and Cancer (IDC) Translational Diabetes Programme, Helmholtz-Zentrum, Munich, Germany
- *Correspondence: Peter P. Nawroth,
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14
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Bhattacharya PT, Hameed AMA, Bhattacharya ST, Chirinos JA, Hwang WT, Birati EY, Menachem JN, Chatterjee S, Giri JS, Kawut SM, Kimmel SE, Mazurek JA. Risk factors for 30-day readmission in adults hospitalized for pulmonary hypertension. Pulm Circ 2020; 10:2045894020966889. [PMID: 33282194 PMCID: PMC7686634 DOI: 10.1177/2045894020966889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/24/2020] [Indexed: 01/15/2023] Open
Abstract
Readmissions for pulmonary hypertension are poorly understood and understudied.
We sought to determine national estimates and risk factors for 30-day
readmission after pulmonary hypertension-related hospitalizations. We utilized
the Healthcare Cost and Utilization Project Nationwide Readmission Database,
which has weighted estimates of roughly 35 million discharges in the US. Adult
patients with primary International Classification of Disease, Ninth Revision,
Clinical Modification diagnosis codes of 416.0 and 416.8 for primary and
secondary pulmonary hypertension with an index admission between 2012 and 2014
and any readmission within 30 days of the index event were identified.
Predictors of 30-day readmission were identified using multivariable logistic
regression with adjustment for covariates. Results showed that the national
estimate for Primary Pulmonary Hypertension vs Secondary Pulmonary
Hypertension-related index events between 2012 and 2014 with 30-day readmission
was 247 vs 2550 corresponding to a national readmission risk estimate of 17% vs
18.3%, respectively. The presence of fluid and electrolyte disorders, renal
failure, and alcohol abuse were associated with increased risk of readmission in
Primary Pulmonary Hypertension, while factors associated with Secondary
Pulmonary Hypertension readmissions included anemia, congestive heart failure,
lung disease, fluid and electrolyte disorders, renal failure, diabetes, and
liver disease. The median cost of Primary Pulmonary Hypertension admissions and
readmissions were $46,132 (IQR: $25,384–$85,647) and $41,604.50 (IQR:
$22,481.50–$84,420.50), respectively. The median costs of Secondary Pulmonary
Hypertension admissions and readmissions were $34,893 (IQR: $19,670–$66,143) and
$36,279 (IQR: $19,059–$74,679), respectively. In conclusion, approximately 19%
of Primary Pulmonary Hypertension and Secondary Pulmonary Hypertension
hospitalizations result in 30-day readmission, with significant costs accrued
during the index hospitalization and readmission. With evolving clinical
terminology and diagnostic codes, future study will need to better clarify
underlying factors associated with readmissions amongst pulmonary hypertension
sub-types, and identify methods and procedures to minimize readmission risk.
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Affiliation(s)
- Priyanka T Bhattacharya
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Asif M Abdul Hameed
- Department of Pulmonary Disease and Critical Care Medicine, Wayne State University, Detroit, MI, USA
| | | | - Julio A Chirinos
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Edo Y Birati
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan N Menachem
- Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Saurav Chatterjee
- Department of Cardiovascular Medicine, St Francis Hospital of the University of Connecticut, Hartford, CT, USA
| | - Jay S Giri
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Steven M Kawut
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen E Kimmel
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy A Mazurek
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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15
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Trammell AW, Hemnes AR, Tseng V, Shah AJ, Phillips LS, Hart CM. Influence of Body Weight and Diabetes Mellitus in Patients With Pulmonary Hypertension. Am J Cardiol 2020; 134:130-137. [PMID: 32919617 DOI: 10.1016/j.amjcard.2020.07.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Pulmonary hypertension (PH) is a complex condition that arises due to pulmonary vascular disease, heart disease, lung disease, chronic thromboembolism, or several rare causes. Regardless of underlying cause, PH increases mortality, yet there are no directed treatments for the most common forms of PH due to left heart or lung disease. Because metabolic factors have been implicated in the pathogenesis of PH, we used a large administrative cohort to assess diabetes and weight, potentially modifiable risk factors, on PH outcome. We analyzed 110,495 veterans diagnosed with PH from January 1, 2003 to September 30, 2015 in the Veterans Health Affairs system. Veterans with PH survived an average of 3.88 [IQR 3.85, 3.92] years after PH diagnosis. Diabetes occurred in 36% and increased risk of death by 31% (95% confidence interval 28% to 33%, multivariate adjusted). Higher body mass index was associated with lower mortality in a J-shaped pattern with highest risk in underweight and normal weight veterans. Improved survival in obesity has been referred to as the obesity paradox in heart failure and other diseases. These data show that lower weight and diabetes are strong risk factors for mortality in PH. Our results underscore the importance of systemic conditions on outcome in PH.
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Affiliation(s)
- Aaron W Trammell
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta VA Health Care System, Department of Veterans Affairs, Decatur, Georgia.
| | - Anna R Hemnes
- Division of Allergy, Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Victor Tseng
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta VA Health Care System, Department of Veterans Affairs, Decatur, Georgia
| | - Amit J Shah
- Atlanta VA Health Care System, Department of Veterans Affairs, Decatur, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lawrence S Phillips
- Atlanta VA Health Care System, Department of Veterans Affairs, Decatur, Georgia; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Charles Michael Hart
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta VA Health Care System, Department of Veterans Affairs, Decatur, Georgia
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16
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Le Ribeuz H, Capuano V, Girerd B, Humbert M, Montani D, Antigny F. Implication of Potassium Channels in the Pathophysiology of Pulmonary Arterial Hypertension. Biomolecules 2020; 10:biom10091261. [PMID: 32882918 PMCID: PMC7564204 DOI: 10.3390/biom10091261] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare and severe cardiopulmonary disease without curative treatments. PAH is a multifactorial disease that involves genetic predisposition, epigenetic factors, and environmental factors (drugs, toxins, viruses, hypoxia, and inflammation), which contribute to the initiation or development of irreversible remodeling of the pulmonary vessels. The recent identification of loss-of-function mutations in KCNK3 (KCNK3 or TASK-1) and ABCC8 (SUR1), or gain-of-function mutations in ABCC9 (SUR2), as well as polymorphisms in KCNA5 (Kv1.5), which encode two potassium (K+) channels and two K+ channel regulatory subunits, has revived the interest of ion channels in PAH. This review focuses on KCNK3, SUR1, SUR2, and Kv1.5 channels in pulmonary vasculature and discusses their pathophysiological contribution to and therapeutic potential in PAH.
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Affiliation(s)
- Hélène Le Ribeuz
- Faculté de Médecine, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; (H.L.R.); (V.C.); (B.G.); (M.H.); (D.M.)
- INSERM UMR_S 999, Hypertension pulmonaire, Physiopathologie et Innovation Thérapeutique, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l’Hypertension Pulmonaire, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Véronique Capuano
- Faculté de Médecine, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; (H.L.R.); (V.C.); (B.G.); (M.H.); (D.M.)
- INSERM UMR_S 999, Hypertension pulmonaire, Physiopathologie et Innovation Thérapeutique, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l’Hypertension Pulmonaire, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Barbara Girerd
- Faculté de Médecine, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; (H.L.R.); (V.C.); (B.G.); (M.H.); (D.M.)
- INSERM UMR_S 999, Hypertension pulmonaire, Physiopathologie et Innovation Thérapeutique, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l’Hypertension Pulmonaire, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Faculté de Médecine, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; (H.L.R.); (V.C.); (B.G.); (M.H.); (D.M.)
- INSERM UMR_S 999, Hypertension pulmonaire, Physiopathologie et Innovation Thérapeutique, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l’Hypertension Pulmonaire, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - David Montani
- Faculté de Médecine, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; (H.L.R.); (V.C.); (B.G.); (M.H.); (D.M.)
- INSERM UMR_S 999, Hypertension pulmonaire, Physiopathologie et Innovation Thérapeutique, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l’Hypertension Pulmonaire, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Fabrice Antigny
- Faculté de Médecine, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; (H.L.R.); (V.C.); (B.G.); (M.H.); (D.M.)
- INSERM UMR_S 999, Hypertension pulmonaire, Physiopathologie et Innovation Thérapeutique, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l’Hypertension Pulmonaire, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
- Correspondence: or ; Tel.: +33-1-40-94-22-99
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17
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Shi XF, Su YC. Vascular Metabolic Mechanisms of Pulmonary Hypertension. Curr Med Sci 2020; 40:444-454. [PMID: 32681249 DOI: 10.1007/s11596-020-2198-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/10/2020] [Indexed: 02/07/2023]
Abstract
Pulmonary hypertension (PH) is a severe and progressive disease characterized by increased pulmonary vascular resistance leading to right heart failure and death. In PH, the cellular metabolisms including those of the three major nutrients (carbohydrate, lipid and protein) are aberrant in pulmonary vascular cells. Glucose uptake, glycolysis, insulin resistance, sphingolipid S1P, PGE2, TXA2, leukotrienes and glutaminolysis are upregulated, and phospholipid-prostacyclin and L-arginine-nitric oxide pathway are compromised in lung vascular cells. Fatty acid metabolism is disordered in lung endothelial cells and smooth muscle cells. These molecular mechanisms are integrated to promote PH-specific abnormal vascular cell proliferation and vascular remodeling. This review summarizes the recent advances in the metabolic reprogramming of glucose, fatty acid, and amino acid metabolism in pulmonary vascular remodeling in PH and the mechanisms for how these alterations affect vascular cell fate and impact the course of PH.
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Affiliation(s)
- Xiao-Fan Shi
- Department of Pharmacology & Toxicology, Augusta University, Augusta, GA, 30912, USA
| | - Yun-Chao Su
- Department of Pharmacology & Toxicology, Augusta University, Augusta, GA, 30912, USA. .,Department of Medicine, Augusta University, Augusta, GA, 30912, USA. .,Vascular Biology Center, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA.
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18
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Khaing P, Pandit P, Awsare B, Summer R. Pulmonary Circulation in Obesity, Diabetes, and Metabolic Syndrome. Compr Physiol 2019; 10:297-316. [DOI: 10.1002/cphy.c190018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Johnson J, Lakshmanan G, M B, R M V, Kalimuthu K, Sekar D. Computational identification of MiRNA-7110 from pulmonary arterial hypertension (PAH) ESTs: a new microRNA that links diabetes and PAH. Hypertens Res 2019; 43:360-362. [PMID: 31792346 DOI: 10.1038/s41440-019-0369-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Jayapriya Johnson
- Dental Research Cell (DRC-BRULAC), Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Science (SIMATS), Saveetha University, Chennai, 600077, India
| | - Ganesh Lakshmanan
- Department of Anatomy, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Science (SIMATS), Saveetha University, Chennai, 600077, India
| | - Biruntha M
- Department of Animal Health and Management, Alagappa University, Tamil Nadu, 630003, India
| | - Vidhyavathi R M
- Department of Bioinformatics, Alagappa University, Tamil Nadu, 630003, India
| | - Kohila Kalimuthu
- Department of Obstetrics and Gynaecology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Science (SIMATS), Saveetha University, Chennai, 600077, India
| | - Durairaj Sekar
- Dental Research Cell (DRC-BRULAC), Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Science (SIMATS), Saveetha University, Chennai, 600077, India.
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Abstract
Diabetes mellitus is a chronic, progressive, incompletely understood metabolic disorder whose prevalence has been increasing steadily worldwide. Even though little attention has been paid to lung disorders in the context of diabetes, its prevalence has recently been challenged by newer studies of disease development. In this review, we summarize and discuss the role of diabetes mellitus involved in the progression of pulmonary diseases, with the main focus on pulmonary fibrosis, which represents a chronic and progressive disease with high mortality and limited therapeutic options.
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Affiliation(s)
- Saeed Kolahian
- Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, and Interfaculty Center of Pharmacogenomics and Drug Research (ICePhA), Eberhard Karls University Hospitals and Clinics, Tübingen, Germany.
- Department of Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Eberhard Karls University Hospitals and Clinics, Tübingen, Germany.
- Department of Pharmacogenomics, University of Tübingen, Wilhelmstrasse. 56, D-72074, Tübingen, Germany.
| | - Veronika Leiss
- Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, and Interfaculty Center of Pharmacogenomics and Drug Research (ICePhA), Eberhard Karls University Hospitals and Clinics, Tübingen, Germany
| | - Bernd Nürnberg
- Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, and Interfaculty Center of Pharmacogenomics and Drug Research (ICePhA), Eberhard Karls University Hospitals and Clinics, Tübingen, Germany
- Department of Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Eberhard Karls University Hospitals and Clinics, Tübingen, Germany
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21
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Menachem JN, Beckman JA. All for One or One for All? J Card Fail 2019; 25:733-734. [PMID: 31330298 DOI: 10.1016/j.cardfail.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jonathan N Menachem
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua A Beckman
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
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22
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Santosh S, Chu C, Mwangi J, Narayan M, Mosman A, Nayak R, Philipneri M. Changes in pulmonary artery systolic pressure and right ventricular function in patients with end-stage renal disease on maintenance dialysis. Nephrology (Carlton) 2019; 24:74-80. [PMID: 29053201 DOI: 10.1111/nep.13183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 12/24/2022]
Abstract
AIM Pulmonary hypertension is common in patients with end-stage renal disease, and portends a poor prognosis. There are little data in this population, and previous studies have not evaluated quantitative changes in haemodynamics over time while on maintenance dialysis. This study sought to estimate changes in pulmonary artery systolic pressure (PASP) and right ventricular function over time, and to predict PASP change using clinical variables routinely available at time of initial measurement, in patients on maintenance dialysis. METHODS We retrospectively studied patients with end-stage renal disease at a university-affiliated dialysis centre who had two separate echocardiograms 1-4 years apart. RESULTS Seventy-six patients (65 haemodialysis, 11 peritoneal dialysis) were included. PASP was estimated by echocardiography. Baseline PASP was predicted by left-sided valvular disease, anaemia, COPD, left-ventricular mass index, and haemodialysis modality (P = 0.07 for modality). Average increase in PASP was 2.41 mmHg per year. Higher rates of PASP change were predicted by E/e' ratio by tissue doppler on echocardiogram, diabetes mellitus, low LV mass, and left-sided valvular heart disease (P = 0.07 for valvular disease). Patients with higher PASP had higher incidence of new-onset right ventricular dysfunction. CONCLUSION In patients with end-stage renal disease, PASP increases over time. Changes are moderately predictable. Higher PASP predicted development of right ventricular dysfunction.
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Affiliation(s)
- Sadashiv Santosh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Cheng Chu
- Division of Nephrology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - John Mwangi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Melin Narayan
- Division of Nephrology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Amy Mosman
- Division of Nephrology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Ravi Nayak
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Marie Philipneri
- Division of Nephrology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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23
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Grinnan D, Trankle C, Andruska A, Bloom B, Spiekerkoetter E. Drug repositioning in pulmonary arterial hypertension: challenges and opportunities. Pulm Circ 2019; 9:2045894019832226. [PMID: 30729869 PMCID: PMC6852366 DOI: 10.1177/2045894019832226] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Despite many advances in medical therapy for pulmonary arterial hypertension (PAH) over the past 20 years, long-term survival is still poor. Novel therapies which target the underlying pathology of PAH and which could be added to current vasodilatory therapies to halt disease progression and potentially reverse pulmonary vascular remodeling are highly sought after. Given the high attrition rates, substantial costs, and slow pace of new drug development, repositioning of “old” drugs is increasingly becoming an attractive path to identify novel treatment options, especially for a rare disease such as PAH. We here summarize the limitations of current PAH therapy, the general concept of repurposing and repositioning, success stories of approved repositioned drugs in PAH as well as novel repositioned drugs that show promise in preclinical models of pulmonary hypertension (PH) and are currently tested in clinical trials. We furthermore discuss various data-driven as well as experimental approaches currently used to identify repurposed drug candidates and review challenges for the “repositioning community” with regards to funding and patent and regulatory considerations, and to illustrate opportunities for collaborative solutions for drug repositioning relevant to PAH.
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Affiliation(s)
- Daniel Grinnan
- 1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Cory Trankle
- 2 Department of Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam Andruska
- 3 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.,4 Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
| | | | - Edda Spiekerkoetter
- 3 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.,4 Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
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24
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Khateeb J, Fuchs E, Khamaisi M. Diabetes and Lung Disease: A Neglected Relationship. Rev Diabet Stud 2019; 15:1-15. [PMID: 30489598 DOI: 10.1900/rds.2019.15.1] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a systemic disorder associated with inflammation and oxidative stress which may target many organs such as the kidney, retina, and the vascular system. The pathophysiology, mechanisms, and consequences of diabetes on these organs have been studied widely. However, no work has been done on the concept of the lung as a target organ for diabetes and its implications for lung diseases. AIM In this review, we aimed to investigate the effects of diabetes and hypoglycemic agent on lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, pulmonary hypertension, and lung cancer. We also reviewed the potential mechanisms by which these effects may affect lung disease patients. RESULTS Our results suggest that diabetes can affect the severity and clinical course of several lung diseases. CONCLUSIONS Although the diabetes-lung association is epidemiologically and clinically well-established, especially in asthma, the underlying mechanism and pathophysiology are not been fully understood. Several mechanisms have been suggested, mainly associated with the pro-inflammatory and proliferative properties of diabetes, but also in relation to micro- and macrovascular effects of diabetes on the pulmonary vasculature. Also, hypoglycemic drugs may influence lung diseases in different ways. For example, metformin was considered a potential therapeutic agent in lung diseases, while insulin was shown to exacerbate lung diseases; this suggests that their effects extend beyond their hypoglycemic properties.
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Affiliation(s)
- Jasmin Khateeb
- Department of Internal Medicine D, Rambam Health Care Campus, Haifa, Israel
| | - Eyal Fuchs
- Pulmonary Division, Rambam Health Care Campus, Haifa, Israel
| | - Mogher Khamaisi
- Department of Internal Medicine D, Rambam Health Care Campus, Haifa, Israel
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25
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Hogan SE, Rodriguez Salazar MP, Cheadle J, Glenn R, Medrano C, Petersen TH, Ilagan RM. Mesenchymal stromal cell-derived exosomes improve mitochondrial health in pulmonary arterial hypertension. Am J Physiol Lung Cell Mol Physiol 2019; 316:L723-L737. [PMID: 30652491 DOI: 10.1152/ajplung.00058.2018] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Secreted exosomes are bioactive particles that elicit profound responses in target cells. Using targeted metabolomics and global microarray analysis, we identified a role of exosomes in promoting mitochondrial function in the context of pulmonary arterial hypertension (PAH). Whereas chronic hypoxia results in a glycolytic shift in pulmonary artery smooth muscle cells (PASMCs), exosomes restore energy balance and improve O2 consumption. These results were confirmed in a hypoxia-induced mouse model and a semaxanib/hypoxia rat model of PAH wherein exosomes improved the mitochondrial dysfunction associated with disease. Importantly, exosome exposure increased PASMC expression of pyruvate dehydrogenase (PDH) and glutamate dehydrogenase 1 (GLUD1), linking exosome treatment to the TCA cycle. Furthermore, we show that although prolonged hypoxia induced sirtuin 4 expression, an upstream inhibitor of both GLUD1 and PDH, exosomes reduced its expression. These data provide direct evidence of an exosome-mediated improvement in mitochondrial function and contribute new insights into the therapeutic potential of exosomes in PAH.
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Affiliation(s)
- Sarah E Hogan
- Department of Regenerative Medicine, United Therapeutics Corporation , Durham, North Carolina
| | | | - John Cheadle
- Department of Regenerative Medicine, United Therapeutics Corporation , Durham, North Carolina
| | - Rachel Glenn
- Department of Regenerative Medicine, United Therapeutics Corporation , Durham, North Carolina
| | - Carolina Medrano
- Department of Regenerative Medicine, United Therapeutics Corporation , Durham, North Carolina
| | - Thomas H Petersen
- Department of Regenerative Medicine, United Therapeutics Corporation , Durham, North Carolina
| | - Roger M Ilagan
- Department of Regenerative Medicine, United Therapeutics Corporation , Durham, North Carolina
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26
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Kang Y, Wang S, Huang J, Cai L, Keller BB. Right ventricular dysfunction and remodeling in diabetic cardiomyopathy. Am J Physiol Heart Circ Physiol 2019; 316:H113-H122. [DOI: 10.1152/ajpheart.00440.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The increasing prevalence of diabetic cardiomyopathy (DCM) is an important threat to health worldwide. While left ventricular (LV) dysfunction in DCM is well recognized, the accurate detection, diagnosis, and treatment of changes in right ventricular (RV) structure and function have not been well characterized. The pathophysiology of RV dysfunction in DCM may share features with LV diastolic and systolic dysfunction, including pathways related to insulin resistance and oxidant injury, although the RV has a unique cellular origin and composition and unique biomechanical properties and is coupled to the lower-impedance pulmonary vascular bed. In this review, we discuss potential mechanisms responsible for RV dysfunction in DCM and review the imaging approaches useful for early detection, protection, and intervention strategies. Additional data are required from animal models and clinical trials to better identify the onset and features of altered RV and pulmonary vascular structure and function during the onset and progression of DCM and to determine the efficacy of early detection and treatment of RV dysfunction on clinical symptoms and outcomes.
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Affiliation(s)
- Yin Kang
- Department of Anesthesiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Sheng Wang
- Department of Anesthesiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, and Department of Anesthesiology, Jewish Hospital, Louisville, Kentucky
| | - Lu Cai
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky
- Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
| | - Bradley B. Keller
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky
- Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
- Kosair Charities Pediatric Heart Research Program, Cardiovascular Innovation Institute, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
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27
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Untargeted Metabolic Profiling Cell-Based Approach of Pulmonary Artery Smooth Muscle Cells in Response to High Glucose and the Effect of the Antioxidant Vitamins D and E. Metabolites 2018; 8:metabo8040087. [PMID: 30513640 PMCID: PMC6316736 DOI: 10.3390/metabo8040087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a multi-factorial disease characterized by the hyperproliferation of pulmonary artery smooth muscle cells (PASMCs). Excessive reactive oxygen species (ROS) formation resulted in alterations of the structure and function of pulmonary arterial walls, leading to right ventricular failure and death. Diabetes mellitus has not yet been implicated in pulmonary hypertension. However, recently, variable studies have shown that diabetes is correlated with pulmonary hypertension pathobiology, which could participate in the modification of pulmonary artery muscles. The metabolomic changes in PASMCs were studied in response to 25 mM of D-glucose (high glucose, or HG) in order to establish a diabetic-like condition in an in vitro setting, and compared to five mM of D-glucose (normal glucose, or LG). The effect of co-culturing these cells with an ideal blood serum concentration of cholecalciferol-D3 and tocopherol was also examined. The current study aimed to examine the role of hyperglycemia in pulmonary arterial hypertension by the quantification and detection of the metabolomic alteration of smooth muscle cells in high-glucose conditions. Untargeted metabolomics was carried out using hydrophilic interaction liquid chromatography and high-resolution mass spectrometry. Cell proliferation was assessed by cell viability and the [³H] thymidine incorporation assay, and the redox state within the cells was examined by measuring reactive oxygen species (ROS) generation. The results demonstrated that PASMCs in high glucose (HG) grew, proliferated faster, and generated higher levels of superoxide anion (O₂·-) and hydrogen peroxide (H₂O₂). The metabolomics of cells cultured in HG showed that the carbohydrate pathway, especially that of the upper glycolytic pathway metabolites, was influenced by the activation of the oxidation pathway: the pentose phosphate pathway (PPP). The amount of amino acids such as aspartate and glutathione reduced via HG, while glutathione disulfide, N6-Acetyl-L-lysine, glutamate, and 5-aminopentanoate increased. Lipids either as fatty acids or glycerophospholipids were downregulated in most of the metabolites, with the exception of docosatetraenoic acid and PG (16:0/16:1(9Z)). Purine and pyrimidine were influenced by hyperglycaemia following PPP oxidation. The results in addition showed that cells exposed to 25 mM of glucose were oxidatively stressed comparing to those cultured in five mM of glucose. Cholecalciferol (D3, or vitamin D) and tocopherol (vitamin E) were shown to restore the redox status of many metabolic pathways.
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28
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Takahashi T, Yoshihisa A, Sugimoto K, Yokokawa T, Misaka T, Kaneshiro T, Oikawa M, Kobayashi A, Nakazato K, Ishida T, Takeishi Y. Associations between diabetes mellitus and pulmonary hypertension in chronic respiratory disease patients. PLoS One 2018; 13:e0205008. [PMID: 30300400 PMCID: PMC6177140 DOI: 10.1371/journal.pone.0205008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Abstract
Background Pulmonary hypertension (PH) is a common complication of chronic respiratory disease. Recent studies have reported diabetes mellitus (DM) to be a poor prognostic factor in patients with chronic respiratory disease, including chronic obstructive pulmonary disease or interstitial pneumoniae. However, the association between DM and PH in chronic respiratory disease remains unclear. In this study, we aimed to investigate whether DM is a predictor of PH in patients with chronic respiratory disease. Methods We prospectively analyzed 386 patients in our hospital with chronic respiratory disease. An echocardiographic pressure gradient between the right atrium and the right ventricle of ≥ 40 mmHg was defined as PH. We compared the clinical characteristics and impact of DM between chronic respiratory disease patients with and those without PH. Results Of the 386 patients, 42 (10.9%) were diagnosed as having PH. The PH group had higher modified medical research council (mMRC) grade and complication rate of DM, but not hypertension and hyperlipidemia, when compared to the non-PH group. Multivariable logistic regression analysis revealed that mMRC scale (odds ratio 1.702, 95% confidence interval, 1.297 to 2.232, P < 0.001) and presence of DM (odd ratio 2.935, 95% confidence interval, 1.505 to 5.725, P = 0.002) were associated with PH in chronic respiratory disease patients. Conclusion DM is potentially associated with PH and is an independent factor for prediction of PH in patients with chronic respiratory disease.
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Affiliation(s)
- Tomoko Takahashi
- Clinical Research Center, Fukushima Medical University Hospital, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Koichi Sugimoto
- Department of Pulmonary Hypertension, Fukushima Medical University, Fukushima, Japan
- * E-mail:
| | - Tetsuro Yokokawa
- Department of Pulmonary Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Tomofumi Misaka
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kaneshiro
- Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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29
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Jose A, King CS, Shlobin OA, Brown AW, Wang C, Nathan SD. Exercise pulmonary haemodynamic response predicts outcomes in fibrotic lung disease. Eur Respir J 2018; 52:13993003.01015-2018. [PMID: 30093570 DOI: 10.1183/13993003.01015-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/25/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Arun Jose
- Pulmonary, Critical Care and Sleep Medicine Division, The George Washington University MFA, Washington, DC, USA
| | - Christopher S King
- Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Oksana A Shlobin
- Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA, USA
| | - A Whitney Brown
- Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Chengxi Wang
- Internal Medicine Division, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Steven D Nathan
- Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA, USA
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30
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Willson C, Watanabe M, Tsuji-Hosokawa A, Makino A. Pulmonary vascular dysfunction in metabolic syndrome. J Physiol 2018; 597:1121-1141. [PMID: 30125956 DOI: 10.1113/jp275856] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome is a critically important precursor to the onset of many diseases, such as cardiovascular disease, and cardiovascular disease is the leading cause of death worldwide. The primary risk factors of metabolic syndrome include hyperglycaemia, abdominal obesity, dyslipidaemia, and high blood pressure. It has been well documented that metabolic syndrome alters vascular endothelial and smooth muscle cell functions in the heart, brain, kidney and peripheral vessels. However, there is less information available regarding how metabolic syndrome can affect pulmonary vascular function and ultimately increase an individual's risk of developing various pulmonary vascular diseases, such as pulmonary hypertension. Here, we review in detail how metabolic syndrome affects pulmonary vascular function.
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Affiliation(s)
- Conor Willson
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Makiko Watanabe
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | | | - Ayako Makino
- Department of Physiology, University of Arizona, Tucson, AZ, USA
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31
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Sun XQ, Abbate A, Bogaard HJ. Role of cardiac inflammation in right ventricular failure. Cardiovasc Res 2018; 113:1441-1452. [PMID: 28957536 DOI: 10.1093/cvr/cvx159] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/09/2017] [Indexed: 12/18/2022] Open
Abstract
Right ventricular failure (RVF) is the main determinant of mortality in patients with pulmonary arterial hypertension (PAH). Although the exact pathophysiology underlying RVF remains unclear, inflammation may play an important role, as it does in left heart failure. Perivascular pulmonary artery and systemic inflammation is relatively well studied and known to contribute to the initiation and maintenance of the pulmonary vascular insult in PAH. However, less attention has been paid to the role of cardiac inflammation in RVF and PAH. Consistent with many other types of heart failure, cardiac inflammation, triggered by systemic and local stressors, has been shown in RVF patients as well as in RVF animal models. RV inflammation likely contributes to impaired RV contractility, maladaptive remodelling and a vicious circle between RV and pulmonary vascular injury. Although the potential to improve RV function through anti-inflammatory therapy has not been tested, this approach has been applied clinically in left ventricular failure patients, with variable success. Because inflammation plays a dual role in the development of both pulmonary vascular pathology and RVF, anti-inflammatory therapies may have a potential double benefit in patients with PAH and associated RVF.
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Affiliation(s)
- Xiao-Qing Sun
- Department of Pulmonology, VU University Medical Center/Institute for Cardiovascular Research, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Antonio Abbate
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Harm-Jan Bogaard
- Department of Pulmonology, VU University Medical Center/Institute for Cardiovascular Research, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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32
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Soto M, Bang SI, McCombs J, Rodgers KE. Renin Angiotensin system-modifying therapies are associated with improved pulmonary health. Clin Diabetes Endocrinol 2017; 3:6. [PMID: 28702260 PMCID: PMC5488416 DOI: 10.1186/s40842-017-0044-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/22/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pulmonary diseases are often complicated and have diverse etiologies. One common factor is the lack of therapeutics available for these diseases. The goal of this study was to investigate the impact of Renin-Angiotensin System (RAS)-modifying medications on incidence and time to pulmonary complications. METHODS A retrospective analysis was conducted using claims data from a US commercial insurance company (2007-2013). The study consisted of patients with an emerging hypertension (HTN) diagnosis. Cox analysis was used to look at the effect of angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) in this population. The events included pneumonia and influenza (infectious), Chronic obstructive pulmonary disease (COPD) and allied conditions (inflammatory), and other diseases (structural). RESULTS A total of 215,225 patients were followed in the study. These fell into three groups depending on the first prescribed anti-hypertension medication; ACE-Is (47.21%), ARBs (11.40%) and calcium channel blockers (CCBs)/Diuretics-Control (41.39%). The use of ACE-I as first treatment significantly reduced the incidence of infectious (Hazard Ratio (HR) 0.886, 95% Confidence Interval (95% CI) 0.859-0.886), inflammatory (HR 0.924, 95% CI 0.906-0.942) and structural outcomes (HR 0.865, 95% CI 0.847-0.885); it also increased the time (delayed) to diagnosis with prolonged treatment. Primary ARB use only significantly lowered the incidence of structural outcomes (HR 0.900, 95% CI 0.868-0.933); prolonged treatment did reduce incidence of all three diagnosis groups and significantly delayed disease onset. CONCLUSIONS There is an association between the use of ACE-Is and ARBs and a delay in the progression of pulmonary complications in vulnerable populations. Research into the RAS may identify future therapies for patients with potential chronic pulmonary conditions.
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Affiliation(s)
- Maira Soto
- Titus Family Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, 1985 Zonal Ave.,PSC 530, Los Angeles, CA 90033 USA
| | - Soo I. Bang
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, VPD 212B, Los Angeles, CA 90089 USA
| | - Jeff McCombs
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, VPD 212B, Los Angeles, CA 90089 USA
| | - Kathleen E. Rodgers
- Titus Family Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, 1985 Zonal Ave.,PSC 530, Los Angeles, CA 90033 USA
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33
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Pan M, Han Y, Si R, Guo R, Desai A, Makino A. Hypoxia-induced pulmonary hypertension in type 2 diabetic mice. Pulm Circ 2017; 7:175-185. [PMID: 28680577 PMCID: PMC5448524 DOI: 10.1086/690206] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/16/2016] [Indexed: 12/20/2022] Open
Abstract
Hypoxia-induced pulmonary hypertension (HPH) is a progressive disease that is mainly caused by chronic exposure to high altitude, chronic obstructive lung disease, and obstructive sleep apnea. The increased pulmonary vascular resistance and increased pulmonary arterial pressure result in increased right ventricular afterload, leading to right heart failure and increased morbidity. There are several clinical reports suggesting a link between PH and diabetes, insulin resistance, or obesity; however, it is unclear whether HPH is associated with diabetes as a progressive complication in diabetes. The major goal of this study is to examine the effect of diabetic "preconditioning" or priming effect on the progression of HPH and define the molecular mechanisms that explain the link between diabetes and HPH. Our data show that HPH is significantly enhanced in diabetic mice, while endothelium-dependent relaxation in pulmonary arteries is significantly attenuated in chronically hypoxic diabetic mice (DH). In addition, we demonstrate that mouse pulmonary endothelial cells (MPECs) isolated from DH mice exhibit a significant increase in mitochondrial reactive oxygen species (ROS) concentration and decreased SOD2 protein expression. Finally, scavenging mitochondrial ROS by mitoTempol restores endothelium-dependent relaxation in pulmonary arteries that is attenuated in DH mice. These data suggest that excessive mitochondrial ROS production in diabetic MPECs leads to the development of severe HPH in diabetic mice exposed to hypoxia.
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Affiliation(s)
- Minglin Pan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Han
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Rui Si
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Rui Guo
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Ankit Desai
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Ayako Makino
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Department of Physiology, University of Arizona, Tucson, AZ, USA
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Mehta S, Vachiéry JL. Pulmonary hypertension: the importance of correctly diagnosing the cause. Eur Respir Rev 2016; 25:372-380. [DOI: 10.1183/16000617.0104-2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/18/2016] [Indexed: 01/22/2023] Open
Abstract
Pulmonary hypertension (PH) is a complex condition that can occur as a result of a wide range of disorders, including left heart disease, lung disease and chronic pulmonary thromboembolism. Contemporary PH patients are older and frequently have a multitude of comorbidities that may contribute to or simply coincide with their PH. Identifying the cause of PH in these complicated patients can be challenging but is essential, given that the aetiology of the disease has a significant impact on the management options available. In this article, we present two cases that highlight the difficulties involved in obtaining a precise diagnosis of the cause of PH within the setting of multiple comorbidities. The importance of performing a comprehensive, multidimensional diagnostic work-up is demonstrated, in addition to the need to specifically consider cardiopulmonary haemodynamic data in the context of the wider clinical picture. The article also illustrates why achieving an accurate diagnosis is necessary for optimal patient management. This may involve treatment of comorbidities as a priority, which can ameliorate the severity of PH, obviating the need to consider PH-targeted medical treatment.
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The Clinical Significance of HbA1c in Operable Chronic Thromboembolic Pulmonary Hypertension. PLoS One 2016; 11:e0152580. [PMID: 27031508 PMCID: PMC4816563 DOI: 10.1371/journal.pone.0152580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/16/2016] [Indexed: 01/30/2023] Open
Abstract
Background Glycosylated hemoglobin A1c (HbA1c) has been proposed as an independent predictor of long-term prognosis in pulmonary arterial hypertension. However, the clinical relevance of HbA1c in patients with operable chronic thromboembolic pulmonary hypertension (CTEPH) remains unknown. The aim of the present study was to investigate the clinical significance of HbA1c as a biomarker in CTEPH. Methods Prospectively, 102 patients underwent pulmonary endarterectomy (PEA) in our national referral center between March 2013 and March 2014, of which after exclusion 45 patients were analyzed. HbA1c- levels, hemodynamic and exercise parameters were analyzed prior and one-year post-PEA. Results 45 patients (BMI: 27.3 ± 6.0 kg/m2; age: 62.7 ± 12.3 years) with a mean pulmonary arterial pressure (mPAP) of 43.6 ± 9.4 mmHg, a pulmonary vascular resistance (PVR) of 712.1 ± 520.4 dyn*s/cm5, a cardiac index (CI) of 2.4 ± 0.5 l/min/m2 and a mean HbA1c-level of 39.8 ± 5.6 mmol/mol were included. One-year post-PEA pulmonary hemodynamic and functional status significantly improved in our cohort. Baseline HbA1c-levels were significantly associated with CI, right atrial pressure, peak oxygen uptake and the change of 6-minute walking distance using linear regression analysis. However, using logistic regression analysis baseline HbA1c-levels were not significantly associated with residual post-PEA PH. Conclusions This is the first prospective study to describe an association of HbA1c-levels with pulmonary hemodynamics and exercise capacity in operable CTEPH patients. Our preliminary results indicate that in these patients impaired glucose metabolism as assessed by HbA1c is of clinical significance. However, HbA1c failed as a predictor of the hemodynamic outcome one-year post-PEA.
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Grinnan D, Farr G, Fox A, Sweeney L. The Role of Hyperglycemia and Insulin Resistance in the Development and Progression of Pulmonary Arterial Hypertension. J Diabetes Res 2016; 2016:2481659. [PMID: 27376089 PMCID: PMC4916286 DOI: 10.1155/2016/2481659] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022] Open
Abstract
Pulmonary hypertension is a progressive disorder which often leads to right ventricular failure and death. While the existing classification system for pulmonary hypertension does not account for the impact of diabetes mellitus, evidence is emerging that suggests that diabetes is associated with pulmonary hypertension and that diabetes modifies the course of pulmonary hypertension. There is also growing radiographic, hemodynamic, biochemical, and pathologic data supporting an association between diabetes and pulmonary hypertension. More robust epidemiologic studies are needed to confirm an association between diabetes and pulmonary hypertension and to show that diabetes is a disease modifier in pulmonary hypertension. In addition, evaluating the effects of glucose control in animals with pulmonary hypertension and diabetes (as well as in humans) is warranted.
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Affiliation(s)
- Daniel Grinnan
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298, USA
- *Daniel Grinnan:
| | - Grant Farr
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298, USA
| | - Adam Fox
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298, USA
| | - Lori Sweeney
- Division of Endocrinology, Virginia Commonwealth University Health System, Richmond, VA 23298, USA
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