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Lauder L, Mahfoud F, Azizi M, Bhatt DL, Ewen S, Kario K, Parati G, Rossignol P, Schlaich MP, Teo KK, Townsend RR, Tsioufis C, Weber MA, Weber T, Böhm M. Hypertension management in patients with cardiovascular comorbidities. Eur Heart J 2022:6808663. [DOI: 10.1093/eurheartj/ehac395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Arterial hypertension is a leading cause of death globally. Due to ageing, the rising incidence of obesity, and socioeconomic and environmental changes, its incidence increases worldwide. Hypertension commonly coexists with Type 2 diabetes, obesity, dyslipidaemia, sedentary lifestyle, and smoking leading to risk amplification. Blood pressure lowering by lifestyle modifications and antihypertensive drugs reduce cardiovascular (CV) morbidity and mortality. Guidelines recommend dual- and triple-combination therapies using renin–angiotensin system blockers, calcium channel blockers, and/or a diuretic. Comorbidities often complicate management. New drugs such as angiotensin receptor-neprilysin inhibitors, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists improve CV and renal outcomes. Catheter-based renal denervation could offer an alternative treatment option in comorbid hypertension associated with increased sympathetic nerve activity. This review summarises the latest clinical evidence for managing hypertension with CV comorbidities.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Michel Azizi
- Université Paris Cité, INSERM CIC1418 , F-75015 Paris , France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department, DMU CARTE , F-75015 Paris , France
- FCRIN INI-CRCT , Nancy , France
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School , Boston, MA , USA
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine , Tochigi , Japan
| | - Gianfranco Parati
- Department of Medicine and Surgery, Cardiology Unit, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS , Milan , Italy
| | - Patrick Rossignol
- FCRIN INI-CRCT , Nancy , France
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques - Plurithématique 14-33 and INSERM U1116 , Nancy , France
- CHRU de Nancy , Nancy , France
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School—Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia , Perth, WA , Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital , Perth, WA , Australia
| | - Koon K Teo
- Population Health Research Institute, McMaster University , Hamilton, ON , Canada
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Costas Tsioufis
- National and Kapodistrian University of Athens, 1st Cardiology Clinic, Hippocratio Hospital , Athens , Greece
| | | | - Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen , Wels , Austria
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
- Cape Heart Institute (CHI), Faculty of Health Sciences, University of Cape Town , Cape Town , South Africa
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Abstract
IMPORTANCE Acute coronary syndromes (ACS) are characterized by a sudden reduction in blood supply to the heart and include ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina. Each year, an estimated more than 7 million people in the world are diagnosed with ACS, including more than 1 million patients hospitalized in the US. OBSERVATIONS Chest discomfort at rest is the most common presenting symptom of ACS and affects approximately 79% of men and 74% of women presenting with ACS, although approximately 40% of men and 48% of women present with nonspecific symptoms, such as dyspnea, either in isolation or, more commonly, in combination with chest pain. For patients presenting with possible ACS, electrocardiography should be performed immediately (within 10 minutes of presentation) and can distinguish between STEMI and non-ST-segment elevation ACS (NSTE-ACS). STEMI is caused by complete coronary artery occlusion and accounts for approximately 30% of ACS. ACS without significant ST-segment elevation on electrocardiography, termed NSTE-ACS, account for approximately 70% of ACS, are caused by partial or intermittent occlusion of the artery and are associated with ST-segment depressions (approximately 31%), T-wave inversions (approximately 12%), ST-segment depressions combined with T-wave inversions (16%), or neither (approximately 41%). When electrocardiography suggests STEMI, rapid reperfusion with primary percutaneous coronary intervention (PCI) within 120 minutes reduces mortality from 9% to 7%. If PCI within 120 minutes is not possible, fibrinolytic therapy with alteplase, reteplase, or tenecteplase at full dose should be administered for patients younger than 75 years without contraindications and at half dose for patients 75 years or older (or streptokinase at full dose if cost is a consideration), followed by transfer to a facility with the goal of PCI within the next 24 hours. High-sensitivity troponin measurements are the preferred test to evaluate for NSTEMI. In high-risk patients with NSTE-ACS and no contraindications, prompt invasive coronary angiography and percutaneous or surgical revascularization within 24 to 48 hours are associated with a reduction in death from 6.5% to 4.9%. CONCLUSIONS AND RELEVANCE Each year, an estimated more than 7 million people are diagnosed with ACS worldwide. For patients with STEMI, coronary catheterization and PCI within 2 hours of presentation reduces mortality, with fibrinolytic therapy reserved for patients without access to immediate PCI. For high-risk patients with NSTE-ACS without contraindications, prompt invasive coronary angiography followed by percutaneous or surgical revascularization is associated with lower rates of death.
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Affiliation(s)
- Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Institute, Harvard Medical School, Boston, Massachusetts
| | - Renato D Lopes
- Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Umebayashi R, Uchida HA, Okuyama Y, Kakio Y, Hanayama Y, Shikata K, Wada J. The clinical efficacy of angiotensin II type1 receptor blockers on inflammatory markers in patients with hypertension: a multicenter randomized-controlled trial; MUSCAT-3 study. Biomarkers 2018; 24:255-261. [PMID: 30444137 DOI: 10.1080/1354750x.2018.1548033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The purpose of present study was to evaluate the clinical efficacy of irbesartan on the anti-inflammatory and anti-oxidative stress effect in patients with hypertension compared to other ARBs. Further, we assessed the effect of the ARBs on kidney function and urinary albumin excretion. Methods: Eighty-five outpatients with hypertension who took an ARB except irbesartan more than 3 months were assigned into two groups, one continued the same ARB and the other switched the ARB to irbesartan for 6 months. Results: Although blood pressures were equally controlled (continue group: 148 ± 2/79 ± 2 mmHg to 131 ± 2/74 ± 2 mmHg; switch group: 152 ± 2/81 ± 2 mmHg to 132 ± 2/74 ± 2 mmHg; p < 0.001 each), the inflammatory markers (hsCRP, PTX3, MCP-1) and oxidative stress marker (MDA-LDL) did not change after 6 months in both groups. Urinary albumin excretion was significantly reduced only in the switch group without renal function deterioration (switch group 292.4 ± 857.9 mg/gCr to 250.6 ± 906.5 mg/gCr, p = 0.012). Conclusion: These results provide knowledge of the characteristics of irbesartan, suggesting appropriate choice of ARBs in the treatment for hypertension should be considered.
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Affiliation(s)
- Ryoko Umebayashi
- a Department of Nephrology, Rheumatology, Endocrinology and Metabolism , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Haruhito A Uchida
- a Department of Nephrology, Rheumatology, Endocrinology and Metabolism , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan.,b Department of Chronic Kidney Disease and Cardiovascular Disease , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Yuka Okuyama
- a Department of Nephrology, Rheumatology, Endocrinology and Metabolism , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Yuki Kakio
- a Department of Nephrology, Rheumatology, Endocrinology and Metabolism , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Yoshihisa Hanayama
- a Department of Nephrology, Rheumatology, Endocrinology and Metabolism , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan.,c Department of General Medicine , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Kenichi Shikata
- a Department of Nephrology, Rheumatology, Endocrinology and Metabolism , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan.,d Center for Innovative Clinical Medicine , Okayama University Hospital , Okayama , Japan
| | - Jun Wada
- a Department of Nephrology, Rheumatology, Endocrinology and Metabolism , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
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Beygui F, Van Belle E, Ecollan P, Machecourt J, Hamm CW, Lopez De Sa E, Flather M, Verheugt FWA, Vicaut E, Zannad F, Pitt B, Montalescot G. Individual participant data analysis of two trials on aldosterone blockade in myocardial infarction. Heart 2018; 104:1843-1849. [PMID: 29695512 DOI: 10.1136/heartjnl-2018-312950] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Two recent randomised trials studied the benefit of mineralocorticoid receptor antagonists (MRAs) in ST-segment elevation myocardial infarction (STEMI) irrespective or in absence of heart failure. The studies were both undersized to assess hard clinical endpoints. A pooled analysis was preplanned by the steering committees. METHODS We conducted a prespecified meta-analysis of patient-level data of patients with STEMI recruited in two multicentre superiority trials, randomised within 72 hours after symptom onset. Patients were allocated (1:1) to two MRA regimens: (1) an intravenous bolus of potassium canrenoate (200 mg) followed by oral spironolactone (25 mg once daily) versus standard therapy or (2) oral eplerenone (25-50 mg) versus placebo. The primary and key secondary outcomes, all-cause death and the composite of all-cause death or resuscitated sudden death, respectively, were assessed in the intention-to-treat population using a Cox model stratified on the study identifier. RESULTS Patients were randomly assigned to receive (n=1118) or not the MRA regimen (n=1123). After a median follow-up time of 188 days, the primary and secondary outcomes occurred in 5 (0.4%) and 17 (1.5%) patients (adjusted HR (adjHR) 0.31, 95% CI 0.11 to 0.86, p=0.03) and 6 (0.5%) and 22 (2%) patients (adjHR 0.26, 95% CI 0.10 to 0.65, p=0.004) in the MRA and control groups, respectively. There were also trends towards lower rates of cardiovascular death (p=0.06) and ventricular fibrillation (p=0.08) in the MRA group. CONCLUSION Our analysis suggests that compared with standard therapy, MRA regimens are associated with a reduction of death and death or resuscitated sudden death in STEMI.
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Affiliation(s)
- Farzin Beygui
- ACTION Study Group, Service de Cardiologie, Centre Hospitalier Universitaire de Caen, EA4650 Normandie Université, Caen, Basse-Normandie, France
| | - Eric Van Belle
- INSERM U1011 and Cardiology, Institut Coeur Poumon, CHRU de Lille, Lille, France
| | - Patrick Ecollan
- SAMU, ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
| | - Jacques Machecourt
- Service de Cardiologie, Centre Hospitalier Universitaire de Grenoble, Grenoble, Rhône-Alpes, France
| | | | | | - Marcus Flather
- Cardiology, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Eric Vicaut
- ACTION Study Group, Unite de Recherche Clinique, Hôpital Lariboisière, Paris, France
| | - Faiez Zannad
- Inserm CIC 1433 and Cardiology, Centre Hospitalier Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Bertram Pitt
- University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Gilles Montalescot
- Cardiology, Sorbonne Université-Paris 6, ACTION Study Group, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtriėre, INSERM UMRS 1166, Paris, France
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Wang G, Zhang Q, Yuan W, Wu J, Li C. Enalapril protects against myocardial ischemia/reperfusion injury in a swine model of cardiac arrest and resuscitation. Int J Mol Med 2016; 38:1463-1473. [PMID: 27633002 PMCID: PMC5065301 DOI: 10.3892/ijmm.2016.2737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/06/2016] [Indexed: 12/16/2022] Open
Abstract
There is strong evidence to suggest that angiotensin-converting enzyme inhibitors (ACEIs) protect against local myocardial ischemia/reperfusion (I/R) injury. This study was designed to explore whether ACEIs exert cardioprotective effects in a swine model of cardiac arrest (CA) and resuscitation. Male pigs were randomly assigned to three groups: sham-operated group, saline treatment group and enalapril treatment group. Thirty minutes after drug infusion, the animals in the saline and enalapril groups were subjected to ventricular fibrillation (8 min) followed by cardiopulmonary resuscitation (up to 30 min). Cardiac function was monitored, and myocardial tissue and blood were collected for analysis. Enalapril pre-treatment did not improve cardiac function or the 6-h survival rate after CA and resuscitation; however, this intervention ameliorated myocardial ultrastructural damage, reduced the level of plasma cardiac troponin I and decreased myocardial apoptosis. Plasma angiotensin (Ang) II and Ang-(1–7) levels were enhanced in the model of CA and resuscitation. Enalapril reduced the plasma Ang II level at 4 and 6 h after the return of spontaneous circulation whereas enalapril did not affect the plasma Ang-(1–7) level. Enalapril pre-treatment decreased the myocardial mRNA and protein expression of angiotensin-converting enzyme (ACE). Enalapril treatment also reduced the myocardial ACE/ACE2 ratio, both at the mRNA and the protein level. Enalapril pre-treatment did not affect the upregulation of ACE2, Ang II type 1 receptor (AT1R) and MAS after CA and resuscitation. Taken together, these findings suggest that enalapril protects against ischemic injury through the attenuation of the ACE/Ang II/AT1R axis after CA and resuscitation in pigs. These results suggest the potential therapeutic value of ACEIs in patients with CA.
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Affiliation(s)
- Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Qian Zhang
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (NO.BZ0370), Beijing 100020, P.R. China
| | - Wei Yuan
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (NO.BZ0370), Beijing 100020, P.R. China
| | - Junyuan Wu
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (NO.BZ0370), Beijing 100020, P.R. China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (NO.BZ0370), Beijing 100020, P.R. China
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Abdel-Raheem IT, Omran GA, Katary MA. Irbesartan, an angiotensin II receptor antagonist, with selective PPAR-gamma-modulating activity improves function and structure of chemotherapy-damaged ovaries in rats. Fundam Clin Pharmacol 2015; 29:286-98. [DOI: 10.1111/fcp.12119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/08/2015] [Accepted: 03/14/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Ihab T. Abdel-Raheem
- Department of Pharmacology and Toxicology; Faculty of Pharmacy; Damanhour University; Damanhour 22111 Egypt
| | - Gamal A. Omran
- Department of Biochemistry; Faculty of Pharmacy; Damanhour University; Damanhour 22111 Egypt
| | - Mohamed Alaa Katary
- Department of Pharmacology and Toxicology; Faculty of Pharmacy; Damanhour University; Damanhour 22111 Egypt
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7
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Scirica BM. Evaluating the efficacy of mineralocorticoid receptor antagonism in patients with STEMI without heart failure. Eur Heart J 2014; 35:2276-8. [DOI: 10.1093/eurheartj/ehu191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Bainey KR, Armstrong PW, Fonarow GC, Cannon CP, Hernandez AF, Peterson ED, Peacock WF, Laskey WK, Zhao X, Schwamm LH, Bhatt DL. Use of Renin–Angiotensin System Blockers in Acute Coronary Syndromes. Circ Cardiovasc Qual Outcomes 2014; 7:227-35. [DOI: 10.1161/circoutcomes.113.000422] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Kevin R. Bainey
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Paul W. Armstrong
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Gregg C. Fonarow
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Christopher P. Cannon
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Adrian F. Hernandez
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Eric D. Peterson
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - W. Frank Peacock
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Warren K. Laskey
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Xin Zhao
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Lee H. Schwamm
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Deepak L. Bhatt
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
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9
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Beygui F, Labbé JP, Cayla G, Ennezat PV, Motreff P, Roubille F, Silvain J, Barthélémy O, Delarche N, Van Belle E, Collet JP, Montalescot G. Early mineralocorticoid receptor blockade in primary percutaneous coronary intervention for ST-elevation myocardial infarction is associated with a reduction of life-threatening ventricular arrhythmia. Int J Cardiol 2013; 167:73-9. [DOI: 10.1016/j.ijcard.2011.11.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 10/28/2011] [Accepted: 11/27/2011] [Indexed: 10/14/2022]
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Udell JA, Morrow DA, Braunwald E, Swedberg K, Bode C, Rifai N, Brunel PC, Prescott MF, Ren F, Hoffman EB, Scirica BM. Inhibition of the Renin-Angiotensin System Reduces the Rise in Serum Aldosterone in Acute Coronary Syndrome Patients with Preserved Left Ventricular Function: Observations from the AVANT GARDE-TIMI 43 Trial. Clin Chem 2013; 59:959-67. [DOI: 10.1373/clinchem.2012.199729] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Acute coronary syndrome (ACS) activates neurohormonal pathways, including elevations in circulating aldosterone, with deleterious cardiovascular effects. We aimed to determine if early, more complete renin-angiotensin-aldosterone system inhibition (RAASI) in post-ACS patients without ventricular dysfunction or heart failure would result in a graded reduction in aldosterone concentrations.
METHODS
We performed serial measurement of serum aldosterone within the Aliskiren and Valsartan to Reduce NT-proBNP via Renin-Angiotensin-Aldosterone-System Blockade (AVANT GARDE)–Thrombolysis in Myocardial Infarction (TIMI) 43 trial, a randomized double-blind, placebo controlled trial of RAASI by valsartan, aliskiren, or both in post-ACS patients with preserved ventricular function but increased natriuretic peptides. Aldosterone was measured at randomization and week 8.
RESULTS
Median aldosterone concentrations were comparable across treatment arms at baseline (9.26 ng/dL; interquartile range 7.12–12.76; n = 1073). In the placebo group, there was a significant increase in aldosterone over 8 weeks (19.7% rise, 2.20 (0.36) ng/dL, P < 0.0001) that was significantly reduced across active RAASI therapies (1.36 (0.39) ng/dL with aliskiren; 1.02 (0.37) ng/dL with valsartan; and 0.85 (0.37) ng/dL with combination therapy, P trend = 0.008). Compared to placebo, RAASI monotherapy resulted in a pooled relative absolute aldosterone change of −1.01 (0.45) ng/dL (P = 0.026 vs placebo), and combination therapy resulted in a relative absolute aldosterone change of −1.35 (0.52) ng/dL (P = 0.01 vs placebo). No significant difference in aldosterone concentrations was achieved between dual vs single RAASI (P = 0.47).
CONCLUSIONS
In ACS patients with preserved ventricular function but increased natriuretic peptides, serum aldosterone rises over time and is blunted by more complete RAASI. The clinical implications and role for RAASI in this population warrant further investigation.
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Affiliation(s)
- Jacob A Udell
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Karl Swedberg
- Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Bode
- Department of Internal Medicine/Cardiology, Medizinische Universitatsklinik, Freiburg, Germany
| | - Nader Rifai
- Department of Laboratory Medicine, Children's Hospital Boston, Boston, MA
| | - Patrick C Brunel
- Clinical Development and Medical Affairs, Novartis Pharma AG, Basel, Switzerland
| | - Margaret F Prescott
- Clinical Development and Medical Affairs, Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - Fang Ren
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Elaine B Hoffman
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Benjamin M Scirica
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Crowley MJ, Powers BJ, Myers ER, McBroom AJ, Sanders GD. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treatment of ischemic heart disease: Future research needs prioritization. Am Heart J 2012; 163:777-782.e8. [PMID: 22607854 DOI: 10.1016/j.ahj.2012.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 02/15/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND A recent review evaluated the comparative effectiveness of angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) in patients with or at high risk for stable ischemic heart disease (IHD). The prioritization of future research needs has customarily been an informal process that is not responsive to the needs of all relevant stakeholders. METHODS As part of the Agency for Healthcare Research and Quality Effective Healthcare Program, the Duke Evidence-Based Practice Center engaged a diverse stakeholder group in 3 exercises designed to prioritize future research needs pertaining to the comparative effectiveness of ACE-I/ARB in patients with stable IHD. RESULTS Our stakeholders prioritized the following areas of research pertaining to the comparative effectiveness of ACE-I/ARB in stable IHD: (1) strategies to enhance greater evidence-based use, (2) impact of adherence on effectiveness or harms, (3) impact of comorbidities on effectiveness or harms, (4) medication impact on patient quality of life, (5) impact of demographic differences on effectiveness or harms, and (6) medication impact on incidence of new diagnoses. This project also yielded suggestions regarding potential study designs to address these future research needs. CONCLUSIONS Our stakeholders prioritized research designed to facilitate (1) tailored ACE-I/ARB treatment based on individual patient characteristics and (2) implementation of ACE-I/ARB use among patients most likely to benefit. With respect to suggested study designs, it was felt that analysis of existing data would sufficiently address many of the top-tier future research needs (FRNs).
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Demyanets S, Huber K, Wojta J. Vascular effects of glycoprotein130 ligands--part II: biomarkers and therapeutic targets. Vascul Pharmacol 2012; 57:29-40. [PMID: 22245786 DOI: 10.1016/j.vph.2011.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 12/15/2011] [Accepted: 12/25/2011] [Indexed: 12/13/2022]
Abstract
Glycoprotein130 (gp130) ligands are defined by the use of the common receptor subunit gp130 and comprise interleukin (IL)-6, oncostatin M (OSM), IL-11, leukemia inhibitory factor (LIF), cardiotrophin-1 (CT-1), cardiotrophin-like cytokine (CLC), ciliary neurotrophic factor (CNTF), IL-27 and neuropoietin (NP). In part I of this review we addressed the pathophysiological functions of gp130 ligands with respect to the vascular wall. In part II of this review on the vascular effects of gp130 ligands we will discuss data about possible use of these molecules as biomarkers to predict development or progression of cardiovascular diseases. Furthermore, the possibility to modulate circulating levels of gp130 ligands or their tissue expression by specific antibodies, soluble gp130 protein, renin-angiotensin-aldosterone system (RASS) inhibitors, statins, agonists of peroxisome proliferator-activated receptors (PPAR), hormone replacement therapy, nonsteroidal anti-inflammatory drugs (NSAID) or lifestyle modulating strategies are presented. Recent knowledge about the application of recombinant cytokines from the gp130 cytokine family as therapeutic agents in obesity or atherosclerosis is also summarized. Thus the purpose of this review is to cover a possible usefulness of gp130 ligands as biomarkers and targets for therapy in cardiovascular pathologies.
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Affiliation(s)
- Svitlana Demyanets
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Beygui F, Silvain J, Pena A, Bellemain-Appaix A, Collet JP, Drexler H, Bhatt D, Vicaut E, Montalescot G. Usefulness of biomarker strategy to improve GRACE score's prediction performance in patients with non-ST-segment elevation acute coronary syndrome and low event rates. Am J Cardiol 2010; 106:650-8. [PMID: 20723640 DOI: 10.1016/j.amjcard.2010.04.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 04/15/2010] [Accepted: 04/15/2010] [Indexed: 11/26/2022]
Abstract
We sought to assess whether multiple biomarkers would correlate with the outcome and could improve event prediction in non-ST-segment elevation acute coronary syndrome populations with low event rates. Nine inflammatory, ischemic, or neurohormonal biomarkers were measured within 48 hours after symptom onset in 440 patients with non-ST-segment elevation acute coronary syndrome from the ARCHIPELAGO (Irbesartan in Patients With Acute Coronary Syndrome Without ST Segment Elevation) trial. We assessed the relation between biomarkers and ischemic or heart failure composite end points at 2 months of follow-up. We also evaluated whether biomarkers could improve the predictive performance of the validated and well-performing Global Registry of Acute Coronary Events risk score. Among all biomarkers measured at baseline, only interleukin-6 correlated with the ischemic end point (adjusted odds ratio 1.69, 95% confidence interval [CI] 1.23 to 2.31). The independent correlates of the heart failure end point were B-type natriuretic peptide (adjusted odds ratio 3.16, 95% CI 1.99 to 5.03), aldosterone (adjusted odds ratio 1.57, 95% CI 1.14 to 2.16) and matrix metalloproteinase-9 (adjusted odds ratio 0.64, 95% CI 0.46 to 0.88). The Global Registry of Acute Coronary Events score predicted poorly the ischemic end point (area under the curve [AUC] 0.591) and fairly (AUC 0.775) the heart failure end point. The performance of the models was significantly improved by the introduction of interleukin-6 (AUC 0.685) for the ischemic end point and of the 3 biomarkers (AUC 0.874) for the heart failure end point. In conclusion, the interleukin-6 level only, and B-type natriuretic peptide, aldosterone, and matrix metalloproteinase-9 together, independently correlated with the ischemic and heart failure end points, respectively. The Global Registry of Acute Coronary Events risk score's performance was significantly improved with a biomarker strategy. In low-risk populations, a strategy using these biomarkers might help in identifying patients at greater risk of additional events.
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Tousoulis D, Androulakis E, Papageorgiou N, Briasoulis A, Siasos G, Antoniades C, Stefanadis C. From Atherosclerosis to Acute Coronary Syndromes: The Role of Soluble CD40 Ligand. Trends Cardiovasc Med 2010; 20:153-64. [DOI: 10.1016/j.tcm.2010.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 10/11/2010] [Indexed: 12/22/2022]
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