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Palić B, Brizić I, Sher EK, Cvetković I, Džidić-Krivić A, Abdelghani HTM, Sher F. Effects of Zofenopril on Arterial Stiffness in Hypertension Patients. Mol Biotechnol 2023:10.1007/s12033-023-00861-5. [PMID: 37702881 DOI: 10.1007/s12033-023-00861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/29/2023] [Indexed: 09/14/2023]
Abstract
Angiotensin-converting enzyme inhibitors (ACEIs) reduce arterial stiffness beyond their antihypertensive effect. Studies showed that sulfhydryl ACEIs have the antioxidative potential to improve endothelial function, which might have a clinical effect on arterial distensibility. However, there are no studies that directly compare the effects of sulfhydryl (zofenopril) and non-sulfhydryl ACEIs (enalapril) on arterial stiffness. Therefore, this prospective study aims to compare the effects of enalapril and zofenopril on arterial stiffness and oxidative stress in both short- and long-term treatment of arterial hypertension (AH). Baseline and post-treatment peripheral and central arterial pressure indices, augmentation index (Aix), aortic pulse wave velocity (ao-PWV), serum levels of oxidized low-density cholesterol lipoprotein, LDL and uric acid (UA) were measured. The results showed that acute treatment with zofenopril, in contrast to enalapril, significantly decreased peripheral and central Aix (p < 0.001). Chronic treatment with zofenopril showed a superior effect over enalapril on the reduction of the peripheral systolic arterial pressure with reduction of ao-PWV (p = 0.004), as well as a reduction in peripheral Aix (p = 0.021) and central Aix (p = 0.021). Therefore, this study indicates that zofenopril has beneficial effects on the reduction of arterial stiffness compared to enalapril. It has potent clinical efficacy in AH treatment and further studies should compare its safety and long-term efficacy to other AH drugs that would aid clinicians in treating AH and other various cardiovascular diseases that have arterial stiffness as a common denominator.
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Affiliation(s)
- Benjamin Palić
- Department of Internal Medicine, University Clinical Hospital Mostar, 88000, Mostar, Bosnia and Herzegovina
| | - Ivica Brizić
- Department of Internal Medicine, University Clinical Hospital Mostar, 88000, Mostar, Bosnia and Herzegovina
| | - Emina Karahmet Sher
- Department of Biosciences, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK.
| | - Ivona Cvetković
- Department of Laboratory Diagnostics, University Clinical Hospital Mostar, 88000, Mostar, Bosnia and Herzegovina
| | - Amina Džidić-Krivić
- Department of Neurology, Cantonal Hospital Zenica, 72000, Zenica, Bosnia and Herzegovina
- International Society of Engineering Science and Technology, Nottingham, UK
| | - Heba Taha Mohmmed Abdelghani
- Department of Physiology of Physical Activity, College of Sport Sciences and Physical Activity, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Farooq Sher
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK.
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Doehner W, Anker SD, Butler J, Zannad F, Filippatos G, Ferreira JP, Salsali A, Kaempfer C, Brueckmann M, Pocock SJ, Januzzi JL, Packer M. Uric acid and sodium-glucose cotransporter-2 inhibition with empagliflozin in heart failure with reduced ejection fraction: the EMPEROR-reduced trial. Eur Heart J 2022; 43:3435-3446. [PMID: 35788657 PMCID: PMC9492270 DOI: 10.1093/eurheartj/ehac320] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/10/2022] [Accepted: 06/03/2022] [Indexed: 12/13/2022] Open
Abstract
Background The sodium-glucose cotransporter-2 inhibitor empagliflozin decreases the risk of cardiovascular death or hospitalization for heart failure (HF) in patients with HF with reduced ejection fraction. Empagliflozin reduces serum uric acid (SUA), but the relevance of this effect in patients with HF is unclear. This study aimed to investigate the effect of empagliflozin on SUA levels and the therapeutic efficacy of empagliflozin in relation to SUA. Methods The association between SUA and the composite primary outcome of cardiovascular death or hospitalization for worsening HF, its components, and all-cause mortality was investigated in 3676 patients of the EMPEROR-Reduced trial (98.6% of the study cohort). The treatment effect of empagliflozin was studied in relation to SUA as continuous variable, to clinical hyperuricaemia (SUA >5.7 mg/dL for women, >7.0 mg/dL for men) and in subgroups of patients of tertiles of SUA. Results Hyperuricaemia was prevalent in 53% of patients with no sex differences. Elevated SUA (highest tertile, mean SUA 9.38 ± 1.49 mg/dL) was associated with advanced severity of HF and with worst outcome [composite outcome, hazard ratio (HR) 1.64 (95% confidence interval, CI 1.28–2.10); cardiovascular mortality, HR 1.98 (95% CI 1.35–2.91); all-cause mortality, HR 1.8 (95% CI 1.29–2.49), all P < 0.001] in multivariate adjusted analyses, as compared with the lowest tertile. SUA was reduced following treatment with empagliflozin at 4 weeks (vs. placebo: −1.12 ± 0.04 mg/dL, P < 0.0001) and remained lower throughout follow-up, with a similar reduction in all prespecified subgroups. Empagliflozin reduced events of clinically relevant hyperuricaemia (acute gout, gouty arthritis or initiation of anti-gout therapy) by 32% [HR 0.68 (95% CI 0.52–0.89), P = 0.004]. The beneficial effect of empagliflozin on the primary endpoint was independent of baseline SUA [HR 0.76 (95% CI 0.65–0.88), P < 0.001) and of the change in SUA at 4 weeks [HR 0.81 (95% CI 0.69–0.95), P = 0.012]. As a hypothesis-generating finding, an interaction between SUA and treatment effect suggested a benefit of empagliflozin on mortality (cardiovascular and all-cause mortality) in patients in elevated SUA (P for interaction = 0.005 and = 0.011, respectively). Conclusion Hyperuricaemia is common in HF and is an independent predictor of advanced disease severity and increased mortality. Empagliflozin induced a rapid and sustained reduction of SUA levels and of clinical events related to hyperuricaemia. The benefit of empagliflozin on the primary outcome was observed independently of SUA.
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Affiliation(s)
- Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies, and Department of Cardiology (CVK), and German Centre for Cardiovascular Research Partner Site Berlin, and Center for Stroke Research Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Stefan D Anker
- Berlin Institute of Health Center for Regenerative Therapies, and Department of Cardiology (CVK), and German Centre for Cardiovascular Research Partner Site Berlin, and Center for Stroke Research Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Javed Butler
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX 75226 USA.,Department of Medicine, University of Mississippi School of Medicine, Jackson, MS 39216, USA
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique 1433, U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy 54500, France
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, 12461, Haidari Athens, Greece
| | - João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique 1433, U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy 54500, France.,UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
| | - Afshin Salsali
- Heart Failure and Diabetes Global Development, Boehringer Ingelheim Pharmaceuticals, Inc, 900 Ridgebury Rd, Ridgefield, CT 06877, USA.,Faculty of Medicine, Rutgers University, New Brunswick, NJ 07103, USA
| | - Carolyn Kaempfer
- Faculty of Medicine, Rutgers University, New Brunswick, NJ 07103, USA.,mainanalytics GmbH, Sulzbach, Otto-Volger-Str. 3c, 65843 Sulzbach/Taunus, Germany
| | - Martina Brueckmann
- Boehringer Ingelheim International, Binger Str. 173, 55218 Ingelheim, Germany.,First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Milton Packer
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.,Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas ,TX 75226 USA.,Imperial College, London SW7 2BX, UK
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Gao Z, Shi H, Xu W, Guan Z, Su X, Guo N, Ma H. Hyperuricemia Increases the Risk of Atrial Fibrillation: A Systematic Review and Meta-Analysis. Int J Endocrinol 2022; 2022:8172639. [PMID: 36046801 PMCID: PMC9420608 DOI: 10.1155/2022/8172639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Association between hyperuricemia (HUA) and atrial fibrillation (AF) remains unclear. We reviewed clinical evidence and aimed to determine whether hyperuricemia leads to a high risk of atrial fibrillation. Most studies were identified through databases online. Keywords used in literature search were hyperuricemia, atrial fibrillation, metabolic disorder, endocrine disorder, or uric acid. Three studies were provided by the authors. Literature search was performed without any data or language restriction. Observational studies, including cohort studies and cross-sectional studies, were used. Study type should be clearly defined. Cross-sectional studies should clearly introduce the sources of epidemiological data. Studies were excluded if with too many complications unrelated to AF enrolled. Data were independently extracted by three individuals. Data synthesis was conducted by R version 4.1.2. Prevalence of atrial fibrillation was the main outcome. Results of meta-analysis were presented as risk ratio (RR) for different prevalence of AF between individuals with and without HUA. All data included were obtained after follow-up work is completed. Data from 608,810 participants showed that patients with hyperuricemia were easier to suffer from atrial fibrillation (RR, 2.42; 95% CI, 1.24-3.03). And the meta-regressions suggested growth of linear proportion between the ratio of current drinkers and hyperuricemia (QM = 41.0069, P < 0.001). Subgroup analyses demonstrated consistent results in different countries. And design of the observational studies brought heterogeneity, but no uncertainties. Patients with hyperuricemia were easier to suffer from atrial fibrillation. Treatment of hyperuricemia or gout may bring potential benefits for AF patients.
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Affiliation(s)
- Zheng Gao
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
- Department of First Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hekai Shi
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
- Department of Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Xu
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
- Department of Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Xiuxiu Su
- College of Physical Education, Hebei Normal University, Shijiazhuang, China
| | - Nuojin Guo
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
- Department of Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huijie Ma
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
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Christoph M, Schön S, Wunderlich C. Hyperurikämie, Gicht und Herz – eine kritische Diskussion im Licht der aktuellen Literatur. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1347-4144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungZahlreiche Untersuchungen zeigen, dass Patienten mit Hyperurikämie und insbesondere mit symptomatischer Hyperurikämie, einer Gicht, kardiovaskuläre Risikopatienten sind. Bei symptomatischer Hyperurikämie sollte nach aktuellen Leitlinien eine harnsäuresenkende Therapie mit Zielwert-Erreichung eingeleitet werden. Darüber hinaus sind die Diagnose und optimale Therapie der klassischen kardiovaskulären Risikofaktoren von besonderer Bedeutung.
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Affiliation(s)
- Marian Christoph
- Klinik für Innere Medizin, Klinikum Chemnitz gGmbH Krankenhaus Küchwald, Chemnitz, Deutschland
| | - Steffen Schön
- Klinik für Innere Medizin, HELIOS Klinikum Pirna, Pirna, Deutschland
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