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Guo DC, Gao JW, Wang X, Chen ZT, Gao QY, Chen YX, Wang JF, Liu PM, Zhang HF. Remnant cholesterol and risk of incident hypertension: a population-based prospective cohort study. Hypertens Res 2024; 47:1157-1166. [PMID: 38212367 DOI: 10.1038/s41440-023-01558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/21/2023] [Accepted: 12/02/2023] [Indexed: 01/13/2024]
Abstract
Remnant cholesterol (RC) has been associated with atherosclerotic cardiovascular disease, but its relationship with hypertension remains unclear. This prospective cohort study aimed to investigate the association between RC and subsequent hypertension risk. Data from the UK Biobank, comprising 295,062 participants initially free of hypertension, were analyzed. Cox proportional hazards regression assessed the association between RC quartiles and hypertension risk. Discordance analysis evaluated the risk of hypertension in discordant/concordant groups of RC and low-density lipoprotein cholesterol (LDL-C) using the difference in percentile units (>10 units). Restricted cubic spline curves were used to model the relationship between RC and hypertension risk. The mean ± SD age of participants was 55.1 ± 8.1 years, with 40.6% being men and 94.7% White. During a median follow-up of 12.8 years, 39,038 participants developed hypertension. Comparing extreme quartiles of RC, the hazard ratio (HR) for incident hypertension was 1.20 (95% CI: 1.17-1.24). After adjusting for traditional risk factors, each 1 mmol/L increase in RC levels was associated with a 27% higher risk of incident hypertension (HR: 1.27; 95% CI: 1.23-1.31). The discordant group with high RC/low LDL-C exhibited a higher risk of incident hypertension compared to the concordant group (HR: 1.06; 95% CI: 1.03-1.09). Spline curves further demonstrated a positive association between RC and the risk of incident hypertension. We concluded that elevated RC emerged as an independent risk factor of incident hypertension, extending beyond traditional risk factors. Monitoring RC levels and implementing interventions to lower RC may have potential benefits in preventing hypertension.
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Affiliation(s)
- Da-Chuan Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Jing-Wei Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Xiang Wang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Zhi-Teng Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Qing-Yuan Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yang-Xin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Jing-Feng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Pin-Ming Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
| | - Hai-Feng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
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Kayani M, Fatima N, Yarra PC, Almansouri NE, K D, Balasubramanian A, Parvathaneni N, Mowo-Wale AG, Valdez JA, Nazir Z. Novel Biomarkers in Early Detection of Heart Failure: A Narrative Review. Cureus 2024; 16:e53445. [PMID: 38435138 PMCID: PMC10909379 DOI: 10.7759/cureus.53445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Heart failure (HF) represents a significant global health challenge, characterized by a variety of symptoms resulting from cardiac dysfunction. This dysfunction often leads to systemic and pulmonary congestion. The pathophysiology of HF is complex, involving stimulation of the sympathetic nervous system, which is insufficiently balanced by the release of natriuretic peptide. This imbalance leads to progressive hypertrophy and dilatation of the heart's chambers, impairing its pumping efficiency and increasing the risk of arrhythmias and conduction disorders. The prevalence of HF is exceptionally high in industrialized nations and is expected to increase owing to an aging population and advancements in diagnostic methods. This study emphasizes the critical role of early diagnosis in reducing morbidity and mortality associated with HF, focusing specifically on the evolving importance of biomarkers in managing this condition. Biomarkers have played a key role in transforming the diagnosis and treatment of HF. Traditional biomarkers such as b-type natriuretic peptide and N-terminal pro-b-type natriuretic peptide have been widely adopted for their cost-effectiveness and ease of access. However, the rise of novel biomarkers such as growth differentiation factor 15 and adrenomedullin has shown promising results, offering superior sensitivity and specificity. These new biomarkers enhance diagnostic accuracy, risk stratification, and prognostic evaluation in HF patients. Despite these advancements, challenges remain, such as limited availability, high costs, and the need for further validation in diverse patient populations. Through a comprehensive literature review across databases such as PubMed, Google Scholar, and the Cochrane Library, this study compiles and analyzes data from 18 relevant studies, offering a detailed understanding of the current state of HF biomarkers. The study examines both traditional and emerging biomarkers such as galectin-3 and soluble suppression of tumorigenicity 2 in HF, exploring their clinical roles and impact on patient outcomes.
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Affiliation(s)
- Maryam Kayani
- Cardiology, Shifa Tameer-e-Millat University Shifa College of Medicine, Islamabad, PAK
| | - Neha Fatima
- Internal Medicine, Lisie Hospital, Kochi, IND
| | | | - Naiela E Almansouri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, University of Tripoli, Tripoli, LBY
| | - Deepshikha K
- Cardiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | | | | | | | - Josue A Valdez
- General Practice, Universidad Autónoma de Durango, Los Mochis, MEX
| | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, PAK
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Nemtsova V, Vischer AS, Burkard T. Hypertensive Heart Disease: A Narrative Review Series-Part 3: Vasculature, Biomarkers and the Matrix of Hypertensive Heart Disease. J Clin Med 2024; 13:505. [PMID: 38256639 PMCID: PMC10816030 DOI: 10.3390/jcm13020505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Over the last few decades, research efforts have resulted in major advances in our understanding of the pathophysiology of hypertensive heart disease (HHD). This is the third part of a three-part review series. Here, we focus on the influence of high blood pressure on the micro- and macroalterations that occur in the vasculature in HHD. We also provide an overview of circulating cardiac biomarkers that may prove useful for a better understanding of the pathophysiology, development and progression of HHD, and may play a unique role in the diagnostic and prognostic evaluation of patients with HHD, taking into account their properties showing as abnormal long before the onset of the disease. In the conclusion, we propose an updated definition of HHD and a matrix for clinical classification, which we suspect will be useful in practice, allowing an individual approach to HHD patients.
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Affiliation(s)
- Valeriya Nemtsova
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland; (V.N.); (A.S.V.)
- Internal Diseases and Family Medicine Department, Educational and Scientific Medical Institute of National Technical University «Kharkiv Polytechnic Institute», 61000 Kharkiv, Ukraine
| | - Annina S. Vischer
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland; (V.N.); (A.S.V.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland; (V.N.); (A.S.V.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
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Li J, Yao YX, Yao PS. Circulating Biomarkers and Risk of Hypertension: A Two-Sample Mendelian Randomisation Study. Heart Lung Circ 2023; 32:1434-1442. [PMID: 38042639 DOI: 10.1016/j.hlc.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/27/2023] [Accepted: 09/02/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE This study systematically assessed circulating proteins to identify new serum biomarkers and risk of hypertension using Mendelian randomisation. METHODS The associations between 4,782 human circulating proteins and the risk of hypertension were evaluated using two-sample Mendelian randomisation. The FinnGen study demonstrated a link between genetic predisposition and hypertension in 85,438 cases and 223,663 controls. RESULTS Inverse variance weighted and sensitivity analysis revealed nine proteins in circulation that have a causative effect on hypertension. SMOC1 and TIE1 were determined to be causative factors in the decreased likelihood of developing hypertension, with odds ratios of 0.86 (95% CI 0.81-0.91; p=1.06e-06) and 0.96 (95% CI 0.94-0.98; p=9.39e-05), respectively. NDUFB4, ETHE1, POFUT2, TRIL, ADAM23, GXYLT1, OXT, TPST2, and TMCC3 showed a possible connection to hypertension. CONCLUSIONS This two-sample Mendelian randomisation study found that SMOC1 and TIE1 are causally linked to hypertension, making them a promising target for therapy.
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Affiliation(s)
- Jin Li
- Department of Cardiovascular Medicine, Fujian Provincial Geriatric Hospital, Fuzhou, China
| | - Yue-Xian Yao
- Department of Cardiovascular Medicine, Fujian Provincial Geriatric Hospital, Fuzhou, China
| | - Pei-Sen Yao
- Department of Neurosurgery, Neurosurgical Research Institute, First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
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Ben-Assayag H, Brzezinski RY, Berliner S, Zeltser D, Shapira I, Rogowski O, Toker S, Eldor R, Shenhar-Tsarfaty S. Transitioning from having no metabolic abnormality nor obesity to metabolic impairment in a cohort of apparently healthy adults. Cardiovasc Diabetol 2023; 22:226. [PMID: 37633936 PMCID: PMC10463945 DOI: 10.1186/s12933-023-01954-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION The global prevalence of metabolic syndrome and its association with increased morbidity and mortality has been rigorously studied. However, the true prevalence of "metabolic health", i.e. individuals without any metabolic abnormalities is not clear. Here, we sought to determine the prevalence of "metabolically healthy" individuals and characterize the "transition phase" from metabolic health to development of dysfunction over a follow-up period of 5 years. METHODS We included 20,507 individuals from the Tel Aviv Sourasky Medical Center Inflammation Survey (TAMCIS) which comprises apparently healthy individuals attending their annual health survey. A second follow-up visit was documented after 4.8 (± 0.6) years. We defined a group of metabolically healthy participants without metabolic abnormalities nor obesity and compared their characteristics and change in biomarkers over time to participants who developed metabolic impairment on their follow-up visit. The intersections of all metabolic syndrome components and elevated high sensitivity C-reactive protein (hs-CRP) were also analyzed. RESULTS A quarter of the cohort (5379 individuals, (26.2%) did not fulfill any metabolic syndrome criteria during their baseline visit. A total of 985 individuals (12.7% of returning participants) developed metabolic criteria over time with hypertension being the most prevalent component to develop among these participants. Individuals that became metabolically impaired over time demonstrated increased overlap between metabolic syndrome criteria and elevated hs-CRP levels. The group that became metabolically impaired over time also presented higher delta values of WBC, RBC, liver biomarkers, and uric acid compared with participants who were consistently metabolically impaired. LDL-C (low-density lipoprotein cholesterol) delta levels were similar. CONCLUSIONS Roughly one-quarter of apparently healthy adults are defined as "metabolically healthy" according to current definitions. The transition from health to metabolic dysfunction is accompanied with active inflammation and several non-metabolic syndrome biomarkers. Aggressive screening for these biomarkers, blood pressure and hs-CRP might help identify apparently healthy individuals at increased risk of developing metabolic syndrome over time.
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Affiliation(s)
- Hadas Ben-Assayag
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
| | - Rafael Y Brzezinski
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Berliner
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
| | - David Zeltser
- Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Itzhak Shapira
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
| | - Ori Rogowski
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
| | - Sharon Toker
- Coller School of Management, Tel Aviv University, Tel Aviv, Israel
| | - Roy Eldor
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
- Diabetes Unit, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel.
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Ullah A, Sajid S, Qureshi M, Kamran M, Anwaar MA, Naseem MA, Zaman MU, Mahmood F, Rehman A, Shehryar A, Nadeem MA. Novel Biomarkers and the Multiple-Marker Approach in Early Detection, Prognosis, and Risk Stratification of Cardiac Diseases: A Narrative Review. Cureus 2023; 15:e42081. [PMID: 37602073 PMCID: PMC10434821 DOI: 10.7759/cureus.42081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Cardiac diseases are a primary cause of mortality worldwide, underscoring the importance of early identification and risk stratification to enhance patient outcomes. Biomarkers have become important tools for the risk assessment of cardiovascular disease and monitoring disease progression. This narrative review focuses on the multiple-marker approach, which involves simultaneously evaluating several biomarkers for the early detection and risk stratification of heart diseases. The review covers the clinical applications of novel biomarkers, such as high-sensitivity troponin, galectin-3, source of tumorigenicity 2, B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide, growth differentiation factor 15, myeloperoxidase, fatty acid-binding protein, C-reactive protein, lipoprotein-associated phospholipase A2, microRNAs, circulating endothelial cells, and ischemia-modified albumin. These biomarkers have demonstrated potential in identifying people who are at high risk for developing heart disease and in providing prognostic data. Given the complexity of cardiac illnesses, the multiple-marker approach to risk assessment is extremely beneficial. Implementing the multiple-marker strategy can improve risk stratification, diagnostic accuracy, and patient care in heart disease patients.
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Affiliation(s)
| | - Samar Sajid
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Maria Qureshi
- Family Medicine, Ayub Medical College, Abbottabad, PAK
| | | | - Mohammad Ahsan Anwaar
- Internal Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | | | | | - Fizza Mahmood
- Cardiology/Cardiac Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| | | | | | - Muhammad A Nadeem
- Medicine and Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
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Kuppa A, Tripathi H, Al-Darraji A, Tarhuni WM, Abdel-Latif A. C-Reactive Protein Levels and Risk of Cardiovascular Diseases: A Two-Sample Bidirectional Mendelian Randomization Study. Int J Mol Sci 2023; 24:9129. [PMID: 37298077 PMCID: PMC10252732 DOI: 10.3390/ijms24119129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Elevated C-reactive protein (CRP) levels are an indicator of inflammation, a major risk factor for cardiovascular disease (CVD). However, this potential association in observational studies remains inconclusive. We performed a two-sample bidirectional Mendelian randomization (MR) study using publicly available GWAS summary statistics to evaluate the relationship between CRP and CVD. Instrumental variables (IVs) were carefully selected, and multiple approaches were used to make robust conclusions. Horizontal pleiotropy and heterogeneity were evaluated using the MR-Egger intercept and Cochran's Q-test. The strength of the IVs was determined using F-statistics. The causal effect of CRP on the risk of hypertensive heart disease (HHD) was statistically significant, but we did not observe a significant causal relationship between CRP and the risk of myocardial infarction, coronary artery disease, heart failure, or atherosclerosis. Our primary analyses, after performing outlier correction using MR-PRESSO and the Multivariable MR method, revealed that IVs that increased CRP levels also increased the HHD risk. However, after excluding outlier IVs identified using PhenoScanner, the initial MR results were altered, but the sensitivity analyses remained congruent with the results from the primary analyses. We found no evidence of reverse causation between CVD and CRP. Our findings warrant updated MR studies to confirm the role of CRP as a clinical biomarker for HHD.
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Affiliation(s)
- Annapurna Kuppa
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Himi Tripathi
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ahmed Al-Darraji
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Wadea M. Tarhuni
- Canadian Cardiac Research Center, Department of Internal Medicine, Division of Cardiology, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada;
| | - Ahmed Abdel-Latif
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Ann Arbor VA Healthcare System, Ann Arbor, MI 48109, USA
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Chang HW, Lin WD, Shih PJ, Peng SL, Hsu CY, Lin CL, Liao WL, Sun MF. Acupuncture Decreases Risk of Hypertension in Patients with Chronic Spontaneous Urticaria in Taiwan: A Nationwide Study. Healthcare (Basel) 2023; 11:healthcare11101510. [PMID: 37239796 DOI: 10.3390/healthcare11101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Patients with chronic spontaneous urticaria (CSU) have a higher risk of developing hypertension. This study aimed to determine whether acupuncture could decrease the risk of hypertension in patients with CSU. We enrolled patients newly diagnosed with CSU between 1 January 2008, and 31 December 2018, from the Taiwanese National Health Insurance Research Database. The claims data were assessed from the index date to 31 December 2019. A Cox regression model was used to compare the hazard ratios (HRs) of the two cohorts. The cumulative incidence of hypertension was estimated using the Kaplan-Meier method. After propensity score matching with a 1:1 ratio, 43,547 patients with CSU who received acupuncture were matched with 43,547 patients with CSU who did not receive acupuncture in this study. After considering potential confounding factors, patients who received acupuncture had a significantly lower risk of hypertension than those in the control group (adjusted hazard ratio = 0.56, 95% confidence interval = 0.54-0.58). Patients who received medications combined with acupuncture tended to have the lowest risk of hypertension. This study revealed that acupuncture decreases the risk of hypertension in patients with CSU in Taiwan. The detailed mechanisms can be further clarified through prospective studies.
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Affiliation(s)
- Heng-Wei Chang
- Graduate Institute of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
| | - Wei-De Lin
- Department of Medical Research, China Medical University Hospital, Taichung 404327, Taiwan
| | - Pai-Jun Shih
- Erlin Four Seasons Dermatology Clinic, Erlin Township, Changhua County 526022, Taiwan
| | - Shin-Lei Peng
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung 404333, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404333, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404327, Taiwan
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Center for Personalized Medicine, China Medical University Hospital, Taichung 404327, Taiwan
| | - Mao-Feng Sun
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
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Sequeira-Antunes B, Ferreira HA. Urinary Biomarkers and Point-of-Care Urinalysis Devices for Early Diagnosis and Management of Disease: A Review. Biomedicines 2023; 11:biomedicines11041051. [PMID: 37189669 DOI: 10.3390/biomedicines11041051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Biosensing and microfluidics technologies are transforming diagnostic medicine by accurately detecting biomolecules in biological samples. Urine is a promising biological fluid for diagnostics due to its noninvasive collection and wide range of diagnostic biomarkers. Point-of-care urinalysis, which integrates biosensing and microfluidics, has the potential to bring affordable and rapid diagnostics into the home to continuing monitoring, but challenges still remain. As such, this review aims to provide an overview of biomarkers that are or could be used to diagnose and monitor diseases, including cancer, cardiovascular diseases, kidney diseases, and neurodegenerative disorders, such as Alzheimer’s disease. Additionally, the different materials and techniques for the fabrication of microfluidic structures along with the biosensing technologies often used to detect and quantify biological molecules and organisms are reviewed. Ultimately, this review discusses the current state of point-of-care urinalysis devices and highlights the potential of these technologies to improve patient outcomes. Traditional point-of-care urinalysis devices require the manual collection of urine, which may be unpleasant, cumbersome, or prone to errors. To overcome this issue, the toilet itself can be used as an alternative specimen collection and urinalysis device. This review then presents several smart toilet systems and incorporated sanitary devices for this purpose.
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Circ_0000284: A risk factor and potential biomarker for prehypertension and hypertension. Hypertens Res 2023; 46:720-729. [PMID: 36543889 DOI: 10.1038/s41440-022-01140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/26/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
CircRNAs have been shown to be involved in the development of certain diseases, but their application in prehypertension and hypertension remains unclear. We aimed to explore the potential role of circ_0000284 in revealing the molecular regulatory mechanisms of prehypertension and hypertension. We enrolled a total of 100 patients with normal blood pressure, 100 patients with prehypertension and 100 patients with hypertension. The expression of circ_0000284 among the groups was detected by real-time fluorescence quantitative polymerase chain reaction (qRT‒PCR). Multivariate logistic models were constructed combining conventional risk factors with circ_0000284. A receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of circRNAs in the clinical model. Spearman correlation was used to analyze the correlation of circ_0000284 and the biochemical characteristics of all subjects. The results showed that circ_0000284 was differentially expressed among the normal blood pressure group, prehypertensive group and hypertensive group and showed a significantly upregulated trend in the progression to hypertension (P < 0.05). The ROC curve revealed a high diagnostic ability of circ_0000284 in hypertension in the clinical model (AUC = 0.812). Circ_0000284 also presented a certain ability for early diagnosis of prehypertension (AUC = 0.628). Spearman correlation showed that circ_0000284 was positively correlated with Na and CKMB. Our study suggested that upregulated expression of circ_0000284 was an independent risk factor for prehypertension and hypertension. Circ_0000284 was a potential fingerprint for the early diagnosis of hypertension and distinguished the intermediate stage of hypertension development. Moreover, our study provided new insight into the correlation between circ_0000284 and cardiac injury in the progression to hypertension.
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11
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Barrea L, Verde L, Santangeli P, Lucà S, Docimo A, Savastano S, Colao A, Muscogiuri G. Very low-calorie ketogenic diet (VLCKD): an antihypertensive nutritional approach. J Transl Med 2023; 21:128. [PMID: 36800966 PMCID: PMC9936635 DOI: 10.1186/s12967-023-03956-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/01/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Obesity is accompanied by hormonal, inflammatory and endothelial alterations. These alterations induce a stimulation of several other mechanisms that contribute to the hypertensive state and to increase the cardiovascular morbidity. This pilot, open - label, single- center, prospective clinical trial aimed to evaluate the effect of very low- calorie ketogenic diet (VLCKD) on blood pressure (BP) in women with of obesity and hypertension. METHODS A total of 137 women, who met the inclusion criteria and accepted to adhere to VLCKD, were consecutively enrolled. Assessment of anthropometric parameters (weight, height, and waist circumference), body composition (through bioelectrical impedance analysis), systolic (SBP) and diastolic blood pressure (DBP) and blood sample collection were carried out at baseline and after 45 days of the active phase of VLCKD. RESULTS After VLCKD all the women experienced a significant reduction in body weight and an overall improvement of body composition parameters. In addition, high sensitivity C reactive protein (hs- CRP) levels were significantly diminished (p < 0.001), while phase angle (PhA) increased by almost 9% (p < 0.001). Interestingly, both SBP and DBP were significantly improved (-12.89% and - 10.77%, respectively; p < 0.001). At baseline, SBP and DBP showed statistically significant correlations with body mass index (BMI), waist circumference, hs-CRP levels, PhA, total body water (TBW), extracellular water (ECW), Na / K ratio, and fat mass. Even after VLCKD, all correlations among SBP and DBP with the study variables were statistically significant, except for the association between DBP and Na / K ratio. Changes (%) in both SBP and DBP were associated with ∆BMI%, ∆PhA% and ∆hs- CRP levels (p < 0.001). In addition, only ∆SBP% was associated with ∆waist circumference (p = 0.017), ∆TBW (p = 0.017), and ∆fat mass (p < 0.001); while only ∆DBP% was associated with ∆ECW (p = 0.018), and ∆Na / K ratio (p = 0.048). After adjusting for ∆BMI, ∆WC, ∆PhA, ∆TBW, and ∆fat mass, the correlation between changes in ∆SBP and ∆hs -CRP levels remained statistically significant (p < 0.001). Similarly, the correlation between ∆DBP and ∆hs- CRP levels also remained statistically significant after adjustment for ∆BMI, ∆PhA, ∆Na / K ratio, and ∆ECW (p < 0.001). From multiple regression analysis ∆hs- CRP levels seemed to be the main predictor of changes of BP (p < 0.001). CONCLUSION VLCKD reduces BP in women with of obesity and hypertension in a safely manner.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Direzionale, isola F2, 80143 Napoli, Italy ,grid.4691.a0000 0001 0790 385XDipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Ludovica Verde
- grid.4691.a0000 0001 0790 385XDipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Napoli, Italy ,grid.4691.a0000 0001 0790 385XDepartment of Public Health, University of Naples Federico II, Naples, Italy
| | - Pasquale Santangeli
- grid.239578.20000 0001 0675 4725Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH USA
| | - Stefania Lucà
- grid.411489.10000 0001 2168 2547Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Annamaria Docimo
- grid.4691.a0000 0001 0790 385XDipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Silvia Savastano
- grid.4691.a0000 0001 0790 385XDipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Napoli, Italy ,grid.4691.a0000 0001 0790 385XDipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Annamaria Colao
- grid.4691.a0000 0001 0790 385XDipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Napoli, Italy ,grid.4691.a0000 0001 0790 385XDipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy ,grid.4691.a0000 0001 0790 385XCattedra Unesco “Educazione alla Salute e Allo Sviluppo Sostenibile”, University Federico II, 80131 Napoli, Italy
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Napoli, Italy. .,Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Napoli, Italy. .,Cattedra Unesco "Educazione alla Salute e Allo Sviluppo Sostenibile", University Federico II, 80131, Napoli, Italy.
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12
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Carey A, Fossati S. Hypertension and hyperhomocysteinemia as modifiable risk factors for Alzheimer's disease and dementia: New evidence, potential therapeutic strategies, and biomarkers. Alzheimers Dement 2023; 19:671-695. [PMID: 36401868 PMCID: PMC9931659 DOI: 10.1002/alz.12871] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
This review summarizes recent evidence on how mid-life hypertension, hyperhomocysteinemia (HHcy) and blood pressure variability, as well as late-life hypotension, exacerbate Alzheimer's disease (AD) and dementia risk. Intriguingly, HHcy also increases the risk for hypertension, revealing the importance of understanding the relationship between comorbid cardiovascular risk factors. Hypertension-induced dementia presents more evidently in women, highlighting the relevance of sex differences in the impact of cardiovascular risk. We summarize each major antihypertensive drug class's effects on cognitive impairment and AD pathology, revealing how carbonic anhydrase inhibitors, diuretics modulating cerebral blood flow, have recently gained preclinical evidence as promising treatment against AD. We also report novel vascular biomarkers for AD and dementia risk, highlighting those associated with hypertension and HHcy. Importantly, we propose that future studies should consider hypertension and HHcy as potential contributors to cognitive impairment, and that uncovering the underlying molecular mechanisms and biomarkers would aid in the identification of preventive strategies.
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Affiliation(s)
- Ashley Carey
- Alzheimer’s Center at Temple, Department of Neural Sciences, Temple University Lewis Katz School of Medicine, Philadelphia
| | - Silvia Fossati
- Alzheimer’s Center at Temple, Department of Neural Sciences, Temple University Lewis Katz School of Medicine, Philadelphia
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13
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Cao Y, Li P, Zhang Y, Qiu M, Li J, Ma S, Yan Y, Li Y, Han Y. Dietary Inflammatory Index and All-Cause Mortality in Older Adults with Hypertension: Results from NHANES. J Clin Med 2023; 12:jcm12020506. [PMID: 36675436 PMCID: PMC9864621 DOI: 10.3390/jcm12020506] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Both diet and inflammation are strongly associated with hypertension. However, the relationship between the dietary inflammatory index (DII) and the prognosis of hypertensive patients over 65 years of age is unclear. The objective of this study is to investigate the correlation between DII and all-cause mortality in older adults with hypertension. Data were obtained from the 2011−2018 National Health and Nutrition Examination Survey (NHANES) and followed for survival through December 31, 2019. DII was calculated by the 24 h dietary history interview. Cox proportional hazards models were used to investigate the associations. A total of 2531 participants were finally included. During a median follow-up of 4.33 years, 471 participants were determined as all-cause mortality. After adjusting for confounding factors, DII was positively correlated with the risk of all-cause mortality (HR = 1.08, 95% CI = 1.01−1.16). Compared with the anti-inflammatory diet group (DII < 0), the pro-inflammatory diet group (DII > 0) had a 54% increased risk of all-cause death (HR = 1.54, 95% CI = 1.13−2.10). The results were robust in subgroup and sensitivity analyses. DII was positively correlated with the all-cause mortality of elderly hypertensive patients. The results provided an aid to dietary evaluation in the nonpharmacologic management of hypertension.
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Affiliation(s)
- Yang Cao
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, China
- The Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China
| | - Pengxiao Li
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, China
- The Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China
| | - Yan Zhang
- The Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China
| | - Miaohan Qiu
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, China
| | - Jing Li
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, China
| | - Sicong Ma
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, China
| | - Yudong Yan
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, China
- The Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an 710000, China
| | - Yi Li
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, China
- Correspondence: (Y.L.); (Y.H.)
| | - Yaling Han
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, China
- Correspondence: (Y.L.); (Y.H.)
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14
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Wang Z, Chen J, Song J, Kong L, Wang X, Xu T, Lin S, Dou Y. Plasminogen Activator Inhibitor-1 4G/5G (rs1799889) Polymorphism in Chinese Patients with Diabetes Mellitus and Hypertension. Diabetes Metab Syndr Obes 2023; 16:1133-1147. [PMID: 37122677 PMCID: PMC10132305 DOI: 10.2147/dmso.s410682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Objective To determine the plasminogen activator inhibitor-1 (PAI-1) 4G/5G (rs1799889) genotype of the subjects in a robust detection method and to explore the association of the PAI-1 4G/5G polymorphism with susceptibility to diabetes mellitus (DM) and hypertension (HTN) as well as clinical characteristics. Methods This study recruited 208 patients (68 patients were diagnosed with DM, 70 patients with HTN and 70 patients with DM combined with HTN) and 132 healthy controls (HC). A subset of the population was selected to evaluate the accuracy of the Real-time PCR (RT-PCR) method for detecting PAI-1 4G/5G polymorphism by using the sequencing method as the gold standard. Furthermore, the association of the PAI-1 4G/5G polymorphism with genetic susceptibility to DM and HTN was explored. Moreover, variations in clinical characteristics among individuals with various PAI-1 genotypes were also analyzed in the DM group, the HTN group and the DM+HTN group. Results There was a high concordance between the RT-PCR method and the sequencing method in determining the PAI-1 4G/5G polymorphism. No association was observed between the PAI-1 4G/5G polymorphism and susceptibility to DM, HTN and DM+HTN, respectively. There were no statistical differences in all study indicators among individuals that carrying various genotypes in the HC group. There were several variations in clinical characteristics among individuals harboring different PAI-1 4G/5G genotypes in the DM group, the HTN group and the DM+HTN group. Conclusion The RT-PCR method can accurately identify the PAI-1 4G/5G genotype in different individuals. The PAI-1 4G/5G polymorphism may not be associated with genetic susceptibility to DM, HTN and DM+HTN, but differences in clinical characteristics among individuals with various genotypes may provide a reference for disease assessment and personalized treatment of patients.
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Affiliation(s)
- Ziran Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jintu Chen
- Department of Clinical Laboratory, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, People’s Republic of China
| | - Jingjing Song
- Department of Clinical Laboratory, Anhui Provincial Maternal and Child Health Hospital, Hefei, Anhui, People’s Republic of China
| | - Lingjun Kong
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Xuanzhi Wang
- Department of Medical Laboratory, North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Tengda Xu
- Department of Health Management, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Songbai Lin
- Department of Health Management, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Yaling Dou
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Correspondence: Yaling Dou, Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China, Email
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15
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Forrester SN, Zmora R, Schreiner PJ, Jacobs DR, Roger VL, Thorpe RJ, Kiefe CI. Racial differences in the association of accelerated aging with future cardiovascular events and all-cause mortality: the coronary artery risk development in young adults study, 2007-2018. ETHNICITY & HEALTH 2022; 27:997-1009. [PMID: 33222499 PMCID: PMC8137718 DOI: 10.1080/13557858.2020.1839021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Variability of Cardiovascular disease (CVD) risk, including racial difference, is not fully accounted for by the variability of traditional CVD risk factors. We used a multiple biomarker model as a framework to explore known racial differences in CVD burden. DESIGN We measured associations between accelerated aging (AccA) measured by a combination of biomarkers, and cardiovascular morbidity and all-cause mortality using data from the Coronary Artery Risk Development in Young Adults study (CARDIA). AccA was defined as the difference between biological age, calculated using biomarkers with the Klemera and Doubal method, and chronological age. Using logistic regression, we assessed overall and race-specific associations between AccA, CVD, and all-cause mortality. RESULTS Among our cohort of 2959 Black or White middle-aged adults, after adjustment, a one-year increase in AccA was associated with increased odds of CVD (Odds Ratio (OR) = 1.04; 95% CI: 1.02, 1.06), stroke (OR = 1.12; 95% CI: 1.07, 1.17), and all-cause mortality (OR = 1.05; 95% CI: 1.02, 1.08). We did not find significant overall racial differences, but we did find race by sex differences where Black men differed markedly from White men in the strength of association with CVD (OR = 1.06, 95% CI: 1.01, 1.12). CONCLUSIONS We provide evidence that AccA is associated with future CVD.
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Affiliation(s)
- Sarah N Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rachel Zmora
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Pamela J Schreiner
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - David R Jacobs
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Veronique L Roger
- Department of Cardiovascular Medicine, Veronique L. Roger, Mayo Clinic, Division of Circulatory Failure, Rochester, MN, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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16
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Kawasoe M, Kawasoe S, Kubozono T, Ojima S, Kawabata T, Ikeda Y, Oketani N, Miyahara H, Tokushige K, Miyata M, Ohishi M. Development of a risk prediction score for hypertension incidence using Japanese health checkup data. Hypertens Res 2022; 45:730-740. [PMID: 34961790 DOI: 10.1038/s41440-021-00831-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/06/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022]
Abstract
Hypertension is a risk factor for cardiovascular disease. We developed a simple scoring method for predicting future hypertension using health checkup data. A total of 41,902 participants aged 30-69 years without baseline hypertension who underwent annual health checkups (mean age, 52.3 ± 10.2 years; male, 47.7%) were included. They were randomly assigned to derivation (n = 27,935) and validation cohorts (n = 13,967) at a ratio of 2:1. In the derivation cohort, we performed multivariable logistic regression analysis and assigned scores to each factor significantly associated with 5-year hypertension. We evaluated the predictive ability of the scores using area under the curve (AUC) analysis and then applied them to the validation cohort to assess their validity. The score including items requiring blood sampling ranged from 0 to 14 and included seven indicators (age, body mass index, blood pressure, current smoking, family history of hypertension, diabetes, and hyperuricemia). The score not including items requiring blood sampling ranged from 0 to 12 and included five indicators (the above indicators, except diabetes and hyperuricemia). The score not including items requiring blood sampling was better; blood sampling did not improve diagnostic ability. The AUC of the score not including items requiring blood sampling was 0.76, with a sensitivity and specificity of 0.82 and 0.60, respectively, for scores ≥6 points. The incidence of hypertension gradually and constantly increased (from 0.9 to 49.6%) as the score increased from 0 to ≥10. Analysis in the validation cohort yielded similar results. We developed a simple and useful clinical prediction model to predict the 5-year incidence of hypertension among a general Japanese population. The model had reasonably high predictive ability and reproducibility.
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Affiliation(s)
- Mariko Kawasoe
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.,Kagoshima City Hospital, Kagoshima, Japan
| | - Shin Kawasoe
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Satoko Ojima
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takeko Kawabata
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | | | | | | | - Masaaki Miyata
- School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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17
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Saz-Lara A, Bruno RM, Cavero-Redondo I, Álvarez-Bueno C, Notario-Pacheco B, Martínez-Vizcaíno V. Association Between Arterial Stiffness and Blood Pressure Progression With Incident Hypertension: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:798934. [PMID: 35224042 PMCID: PMC8873377 DOI: 10.3389/fcvm.2022.798934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background Arterial stiffness is an independent predictor of cardiovascular and all-cause mortality that is classically regarded as a consequence of arterial hypertension. However, a growing number of studies have shown that arterial stiffness is involved in the pathogenesis and prognosis of arterial hypertension. Thus, in this systematic review and meta-analysis, we aimed to assess whether arterial stiffness, as measured by pulse wave velocity, systolic blood pressure and diastolic blood pressure are associated with incident hypertension. Methods The Scopus, PubMed, Web of Science and Cochrane Library databases were searched from inception to March 30, 2021. The DerSimonian and Laird method was used to compute pooled relative risk estimates and their respective 95% confidence intervals of association between incident hypertension with pulse wave velocity, systolic blood pressure and diastolic blood pressure. Results Our findings provide a synthesis of the evidence supporting that the higher arterial stiffness (RR: 1.09; 95% CIs: 1.05, 1.12), systolic blood pressure (RR: 1.08; 95% CIs: 1.05, 1.10) and diastolic blood pressure (RR: 1.08; 95% CIs: 1.04, 1.12) are associated with incident hypertension in normotensive adult subjects, with similar independent predictive values. However, our results should be interpreted with caution because the meta-analyses performed showed considerable heterogeneity. Conclusions Our results showed that higher pulse wave velocity, systolic blood pressure and diastolic blood pressure are associated with incident hypertension. These findings are of clinical importance, supporting arterial stiffness as an additional tool for the prevention of arterial hypertension and being a fundamental component to reduce cardiovascular morbidity and mortality. Systematic Review Registration This study was registered in PROSPERO https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=236435 (Registration number: CRD42021236435).
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Affiliation(s)
- Alicia Saz-Lara
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Rosa María Bruno
- INSERM U970, Paris Cardiovascular Research Centre-PARCC, Université de Paris, Paris, France
- Pharmacology Unit, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Rehabilitation in Health Research Center (CIRES), Universidad de las Américas, Santiago, Chile
- *Correspondence: Iván Cavero-Redondo
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | | | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
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18
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Long DL, Guo B, McClure LA, Jaeger BC, Tison S, Howard G, Judd SE, Howard VJ, Plante TB, Zakai NA, Koh I, Cheung KL, Cushman M. Biomarkers as MEDiators of racial disparities in risk factors (BioMedioR): Rationale, study design, and statistical considerations. Ann Epidemiol 2022; 66:13-19. [PMID: 34742867 PMCID: PMC8920757 DOI: 10.1016/j.annepidem.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/06/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Relative to White adults, Black adults have a substantially higher prevalence of hypertension and diabetes, both key risk factors for stroke, cardiovascular disease, cognitive impairment, and dementia. Blood biomarkers have shown promise in identifying contributors to racial disparities in many chronic diseases. METHODS We outline the study design and related statistical considerations for a nested cohort study, the Biomarker Mediators of Racial Disparities in Risk Factors (BioMedioR) study, within the 30,239-person biracial REasons for Geographic And Racial Differences in Stroke (REGARDS) study (2003-present). Selected biomarkers will be assessed for contributions to racial disparities in risk factor development over median 9.4 years of follow-up, with initial focus on hypertension, and diabetes. Here we outline study design decisions and statistical considerations for the sampling of 4,400 BioMedioR participants. RESULTS The population for biomarker assessment was selected using a random sample study design balanced across race and sex to provide the optimal opportunity to describe association of biomarkers with the development of hypertension and diabetes. Descriptive characteristics of the BioMedioR sample and analytic plans are provided for this nested cohort study. CONCLUSIONS This nested biomarker study will examine pathways with the target to help explain racial differences in hypertension and diabetes incidence.
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Affiliation(s)
- D. Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Boyi Guo
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Leslie A. McClure
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania
| | - Byron C. Jaeger
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephanie Tison
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E. Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Virginia J. Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Timothy B. Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont
| | - Neil A. Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont,Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont
| | - Insu Koh
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont
| | - Katharine L. Cheung
- Department of Medicine, Larner College of Medicine at the University of Vermont
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont,Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont
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19
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Kernel-based gene-environment interaction tests for rare variants with multiple quantitative phenotypes. PLoS One 2022; 17:e0275929. [PMID: 36223383 PMCID: PMC9555665 DOI: 10.1371/journal.pone.0275929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022] Open
Abstract
Previous studies have suggested that gene-environment interactions (GEIs) between a common variant and an environmental factor can influence multiple correlated phenotypes simultaneously, that is, GEI pleiotropy, and that analyzing multiple phenotypes jointly is more powerful than analyzing phenotypes separately by using single-phenotype GEI tests. Methods to test the GEI for rare variants with multiple phenotypes are, however, lacking. In our work, we model the correlation among the GEI effects of a variant on multiple quantitative phenotypes through four kernels and propose four multiphenotype GEI tests for rare variants, which are a test with a homogeneous kernel (Hom-GEI), a test with a heterogeneous kernel (Het-GEI), a test with a projection phenotype kernel (PPK-GEI) and a test with a linear phenotype kernel (LPK-GEI). Through numerical simulations, we show that correlation among phenotypes can enhance the statistical power except for LPK-GEI, which simply combines statistics from single-phenotype GEI tests and ignores the phenotypic correlations. Among almost all considered scenarios, Het-GEI and PPK-GEI are more powerful than Hom-GEI and LPK-GEI. We apply Het-GEI and PPK-GEI in the genome-wide GEI analysis of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the UK Biobank. We analyze 18,101 genes and find that LEUTX is associated with SBP and DBP (p = 2.20×10-6) through its interaction with hemoglobin. The single-phenotype GEI test and our multiphenotype GEI tests Het-GEI and PPK-GEI are also used to evaluate the gene-hemoglobin interactions for 22 genes that were previously reported to be associated with SBP or DBP in a meta-analysis of genetic main effects. MYO1C shows nominal significance (p < 0.05) by the Het-GEI test. NOS3 shows nominal significance in DBP and MYO1C in both SBP and DBP by the single-phenotype GEI test.
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20
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C-Reactive Protein Levels in relation to Incidence of Hypertension in Chinese Adults: Longitudinal Analyses from the China Health and Nutrition Survey. Int J Hypertens 2021; 2021:3326349. [PMID: 34925916 PMCID: PMC8683184 DOI: 10.1155/2021/3326349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/25/2021] [Indexed: 01/28/2023] Open
Abstract
Objective To explore the association between high sensitivity C-reactive protein (hs-CRP) levels and incident hypertension, as well as the association between hs-CRP levels and related covariates, in a Chinese adult population. Methods This study was based on the China Health and Nutrition Survey, a continuing open, large-scale prospective cohort study. Adult participants who were free of hypertension were included at baseline survey in 2009 and were followed up in 2015 (follow-up rate: 77.45%). The hs-CRP was measured using the immunoturbidimetric method and divided into three groups: low-risk group (0 ≤ hs-CRP <1 mg/L), average-risk group (1 ≤ hs-CRP <3 mg/L), and high-risk group (3 ≤ hs-CRP ≤10 mg/L). Definite diagnosis of hypertension in the follow-up survey in 2015 was the endpoint event of this study. The areas under the curve (AUC) of the receiver operating characteristic (ROC) curve analyses were used to evaluate the predictive value of the hs-CRP. Results 3794 participants were finally included as study sample, of whom 912 developed hypertension during a 6-year follow-up period (incidence: 24.1%). The incidences of hypertension in hs-CRP low-risk, average-risk, and high-risk groups were 17.6% (200/1135), 25.9% (521/2015), and 29.7% (191/644), respectively. Spearman's correlation analyses showed that there was significant positive correlation between hs-CRP levels and waist circumference, total triglycerides, total cholesterol, age, body mass index, and homeostasis model assessment of insulin resistance index. Stepwise regression analyses showed that participants in the hs-CRP high-risk group had a 46.2% higher risk of developing hypertension compared with those in the hs-CRP low-risk group (odds ratio: 1.462, 95% confidence interval: 1.018–2.101). Baseline systolic and diastolic blood pressure levels and waist circumference contributed the most to the development of hypertension with R2 of 0.076, 0.052, and 0.039, respectively, while hs-CRP had lower area under the curve (AUC) for hypertension, adding baseline BP and WC to the prediction model increased the AUC to 0.708 (95% CI: 0.681–0.735). Conclusion This study revealed a weak positive association between CRP levels and future incidence of hypertension in the Chinese population. The combination of hs-CRP with baseline BP and waist circumference (WC) had a higher predictive value for hypertension (AUC: 0.708), but the predictive value was still limited.
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Plante TB, Long DL, Guo B, Howard G, Carson AP, Howard VJ, Judd SE, Jenny NS, Zakai NA, Cushman M. C-Reactive Protein and Incident Hypertension in Black and White Americans in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort Study. Am J Hypertens 2021; 34:698-706. [PMID: 33326556 PMCID: PMC8351501 DOI: 10.1093/ajh/hpaa215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/16/2020] [Accepted: 12/14/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND More inflammation is associated with greater risk incident hypertension, and Black United States (US) adults have excess burden of hypertension. We investigated whether increased inflammation as quantified by higher C-reactive protein (CRP) explains the excess incidence in hypertension experienced by Black US adults. METHODS We included 6,548 Black and White REasons for Geographic and Racial Differences in Stroke (REGARDS) participants without hypertension at baseline (2003-2007) who attended a second visit (2013-2016). Sex-stratified risk ratios (RRs) for incident hypertension at the second exam in Black compared to White individuals were estimated using Poisson regression adjusted for groups of factors known to partially explain the Black-White differences in incident hypertension. We calculated the percent mediation by CRP of the racial difference in hypertension. RESULTS Baseline CRP was higher in Black participants. The Black-White RR for incident hypertension in the minimally adjusted model was 1.33 (95% confidence interval 1.22, 1.44) for males and 1.15 (1.04, 1.27) for females. CRP mediated 6.6% (95% confidence interval 2.7, 11.3%) of this association in females and 19.7% (9.8, 33.2%) in males. In females, CRP no longer mediated the Black-White RR in a model including waist circumference and body mass index, while in males the Black-White difference was fully attenuated in models including income, education and dietary patterns. CONCLUSIONS Elevated CRP attenuated a portion of the unadjusted excess risk of hypertension in Black adults, but this excess risk was attenuated when controlling for measures of obesity in females and diet and socioeconomic factors in males. Inflammation related to these risk factors might explain part of the Black-White disparity in hypertension.
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Affiliation(s)
- Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - D Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Boyi Guo
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April P Carson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nancy Swords Jenny
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
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Zuk AM, Liberda EN, Tsuji LJS. Examining chronic inflammatory markers on blood pressure measures in the presence of vitamin D insufficiency among indigenous cree adults: results from the cross-sectional Multi-Community Environment-and-Health Study in Eeyou Istchee, Quebec, Canada. BMJ Open 2021; 11:e043166. [PMID: 33504558 PMCID: PMC7843349 DOI: 10.1136/bmjopen-2020-043166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE High blood pressure (BP) is a risk factor for cardiovascular disease. Examining the role of inflammatory mediators on BP is important since vitamin D (VD) is a modifiable risk factor, which possibly modulates inflammatory cytokines. This study simulated what are known as average 'controlled direct effects (CDE)' of inflammatory markers, C reactive protein (CRP), tumour necrosis factor-α (TNF-α), and interlukin-6 (IL-6) on continuous BP measures, while fixing VD, an intermediate variable to specific level. DESIGN Cross-sectional study. SETTING We analysed data from the Multi-Community Environment-and-Health Study, 2005-2009, conducted in Eeyou Istchee, Quebec, Canada. PARTICIPANTS This study recruited 1425 study Indigenous Cree participants from seven Cree communities. Only adults with serum VD levels, inflammatory markers and BP measures were included in this data analysis. PRIMARY AND SECONDARY OUTCOMES MEASURES Inflammatory markers examined the top 25th exposure percentiles. VD 'insufficiency' (ie, 25-hydroxyvitamin-D levels<50 nmol/L) defined by the Institute of Medicine. CDE for each inflammatory marker in the presence and absence of population VD insufficiency simulated the average direct effect change for systolic and diastolic BP (SBP and DBP) measures. All models were adjusted for exposure-and-mediator outcome relationship. RESULTS Among 161 participants, 97 (60 %) were female. The prevalence of VD insufficiency was 32%. CDE estimates show in the presence and absence of population vitamin D insufficiency, inflammatory markers have a slightly different association on BP. TNF-α significantly and inversely associated with SBP in the presence of vitamin D insufficiency, fully adjusted model β = -13.61 (95% CI -24.42 to -2.80); however, TNF-α was not associated with SBP in the absence of vitamin D insufficiency. CRP, IL-6 were also not significantly associated with BP measures, although the magnitude of association was greater for those with elevated inflammation and VD insufficiency. CONCLUSION This novel analysis shows in the presence of VD insufficiency, inflammation (particularly TNF-α) may affect SBP. Additional research is needed to elucidate these findings, and the temporal relationship between these variables.
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Affiliation(s)
- Aleksandra M Zuk
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, Ontario, Canada
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Eric N Liberda
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | - Leonard J S Tsuji
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, Ontario, Canada
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Amar J, Touront N, Ciron AM, Pendaries C. Interactions between hypertension and inflammatory tone and the effect on blood pressure and outcomes in patients with COVID-19. J Clin Hypertens (Greenwich) 2021; 23:238-244. [PMID: 33491247 PMCID: PMC8013547 DOI: 10.1111/jch.14137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022]
Abstract
Arterial hypertension represented one of the most common comorbidities in patients with COVID‐19. However, the impact of hypertension on outcome in COVID‐19 patients is not clear. Close connections between inflammation and blood pressure (BP) have been described, and inflammation plays a key role in the outcome for patients with COVID‐19. Whether hypertension impairs the relationship between inflammation, BP, and outcomes in this context is not known. The aim of this study was to examine the effects of the interactions between inflammation and hypertension status on BP and clinical outcome in patients hospitalized with COVID‐19. We designed a retrospective study in 129 patients hospitalized with COVID‐19 at Toulouse University Hospital. The hospital outcome was admission to the intensive care unit or death. The inflammatory markers were blood C‐reactive protein level (CRP), neutrophil to lymphocyte, and platelet to lymphocyte ratios. We identified strong correlations between CRP (P < .01) and the other inflammatory markers recorded on admission (P < .001) with mean BP within 3 days after admission in normotensive patients, whereas these correlations were absent in patients with hypertension. Also, we observed after multivariate adjustment (P < .05) that CRP level predicted a worse prognosis in hypertensive patients (relative risk 2.52; 95% confidence intervals [1.03‐ 6.17]; P = .04), whereas CRP was not predictive of outcome in patients without hypertension. In conclusion, the study revealed that in COVID‐19 patients, hypertension impairs the relationship between inflammation and BP and interacts with inflammation to affect prognosis. These findings provide insights that could explain the relationship between hypertension and outcomes in COVID‐19 patients.
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Affiliation(s)
- Jacques Amar
- Department of Arterial Hypertension, Toulouse University III, Toulouse, France
| | - Nicolas Touront
- Department of Arterial Hypertension, Toulouse University III, Toulouse, France
| | - Antoine M Ciron
- Department of Arterial Hypertension, Toulouse University III, Toulouse, France
| | - Caroline Pendaries
- Department of Arterial Hypertension, Toulouse University III, Toulouse, France
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Bowker N, Shah RL, Sharp SJ, Luan J, Stewart ID, Wheeler E, Ferreira MAR, Baras A, Wareham NJ, Langenberg C, Lotta LA. Meta-analysis investigating the role of interleukin-6 mediated inflammation in type 2 diabetes. EBioMedicine 2020; 61:103062. [PMID: 33096487 PMCID: PMC7581887 DOI: 10.1016/j.ebiom.2020.103062] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/13/2020] [Accepted: 09/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Evidence from animal models and observational epidemiology points to a role for chronic inflammation, in which interleukin 6 (IL-6) is a key player, in the pathophysiology of type 2 diabetes (T2D). However, it is unknown whether IL-6 mediated inflammation is implicated in the pathophysiology of T2D. METHODS We performed a meta-analysis of 15 prospective studies to investigate associations between IL-6 levels and incident T2D including 5,421 cases and 31,562 non-cases. We also estimated the association of a loss-of-function missense variant (Asp358Ala) in the IL-6 receptor gene (IL6R), previously shown to mimic the effects of IL-6R inhibition, in a large trans-ethnic meta-analysis of six T2D case-control studies including 260,614 cases and 1,350,640 controls. FINDINGS In a meta-analysis of 15 prospective studies, higher levels of IL-6 (per log pg/mL) were significantly associated with a higher risk of incident T2D (1·24 95% CI, 1·17, 1·32; P = 1 × 10-12). In a trans-ethnic meta-analysis of 260,614 cases and 1,350,640 controls, the IL6R Asp358Ala missense variant was associated with lower odds of T2D (OR, 0·98; 95% CI, 0·97, 0·99; P = 2 × 10-7). This association was not due to diagnostic misclassification and was consistent across ethnic groups. IL-6 levels mediated up to 5% of the association between higher body mass index and T2D. INTERPRETATION Large-scale human prospective and genetic data provide evidence that IL-6 mediated inflammation is implicated in the etiology of T2D but suggest that the impact of this pathway on disease risk in the general population is likely to be small. FUNDING The EPICNorfolk study has received funding from the Medical Research Council (MRC) (MR/N003284/1, MC-UU_12015/1 and MC_PC_13048) and Cancer Research UK (C864/A14136). The Fenland Study is funded by the MRC (MC_UU_12015/1 and MC_PC_13046).
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Affiliation(s)
- Nicholas Bowker
- MRC Epidemiology Unit, University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Rupal L Shah
- MRC Epidemiology Unit, University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Jian'an Luan
- MRC Epidemiology Unit, University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Isobel D Stewart
- MRC Epidemiology Unit, University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Eleanor Wheeler
- MRC Epidemiology Unit, University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Manuel A R Ferreira
- Regeneron Genetics Center, 777 Old Saw Mill River Rd, Tarrytown, NY 10591, United States
| | - Aris Baras
- Regeneron Genetics Center, 777 Old Saw Mill River Rd, Tarrytown, NY 10591, United States
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom.
| | - Luca A Lotta
- MRC Epidemiology Unit, University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom; Regeneron Genetics Center, 777 Old Saw Mill River Rd, Tarrytown, NY 10591, United States
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Jacobs A, Pieters M, Schutte AE. The association of PAI-1 with 24 h blood pressure in young healthy adults is influenced by smoking and alcohol use: The African-PREDICT study. Nutr Metab Cardiovasc Dis 2020; 30:2063-2071. [PMID: 32811735 DOI: 10.1016/j.numecd.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The association between plasminogen activator inhibitor-1 (PAI-1) and blood pressure is well established, but it is debatable whether raised PAI-1 levels precede or result from raised blood pressure. Furthermore, it is unclear whether this association already exists in the absence of overt hypertension and to what degree it is influenced by health behaviours. Our aim was to investigate the association of 24 h blood pressure with PAI-1 activity (PAI-1act) in a young, healthy cohort, and to assess the influence of alcohol consumption and smoking on these associations. METHODS AND RESULTS Healthy black and white men and women (aged 20-30 years, n = 1156) were cross-sectionally analysed. Statistical analysis was performed first split by ethnicity and sex and then by alcohol consumption and smoking. Regression analyses adjusted for age revealed positive associations of 24 h blood pressure with PAI-1act in most groups (p < 0.05). In multivariate-adjusted analyses, significance was lost in all groups except black men, who also had higher monocyte chemoattractant protein-1 (MCP-1) and von Willebrand factor antigen (vWFag) compared to white men (both p < 0.001). Analyses in black men, split by self-reported alcohol use and smoking, revealed 24 h blood pressure-PAI-1act associations only in alcohol users (24 h SBP [B = 4.22, p < 0.001], DBP [B = 2.04, p = 0.015] and PP [B = 2.18, p = 0.013]) and smokers (24 h SBP [B = 6.10, p < 0.001] and PP [B = 4.33, p = 0.001]). CONCLUSION Our findings support a positive association between 24 h blood pressure and PAI-1, particularly in individuals with higher MCP-1 and vWFag levels. Furthermore, smoking and alcohol consumption play an important role in modifying the association between blood pressure and PAI-1.
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Affiliation(s)
- Adriaan Jacobs
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa; Hypertension in Africa Research Team (HART), Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Marlien Pieters
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa.
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa; School of Public Health and Community Medicine, University of New South Wales, The George Institute for Global Health, Sydney, Australia.
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Chen J, Xu L, He Q, Wu S, Hu D, Lu K. Correlation Between Ideal Cardiovascular Health Metrics and Plasma hs-CRP Levels in a North China Population: One Four-Year Follow-Up Study. Int J Gen Med 2020; 13:617-625. [PMID: 32982379 PMCID: PMC7505702 DOI: 10.2147/ijgm.s266602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/07/2020] [Indexed: 12/03/2022] Open
Abstract
Background This prospective cohort study aimed to evaluate the potential association of ideal cardiovascular health metrics with the plasma levels of highly sensitive C-reactive protein (hs-CRP) among people in North China. Methods A total of 80,968 participants were included in this study at baseline. Data relating to seven health metrics and plasma hs-CRP levels were collected at baseline and the end of follow-up. The change in health metrics of each individual was compared and recorded. The potential association of gain or loss of each health metric, as well as the change in the total number of health metrics that each individual had during follow-up, with the risk of increased hs-CRP level, were explored by multiple Cox proportional hazards models. Results A total of 72,321 participants (94.51%) completed the follow-up, and the average follow-up time was 4.1 years. Ideal body mass index (BMI), physical activity, smoking status and total cholesterol all had significant impacts on hs-CRP levels, with ideal BMI having the largest impact. Losing ideal BMI during follow-up raised the probability of hs-CRP increase during the follow-up time by 1.72 (95% CI, 1.59–1.86) times for men and 2.05 (95% CI, 1.76–2.39) times for women. The effects of ideal salt intake and blood pressure on hs-CRP levels were uncertain. Changes in the total number of ideal metrics for each individual had a significant cumulative effect on hs-CRP. The hazard ratio of loss of four to six health metrics during follow-up on the risk of hs-CRP increase was 1.69 (95% CI, 1.38–2.06) for men and 1.52 (95% CI, 1.13–2.04) for women. Conclusion Loss or gain of ideal cardiovascular health metrics is associated with significant fluctuations in plasma hs-CRP levels. The cardiovascular benefits brought by the ideal health metrics are mediated at least in part by reducing systemic inflammation in the body.
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Affiliation(s)
- Jia Chen
- Department of Clinical Nutrition, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Liuyue Xu
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Quan He
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Hebei United University, Tangshan 100816, People's Republic of China
| | - Dayi Hu
- Heart Center, Peking University People's Hospital, Beijing 100044, People's Republic of China
| | - Kai Lu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
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Lipphardt M, Dihazi H, Maas JH, Schäfer AK, Amlaz SI, Ratliff BB, Koziolek MJ, Wallbach M. Syndecan-4 as a Marker of Endothelial Dysfunction in Patients with Resistant Hypertension. J Clin Med 2020; 9:jcm9093051. [PMID: 32971813 PMCID: PMC7564403 DOI: 10.3390/jcm9093051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Arterial hypertension (HTN) is one of the most relevant cardiovascular risk factors. Nowadays multiple pharmaceutical treatment options exist with novel interventional methods (e.g., baroreflex activation therapy (BAT)) as a last resort to treat patients with resistant HTN. Although pathophysiology behind resistant HTN is still not fully understood. There is evidence that selected biomarkers may be involved in the pathophysiology of HTN. (2) Methods: We investigated serum SDC4-levels in patients suffering from resistant HTN before and 6 months after BAT implantation. We collected 19 blood samples from patients with resistant HTN and blood pressure above target and measured serum SDC4-levels. (3) Results: Our results showed high serum SDC4-levels in patients with resistant HTN as compared to a healthy population. Patients with both, resistant HTN and diabetes mellitus type II, demonstrated higher serum SDC4-levels. β-blockers had lowering effects on serum SDC4-levels, whereas calcium channel blockers were associated with higher levels of serum SDC4. BAT implantation did not lead to a significant difference in serum SDC4-levels after 6 months of therapy. (4) Conclusion: Based on our results we propose SDC4 is elevated in patients suffering from resistant HTN. Thus, SDC4 might be a potential marker for endothelial dysfunction in patients with resistant hypertension.
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Affiliation(s)
- Mark Lipphardt
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany; (H.D.); (A.-K.S.); (M.J.K.); (M.W.)
- Correspondence: ; Tel.: +49-(0)-551-39-65309; Fax: +49-(0)-551-39-8906
| | - Hassan Dihazi
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany; (H.D.); (A.-K.S.); (M.J.K.); (M.W.)
| | - Jens-Holger Maas
- Department of Transfusion Medicine, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany;
| | - Ann-Kathrin Schäfer
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany; (H.D.); (A.-K.S.); (M.J.K.); (M.W.)
| | - Saskia I. Amlaz
- Department of Cardiology and Pneumology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany;
| | - Brian B. Ratliff
- Renal Research Institute and Departments of Medicine, Pharmacology, and Physiology, New York Medical College, Valhalla, NY 10595, USA;
| | - Michael J. Koziolek
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany; (H.D.); (A.-K.S.); (M.J.K.); (M.W.)
| | - Manuel Wallbach
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany; (H.D.); (A.-K.S.); (M.J.K.); (M.W.)
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Plasminogen activator inhibitor-1 activity and the 4G/5G polymorphism are prospectively associated with blood pressure and hypertension status. J Hypertens 2020; 37:2361-2370. [PMID: 31356402 DOI: 10.1097/hjh.0000000000002204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Plasminogen activator inhibitor-1 (PAI-1) has consistently shown positive associations with blood pressure (BP). Whether elevations in PAI-1 levels precede or result from raised BP is still under debate and data on prospective studies are limited. Hence, we investigated the prospective associations of PAI-1 and the 4G/5G polymorphism with brachial and central BP and pulse pressure (PP) over a 10-year period. METHODS Black South Africans aged 30 years and older were included. Baseline data collection commenced in 2005 (n = 2010) with follow-up data collection in 2010 (n = 1288) and 2015 (n = 926). Plasma PAI-1 activity (PAI-1act), 4G/5G polymorphism genotyping, waist circumference and BP measurements were performed and analysed using sequential regression and mixed models. RESULTS In multivariable adjusted analyses, PAI-1act and the 4G/4G (vs. the 5G/5G) genotype increased the odds of developing hypertension in the total group [1.04 (1.01; 1.08) and 1.82 (1.07; 3.12) respectively]. Furthermore, PAI-1act was prospectively associated with brachial SBP (r = 0.0815) and PP (r = 0.0832) in the total group, and with central PP in women (r = 0.1125; all P < 0.05). Addition of waist circumference to the models either decreased or nullified the contribution of PAI-1act to BP and hypertension development. CONCLUSION PAI-1act and the 4G/4G (vs. the 5G/5G) genotype increased the odds of developing hypertension. Furthermore, PAI-1act associated prospectively with both brachial and central BP. These associations were mediated in part by central adiposity. The study supports the hypothesis that PAI-1 also contributes to hypertension development rather than solely being a consequence thereof.
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Elevated Lipoprotein-Associated Phospholipase A 2 Independently Affects Age-Related Increases in Systolic Blood Pressure: A Nested Case-Control Study in a Prospective Korean Cohort. Int J Hypertens 2020; 2020:5693271. [PMID: 32292598 PMCID: PMC7150680 DOI: 10.1155/2020/5693271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/18/2020] [Indexed: 11/17/2022] Open
Abstract
Inflammatory markers are susceptible to changes over time. Thus, we observed changes in inflammatory markers correlating with age-related increases in blood pressure (BP) through a prospective study. The aim of this study was to investigate changes in inflammatory markers that correlate with age-related increases in BP. The study included 1,500 nondiabetic and normotensive healthy subjects at baseline. Of these, 121 individuals who developed hypertension (defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) after 2 years formed the hypertension group. For each incident hypertension case, 2 age- and sex-matched control subjects were selected among those who did not develop hypertension (control group, n = 242). After baseline adjustment, the hypertension group exhibited greater increases in body mass index (BMI), systolic and diastolic BP, triglyceride, total cholesterol, glucose, Lp-PLA2 activity, and urinary 8-epi-prostaglandin F2α (8-epi-PGF2α ) levels compared to the control group. In the hypertension group, changes in (Δ) systolic BP correlated positively with Δ Lp-PLA2 activity, which correlated positively with Δ low-density lipoprotein (LDL-) cholesterol and Δ urinary 8-epi-PGF2α levels. Moreover, multiple linear regression revealed baseline systolic BP and Δ Lp-PLA2 activity to be independent predictors of Δ systolic BP in the hypertension group. Our results suggest that age-related increases in systolic BP may correlate strongly with elevated Lp-PLA2 activity and that Lp-PLA2 can be considered a biomarker for systolic BP elevation.
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Ghazi L, Baker JV, Sharma S, Jain MK, Palfreeman A, Necsoi C, Murray DD, Neaton JD, Drawz PE. Role of Inflammatory Biomarkers in the Prevalence and Incidence of Hypertension Among HIV-Positive Participants in the START Trial. Am J Hypertens 2020; 33:43-52. [PMID: 31800000 DOI: 10.1093/ajh/hpz132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/03/2019] [Accepted: 08/08/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The association between hypertension (HTN) and inflammatory biomarkers (interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hsCRP]) in HIV-positive persons with CD4+ count >500 cells/mm3 is unknown. METHODS We studied HTN in participants of the Strategic Timing of AntiRetroviral Treatment (START) trial of immediate vs. deferred antiretroviral therapy (ART) in HIV-positive, ART naive adults with CD4+ count > 500 cells/mm3. HTN was defined as having a systolic blood pressure (BP) ≥140 mmHg, a diastolic BP ≥90 mmHg, or using BP-lowering therapy. Logistic and discrete Cox regression models were used to study the association between baseline biomarker levels with prevalent and incident HTN. RESULTS Among 4,249 participants with no history of cardiovascular disease, the median age was 36 years, 55% were nonwhite, and the prevalence of HTN at baseline was 18.9%. After adjustment for race, age, gender, body mass index (BMI), diabetes, smoking, HIV RNA and CD4+ levels, associations of IL-6 and hsCRP with HTN prevalence were not significant (OR per twofold higher:1.10, 95% confidence interval [CI]: 0.99, 1.20 for IL-6 and 1.05, 95% CI: 0.99, 1.10 for hsCRP). Overall incidence of HTN was 6.8 cases/100 person years. In similarly adjusted models, neither IL-6 (Hazard ratios [HR] per twofold higher IL-6 levels: 0.97, 95% CI: 0.88, 1.08) nor hsCRP (HR per twofold higher hsCRP levels: 0.97, 95% CI: 0.92, 1.02) were associated with risk of incident HTN. Associations did not differ by treatment group. Age, race, gender, and BMI were significantly associated with both the prevalence and incidence of HTN. CONCLUSIONS Traditional risk factors and not baseline levels of IL-6 or hsCRP were associated with the prevalence and incidence of HTN in START.
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Affiliation(s)
- Lama Ghazi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason V Baker
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shweta Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mamta K Jain
- Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Adrian Palfreeman
- Department of Infectious Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Coca Necsoi
- Service des Maladies Infectieuses, CHU St-Pierre, ULB, Bruxelles, Belgium
| | - Daniel D Murray
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paul E Drawz
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Chen J, Bundy JD, Hamm LL, Hsu CY, Lash J, Miller ER, Thomas G, Cohen DL, Weir MR, Raj DS, Chen HY, Xie D, Rao P, Wright JT, Rahman M, He J. Inflammation and Apparent Treatment-Resistant Hypertension in Patients With Chronic Kidney Disease. Hypertension 2019; 73:785-793. [PMID: 30776971 DOI: 10.1161/hypertensionaha.118.12358] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Apparent treatment-resistant hypertension (ATRH) is highly prevalent and associated with cardiovascular disease risk in patients with chronic kidney disease. We analyzed the association of inflammatory biomarkers with ATRH and its complications in patients with chronic kidney disease. ATRH was defined as blood pressure ≥140/90 mm Hg while taking ≥3 antihypertensive medications or blood pressure <140/90 mm Hg while taking ≥4 medications. Analyses included 1359 CRIC study (Chronic Renal Insufficiency Cohort) participants with ATRH and 2008 hypertensive participants without. Logistic regression was used to examine cross-sectional associations of inflammatory biomarkers and ATRH adjusting for demographic, lifestyle, and clinical risk factors and treatments. Cox proportional hazards models were used to assess the impact of inflammatory biomarkers on associations of ATRH with composite cardiovascular disease and mortality beyond conventional risk factors. Multivariable-adjusted odds ratio (95% CI) of ATRH for the highest tertile versus the lowest tertile of inflammatory biomarker levels was 1.29 (95% CI, 1.05-1.59) for IL (interleukin)-6, 1.49 (95% CI, 1.20-1.85) for TNF-α (tumor necrosis factor-α), and 0.77 (95% CI, 0.63-0.95) for TGF-β (transforming growth factor-β). High-sensitivity CRP (C-reactive protein), fibrinogen, IL-1β, and IL-1 receptor antagonist were not significantly associated with ATRH. Adding inflammatory biomarkers to Cox models did not attenuate the significant association of ATRH with cardiovascular disease and mortality. Our findings show higher levels of IL-6 and TNF-α and lower levels of TGF-β were independently associated with odds of ATRH. Targeting specific inflammatory pathways may improve blood pressure control in patients with chronic kidney disease.
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Affiliation(s)
- Jing Chen
- From the Department of Medicine (J.C., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA.,Department of Epidemiology (J.C., J.D.B., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA.,Tulane University Translational Science Institute, New Orleans, LA (J.C., L.L.H., J.H.)
| | - Joshua D Bundy
- Department of Epidemiology (J.C., J.D.B., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.D.B.)
| | - L Lee Hamm
- From the Department of Medicine (J.C., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA.,Department of Epidemiology (J.C., J.D.B., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA.,Tulane University Translational Science Institute, New Orleans, LA (J.C., L.L.H., J.H.)
| | - Chi-Yuan Hsu
- Department of Medicine, University of California San Francisco School of Medicine, CA (C.-y.H.)
| | - James Lash
- Department of Medicine, University of Illinois College of Medicine, Chicago (J.L.)
| | - Edgar R Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (E.R.M.)
| | - George Thomas
- Department of Nephrology and Hypertension, Cleveland Clinic, OH (G.T.)
| | - Debbie L Cohen
- Department of Medicine (D.L.C.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Matthew R Weir
- Department of Medicine, University of Maryland School of Medicine, Baltimore (M.R.W.)
| | - Dominic S Raj
- Department of Medicine, Georgetown University School of Medicine, Washington, DC (D.S.R.)
| | - Hsiang-Yu Chen
- Department of Biostatistics, Epidemiology, and Informatics (H.-y.C., D.X.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Dawei Xie
- Department of Biostatistics, Epidemiology, and Informatics (H.-y.C., D.X.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Panduranga Rao
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor (P.R.)
| | - Jackson T Wright
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (J.T.W., M.R.)
| | - Mahboob Rahman
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (J.T.W., M.R.)
| | - Jiang He
- From the Department of Medicine (J.C., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA.,Department of Epidemiology (J.C., J.D.B., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA.,Tulane University Translational Science Institute, New Orleans, LA (J.C., L.L.H., J.H.)
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Lin YT, Fall T, Hammar U, Gustafsson S, Ingelsson E, Ärnlöv J, Lind L, Engström G, Sundström J. Proteomic Analysis of Longitudinal Changes in Blood Pressure. J Clin Med 2019; 8:jcm8101585. [PMID: 31581667 PMCID: PMC6832911 DOI: 10.3390/jcm8101585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 01/01/2023] Open
Abstract
Hypertension is the leading risk factor for premature death worldwide. The identification of modifiable causes of hypertension remains an imperative task. We aimed to investigate associations between 79 proteins implicated in cardiovascular disease and longitudinal blood pressure (BP) changes in three Swedish prospective cohorts. In a discovery phase, we investigated associations between baseline circulating protein levels assessed with a proximity extension assay and BP stage progression at follow-up 5 years later among persons without BP-lowering drugs at baseline in two independent community-based cohorts from the Prospective Investigation of the Vasculature in Uppsala Seniors study (PIVUS) and the Uppsala Longitudinal Study of Adult Men (ULSAM). We used an independent cohort, the Malmö Diet and Cancer Study (MDC), for replication. The primary outcome of BP stage progression was defined as per the 2017 AHA/ACC (American Heart Association/ American College of Cardiology) Guideline BP categories. We also investigated associations of protein levels with changes in BP on a continuous scale, and meta-analyzed all three cohorts. Levels of renin were associated with BP stage progression with a 5% false discovery rate (FDR) in the ULSAM (n = 238) and PIVUS (n = 566) cohorts, but we could not replicate this association in the MDC cohort (n = 2659). The association in the discovery cohorts was modest, with an odds ratio for BP stage progression over 5 years of 1.33 (95% confidence interval 1.14 to 1.56) per standard deviation of baseline renin. In conclusion, we could not find any novel robust associations with longitudinal BP increase in a proximity extension assay-based proteomics investigation in three cohorts.
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Affiliation(s)
- Yi-Ting Lin
- Department of Medical Sciences, Uppsala University, 75236 Uppsala, Sweden.
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 807 Kaohsiung City, Taiwan.
| | - Tove Fall
- Department of Medical Sciences, Uppsala University, 75236 Uppsala, Sweden.
| | - Ulf Hammar
- Department of Medical Sciences, Uppsala University, 75236 Uppsala, Sweden.
| | - Stefan Gustafsson
- Department of Medical Sciences, Uppsala University, 75236 Uppsala, Sweden.
| | - Erik Ingelsson
- Department of Medical Sciences, Uppsala University, 75236 Uppsala, Sweden.
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA.
- Stanford Diabetes Research Center, Stanford University, Stanford, CA 94305, USA.
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, 14152 Huddinge, Sweden.
- School of Health and Social Studies, Dalarna University, 79131 Falun, Sweden.
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, 75236 Uppsala, Sweden.
| | - Gunnar Engström
- Department of Clinical Sciences, Cardiovascular Epidemiology, Lund University, 21428 Malmö, Sweden.
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, 75236 Uppsala, Sweden.
- The George Institute for Global Health, University of New South Wales, Sydney 2042, Australia.
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Pan L, Li G, Wan S, Yihuo W, Yang F, Li Z, Shan G. The association between high-sensitivity C-reactive protein and blood pressure in Yi people. BMC Public Health 2019; 19:991. [PMID: 31340788 PMCID: PMC6657064 DOI: 10.1186/s12889-019-7324-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/16/2019] [Indexed: 02/08/2023] Open
Abstract
Background High-sensitivity C-reactive protein (hs-CRP) is a common risk factor for developing cardiovascular disease. However, there has been no study reporting the relationship between hs-CRP and blood pressure in Yi adults. The aim of this study is to investigate the association between hs-CRP and blood pressure in Yi adults. Methods In this cross-sectional study, included subjects were 2916 Yi migrants or farmers aged 20–80 years, recruited by using a stratified cluster sampling method from Liangshan Yi Autonomous Prefecture of Sichuan Province in 2014. The directed acyclic graphs(DAG) was used to select a minimal sufficient adjustment sets of variables which would identification the unconfounded effect of hs-CRP and hypertension. Multiple linear and multinomial logit analysis were used to estimate the effect of hs-CRP on SBP/DBP/MAP/PP and the prevalence of prehypertension/hypertension after adjustment for the relevant confounders. Results The median level of hs-CRP was 1.20 (0.50–3.06)mg/L in Yi migrants, and 0.84(0.36–2.52) mg/L in Yi farmers, and the prevalence of high hs-CRP was 23.25%. For hs-CRP > 3 mg/L group, the adjusted PP tended to have lower values (β = − 1.49, 95%CI: − 2.49--0.49, P = 0.0034) compared with < 1 mg/L group. After adjusting for confounders, there were no significant association between hs-CRP and prehypertension/hypertension (P > 0.05). Conclusions Our results suggest that high hs-CRP is prevalent in Yi people, and this study does not support hs-CRP as a risk factor of prehypertension or hypertension.
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Affiliation(s)
- Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Guoju Li
- Qingdao Women and Children's Hospital, Qingdao University, Qingdao, 266011, Shandong, China
| | | | - WuLi Yihuo
- Department for Chronic Noncommunicable Diseases Control, Puge County Center for Disease Control and Prevention, Xichang, Sichuan, China
| | - Fang Yang
- Xichang Municipal Center for Disease Control and Prevention, Xichang, Sichuan, China
| | - Zheng Li
- Xichang Municipal Center for Disease Control and Prevention, Xichang, Sichuan, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
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Andersson C, Johnson AD, Benjamin EJ, Levy D, Vasan RS. 70-year legacy of the Framingham Heart Study. Nat Rev Cardiol 2019; 16:687-698. [DOI: 10.1038/s41569-019-0202-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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35
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Tomiyama H, Ohkuma T, Ninomiya T, Mastumoto C, Kario K, Hoshide S, Kita Y, Inoguchi T, Maeda Y, Kohara K, Tabara Y, Nakamura M, Ohkubo T, Watada H, Munakata M, Ohishi M, Ito N, Nakamura M, Shoji T, Vlachopoulos C, Aboyans V, Yamashina A. Steno-Stiffness Approach for Cardiovascular Disease Risk Assessment in Primary Prevention. Hypertension 2019; 73:508-513. [DOI: 10.1161/hypertensionaha.118.12110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Hirofumi Tomiyama
- From the Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Japan (H.T., C.M., A.Y.)
| | - Toshiaki Ohkuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Kyushu University
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Kyushu University
| | - Chisa Mastumoto
- From the Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Japan (H.T., C.M., A.Y.)
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (K. Kario, S.H.)
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (K. Kario, S.H.)
| | - Yoshikuni Kita
- Faculty of Nursing Science, Tsuruga Nursing University (Y.K.)
| | - Toyoshi Inoguchi
- Innovation Center for Medical Redox Navigation (T.I.), Kyushu University
| | - Yasutaka Maeda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University
| | - Katsuhiko Kohara
- Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University (K. Kohara)
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine (Y.T.)
| | - Motoyuki Nakamura
- Department of Internal Medicine, Iwate Medical University (Motoyuki Nakamura)
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine (T. Ohkubo)
| | - Hirotaka Watada
- Departments of Metabolism and Endocrinology, Graduate School of Medicine, Juntendo University (H.W.)
| | - Masanori Munakata
- Research Center for Lifestyle-related Disease, Tohoku Rosai Hospital (M.M.)
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University (M.O.)
| | - Norihisa Ito
- Department of Vascular Medicine, Osaka University Graduate School of Medicine (N.I.)
| | | | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine (T.S.)
| | - Charalambos Vlachopoulos
- Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital (C.V.)
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France (V.A.)
| | - Akira Yamashina
- From the Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, Japan (H.T., C.M., A.Y.)
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36
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Jayedi A, Rahimi K, Bautista LE, Nazarzadeh M, Zargar MS, Shab-Bidar S. Inflammation markers and risk of developing hypertension: a meta-analysis of cohort studies. Heart 2019; 105:686-692. [PMID: 30700522 DOI: 10.1136/heartjnl-2018-314216] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To systematically assess the association of circulating inflammation markers with the future risk of hypertension. METHODS We did a systematic literature search of PubMed and Scopus, from database inception to July 10, 2018. Prospective and retrospective cohort studies evaluating the association of circulating C reactive protein (CRP), high-sensitive CRP (hs-CRP), interleukin 6 (IL-6) and IL-1β to the risk of developing hypertension in the general population were included. The relative risks (RRs) for the top versus bottom tertiles of circulating biomarkers were calculated using a fixed-effects/random-effects model. A potential non-linear dose-response association was tested. RESULTS Fourteen prospective cohort studies, two retrospective cohort studies and five nested case-control studies involving 142 640 participants and 20 676 cases were identified. The RR for the third versus first tertiles of circulating CRP was 1.23 (95% CI 1.11 to 1.35; I2=59%, n=12). The association remained unchanged after adjustment for body mass index. The RRs for other biomarkers were as follows: hs-CRP (RR 1.20, 95% CI 1.02 to 1.37; I2=74%, n=7), IL-6 (RR 1.51, 95% CI 1.30 to 1.71; I2=0%, n=5), and IL-1β (RR 1.22, 95% CI 0.92 to 1.51; I2=0%, n=3). A non-linear dose-response meta-analysis demonstrated that the risk of hypertension increased linearly with increasing circulating inflammation markers, even within the low-risk and intermediate-risk categories. CONCLUSIONS Higher levels of circulating CRP, hs-CRP and IL-6, but not IL-1β, were associated with the risk of developing hypertension. The association persisted in subgroups of studies defined by major sources of heterogeneity.
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Affiliation(s)
- Ahmad Jayedi
- Food (salt) Safety Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Kazem Rahimi
- George Institute for Global Health, University of Oxford, Oxford, UK.,Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Leonelo E Bautista
- Department of Population Health, School of Medicine, University of Wisconsin at Madison, Wisconsin, USA
| | - Milad Nazarzadeh
- George Institute for Global Health, University of Oxford, Oxford, UK.,Collaboration Center of Meta-Analysis Research, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mahdieh Sadat Zargar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Peña-Oyarzun D, Bravo-Sagua R, Diaz-Vega A, Aleman L, Chiong M, Garcia L, Bambs C, Troncoso R, Cifuentes M, Morselli E, Ferreccio C, Quest AFG, Criollo A, Lavandero S. Autophagy and oxidative stress in non-communicable diseases: A matter of the inflammatory state? Free Radic Biol Med 2018; 124:61-78. [PMID: 29859344 DOI: 10.1016/j.freeradbiomed.2018.05.084] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 12/11/2022]
Abstract
Non-communicable diseases (NCDs), also known as chronic diseases, are long-lasting conditions that affect millions of people around the world. Different factors contribute to their genesis and progression; however they share common features, which are critical for the development of novel therapeutic strategies. A persistently altered inflammatory response is typically observed in many NCDs together with redox imbalance. Additionally, dysregulated proteostasis, mainly derived as a consequence of compromised autophagy, is a common feature of several chronic diseases. In this review, we discuss the crosstalk among inflammation, autophagy and oxidative stress, and how they participate in the progression of chronic diseases such as cancer, cardiovascular diseases, obesity and type II diabetes mellitus.
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Affiliation(s)
- Daniel Peña-Oyarzun
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile; Instituto de Investigación en Ciencias Odontológicas (ICOD), Facultad de Odontología, Universidad de Chile, Santiago, Chile
| | - Roberto Bravo-Sagua
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile; Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Alexis Diaz-Vega
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile; Center for Studies of Exercise, Metabolism and Cancer Studies (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Larissa Aleman
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mario Chiong
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile; Center for Studies of Exercise, Metabolism and Cancer Studies (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Lorena Garcia
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile; Center for Studies of Exercise, Metabolism and Cancer Studies (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Claudia Bambs
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Troncoso
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile; Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Mariana Cifuentes
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile; Center for Studies of Exercise, Metabolism and Cancer Studies (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Eugenia Morselli
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrew F G Quest
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile; Center for Studies of Exercise, Metabolism and Cancer Studies (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Alfredo Criollo
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile; Instituto de Investigación en Ciencias Odontológicas (ICOD), Facultad de Odontología, Universidad de Chile, Santiago, Chile.
| | - Sergio Lavandero
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile; Center for Studies of Exercise, Metabolism and Cancer Studies (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Universidad de Chile, Santiago, Chile; Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Ray EC, Miller RG, Demko JE, Costacou T, Kinlough CL, Demko CL, Unruh ML, Orchard TJ, Kleyman TR. Urinary Plasmin(ogen) as a Prognostic Factor for Hypertension. Kidney Int Rep 2018; 3:1434-1442. [PMID: 30450470 PMCID: PMC6224670 DOI: 10.1016/j.ekir.2018.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/25/2018] [Accepted: 06/25/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction Plasmin and its precursor, plasminogen, are detectable in urine from patients with glomerular disease. Urinary plasmin(ogen) levels correlate with blood pressure (BP) and may contribute to renal Na+ retention by activating the epithelial Na+ channel (ENaC). In a longitudinal nested-cohort study, we asked whether urinary plasmin(ogen) levels predict subsequent increase in BP, incident hypertension, or mortality in subjects with type I diabetes, who often develop proteinuria. Methods The Pittsburgh Epidemiology of Diabetes Complications (EDC) study followed up type I diabetic subjects for 25 years. Urine specimens from 70 subjects with a spectrum of baseline urinary albumin levels were examined. Outcomes included increased BP after 2 years (≥1 SD over baseline systolic or diastolic BP, examined via logistic regression), 25-year incident hypertension (≥140/90 mm Hg or initiating BP-lowering medications), and all-cause or cardiovascular mortality, examined using Cox regression. Results Subjects experiencing a 2-year increase in BP had higher baseline urinary plasmin(ogen)/creatinine levels (uPl/Cr) than other subjects (P = 0.04); the difference in baseline urinary albumin/creatinine levels (uAlb/Cr) was similar (P = 0.07). Baseline uPl/Cr was associated with increased 25-year hypertension incidence (hazard ratio = 2.05, P = 0.001), all-cause mortality (HR = 2.05, P = 0.01) and cardiovascular mortality (HR = 3.30, P = 0.005), although not independent of uAlb/Cr. Conclusion This is the first long-term prospective study addressing clinical outcomes associated with increased urinary plasmin(ogen). Findings are consistent with a role for plasmin(ogen) in promoting increased BP, but also demonstrate the difficulty in distinguishing effects due to plasmin(ogen) from those of albuminuria.
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Affiliation(s)
- Evan C. Ray
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Correspondence: Evan C. Ray, Renal-Electrolyte Division, A915 Scaife Hall, 3550 Terrace Street, Pittsburgh, Pennsylvania 15261, USA.
| | - Rachel G. Miller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John E. Demko
- University of California San Francisco, San Francisco, California, USA
| | - Tina Costacou
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carol L. Kinlough
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Casey L. Demko
- University of California San Francisco, San Francisco, California, USA
| | - Mark L. Unruh
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
- Nephrology Section, New Mexico Veterans Hospital, Albuquerque, New Mexico, USA
| | - Trevor J. Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas R. Kleyman
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Relationship between plasma plasminogen activator inhibitor-1 and hypertension in American Indians: findings from the Strong Heart Study. J Hypertens 2018; 35:1787-1793. [PMID: 28379891 DOI: 10.1097/hjh.0000000000001375] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Deficient plasminogen activator inhibitor-1 (PAI-1) prevented hypertension in mice. Plasma PAI-1 was associated with hypertension in cross-sectional analyses, but the prospective association of PAI-1 with incident hypertension in large epidemiological studies is scarce. METHODS Leveraging two longitudinal cohorts of American Indians in the Strong Heart Study (SHS, N = 1019) and the Strong Heart Family Study (SHFS, N = 1502), we examined the prospective association of plasma PAI-1 with incident hypertension by multivariate logistic regression, adjusting for age, sex, study site, smoking, drinking, dietary sodium, obesity, lipids, fasting glucose, kidney function, inflammation, and follow-up years. Family relatedness in the SHFS was accounted for using the GLIMMIX procedure. Plasma PAI-1 level at baseline was measured by immunoassay. All participants were free of hypertension, cardiovascular diseases, and chronic kidney disease at baseline. RESULTS A total of 305 and 258 participants, respectively, from the SHS (57 ± 7 years) and the SHFS (33 ± 13 years) developed incident hypertension during follow-up. In the SHS, higher level of log-transformed PAI-1 was associated with 1.35-fold increased risk of hypertension [odds ratio (OR) (95% confidence interval): 1.35 (1.06-1.72)]. Analysis using categorical PAI-1 (in tertiles) showed that participants in the highest tertile (≥58 ng/ml) had 63% increased risk for hypertension [OR = 1.63 (1.12-2.37)] compared with those in the lowest tertile (<33 ng/ml). This association was confirmed in the SHFS with similar effect sizes [OR = 1.41 (1.11-1.81) for log-transformed PAI-1; OR = 1.64 (1.08-2.50) for categorical PAI-1: ≥58 vs. <33 ng/ml]. CONCLUSION A higher level of plasma PAI-1 is significantly associated with hypertension in American Indians, independent of established risk factors. The potential causality warrants further investigation.
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Ferreira I, Hovind P, Schalkwijk CG, Parving HH, Stehouwer CDA, Rossing P. Biomarkers of inflammation and endothelial dysfunction as predictors of pulse pressure and incident hypertension in type 1 diabetes: a 20 year life-course study in an inception cohort. Diabetologia 2018; 61:231-241. [PMID: 29101422 PMCID: PMC6448953 DOI: 10.1007/s00125-017-4470-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 09/07/2017] [Indexed: 11/06/2022]
Abstract
AIMS/HYPOTHESIS Vascular inflammation and endothelial dysfunction are thought to contribute to arterial stiffening and hypertension. This study aims to test this hypothesis with longitudinal data in the context of type 1 diabetes. METHODS We investigated, in an inception cohort of 277 individuals with type 1 diabetes, the course, tracking and temporal inter-relationships of BP, specifically pulse pressure (a marker of arterial stiffening) and hypertension, and the following biomarkers of systemic and vascular inflammation/endothelial dysfunction: C-reactive protein (CRP), soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cellular adhesion molecule-1 (sVCAM-1) and soluble E-selectin (sE-selectin). These biomarkers and other risk factors were measured at baseline and repeatedly up to 20 years after the onset of type 1 diabetes. Data were analysed with generalised estimating equations including adjustments for age, sex, smoking status, BMI, HbA1c, serum creatinine, total cholesterol, urinary AER, insulin treatment dose and mean arterial pressure. RESULTS Increases were noted in all biomarkers except sE-selectin, which decreased over time. Levels differed from baseline at 2-4 years and preceded the increase in pulse pressure, which occurred at 8-10 years after the onset of type 1 diabetes. Higher levels of sICAM-1 and sVCAM-1, but not CRP or sE-selectin, at baseline and throughout the 20 year follow-up, were significantly associated with higher (changes in) pulse pressure at subsequent time points. Higher levels of sVCAM-1 at baseline and during follow-up were also significantly associated with the prevalence (OR 3.60 [95% CI 1.36, 9.53] and OR 2.28 [1.03, 5.25], respectively) and incidence (OR 2.89 [1.08, 7.75] and OR 3.06 [1.01, 9.26], respectively) of hypertension. We also investigated the longitudinal associations between BP or hypertension as determinants of subsequent (changes in) levels of CRP, sICAM-1, sVCAM-1 and sE-selectin, but did not find evidence to support a reverse causality hypothesis. CONCLUSIONS/INTERPRETATION These findings support the involvement of vascular endothelial dysfunction and inflammation in the development of premature arterial stiffening and hypertension in type 1 diabetes.
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Affiliation(s)
- Isabel Ferreira
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus - Public Health Building, Herston Rd, Brisbane, 4006, Australia.
| | - Peter Hovind
- Steno Diabetes Centre, Gentofte, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Glostrup, Denmark
| | - Casper G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Peter Debyelaan 25, 6229HX, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, MUMC+, Maastricht, the Netherlands
| | - Hans-Henrik Parving
- Department of Medical Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Peter Debyelaan 25, 6229HX, Maastricht, the Netherlands.
- CARIM School for Cardiovascular Diseases, MUMC+, Maastricht, the Netherlands.
| | - Peter Rossing
- Steno Diabetes Centre, Gentofte, Denmark
- Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- HEALTH, Aarhus University, Aarhus, Denmark
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Li Y, Li XH, Huang X, Yin L, Guo CX, Liu C, He YM, Liu X, Yuan H. Individualized prevention against hypertension based on Traditional Chinese Medicine Constitution Theory: A large community-based retrospective, STROBE-compliant study among Chinese population. Medicine (Baltimore) 2017; 96:e8513. [PMID: 29145254 PMCID: PMC5704799 DOI: 10.1097/md.0000000000008513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 09/08/2017] [Accepted: 10/10/2017] [Indexed: 12/18/2022] Open
Abstract
Traditional Chinese Medicine Constitution (TCMC) theory states that individuals with a biased TCMC are more likely to suffer from specific diseases. However, little is known regarding the influence of TCMC on susceptibility to hypertension. The aim of this study is to examine the possible relationship between TCMC and hypertension. Retrospective evaluation and observation were performed using the STROBE guidelines checklist. A large community-based cross-sectional study was conducted between 2009 and 2013 in Changsha, China. TCMC was assessed using a questionnaire that included 68 items. TCMC distributions and the associations of different TCMCs with hypertension risk were analyzed. In total, 144,439 subjects underwent evaluations of TCMC and blood pressure (BP). There were significant differences in the hypertension prevalence among the various TCMC groups (P < .01). An adjusted logistic regression model indicated that those with phlegm wetness, yin deficiency, blood stasis, or qi deficiency were more likely to have hypertension. Analysis of the clinical characteristics related to TCMC indicated that different TCMCs corresponded to different hypertension classifications using Western medicine criteria; for example, phlegm wetness with hypertension was similar to obesity-related hypertension. Our results suggest that phlegm wetness, yin deficiency, blood stasis, and qi deficiency have different effects on the prevalence of hypertension. More attention should be paid to TCMCs associated with susceptibility to hypertension, and corresponding preventive and therapeutic treatments should be developed according to different TCMCs.
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Affiliation(s)
- Ying Li
- Department of Health Management, The Third Xiangya Hospital
- Health Management Research Center, Central South University
| | - Xiao-Hui Li
- Department of Pharmacology, School of Pharmaceutical Sciences, Central South University
| | - Xin Huang
- Preventive Medicine, Medical School of Hunan Normal University, Changsha
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing
| | - Cheng-Xian Guo
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha
| | - Chang Liu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha
| | - Yong-Mei He
- Second Department of Geriatric Medicine, Aerospace Center Hospital, Beijing, P. R. China
| | - Xing Liu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha
| | - Hong Yuan
- Health Management Research Center, Central South University
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha
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Abstract
Hypertension is an important preventable risk factor for disease and death worldwide. In light of the world's population growth and aging, hypertension is a global public health issue. Many studies have shown associations between pre-hypertension and a higher risk of the future development of hypertension and cardiovascular disease in general populations. However, pre-hypertension per se is not a disease with an immediate high risk, and the clinical value of the identification of pre-hypertension is the potential detection of the early stage of the risk of hypertension and/or cardiovascular disease over an individual's lifespan. We recently assessed the impacts of age-related differences in risk factors on new-onset hypertension among normotensive individuals. As risk factors of the new onset of hypertension, the impact of diastolic blood pressure compared with systolic blood pressure (SBP), men compared with women, and higher body mass index were greater in the younger adults, whereas in the older adults, the impact of SBP and female sex were greater. Proteinuria was a risk factor for hypertension in both younger and older adults. Non-pharmacological approaches such as body weight reduction, low-salt diet, physical exercise, and good sleep hygiene should be first-line treatments for pre-hypertension. In addition, careful observation to detect the new onset of hypertension and the identification of the appropriate timing of pharmacologic treatment should be conducted, especially in adults with pre-hypertension and the risk factors mentioned above.
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Affiliation(s)
- Hiroshi Kanegae
- Genki Plaza Medical Center for Health Care, Tokyo, Japan.,Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | | | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
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Malkoc A, Probst D, Lin C, Khanwalker M, Beck C, Cook CB, La Belle JT. Enhancing Glycemic Control via Detection of Insulin Using Electrochemical Impedance Spectroscopy. J Diabetes Sci Technol 2017; 11:930-935. [PMID: 28299957 PMCID: PMC5950988 DOI: 10.1177/1932296817699639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Currently, glycemic management for individuals with diabetes mellitus involves monitoring glucose only, which is insufficient as glucose metabolism involves other biomarkers such as insulin. Monitoring additional biomarkers alongside glucose has been proposed to improve glycemic control. In this work, the development of a rapid and label-free insulin biosensor with high sensitivity and accuracy is presented. The insulin sensor prototype also serves as a prior study for a multimarker sensing platform technology that can further improve glycemic control in the future. METHODS Electrochemical impedance spectroscopy was used to identify an optimal frequency specific to insulin detection on a gold disk electrode with insulin antibody immobilized, which was accomplished by conjugating the primary amines of insulin antibody to the carboxylic bond of the self-assembling monolayer on the gold surface. After blocking with ethanolamine, the insulin physiological concentration gradient was tested. The imaginary impedance was correlated to insulin concentration and the results were compared with standard equivalent circuit analysis and correlation of charge transfer resistance to target concentration. RESULTS The optimal frequency of insulin is 810.5 Hz, which is characterized by having the highest sensitivity and sufficient specificity. The lower limit of detection was 2.26 [Formula: see text] which is comparable to a standard and better than traditional approaches. CONCLUSION An insulin biosensor prototype capable of detecting insulin in physiological range without complex data normalization was developed. This prototype will be the ground works of a multimarker platform sensor technology for future all-in-one glycemic management sensors.
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Affiliation(s)
- Aldin Malkoc
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - David Probst
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Chi Lin
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Mukund Khanwalker
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Connor Beck
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | | | - Jeffrey T. La Belle
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
- Mayo Clinic Arizona, Scottsdale, AZ, USA
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Currie G, Delles C. Use of Biomarkers in the Evaluation and Treatment of Hypertensive Patients. Curr Hypertens Rep 2017; 18:54. [PMID: 27221728 DOI: 10.1007/s11906-016-0661-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The current definition of hypertension is based on blood pressure values, and blood pressure also drives treatment decisions, is the most important treatment monitoring tool and helps estimating risk of hypertension-related organ damage. In an era of precision medicine, additional biomarkers are needed in the diagnosis and management of patients with hypertension. In this review, we outline the areas in which functional, imaging and circulating biomarkers could help in a more individualised definition of hypertension and associated risk. We will cover biomarkers for diagnosis; of pathophysiology and prediction of hypertension; response to treatment, organ damage; and to monitor treatment. A clear focus is on the vasculature, the heart and the kidneys, whereas we see a need to further develop biomarkers of cerebral function in order to diagnose cognition deficits and monitor changes in cognition in the future to support addressing the growing burden of hypertension-associated vascular dementia.
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Affiliation(s)
- Gemma Currie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, Scotland, UK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, Scotland, UK.
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Tomiyama H, Shiina K, Matsumoto-Nakano C, Ninomiya T, Komatsu S, Kimura K, Chikamori T, Yamashina A. The Contribution of Inflammation to the Development of Hypertension Mediated by Increased Arterial Stiffness. J Am Heart Assoc 2017; 6:JAHA.117.005729. [PMID: 28666991 PMCID: PMC5586296 DOI: 10.1161/jaha.117.005729] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The mechanisms underlying the possible contribution of chronic inflammation to the development of hypertension remain unclear. We examined the longitudinal association of inflammation with the progression of vascular and/or renal abnormalities in the development of hypertension. METHODS AND RESULTS In 3274 middle-aged Japanese men without hypertension at the study baseline, brachial-ankle pulse wave velocity, blood pressure, estimated glomerular filtration rate, and serum CRP (C reactive protein) levels were measured annually during a 9-year period. During this study period, 474 participants (14.5%) developed hypertension. Analysis of the repeated-measures data revealed that sustained elevation of serum CRP levels was associated with a longitudinal increase of the brachial-ankle pulse wave velocity. A linear mixed model analysis revealed that higher log-transformed serum CRP values (log CRP) at each measurement were associated with a higher annual increase of the brachial-ankle pulse wave velocity (estimate=32.553±11.635 cm/s per log CRP, P=0.018), and that higher values of the brachial-ankle pulse wave velocity at each measurement were associated with a higher annual elevation of blood pressure (estimate=0.025±0.002 mm Hg per log CRP, P<0.001). CONCLUSIONS In middle-aged Japanese men without hypertension at study baseline, long-term active inflammation appears to be associated with a longitudinal increase of arterial stiffness. In turn, this longitudinal increase of arterial stiffness appears to be associated with longitudinal elevation of blood pressure to the hypertensive range. Thus, systemic inflammation may play a role in the pathogenesis of hypertension by the progression of arterial stiffness.
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Affiliation(s)
- Hirofumi Tomiyama
- Department of Cardiology, Tokyo Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Kazuki Shiina
- Department of Cardiology, Tokyo Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Chisa Matsumoto-Nakano
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshiharu Ninomiya
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Shunsuke Komatsu
- Department of Cardiology, Tokyo Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Kazutaka Kimura
- Department of Cardiology, Tokyo Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Taishiro Chikamori
- Department of Cardiology, Tokyo Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University, Shinjyuku-ku, Tokyo, Japan
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Gajjala PR, Jankowski V, Heinze G, Bilo G, Zanchetti A, Noels H, Liehn E, Perco P, Schulz A, Delles C, Kork F, Biessen E, Narkiewicz K, Kawecka-Jaszcz K, Floege J, Soranna D, Zidek W, Jankowski J. Proteomic-Biostatistic Integrated Approach for Finding the Underlying Molecular Determinants of Hypertension in Human Plasma. Hypertension 2017; 70:412-419. [PMID: 28652472 DOI: 10.1161/hypertensionaha.116.08906] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/03/2017] [Accepted: 05/07/2017] [Indexed: 01/08/2023]
Abstract
Despite advancements in lowering blood pressure, the best approach to lower it remains controversial because of the lack of information on the molecular basis of hypertension. We, therefore, performed plasma proteomics of plasma from patients with hypertension to identify molecular determinants detectable in these subjects but not in controls and vice versa. Plasma samples from hypertensive subjects (cases; n=118) and controls (n=85) from the InGenious HyperCare cohort were used for this study and performed mass spectrometric analysis. Using biostatistical methods, plasma peptides specific for hypertension were identified, and a model was developed using least absolute shrinkage and selection operator logistic regression. The underlying peptides were identified and sequenced off-line using matrix-assisted laser desorption ionization orbitrap mass spectrometry. By comparison of the molecular composition of the plasma samples, 27 molecular determinants were identified differently expressed in cases from controls. Seventy percent of the molecular determinants selected were found to occur less likely in hypertensive patients. In cross-validation, the overall R2 was 0.434, and the area under the curve was 0.891 with 95% confidence interval 0.8482 to 0.9349, P<0.0001. The mean values of the cross-validated proteomic score of normotensive and hypertensive patients were found to be -2.007±0.3568 and 3.383±0.2643, respectively, P<0.0001. The molecular determinants were successfully identified, and the proteomic model developed shows an excellent discriminatory ability between hypertensives and normotensives. The identified molecular determinants may be the starting point for further studies to clarify the molecular causes of hypertension.
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Affiliation(s)
- Prathibha R Gajjala
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Vera Jankowski
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Georg Heinze
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Grzegorz Bilo
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Alberto Zanchetti
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Heidi Noels
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Elisa Liehn
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Paul Perco
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Anna Schulz
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Christian Delles
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Felix Kork
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Erik Biessen
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Krzysztof Narkiewicz
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Kalina Kawecka-Jaszcz
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Juergen Floege
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Davide Soranna
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Walter Zidek
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Joachim Jankowski
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.).
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Unruh ML, Pankratz VS, Demko JE, Ray EC, Hughey RP, Kleyman TR. Trial of Amiloride in Type 2 Diabetes with Proteinuria. Kidney Int Rep 2017; 2:893-904. [PMID: 28890943 PMCID: PMC5584552 DOI: 10.1016/j.ekir.2017.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction Renal sodium (Na+) retention and extracellular fluid volume expansion are hallmarks of nephrotic syndrome, which occurs even in the absence of activation of hormones that stimulate renal Na+ transporters. Plasmin-dependent activation of the epithelial Na+ channel has been proposed to have a role in renal Na+ retention in the setting of nephrotic syndrome. We hypothesized that the epithelial Na+ channel inhibitor amiloride would be an effective therapeutic agent in inducing a natriuresis and lowering blood pressure in individuals with macroscopic proteinuria. Methods We conducted a pilot double-blind randomized cross-over study comparing the effects of daily administration of either oral amiloride or hydrochlorothiazide to patients with type 2 diabetes and macroscopic proteinuria. Safety and efficacy were assessed by monitoring systolic blood pressure, kidney function, adherence, weight, urinary Na+ excretion, and serum electrolytes. Nine subjects were enrolled in the trial. Results No significant difference in systolic blood pressure or weight was seen between subjects receiving hydrochlorothiazide and those receiving amiloride (P ≥ 0.15). Amiloride induced differences in serum potassium (P < 0.001), with a 0.88 ± 0.30 mmol/l greater acute increase observed. Two subjects developed acute kidney injury and hyperkalemia when treated with amiloride. Four subjects had readily detectable levels of urinary plasminogen plus plasmin, and 5 did not. Changes in systolic blood pressure in response to amiloride did not differ between individuals with versus those without detectable urinary plasminogen plus plasmin. Discussion In summary, among patients with type 2 diabetes, normal renal function, and proteinuria, there were reductions in systolic blood pressure in groups treated with hydrochlorothiazide or amiloride. Acute kidney injury and severe hyperkalemia were safety concerns with amiloride.
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Affiliation(s)
- Mark L Unruh
- Nephrology Division, Department of Internal Medicine, University of New Mexico, Albuquerque NM.,New Mexico VA Health Care System, Albuquerque, NM
| | - V Shane Pankratz
- Nephrology Division, Department of Internal Medicine, University of New Mexico, Albuquerque NM
| | - John E Demko
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Evan C Ray
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca P Hughey
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Cell Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas R Kleyman
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Cell Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Huang W, Chang CL, Brault ND, Gur O, Wang Z, Jalal SI, Low PS, Ratliff TL, Pili R, Savran CA. Separation and dual detection of prostate cancer cells and protein biomarkers using a microchip device. LAB ON A CHIP 2017; 17:415-428. [PMID: 28054089 DOI: 10.1039/c6lc01279e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Current efforts for the detection of prostate cancer using only prostate specific antigen are not ideal and indicate a need to develop new assays - using multiple targets - that can more accurately stratify disease states. We previously introduced a device capable of the concurrent detection of cellular and molecular markers from a single sample fluid. Here, an improved design, which achieves affinity as well as size-based separation of captured targets using antibody-conjugated magnetic beads and a silicon chip containing micro-apertures, is presented. Upon injection of the sample, the integration of magnetic attraction with the micro-aperture chip permits larger cell-bead complexes to be isolated in an upper chamber with the smaller protein-bead complexes and remaining beads passing through the micro-apertures into the lower chamber. This enhances captured cell purity for on chip quantification, allows the separate retrieval of captured cells and proteins for downstream analysis, and enables higher bead concentrations for improved multiplexed ligand targeting. Using LNCaP cells and prostate specific membrane antigen (PSMA) to model prostate cancer, the device was able to detect 34 pM of spiked PSMA and achieve a cell capture efficiency of 93% from culture media. LNCaP cells and PSMA were then spiked into diluted healthy human blood to mimic a cancer patient. The device enabled the detection of spiked PSMA (relative to endogenous PSMA) while recovering 85-90% of LNCaP cells which illustrated the potential of new assays for the diagnosis of prostate cancer.
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Affiliation(s)
- Wanfeng Huang
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA. and Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, USA
| | - Chun-Li Chang
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA. and Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, USA
| | - Norman D Brault
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA. and Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, USA
| | - Onur Gur
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA. and Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, USA
| | - Zhe Wang
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA. and Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, USA
| | - Shadia I Jalal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Philip S Low
- Department of Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | - Timothy L Ratliff
- Center for Cancer Research and Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA
| | - Roberto Pili
- Genitourinary Program, Roswell Park Cancer Institute, Buffalo, NY 14263, USA and Genitourinary Program, Indiana University-Simon Cancer Center, Indianapolis, IN 46202, USA
| | - Cagri A Savran
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA. and Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, USA and Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
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Lin C, Ryder L, Probst D, Caplan M, Spano M, LaBelle J. Feasibility in the development of a multi-marker detection platform. Biosens Bioelectron 2016; 89:743-749. [PMID: 27816597 DOI: 10.1016/j.bios.2016.10.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 01/08/2023]
Abstract
A feasibility study for a label-free, multi-marker single sensor using electrochemical impedance spectroscopy (EIS), imaginary impedance, and a signal decoupling technique is reported. To our knowledge, this is the first reported attempt of using imaginary impedance for biomarker detection and multi-marker detection. The electrochemical responses of purified low and high density lipoproteins (LDL and HDL, respectively) were first individually characterized through the immobilization of their molecular recognition elements (MREs) onto gold disk electrodes (GDEs). The co-immobilization was performed by immobilizing the MREs of both LDL and HDL on the same GDE, which was then used to detect LDL and HDL simultaneously in mixed solution. Previous individual purified responses were then used to de-convolute the mixed response, when the two biomarkers were detected in mixed solutions. The optimal frequencies of LDL and HDL were found to be 81.38Hz and 5.49Hz, respectively, which shifted to 175.8Hz and 3.74Hz under co-immobilized conditions. After comparing the electrochemical signal in complex and imaginary impedance, imaginary impedance was found to be more suitable for multi-marker detection purposes. Since imaginary impedance is related to capacitance, electric displacement, relative permittivity, and effective capacitance were derived to elucidate the theory of optimal frequency. This work shows that EIS has the potential for multi-marker detection and can be extended to monitor other complex diseases such as diabetes mellitus for better management and diagnostic purposes.
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Affiliation(s)
- Chi Lin
- Harrington Program of Biomedical Engineering, in the School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Lindsey Ryder
- Harrington Program of Biomedical Engineering, in the School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - David Probst
- Harrington Program of Biomedical Engineering, in the School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Michael Caplan
- Harrington Program of Biomedical Engineering, in the School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Mark Spano
- Harrington Program of Biomedical Engineering, in the School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Jeffrey LaBelle
- Harrington Program of Biomedical Engineering, in the School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
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Abstract
The cardiovascular research and clinical communities are ideally positioned to address the epidemic of noncommunicable causes of death, as well as advance our understanding of human health and disease, through the development and implementation of precision medicine. New tools will be needed for describing the cardiovascular health status of individuals and populations, including 'omic' data, exposome and social determinants of health, the microbiome, behaviours and motivations, patient-generated data, and the array of data in electronic medical records. Cardiovascular specialists can build on their experience and use precision medicine to facilitate discovery science and improve the efficiency of clinical research, with the goal of providing more precise information to improve the health of individuals and populations. Overcoming the barriers to implementing precision medicine will require addressing a range of technical and sociopolitical issues. Health care under precision medicine will become a more integrated, dynamic system, in which patients are no longer a passive entity on whom measurements are made, but instead are central stakeholders who contribute data and participate actively in shared decision-making. Many traditionally defined diseases have common mechanisms; therefore, elimination of a siloed approach to medicine will ultimately pave the path to the creation of a universal precision medicine environment.
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Affiliation(s)
- Elliott M Antman
- Brigham and Women's Hospital, TIMI Study Group, 350 Longwood Avenue, Office Level One, Boston, Massachusetts 02115, USA
| | - Joseph Loscalzo
- Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA
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