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Vaes B, Indestege P, Serneels T, Hegendörfer E, van Peet PG, Poortvliet RKE, Wallemacq P, Gussekloo J, Degryse J. Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study. BMJ Open 2020; 10:e035809. [PMID: 32595156 PMCID: PMC7322328 DOI: 10.1136/bmjopen-2019-035809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To test new cardiovascular (CV) risk models in very old adults with and without a history of CV disease (CVD), based on traditional risk factors and biomarkers. DESIGN Cross-validated prospective cohort study. The models were tested in the BELFRAIL Study and externally validated in the Leiden 85-plus Study. SETTING General practice, Belgium and The Netherlands. PARTICIPANTS The BELFRAIL cohort consisted of 266 patients aged 80 years or older without a history of CVD and 260 with a history of CVD. The Leiden 85-plus Study consisted of 264 patients aged 85 years without a history of CVD and 282 with a history of CVD. OUTCOME MEASURES The model with traditional risk factors and biomarkers, as well as the model using only biomarkers, was compared with the model with only traditional risk factors to predict 3-year CV morbidity and mortality. A competing-risk analysis was performed, and the continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI) and net benefit were used to compare the predictive value of the different models. RESULTS Traditional risk factors poorly predicted CV mortality and morbidity. In participants without a history of CVD, adding N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) improved the prediction (NRI 0.56 (95% CI 0.16 to 0.99) and relative IDI 4.01 (95% CI 2.19 to 6.28)). In participants with a history of CVD, the NRI with the addition of NT-pro-BNP and high-sensitivity C reactive protein was 0.38 (95% CI 0.09 to 0.70), and the relative IDI was 0.53 (95% CI 0.23 to 0.90). Moreover, in participants without a history of CVD, NT-pro-BNP performed well as a stand-alone predictor (NRI 0.32 (95% CI -0.12 to 0.74) and relative IDI 3.44 (95% CI 1.56 to 6.09)). CONCLUSIONS This study tested new risk models to predict CV morbidity and mortality in very old adults. Especially, NT-pro-BNP showed a strong added predictive value. This opens perspectives for clinicians who are in need of an easily applicable strategy for CV risk prediction in very old adults.
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Affiliation(s)
- Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Paulien Indestege
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Tinne Serneels
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Eralda Hegendörfer
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Petra G van Peet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Pierre Wallemacq
- Laboratory of Analytical Biochemistry, Cliniques Universitaires St Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Degryse
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium
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Chen JR, Wang Q, Wu W, Zhang SJ. Comparison of prognostic values of high-sensitivity cardiac troponin T and N-terminal prohormone brain natriuretic peptide to assess mortality in elderly inpatients. Clin Interv Aging 2018; 14:81-90. [PMID: 30643397 PMCID: PMC6318716 DOI: 10.2147/cia.s187757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Studies have shown that increases in low-level high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) in the elderly population lead to high risk of adverse clinical outcomes, such as mortality. In this study, associations between the two biomarkers and long-term mortality in elderly patients hospitalized for medical conditions other than acute cardiovascular events were investigated. A comparison of the predictive value of hs-cTnT and NT-proBNP for all-cause mortality was conducted. METHODS A cohort of 715 elderly inpatients free of acute cardiovascular events was initially recruited. Based on tertiles of baseline hs-cTnT and NT-proBNP levels, the elderly were arranged into low, middle, and high groups. The mortality of each group was observed and the predictive values of hs-cTnT and NT-proBNP compared. Additionally, all-cause mortality was analyzed for hs-cTnT and NT-proBNP combined. RESULTS There were 135 (18.9%) all-cause mortality cases identified during follow-up (median 47 months). The upper tertile of hs-cTnT was significantly associated with an increased risk of mortality (HR 3.29, 95% CI 1.85-5.85), even after adjustment for potential confounders. However, there were no significant differences observed in mortality rates among the three NT-proBNP groups after adjustment for potential confounders (HR 1.77, 95% CI 0.83-3.17). Compared to NT-proBNP, hs-cTnT was a better predictor of mortality, as area under curves for hs-cTnT and NT-proBNP at 60 months were 0.712 (95% CI 0.616-0.809) and 0.585 (95% CI 0.483-0.6871), respectively. Also, the combination of the two cardiac biomarkers did not render a better predictive value for mortality than hs-cTnT alone. CONCLUSION Unlike hs-cTnT, baseline NT-proBNP levels failed to show an independent association with all-cause mortality in hospitalized elderly without acute cardiovascular events. hs-cTnT provided significant prognostic value for mortality in the study cohort.
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Affiliation(s)
- Jie-Ruo Chen
- Department of Geriatrics, Fuxing Hospital, affiliated to Capital Medical University, Beijing, China,
| | - Qing Wang
- Department of Geriatrics, Fuxing Hospital, affiliated to Capital Medical University, Beijing, China,
| | - Wei Wu
- General Practice Ward, Fuxing Hospital, affiliated to Capital Medical University, Beijing, China
| | - Shao-Jing Zhang
- Department of Geriatrics, Fuxing Hospital, affiliated to Capital Medical University, Beijing, China,
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Abdelmoneim SS, Ball CA, Mantovani F, Hagen ME, Eifert-Rain S, Wilansky S, Castello R, Pellikka PA, Best PJ, Mulvagh SL. Prognostic Utility of Stress Testing and Cardiac Biomarkers in Menopausal Women at Low to Intermediate Risk for Coronary ARTery Disease (SMART Study): 5-Year Outcome. J Womens Health (Larchmt) 2018; 27:542-551. [DOI: 10.1089/jwh.2017.6506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Sahar S. Abdelmoneim
- Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Cardiovascular Diseases, Assiut University, Assuit, Egypt
| | - Caroline A. Ball
- Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Francesca Mantovani
- Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Arcispedale Santa Maria Nuova (IRCCS), Reggio Emilia, Italy
| | - Mary E. Hagen
- Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Susan Eifert-Rain
- Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Susan Wilansky
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona
| | | | - Patricia A. Pellikka
- Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patricia J.M. Best
- Women's Heart Clinic, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Cardiovascular Catheterization Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sharon L. Mulvagh
- Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Women's Heart Clinic, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Smeets M, Degryse J, Janssens S, Matheï C, Wallemacq P, Vanoverschelde JL, Aertgeerts B, Vaes B. Diagnostic rules and algorithms for the diagnosis of non-acute heart failure in patients 80 years of age and older: a diagnostic accuracy and validation study. BMJ Open 2016; 6:e012888. [PMID: 27855108 PMCID: PMC5073666 DOI: 10.1136/bmjopen-2016-012888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Different diagnostic algorithms for non-acute heart failure (HF) exist. Our aim was to compare the ability of these algorithms to identify HF in symptomatic patients aged 80 years and older and identify those patients at highest risk for mortality. DESIGN Diagnostic accuracy and validation study. SETTING General practice, Belgium. PARTICIPANTS 365 patients with HF symptoms aged 80 years and older (BELFRAIL cohort). Participants underwent a full clinical assessment, including a detailed echocardiographic examination at home. OUTCOME MEASURES The diagnostic accuracy of 4 different algorithms was compared using an intention-to-diagnose analysis. The European Society of Cardiology (ESC) definition of HF was used as the reference standard for HF diagnosis. Kaplan-Meier curves for 5-year all-cause mortality were plotted and HRs and corresponding 95% CIs were calculated to compare the mortality risk predicting abilities of the different algorithms. Net reclassification improvement (NRI) was calculated. RESULTS The prevalence of HF was 20% (n=74). The 2012 ESC algorithm yielded the highest sensitivity (92%, 95% CI 83% to 97%) as well as the highest referral rate (71%, n=259), whereas the Oudejans algorithm yielded the highest specificity (73%, 95% CI 68% to 78%) and the lowest referral rate (36%, n=133). These differences could be ascribed to differences in N-terminal probrain natriuretic peptide cut-off values (125 vs 400 pg/mL). The Kelder and Oudejans algorithms exhibited NRIs of 12% (95% CI 0.7% to 22%, p=0.04) and 22% (95% CI 9% to 32%, p<0.001), respectively, compared with the ESC algorithm. All algorithms detected patients at high risk for mortality (HR 1.9, 95% CI 1.4 to 2.5; Kelder) to 2.3 (95% CI 1.7 to 3.1; Oudejans). No significant differences were observed among the algorithms with respect to mortality risk predicting abilities. CONCLUSIONS Choosing a diagnostic algorithm for non-acute HF in elderly patients represents a trade-off between sensitivity and specificity, mainly depending on differences between cut-off values for natriuretic peptides.
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Affiliation(s)
- Miek Smeets
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
| | - Jan Degryse
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, Universitair Ziekenhuis Gasthuisberg, KU Leuven (KUL), Leuven, Belgium
| | - Catharina Matheï
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
| | - Pierre Wallemacq
- Laboratory of Analytical Biochemistry, Cliniques Universitaires St Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Jean-Louis Vanoverschelde
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium
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Sarzani R, Spannella F, Giulietti F, Fedecostante M, Giordano P, Gattafoni P, Espinosa E, Busco F, Piccinini G, Dessì-Fulgheri P. NT-proBNP and Its Correlation with In-Hospital Mortality in the Very Elderly without an Admission Diagnosis of Heart Failure. PLoS One 2016; 11:e0153759. [PMID: 27077910 PMCID: PMC4831737 DOI: 10.1371/journal.pone.0153759] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/04/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The diagnosis of heart failure (HF) is often difficult and underestimated in very elderly comorbid patients, especially when an echocardiographic evaluation is not available or feasible. AIM to evaluate NT-proBNP values and their correlation with in-hospital mortality in a population of very elderly hospitalized for medical conditions other than HF. METHODS We performed a prospective observational study on 403 very elderly admitted to an Internal Medicine and Geriatrics Department. Exclusion criterion was an admission diagnosis of HF. Patients with at least one symptom or sign compatible with HF were tested for NT-proBNP. NT-proBNP values < 300 pg/ml were considered as an age-independent exclusion criterion for HF (high negative predictive value), while NT-proBNP values ≥ 1800 pg/ml were considered as a diagnostic criterion. Main comorbidities and laboratory parameters were considered to adjust regression analyses between NT-proBNP and in-hospital mortality. RESULTS NT-proBNP values ≥ 1800 pg/ml were present in 61.0% of patients and 32.8% of patients laid between 300 ≤ NT-proBNP < 1800 pg/ml values. NT-proBNP values were associated with the main indices of disease severity/organ failure considered such as reduced eGFR, reduced albumin and elevated CRP. NT-proBNP values ≥ 1800 pg/ml and ln(NT-proBNP) values were significantly associated with in-hospital mortality independently from the main comorbidities and lab parameters considered. The patients, who were already taking ACE inhibitors/Angiotensin Receptor Blockers before admission, showed lower in-hospital mortality. CONCLUSIONS Testing for NT-proBNP should be strongly recommended in the hospitalized very elderly, because of the very high prevalence of underlying HF and its impact on in-hospital mortality, to identify an underlying cardiac involvement that requires appropriate treatment.
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Affiliation(s)
- Riccardo Sarzani
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Francesco Spannella
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Federico Giulietti
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | | | - Piero Giordano
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Pisana Gattafoni
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Emma Espinosa
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Franco Busco
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Clinical Analysis Laboratory, Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
| | - Gina Piccinini
- Clinical Analysis Laboratory, Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
| | - Paolo Dessì-Fulgheri
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
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Turkeshi E, Vaes B, Andreeva E, Matheï C, Adriaensen W, Van Pottelbergh G, Degryse JM. Airflow limitation by the Global Lungs Initiative equations in a cohort of very old adults. Eur Respir J 2015; 46:123-32. [DOI: 10.1183/09031936.00217214] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/18/2015] [Indexed: 11/05/2022]
Abstract
The cut-off for forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) defining airflow limitation for chronic obstructive pulmonary disease (COPD) is still contested. We assessed airflow limitation prevalence by the lower limit of normal (LLN) of Global Lungs Initiative (GLI) 2012 reference values and its predictive ability for all-cause mortality and hospitalisation in very old adults (aged ≥80 years) compared with the fixed cut-off.In a Belgian population-based prospective cohort of 411 very old adults, airflow limitation prevalence by the 5th percentile of GLI 2012 z-scores (GLI-LLN) and fixed cut-off (0.70) were compared with COPD reported by general practitioners (GPs). Survival and Cox regression multivariable analysis assessed the association of airflow limitation by both cut-offs with 5-year all-cause mortality and first hospitalisation at 3 years.9.2% had airflow limitation by GLI-LLN and 27% by fixed cut-off, without good agreement (kappa coefficient ≤0.40) with GP-reported COPD (9%). Only airflow limitation by GLI-LLN was independently associated with mortality (adjusted hazard ratio 2.10, 95% CI 1.30–3.38). FEV1/FVC <0.70 but ≥GLI-LLN (17.8%) had no significantly higher risk for mortality or hospitalisation.In a cohort of very old adults, airflow limitation by GLI-LLN has lower prevalence than by fixed cut-off, independently predicts all-cause mortality and does not miss individuals with significantly higher all-cause mortality and hospitalisation.
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Poortvliet RK, Blom JW, de Craen AJ, Mooijaart SP, Westendorp RG, Assendelft WJ, Gussekloo J, de Ruijter W. Low blood pressure predicts increased mortality in very old age even without heart failure: the Leiden 85-plus Study. Eur J Heart Fail 2014; 15:528-33. [DOI: 10.1093/eurjhf/hfs203] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rosalinde K.E. Poortvliet
- Department of Public Health and Primary Care; Leiden University Medical Center; PO Box 9600 2300 RC Leiden The Netherlands
| | - Jeanet W. Blom
- Department of Public Health and Primary Care; Leiden University Medical Center; PO Box 9600 2300 RC Leiden The Netherlands
| | - Anton J.M. de Craen
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden The Netherlands
- Institute for Evidence-Based Medicine in Old Age; Leiden The Netherlands
| | - Rudi G.J. Westendorp
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden The Netherlands
- Netherlands Consortium for Healthy Ageing; Leiden The Netherlands
| | - Willem J.J. Assendelft
- Department of Public Health and Primary Care; Leiden University Medical Center; PO Box 9600 2300 RC Leiden The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care; Leiden University Medical Center; PO Box 9600 2300 RC Leiden The Netherlands
| | - Wouter de Ruijter
- Department of Public Health and Primary Care; Leiden University Medical Center; PO Box 9600 2300 RC Leiden The Netherlands
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Maries L. Diagnostic and prognostic values of B-type natriuretic peptides (BNP) and N-terminal fragment brain natriuretic peptides (NT-pro-BNP). Cardiovasc J Afr 2013; 24:286-9. [PMID: 24217307 PMCID: PMC3807675 DOI: 10.5830/cvja-2013-055] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 08/14/2013] [Indexed: 11/06/2022] Open
Abstract
B-type natriuretic peptide (BNP) is a member of a fournatriuretic peptide family that shares a common 17-peptide ring structure. The N-terminal fragment (NT-pro-BNP) is biologically inert, but both are secreted in the plasma in equimolar quantities and both have been evaluated for use in the management of congestive heart failure. BNP and NT-pro-BNP are frequently used in the diagnosis of congestive heart failure and distinguishing between patients with dyspnoea of cardiac or pulmonary origin. Values of NT-pro-BNP are affected by age or the presence of one or several co-morbidities such as chronic renal failure, type 2 diabetes, and acute coronary syndrome. 'Normal' values of these peptides also vary depending on the type of test used. The performance characteristics of these tests vary depending on the patients on whom they are used and the manufacturer. For this reason, the determination of reference values for this peptide represents such a challenge.
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Vaidya A, Underwood PC, Hopkins PN, Jeunemaitre X, Ferri C, Williams GH, Adler GK. Abnormal aldosterone physiology and cardiometabolic risk factors. Hypertension 2013; 61:886-93. [PMID: 23399714 DOI: 10.1161/hypertensionaha.111.00662] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abnormal aldosterone physiology has been implicated in the pathogenesis of cardiometabolic diseases. Single aldosterone measurements capture only a limited range of aldosterone physiology. New methods of characterizing aldosterone physiology may provide a more comprehensive understanding of its relationship with cardiometabolic disease. We evaluated whether novel indices of aldosterone responses to dietary sodium modulation, the sodium-modulated aldosterone suppression-stimulation index (SASSI for serum and SAUSSI for urine), could predict cardiometabolic risk factors. We performed cross-sectional analyses on 539 subjects studied on liberal and restricted sodium diets with serum and urinary aldosterone measurements. SASSI and SAUSSI were calculated as the ratio of aldosterone on liberal (maximally suppressed aldosterone) to the aldosterone on restricted (stimulated aldosterone) diets and associated with risk factors using adjusted regression models. Cardiometabolic risk factors associated with either impaired suppression of aldosterone on liberal diet, or impaired stimulation on restricted diet, or both; in all of these individual cases, these risk factors associated with higher SASSI or SAUSSI. In the context of abnormalities that constitute the metabolic syndrome, there was a strong positive association between the number of metabolic syndrome components (0-4) and both SASSI and SAUSSI (P<0.0001) that was independent of known aldosterone secretagogues (angiotensin II, corticotropin, potassium). SASSI and SAUSSI exhibited a high sensitivity in detecting normal individuals with zero metabolic syndrome components (86% for SASSI and 83% for SAUSSI). Assessing the physiological range of aldosterone responses may provide greater insights into adrenal pathophysiology. Dysregulated aldosterone physiology may contribute to, or result from, early cardiometabolic abnormalities.
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Affiliation(s)
- Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Nybo M, Jeune B, Andersen-Ranberg K. Natriuretic Peptide Concentrations in Centenarians. J Am Geriatr Soc 2012; 60:991-3. [DOI: 10.1111/j.1532-5415.2012.03929.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mads Nybo
- Department of Clinical Biochemistry and Pharmacology; Odense University Hospital; Odense; Denmark
| | - Bernard Jeune
- Department of Epidemiology; Institute of Public Health and Danish Ageing Research Centre; University of Southern Denmark; Odense; Denmark
| | - Karen Andersen-Ranberg
- Department of Epidemiology; Institute of Public Health and Danish Ageing Research Centre; University of Southern Denmark; Odense; Denmark
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Packer M. Can brain natriuretic peptide be used to guide the management of patients with heart failure and a preserved ejection fraction? The wrong way to identify new treatments for a nonexistent disease. Circ Heart Fail 2011; 4:538-40. [PMID: 21934089 DOI: 10.1161/circheartfailure.111.963710] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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