1
|
Gera P, Oliveira VD, Frishman WH, Aronow WS. Cardiac Manifestations of Hemochromatosis. Cardiol Rev 2024:00045415-990000000-00313. [PMID: 39145627 DOI: 10.1097/crd.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Cardiac hemochromatosis, a consequence of primary or secondary iron-overload conditions, poses a threat to patient health, leading to cardiomyopathy and heart failure. This review aims to compile comprehensive information on cardiac hemochromatosis, elucidating its pathophysiology, clinical presentation, diagnosis, and management strategies. Primary and secondary hemochromatosis, genetic and acquired forms, can result in cardiotoxicity by means of iron dysregulation. Diagnostic tools, including biochemical markers, electrocardiography, echocardiography, and magnetic resonance imaging (MRI), are utilized for early detection as well as long-term monitoring post-treatment. For treatment options, phlebotomy is the standard, but for some patients (such as those with anemia), chelation therapy is an alternative option. Other potential therapies include erythrocytapheresis, calcium channel blockers, and hepcidin-targeted approaches, for which more research is needed to understand cardiac function benefits. With the onset of cardiac symptoms, patient health rapidly deteriorates. Thus, timely intervention to mitigate associated morbidity and mortality by means of screening can promote and prolong patient survival.
Collapse
Affiliation(s)
- Priyanka Gera
- From the Departments of Cardiology and Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY
| | | | | | | |
Collapse
|
2
|
Selvaraj S, Seidelmann S, Silvestre OM, Claggett B, Ndumele CE, Cheng S, Yu B, Fernandes-Silva MM, Grove ML, Boerwinkle E, Shah AM, Solomon SD. HFE H63D Polymorphism and the Risk for Systemic Hypertension, Myocardial Remodeling, and Adverse Cardiovascular Events in the ARIC Study. Hypertension 2019; 73:68-74. [PMID: 30571559 DOI: 10.1161/hypertensionaha.118.11730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
H63D has been identified as a novel locus associated with the development of hypertension. The quantitative risks for hypertension, cardiac remodeling, and adverse events are not well studied. We analyzed white participants from the ARIC study (Atherosclerosis Risk in Communities) with H63D genotyping (N=10 902). We related genotype status to prevalence of hypertension at each of 5 study visits and risk for adverse cardiovascular events. Among visit 5 participants (N=4507), we related genotype status to echocardiographic features. Frequencies of wild type (WT)/WT, H63D/WT, and H63D/H63D were 73%, 24.6%, and 2.4%. The average age at baseline was 54.9±5.7 years and 47% were men. Participants carrying the H63D variant had higher systolic blood pressure ( P=0.004), diastolic blood pressure (0.012), and more frequently had hypertension ( P<0.001). Compared with WT/WT, H63D/WT and H63D/H63D participants had a 2% to 4% and 4% to 7% absolute increase in hypertension risk at each visit, respectively. The population attributable risk of H63D for hypertension among individuals aged 45 to 64 was 3.2% (95% CI, 1.3-5.1%) and 1.3% (95% CI, 0.0-2.4%) among individuals >65 years. After 25 years of follow-up, there was no relationship between genotype status and any outcome ( P>0.05). H63D/WT and H63D/H63D genotypes were associated with small differences in cardiac remodeling. In conclusion, the HFE H63D variant confers an increased risk for hypertension per allele and, given its frequency, accounts for a significant number of cases of hypertension. However, there was no increased risk for adverse cardiovascular events or substantial left ventricular remodeling.
Collapse
Affiliation(s)
- Senthil Selvaraj
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia (S. Selvaraj)
| | - Sara Seidelmann
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S. Seidelmann, O.M.S., B.C., S.C., M.M.F.-S., A.M.S., S.D.S.)
| | - Odilson M Silvestre
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S. Seidelmann, O.M.S., B.C., S.C., M.M.F.-S., A.M.S., S.D.S.)
| | - Brian Claggett
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S. Seidelmann, O.M.S., B.C., S.C., M.M.F.-S., A.M.S., S.D.S.)
| | - Chiadi E Ndumele
- Department of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (C.E.N.)
| | - Susan Cheng
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S. Seidelmann, O.M.S., B.C., S.C., M.M.F.-S., A.M.S., S.D.S.)
| | - Bing Yu
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston (B.Y., M.L.G., E.B.)
| | - Miguel M Fernandes-Silva
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S. Seidelmann, O.M.S., B.C., S.C., M.M.F.-S., A.M.S., S.D.S.)
| | - Megan L Grove
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston (B.Y., M.L.G., E.B.)
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston (B.Y., M.L.G., E.B.).,Baylor College of Medicine, Human Genome Sequencing Center, Houston, TX (E.B.)
| | - Amil M Shah
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S. Seidelmann, O.M.S., B.C., S.C., M.M.F.-S., A.M.S., S.D.S.)
| | - Scott D Solomon
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S. Seidelmann, O.M.S., B.C., S.C., M.M.F.-S., A.M.S., S.D.S.)
| |
Collapse
|
3
|
Christiansen M, Hedley PL, Theilade J, Stoevring B, Leren TP, Eschen O, Sørensen KM, Tybjærg-Hansen A, Ousager LB, Pedersen LN, Frikke-Schmidt R, Aidt FH, Hansen MG, Hansen J, Bloch Thomsen PE, Toft E, Henriksen FL, Bundgaard H, Jensen HK, Kanters JK. Mutations in Danish patients with long QT syndrome and the identification of a large founder family with p.F29L in KCNH2. BMC MEDICAL GENETICS 2014; 15:31. [PMID: 24606995 PMCID: PMC4007532 DOI: 10.1186/1471-2350-15-31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 02/18/2014] [Indexed: 01/08/2023]
Abstract
Background Long QT syndrome (LQTS) is a cardiac ion channelopathy which presents clinically with palpitations, syncope or sudden death. More than 700 LQTS-causing mutations have been identified in 13 genes, all of which encode proteins involved in the execution of the cardiac action potential. The most frequently affected genes, covering > 90% of cases, are KCNQ1, KCNH2 and SCN5A. Methods We describe 64 different mutations in 70 unrelated Danish families using a routine five-gene screen, comprising KCNQ1, KCNH2 and SCN5A as well as KCNE1 and KCNE2. Results Twenty-two mutations were found in KCNQ1, 28 in KCNH2, 9 in SCN5A, 3 in KCNE1 and 2 in KCNE2. Twenty-six of these have only been described in the Danish population and 18 are novel. One double heterozygote (1.4% of families) was found. A founder mutation, p.F29L in KCNH2, was identified in 5 “unrelated” families. Disease association, in 31.2% of cases, was based on the type of mutation identified (nonsense, insertion/deletion, frameshift or splice-site). Functional data was available for 22.7% of the missense mutations. None of the mutations were found in 364 Danish alleles and only three, all functionally characterised, were recorded in the Exome Variation Server, albeit at a frequency of < 1:1000. Conclusion The genetic etiology of LQTS in Denmark is similar to that found in other populations. A large founder family with p.F29L in KCNH2 was identified. In 48.4% of the mutations disease causation was based on mutation type or functional analysis.
Collapse
Affiliation(s)
- Michael Christiansen
- Department of Clinical Biochemistry, Immunology and Genetics, Statens Serum Institut, Ørestads Boulevard 5, 2300S, Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Lian J, Xu L, Huang Y, Le Y, Jiang D, Yang X, Xu W, Huang X, Dong C, Ye M, Zhou J, Duan S. Meta-analyses of HFE variants in coronary heart disease. Gene 2013; 527:167-73. [PMID: 23792061 DOI: 10.1016/j.gene.2013.06.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/17/2013] [Accepted: 06/03/2013] [Indexed: 11/16/2022]
Abstract
AIM HFE gene variants can cause hereditary hemochromatosis (HH) that often comes along with an increased risk of coronary heart disease (CHD). The goal of our study is to assess the contribution of four HFE gene variants to the risk of CHD. METHODS AND RESULTS We conducted four meta-analyses of the studies examining the association between four HFE gene variants and the risk of CHD. A systematic search was conducted using MEDLINE, EMBASE, Web of Science and China National Knowledge Infrastructure (CNKI), Wanfang Chinese Periodical. RESULTS Meta-analyses showed that HFE rs1799945-G allele was associated with a 6% increased risk of CHD (P=0.02, odds ratio (OR)=1.06, 95% confidence interval (CI)=1.01-1.11). However, no association between the other three HFE gene variants (rs1800562, rs1800730, and rs9366637) and CHD risk was observed by the meta-analyses (all P values>0.05). In addition, the results of our case-control study indicated that rs1800562 and rs1800730 were monomorphic, and that rs1799945 and rs9366637 were not associated with CHD in Han Chinese. CONCLUSIONS Our meta-analysis suggested that a significant association existed between rs1799945 mutation and CHD, although this mutation was rare in Han Chinese.
Collapse
Affiliation(s)
- Jiangfang Lian
- Ningbo Medical Center, Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315041, China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Suárez-Ortegón MF, Arbeláez A, Mosquera M, Méndez F, Aguilar-de Plata C. C-reactive protein, waist circumference, and family history of heart attack are independent predictors of body iron stores in apparently healthy premenopausal women. Biol Trace Elem Res 2012; 148:135-8. [PMID: 22328310 DOI: 10.1007/s12011-012-9351-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/27/2012] [Indexed: 12/25/2022]
Abstract
Ferritin levels have been associated with metabolic syndrome and insulin resistance. The aim of the present study was to evaluate the prediction of ferritin levels by variables related to cardiometabolic disease risk in a multivariate analysis. For this aim, 123 healthy women (72 premenopausal and 51 posmenopausal) were recruited. Data were collected through procedures of anthropometric measurements, questionnaires for personal/familial antecedents, and dietary intake (24-h recall), and biochemical determinations (ferritin, C reactive protein (CRP), glucose, insulin, and lipid profile) in blood serum samples obtained. Multiple linear regression analysis was used and variables with no normal distribution were log-transformed for this analysis. In premenopausal women, a model to explain log-ferritin levels was found with log-CRP levels, heart attack familial history, and waist circumference as independent predictors. Ferritin behaves as other cardiovascular markers in terms of prediction of its levels by documented predictors of cardiometabolic disease and related disorders. This is the first report of a relationship between heart attack familial history and ferritin levels. Further research is required to evaluate the mechanism to explain the relationship of central body fat and heart attack familial history with body iron stores values.
Collapse
Affiliation(s)
- M F Suárez-Ortegón
- Physiological Sciences Department, Universidad del Valle, Cali, Colombia.
| | | | | | | | | |
Collapse
|