The prognostic role of galectin-3 and endothelial function in patients with heart failure according to left ventricular ejection fraction classification HF group

Background

Heart failure (HF) is nowadays classified in HF with reduced ejection fraction (HFrEF), HF with mildly-reduced EF (HFmrEF) and HF with preserved EF (HFpEF). Endothelial dysfunction, increased arterial stiffness and galectin-3, a biomarker of myocardial fibrosis, have been linked to major adverse cardiovascular events (MACE) in patients with ischemic HF.

Purpose

The purpose of this prospective, follow-up study was to investigate in patients with stable ischemic HF the prognostic role of circulating galectin-3 levels, endothelial function and arterial stiffness according to left ventricular ejection fraction classification.

Methods

In this study we prospectively enrolled 340 patients with stable ischemic HF. Patients were categorized in HFrEF (when EF below or equal to 40%), HFmrEF (when EF is more than 40%<ef≤49%)> and below/equal to 49%) and HFpEF (when EF is more/equal to 50% along with the presence of structural or functional dysfunction and/or elevated natriuretic peptides) according to recent guidelines upon 2D echocardiographic assessment. We evaluated flow-mediated dilatation (FMD) of brachial artery as a marker of endothelial function, carotid-femoral pulse-wave velocity (PWV) as a marker of arterial stiffness and galectin-3 levels as a biomarker of fibrosis. Patients were followed-up for MACE and the primary endpoint was defined as cardiovascular death, myocardial infarction, coronary revascularization, stroke, and hospitalization due to HF. <ef≤49%)>

Results

Interestingly, FMD values exhibited a stepwise improvement according to LVEF (HFrEF: 4.74±2.35% vs. HFmrEF: 4.97±2.81% vs. HFpEF: 5.94±3.46%, p=0.01) which remained statistically significant after the evaluation of possible confounders including age, sex, cardiovascular risk factors and number of significantly stenosed epicardial coronary arteries (b coefficient: 0.990, 95% CI: 0.166–1.814, p=0.019). Multivessel coronary artery disease (CAD) was more frequent in the group of HFrEF (HFrEF: 56% vs. HFmrEF: 64% vs. HFpEF: 73%, p=0.049). Nevertheless, PWV did not display any association with LVEF. Patients who presented MACE exhibited worse FMD values (4.51±2.35% vs. 5.32±2.67%, p=0.02) and the highest tertile of galectin-3 was linked to more MACEs (36% vs. 5.9%, p=0.01).

Conclusions

FMD values have a linear improvement according to LVEF increase in patients with ischemic HF and worse values are linked to more MACEs. Higher levels of galectin-3 might be used for risk stratification of patients with ischemic HF.

Funding Acknowledgement

Type of funding sources: None.

Lipoprotein-associated phospholipase A2 levels, endothelial dysfunction and arterial stiffness in patients with stable coronary artery disease

Background

Lipoprotein-associated Phospholipase A2 (Lp-PLA2), has inflammatory and atherogenic actions in the vascular wall. We investigate the impact of high Lp-PLA2 levels on endothelial function and arterial stiffness on patients with coronary artery disease (CAD).

Methods

We enrolled 374 consecutive patients with stable CAD (mean age 61±11 years). Endothelial function was evaluated by flow-mediated dilation (FMD) and reflected waves with augmentation index (AIx) of the central aortic pressure. Serum levels of Lp-PLA2 were measured with ELISA.

Results

In the studied population the median values of Lp-PLA2 levels was 125 (96–152) μg/L. There was no difference between subjects with Lp-PLA2 levels above and below 125μg/L concerning classical risk factors for CAD. Importantly, subjects with Lp-PLA2 values ≥125μg/L had significantly impaired FMD (4.44±2.19% vs. 4.89±2.07%, p=0.04) and AIx values (25.21±8.70% vs. 23.06±9.47%, p=0.03), compared to participants with lower Lp-PLA2 serum levels. A linear regression analysis revealed that Lp-PLA2 ≥125μg/L negatively relates to impaired FMD [b=−0.54 (95% CI: −1.05 to −0.02), p=0.04] and AIx values [b=2.14 (95% CI: 0.18–4.01), p=0.03] independently of cofounders.

Conclusions

Elevated Lp-PLA2 relates to endothelial dysfunction and arterial stiffness in CAD patients. These findings highlight the significant role of Lp-PlA2 in the process of atherosclerosis.

Funding Acknowledgement

Type of funding source: None

P2483Differential effects of novel antidiabetics on arterial stiffness in patients with type 2 diabetes mellitus

Background

Arterial stiffness flags increased cardiovascular disease risk in type 2 diabetes mellitus (T2DM) patients. There is limited data on how novel anti-diabetic agents affect arterial stiffness.

Purpose

To investigate the effects of novel anti-diabetic agents on arterial stiffness in T2DM patients.

Patients and methods

We enrolled 64 consecutive patients under stable antidiabetic therapy who did not achieve therapeutic targets. Subjects were assessed to receive an additional antidiabetic agent to optimize glucose control; dipeptidyl peptidase-4 inhibitor (DPP4i, n=14), glucagon like peptide-1 receptor agonist (GLP1RA, n=21), sodium/glucose cotransporter-2 inhibitor (SGLT2i, n=21) or long-acting insulin (n=8). Glycosylated hemoglobin (HbA1c) as well as carotid-femoral pulse wave velocity (PWV) and augmentation index (Alx) were measured (as indices of arterial stiffness) were measured at baseline and 3 months after treatment intensification.

Results

There were no differences between the study groups in traditional risk factors, or baseline HbA1c, PWV and Alx levels (p=NS for all). All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up (for DPP4i: 7.4±0.2% vs 6.7±0.2%, for GLP1RA: 8.3±0.2% vs 6.9±0.1%, for SGLT2i: 7.5±0.1% vs 6.7±0.1% and for insulin 9.8±0.5% vs 7.7±0.4%, p<0.001 for all). PWV decreased from 10.0±0.84 to 9.1±0.43 m/sec (p=0.092) in the DPP4i group, from 11.7±0.72 to 10.2±0.74 m/sec (p<0.001) in the GLP1RA group, from 1.3±0.54 to 9.6±0.59 m/sec (p=0.001) in the SGLT2i group and from 11.6±1.04 to 11.1±1.02 m/sec (p=0.219) in the insulin group. Alx was also decreased from 34.2±1.89 to 31.5±2.17% (p=0.023) in the DPP4i group, from 29.1±1.52 to 25.6±2.09% (p<0.001) in the GLP1RA group, from 29.9±1.44 to 24.2±1.48% (p<0.001) in SGLT2i group, and from 28.2±2.33 to 26.2±1.64% (p=0.153) in insulin group.

Conclusions

These preliminary data provide evidence that treatment intensification -particularly with GLP1RA, and SGLT2i- benefits vascular properties, a finding which could partly explain the positive findings of recent randomized clinical trails in this field.

Acknowledgement/Funding

None

P2481The effect of DPP-4i, GLP-1RA, SGLT-2i and long-acting insulin on platelet function in patients with type 2 diabetes mellitus

Background

Patients with type 2 diabetes mellitus (T2DM) are at higher risk for thrombotic events. Platelet function may be used to assess prothrombotic state in patients with cardiovascular disease.

Purpose

We aimed to investigate whether the administration of novel antidiabetic agents influence platelet function in TDM2 patients.

Patients and methods

We 60 enrolled consecutive patients with T2DM, on stable antidiabetic therapy, who did not achieve therapeutic targets. Subjects were assessed to receive an additional anti-diabetic agent; dipeptidyl peptidase-4 inhibitor (DPP4i, n=14), glucagon like peptide-1 receptor agonist (GLP1RA, n=24), sodium/glucose cotransporter-2 inhibitor (SGLT2i, n=22). Platelet reactivity was measured with PFA-200 collagen/epinephrine (c-EPI) and PFA-200 collagen/ADP (c-ADP) closure time. Glycosylated hemoglobin (HbA1c), c-EPI and c-ADP were assessed at baseline and 3 months after treatment intensification.

Results

There was no difference between the study groups regarding gender, age, hypertension, dyslipidemia, smoking, Hba1c and CADP or CEPI (p=NS for all) at baseline. All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up (for DPP4i: 7.4±0.2% vs 6.7±0.2%, for GLP1RA: 8.3±0.2% vs 6.9±0.1%, for SGLT2i: 7.5±0.1% vs 6.7±0.1% and for insulin 9.8±0.5% vs 7.7±0.4%, p<0.001 for all). After a 3 month-period, treatment intensification with these novel agents did not influence c-EPI and c-ADP values [155.4±6.64 sec vs 152.9±8.28 sec (p=0.678) and 106.6±4.30 sec vs 106.8±3.93 sec (p=0.955) respectively] in whole population. In subgroup analysis, for patients off antiplatelet treatment (n=31), c-EPI was significantly decreased from 148.4±8.5 to 129.8±13.9 sec (p=0.036), but not c-ADP (from 105.4±5.3 to 99.3±4.9 sec, p=0.094). In patients who did receive antiplatelets (n=37), c-EPI and c-ADP were not significantly changed (c-EPI 163.1±10.9 to 179.6±13.9 sec p=0.201 and c-ADP from 106.6±8.2 sec to 114.6±7.3 sec, p=0.318) respectively.

Conclusion

Antiplatelet treatment prevents thrombotic risk in T2DM patients receiving novel antidiabetics. The effects of novel antidiabetics on platelet reactivity -as well as any distinct class properties- merits further investigation.

Acknowledgement/Funding

None

Flavonoids in atherosclerosis: an overview of their mechanisms of action

Polyphenols are composed of a wide variety of molecules that are classified into several categories, according to their chemical type such as phenolic acids, flavonoids, stilbenes, and lignans. Many studies have proven the beneficial effects of flavonoids in atherosclerosis progression and cardiovascular disease. Dietary flavonoids reduce oxidative stress and exert anti-inflammatory actions. Moreover, flavonoids have the ability to avoid the thrombus formation, improve endothelial function, modify lipid levels and regulate glucose metabolism. In the context of this evidence in this review article we summarize the so far acquired knowledge of the most important mechanisms of action of flavonoids in atherosclerosis progression.