Hypertension as a Risk Factor for Heart Failure

Elevated albuminuria, a marker of endothelial renal damage, is a risk factor for cardiovascular events in the general population and in patients with diabetes or hypertension. We report here on its association with mortality in a large population of patients with chronic HF. Albuminuria (albumin/creatinine concentration ratio in a morning spot sample, UACR) was determined in 2131 patients with chronic HF enrolled in 77 centers participating to the GISSI-HF trial. Patients were divided according to normal (UACR <30 mg/g) and abnormal urinary excretion of albumin (≥30 mg/g). Association between elevated albuminuria and all-cause mortality was tested by univariable and multivariable analyses. Elevated albuminuria was found in 25.3% of the population (age 67±11 y, 78.9% males, 30.1% NYHA class III-IV, 55.5% hypertension, 26.1% diabetes) and was more frequent in older patients, those with reduced renal function, diabetes or high CRP. Mortality was significantly higher in patients with elevated albuminuria (20.1% at 1000 days) compared to normals (9.0%, p<0.0001). Elevated albuminuria remained an independent risk factor for all-cause mortality (HR [95%CI] 1.47 [1.18 –1.82]) in a Cox model adjusted for clinical risk factors such as age, gender, NYHA class, renal function, diabetes, BMI and blood pressure. About a quarter of the patients enrolled in the GISSI-HF trial had abnormal urinary albumin excretion, a marker for both renal and systemic vascular disease. We show for the first time in a large representative sample that elevated albuminuria is an independent predictor of all-cause mortality in patients with chronic HF.

Download Full-text

Abstract 1122‐000035: Is Age Critical in Determining Stroke Severity Within the Telestroke Network?

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000035 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Cassie A Simmons ◽

Nicolas Poupore ◽

Fernando Gonzalez ◽

Thomas I Nathaniel

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Risk Factor ◽

Univariate Analysis ◽

Baseline Risk ◽

Stroke Severity ◽

Stroke Patients ◽

Stroke Risk Factor ◽

Patients Âgés ◽

Increased Risk

Introduction : Age is the single most important risk factor for stroke and an estimated 75% of all strokes occur in people >65 years of age. In addition, adults >75 years’ experience more hospitalization stays and higher mortality rates with an estimated 50% in the occurrence of all strokes. Several comorbidities have been linked to an increased risk and severity of acute ischemic stroke (AIS). How these factors differentially contribute to the severity of stroke in patients ages >65 and <75 as well as those ≥75 is not known. In this study, we aim to investigate how age, coupled with various clinical risk factors, affects AIS severity within these two age categories. Methods : This retrospective data analysis study was conducted using the data collected from the PRISMA Health Stroke Registry between 2010 and 2016. Baseline clinical and demographic data for patients ages >65 and <75 as well as those ≥75 was analyzed using univariate analysis. Receiver operating characteristic (ROC) curve analysis and multivariate regression models were used to examine the association of specific baseline risk factors or comorbidities associated with worsening or improving neurologic functions. The primary functions were risk factors associated with improving or worsening neurologic outcome in each age category. Results : Adjusted multivariate analysis showed that AIS population of patients >65 and <75 experiencing heart failure (OR = 4.398, 95% CI, 3.912 – 494.613, P = 0.002) and elevated HDL levels (OR = 1.066, 95% CI, 1.009 – 1.126, P = 0.024) trended towards worsening neurologic functions while patients experiencing obesity (OR = 0.177, 95% CI, 0.041 – 0.760, P = 0.020) exhibited improving neurologic functions. For the patients ≥75 years of age, direct admission (OR = 0.270, 95% CI, 0.085 – 0.856, P = 0.026) was associated with improvement of patients treated in the telestroke. Conclusions : Age is a strong risk factor for AIS, and aged stroke patients have higher morbidity and worsening functional recovery than younger patients. In this study, we observed differences in stroke risk factor profiles for >65 and <75 and ≥75 age categories. Heart failure and elevated HDL levels were significantly associated with worsening neurologic functions among AIS for patients aged >65 and <75. Obese patients and individuals ≥75 years who were directly admitted were most likely to exhibit improving neurologic functions. Most importantly, findings from this study reveal specific risk factors that can be managed to improve the care in older stroke patients treated in the telestroke network.

Download Full-text

Abstract P391: Inhalation Of Airborne Particulate Matter Alters Cardiovascular Function Of Alzheimer-prone Mice

Circulation Research ◽

10.1161/res.129.suppl_1.p391 ◽

2021 ◽

Vol 129 (Suppl_1) ◽

Author(s):

Devin R O'Piela ◽

Ty A Saldana ◽

David M Aslaner ◽

Matthew W Gorr ◽

Amy R Mackos ◽

...

Keyword(s):

Heart Failure ◽

Air Pollution ◽

Risk Factor ◽

Particulate Matter ◽

Mouse Model ◽

Transgenic Mouse ◽

Airborne Particulate Matter ◽

Transgenic Mouse Model ◽

Cardiovascular Dysfunction ◽

Airborne Particulate

Air pollution has detrimental effects on cardiovascular and lung function, and the extent of its pathological consequences continues to be uncovered. Recently, air pollution has been implicated in the development of Alzheimer Disease (AD) progression. AD and heart failure are common co-morbidities, giving reason to believe that cardiovascular dysfunction may contribute to AD. A known contributor to cardiovascular dysfunction-particulate matter (PM 2.5 , < 2.5 μm diameter)—is a critical component of air pollution and is considered a risk factor for heart failure and AD development. This co-morbidity pattern and shared environmental risk factor prompted the hypothesis that PM 2.5 contributes to cardiovascular dysfunction in a transgenic mouse model of AD. We tested our hypothesis by subjecting 6-month-old transgenic (APP) and non-carrier wildtype (WT) male mice to filtered air (FA) or PM 2.5 for 5 days/week, 6 hours/day for 3 months (n = 34). Following exposure, echocardiography, pressure-volume (PV) loops, and respiratory mechanics were performed to detect cardiac and pulmonary changes associated with genotype and exposure conditions among the 3-month group. Echocardiography revealed left ventricular anterior wall thickness in systole was significantly elevated among PM-exposed APP mice compared to FA-exposed APP controls. PV data demonstrated significant reduced end-systolic elastance in PM-exposed mice compared to FA-exposed mice in both WT and APP mouse models, demonstrating impaired contractility. PV loops also showed that the time constant of isovolumetric relaxation was increased in PM-exposed compared to FA-exposed WT mice. APP mice experienced higher lung resistance and central airway resistance with an increasing dose of methacholine. Taken together, these findings indicate airborne particulate matter exposure causes cardiac and pulmonary dysfunction in a transgenic mouse model of AD.

Download Full-text

Abstract P341: Juvenile Exposure To Doxorubicin Differentially Alters The Cardiac Response To Angiotensin II And Isoproterenol In Adult Mice

Circulation Research ◽

10.1161/res.129.suppl_1.p341 ◽

2021 ◽

Vol 129 (Suppl_1) ◽

Author(s):

Marianne K Grant ◽

Beshay N Zordoky

Keyword(s):

Heart Failure ◽

Risk Factor ◽

Angiotensin Ii ◽

Cardiac Function ◽

Cancer Survivors ◽

Childhood Cancer ◽

Significant Risk ◽

Significant Risk Factor ◽

Childhood Cancer Survivors ◽

Cardiac Response

Hypertension is the most significant risk factor for heart failure in doxorubicin (DOX)-treated childhood cancer survivors. We previously developed a two-hit mouse model of juvenile DOX-induced latent cardiotoxicity that is exacerbated by adult-onset angiotensin II (ANGII)-induced hypertension. Nevertheless, it is still not known how juvenile exposure to DOX would predispose the heart to other cardiovascular pathologic stimuli that do not cause hypertension. The objective of this work was to compare the effects of ANGII to those of isoproterenol (ISO) in adult C57BL6/N mice pre-exposed to DOX as juveniles. Five-week-old male mice were administered a low dose of DOX (4 mg/kg/week) or saline for 3 weeks and then allowed to recover for 5 weeks. Thereafter, mice were either infused with ANGII (1.4 mg/kg/day) or injected with ISO (10 mg/kg/day) for 14 days. Juvenile exposure to DOX abrogated the hypertrophic response to both ANGII and ISO, while it failed to correct ANGII- and ISO-induced upregulation in the hypertrophic markers ANP and BNP. ANGII, but not ISO, worsened cardiac function in DOX-exposed mice as measured by echocardiography. Cardiac fibrosis was also exacerbated by ANGII, but not ISO, in DOX-exposed mice as evident by Masson’s trichrome staining and upregulation of the inflammatory and fibrotic markers, Cox-2, Col1a1, Col3a1 , and galectin-3 . In conclusion, the current work demonstrates that ANGII causes more severe deterioration in cardiac function and adverse cardiac remodeling in DOX-exposed mice when compared to ISO. The comparison between DOX/ANGII and DOX/ISO models is critical to understanding why hypertension is the most significant risk factor for heart failure in DOX-treated childhood cancer survivors and thereby devising effective therapeutic strategies against this significant clinical problem.

Download Full-text

Microalbuminuria as an independent risk factor for heart failure in the elderly patients with type 2 diabetes mellitus

Acta Medica Saliniana ◽

10.5457/ams.v49i2.496 ◽

2020 ◽

Vol 49 (2) ◽

Author(s):

Enisa Karić ◽

Zumreta Kušljugić ◽

Enisa Ramić ◽

Olivera Batić- Mujanović ◽

Amila Bajraktarević ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Type 2 Diabetes ◽

Risk Factor ◽

Diabetes Mellitus Type 2 ◽

Independent Risk Factor ◽

The Elderly ◽

Diabetes Mellitus Type ◽

Patients With Diabetes

Introduction:The study evaluated of microalbuminuria as a predictor of heart failure in patients with diabetes mellitus type 2.Materials and methods:The prospective study conducted in a period of time from 01-Feb-2007 to 01-Feb-2010.The study included 100 patients with type 2 diabetes, who had diabetes longer than 5 years. All subjects (average age 66 ± 10 years, 33% male, 67% female) were tested for the presence of microalbuminuria, and 50 patients had microalbuminuria. The second group comprised 50 patients without of microalbuminuria with diabetes mellitus type 2.Results:In the patients with microalbuminuria and diabetes mellitus were found 22% of heart failure and 6% in the second group. Average time to the occurance of heart failure in the first group was 32,5 months, in the second group was 35,3 months.Conclusions:The results show that microalbuminuria is an independent risk factor for heart failure in patients with diabetes mellitus type 2 and microalbuminuria. Patients without microalbuminuria had 3,7 less likely to development heart failure compared to patients with microalbuminuria and diabetes mellitus.

Download Full-text