Wasting as independent risk factor for mortality in chronic heart failure

Objective: to evaluate the effect of renin-angiotensin-aldosterone system (RAAS) blockers on aldosterone level in patients with chronic heart failure with preserved ejection fraction (HFpEF).Materials and methods: the prospective study included 158 patients (58 men and 100 women, mean age 62,3 ± 7,4 years) with HFpEF (> 50 %) and left ventricular diastolic dysfunction. All patients had no history of primary aldosteronism and did not use the mineralocorticoid receptor antagonists during the last 6 weeks. We evaluated the duration of treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-2 receptor antagonists (ARA-2) and its average daily dose. The dose of RAAS blockers was assessed during previous 6 months as a percentage of target. Aldosterone plasma concentration was measured and the normal level was 40 – 160 pg/ml.Results: according to laboratory results 99 patients (62,7 %) had normal aldosterone level (nAld) and 59 patients (37,3 %) had high aldosterone level (hAld). hAld patients had significantly higher duration of RAAS blockers treatment (6 (3; 8) versus 4 (2; 5) years, p < 0,001) and dose (50 (25; 50) % vs 25 (12,5; 50) % of target, р=0,01). Multiple regression analysis showed that after standartization for age, severity of HFpEF, duration of arterial hypertension and comorbidity only long-term (more than 5 years) treatment with RAAS blockers remained the independent risk factor of high aldosterone level (odds ratio 3,16, 95 % confidence interval 2,08 – 8,24).Conclusions: in HFpEF patients’ plasma aldosterone level is closely associated with RAAS blockers treatment. Long-term (more than 5 years) therapy with ACE inhibitors or ARA-2 is the independent risk factor of secondary hyperaldosteronism.

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Abstract 4331: Elevated Albumin Excretion is an Independent Risk Factor in Patients with Chronic Heart Failure. Data from the GISSI-Heart Failure Trial

Circulation ◽

10.1161/circ.118.suppl_18.s_866 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Serge Masson ◽

Luciano Moretti ◽

Ospedale Mazzoni ◽

Maria Grazia Rossi ◽

Emanuele Carbonieri ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Risk Factor ◽

Independent Risk Factor ◽

Cox Model ◽

Nyha Class ◽

Large Population ◽

Creatinine Concentration ◽

Albumin Excretion ◽

All Cause Mortality

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.

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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.

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