scholarly journals Association of Exhaled Carbon Monoxide With Ideal Cardiovascular Health, Circulating Biomarkers, and Incidence of Heart Failure in the Framingham Offspring Study

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Bradley Tun ◽  
Rachel Ehrbar ◽  
Meghan Short ◽  
Susan Cheng ◽  
Ramachandran S. Vasan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Carbon Monoxide ◽  
Ejection Fraction ◽  
Cardiovascular Health ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Health Score ◽  
Reduced Ejection Fraction ◽  
Exhaled Carbon Monoxide

Background Exhaled carbon monoxide (eCO) is directly associated with traditional cardiovascular disease risk factors and incident cardiovascular disease. However, its relation with the cardiovascular health score and incidence of heart failure (HF) has not been investigated. Methods and Results We measured eCO in 3521 Framingham Heart Study Offspring participants attending examination cycle 6 (mean age 59 years, 53% women). We related the cardiovascular health score (composite of blood pressure, fasting plasma glucose, total cholesterol, body mass index, smoking, diet, and physical activity) to eCO adjusting for age, sex, and smoking. Higher cardiovascular health scores were associated with lower eCO (β=−0.02, P <0.0001), even among nonsmokers. Additionally, C‐reactive protein, plasminogen activator inhibitor‐1, fibrinogen, growth differentiation factor‐15, homocysteine, and asymmetrical dimethylarginine were positively associated with eCO ( P ≤0.003 for all). The age‐ and sex‐adjusted and multivariable‐adjusted heritabilities of eCO were 49.5% and 31.4%, respectively. Over a median follow‐up of 18 years, 309 participants (45% women) developed HF. After multivariable adjustment, higher eCO was associated with higher risk of HF (hazards ratio per SD increment: 1.39; 95% CI, 1.19–1.62 [ P <0.001]) and with higher risk of HF with reduced ejection fraction (N=144 events; hazard ratio per SD increment in eCO: 1.43; 95% CI, 1.15–1.77 [ P =0.001]). Conclusions In our community‐based sample, higher levels of eCO were associated with lower cardiovascular health scores, an adverse cardiovascular biomarker profile, and a higher risk of HF, specifically HF with reduced ejection fraction. Our findings suggest that carbon monoxide may identify a novel pathway to HF development.

scholarly journals Association of the Novel Inflammatory Marker GlycA and Incident Heart Failure and Its Subtypes of Preserved and Reduced Ejection Fraction

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Sunyoung Jang ◽  
Oluseye Ogunmoroti ◽  
Chiadi E. Ndumele ◽  
Di Zhao ◽  
Vishal N. Rao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Ejection Fraction ◽  
Disease Risk ◽  
Inflammatory Marker ◽  
Cardiovascular Disease Risk ◽  
Unique Identifier ◽  
Acute Phase Reactants ◽  
Reduced Ejection Fraction ◽  
Increased Risk

Background: GlycA, a nuclear magnetic resonance composite marker of systemic inflammation, reflects serum concentration and glycosylation state of main acute phase reactants. Prior studies have shown plasma GlycA levels were associated with cardiovascular disease even after adjusting for other inflammatory markers. However, little is known about the association of GlycA with the heart failure (HF) subtypes: heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction. We examined the association of GlycA with incident HF and its subtypes in a multiethnic cohort. Methods: We studied 6507 Multi-Ethnic Study of Atherosclerosis participants aged 45 to 84 without baseline cardiovascular disease or HF who had data on GlycA and incident hospitalized HF. We used multivariable-adjusted Cox hazards models to evaluate the association of GlycA with incident total HF, HFpEF, and heart failure with reduced ejection fraction. Models were adjusted for sociodemographics, cardiovascular disease risk factors, and inflammatory biomarkers. Results: The mean (SD) for age was 62 (10) years and for GlycA was 375 (82) μmol/L; 53% women. Over a median follow-up of 14.0 years, participants in the highest quartile of GlycA, compared with the lowest, experienced increased risk of developing any HF (hazard ratio, 1.48 [95% CI, 1.01–2.18]) in fully adjusted models. However, this increased risk was only seen for HFpEF (2.18 [1.15–4.13]) and not heart failure with reduced ejection fraction [1.06 (0.63–1.79)]. There was no significant interaction by sex, age, or race/ethnicity. Conclusions: GlycA was associated with an increased risk of any HF, and in particular, HFpEF. Future studies should examine mechanisms that might explain differential association of GlycA with HF subtypes, and whether therapeutic lowering of GlycA can prevent HFpEF development. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00005487.

Abstract 23: Divergent Temporal Trends in the Incidence of Heart Failure with Preserved and Reduced Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Connie W Tsao ◽  
Asya Lyass ◽  
Martin G Larson ◽  
Ramachandran S Vasan
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Coronary Disease ◽  
Cumulative Incidence ◽  
Disease Risk ◽  
Time Windows ◽  
Cardiovascular Disease Risk ◽  
Myocardial Salvage ◽  
Reduced Ejection Fraction ◽  
The Past

Background: The past two decades have witnessed divergent trends in the prevalence of major cardiovascular disease risk factors and advances in medical therapy for coronary disease. Over this time period (1990-2009), we hypothesized that the incidence of heart failure with preserved ejection fraction (HFPEF) may have decreased with improved blood pressure control, whereas the incidence of heart failure with reduced ejection fraction (HFREF) may have increased due to improved treatment of coronary disease with myocardial salvage. Methods: We studied Framingham Heart Study Original and Offspring Cohort participants at least 40 years of age and free of HF (n=6648, 56% women, 21285 five-year epochs, 769 HF, 97829 person-years). We estimated age- and sex-adjusted rates of HF, HFPEF, and HFREF (cumulative incidence at 5 years) for 5-year time windows between 1990 and 2009 and for 10-year intervals, 1990-1999 and 2000-2009. We used proportional hazards models to estimate cumulative incidence and test time trends in hazards ratios, for the overall sample and for each sex separately. Results: HF incidence varied modestly across the time windows but differences were not statistically significant overall, in men, or in women ( TABLE ). Across the two decades, there was a 40% increase in the incidence of HFPEF (p=0.003), but a 20% decrease in the incidence of HFREF (p<0.0001). The incidence of HFPEF between decades did not change significantly in men but increased 56% in women (p=0.014). Between decades, the incidence of HFREF declined by 13% in men and by 29% in women (p=0.01 and 0.003, respectively). Conclusions: Whereas the overall incidence of HF has not changed significantly in the past two decades, the incidence of HFPEF has risen and that of HFREF has declined reciprocally, opposite to what we hypothesized. Future investigation into the potential factors underlying these intriguing trends is warranted.

scholarly journals Short-Term Effects of Healthy Eating Pattern Cycling on Cardiovascular Disease Risk Factors: Pooled Results from Two Randomized Controlled Trials

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1725 ◽  
Author(s):  
Lauren O'Connor ◽  
Jia Li ◽  
R. Drew Sayer ◽  
Jane Hennessy ◽  
Wayne Campbell
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Healthy Eating ◽  
Cardiovascular Health ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Cardiovascular Disease Risk Factors ◽  
Eating Pattern

Adherence to healthy eating patterns (HEPs) is often short-lived and can lead to repetitive attempts of adopting—but not maintaining—HEPs. We assessed effects of adopting, abandoning, and readopting HEPs (HEP cycling) on cardiovascular disease risk factors (CVD-RF). We hypothesized that HEP cycling would improve, worsen, and again improve CVD-RF. Data were retrospectively pooled for secondary analyses from two randomized, crossover, controlled feeding trials (n = 60, 52 ± 2 years, 30.6 ± 0.6 kg/m2) which included two 5–6 week HEP interventions (Dietary Approaches to Stop Hypertension-style or Mediterranean-style) separated by a four-week unrestricted eating period. Ambulatory and fasting blood pressures (BP), fasting serum lipids, lipoproteins, glucose, and insulin were measured before and during the last week of HEP interventions. Fasting systolic BP and total cholesterol decreased (−6 ± 1 mm Hg and −19 ± 3 mg/dL, respectively, p < 0.05), returned to baseline, then decreased again (−5 ± 1 mm Hg and −13 ± 3 mg/dL, respectively, p < 0.05) when adopting, abandoning, and readopting a HEP; magnitude of changes did not differ. Ambulatory and fasting diastolic BP and high-density lipoprotein cholesterol concentrations followed similar patterns; glucose and insulin remained unchanged. Low-density lipoprotein cholesterol concentrations decreased with initial adoption but not readoption (−13 ± 3 and −6 ± 3, respectively, interaction p = 0.020). Healthcare professionals should encourage individuals to consistently consume a HEP for cardiovascular health but also encourage them to try again if a first attempt is unsuccessful or short-lived.

Abstract 10983: Alcohol Intake and Heart Failure Incidence: Results From the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
P. Elliott Miller ◽  
Di Zhao ◽  
Robyn McClelland ◽  
Alan Bertoni ◽  
Joao A Lima ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Alcohol Use ◽  
Ejection Fraction ◽  
Lower Incidence ◽  
Alcohol Intake ◽  
Self Report ◽  
Antihypertensive Medications ◽  
Ethnic Study ◽  
Reduced Ejection Fraction

Background: Alcohol intake has a well-described J-shaped effect on cardiovascular disease and all-cause mortality. Previous studies have shown a lower incidence of heart failure (HF) with moderate alcohol use. However, it is unknown whether alcohol intake is associated with a lower incidence of HF with reduced ejection fraction (HFrEF) or with preserved ejection fraction (HFpEF). Methods: We performed analyses of participants from the Multi-Ethnic Study of Atherosclerosis (MESA) to assess the association of alcohol and incident HF. Alcohol use was determine by self-report at baseline. Individuals were free of cardiovascular disease at baseline and were followed for a mean of 10.2 ± 2.8 years for incident events. Heart failure was classified as HFrEF (ejection fraction (EF) ≤50%) or HFpEF (EF > 50%) at the time of HF diagnosis. We performed time-fixed Cox proportional hazard regression models to assess associations between alcohol use and incident heart failure. Analyses were adjusted for age, sex, race, smoking (pack-years), and education, and then additionally for systolic and diastolic blood pressures, use of antihypertensive medications, family history of CHD, diabetes, HDL-cholesterol, C-reactive protein, fibrinogen, and interim myocardial infarction as a time-varying covariate. Results: We identified 6,763 individuals with alcohol use data, which included 1,390 (20.6%) never, 1,624 (24.0%) former, and 3,749 (55.4%) current drinkers at baseline. The average age was 62.1 years with 47.2% men. There were 258 HF events with 118 classified as HFrEF, 112 as HFpEF, and 28 participants excluded from analyses due to an unknown EF. Compared to never drinkers, individuals reporting > 2 drinks per day had a higher risk of developing HFpEF [HR 2.41 (95% CI 1.04, 5.60) in model 1 and HR: 2.65 (1.10-6.42) in the fully adjusted model]. There were no significant associations between alcohol use and incident overall HF (HFpEF and HFrEF combined) [HR 1.31 (0.73-2.35)] or HFrEF [HR 0.78 (0.32-1.92)]. Conclusion: In the MESA cohort, individuals who drank greater than 2 alcoholic drinks per day had an increased odds of incident HFpEF but not HFrEF. Follow-up studies are needed to understand the etiology of these differences and to investigate for differences by race and sex.

scholarly journals The Role of Estrogen Receptors in Cardiovascular Disease

2020 ◽  
Vol 21 (12) ◽  
pp. 4314 ◽  
Author(s):  
Laila Aryan ◽  
David Younessi ◽  
Michael Zargari ◽  
Somanshu Banerjee ◽  
Jacqueline Agopian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Estrogen Receptor ◽  
Ejection Fraction ◽  
Estrogen Receptors ◽  
Molecular Mechanisms ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Vascular Pathology ◽  
Reduced Ejection Fraction

Cardiovascular Diseases (CVDs) are the leading cause of death globally. More than 17 million people die worldwide from CVD per year. There is considerable evidence suggesting that estrogen modulates cardiovascular physiology and function in both health and disease, and that it could potentially serve as a cardioprotective agent. The effects of estrogen on cardiovascular function are mediated by nuclear and membrane estrogen receptors (ERs), including estrogen receptor alpha (ERα), estrogen receptor beta (ERβ), and G-protein-coupled ER (GPR30 or GPER). Receptor binding in turn confers pleiotropic effects through both genomic and non-genomic signaling to maintain cardiovascular homeostasis. Each ER has been implicated in multiple pre-clinical cardiovascular disease models. This review will discuss current reports on the underlying molecular mechanisms of the ERs in regulating vascular pathology, with a special emphasis on hypertension, pulmonary hypertension, and atherosclerosis, as well as in regulating cardiac pathology, with a particular emphasis on ischemia/reperfusion injury, heart failure with reduced ejection fraction, and heart failure with preserved ejection fraction.

scholarly journals Glucagon-Like Peptide 1 Receptor Agonists and Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (12) ◽  
pp. 1205-1218 ◽  
Author(s):  
Muhammad Shahzeb Khan ◽  
Gregg C. Fonarow ◽  
Darren K. McGuire ◽  
Adrian F. Hernandez ◽  
Muthiah Vaduganathan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Ejection Fraction ◽  
Atherosclerotic Cardiovascular Disease ◽  
Reduced Ejection Fraction ◽  
Receptor Agonists ◽  
Sodium Glucose Cotransporter ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

With worsening epidemiological trends for both the incidence and prevalence of type 2 diabetes mellitus (T2DM) and heart failure (HF) worldwide, it is critical to implement optimal prevention and treatment strategies for patients with these comorbidities, either alone or concomitantly. Several guidelines and consensus statements have recommended glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter type 2 inhibitors as add-ons to lifestyle interventions with or without metformin in those at high atherosclerotic cardiovascular disease risk. However, these recommendations are either silent about HF or fail to differentiate between the prevention of HF in those at risk versus the treatment of individuals with manifest HF. Furthermore, these documents do not differentiate among those with different HF phenotypes. This distinction, even though important, may not be critical for sodium-glucose cotransporter type 2 inhibitors in view of the consistent data for benefit for both atherosclerotic cardiovascular disease– and HF-related outcomes that have emerged from the regulatory-mandated cardiovascular outcome trials for all sodium-glucose cotransporter type 2 inhibitors and the recent DAPA-HF trial (Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction)demonstrating the benefit of dapagliflozin on HF-related outcomes in patients with HF with reduced ejection fraction with or without T2DM. However, the distinction may be crucial for glucagon-like peptide-1 receptor agonists and other antihyperglycemic agents. Indeed, in several of the new statements, glucagon-like peptide-1 receptor agonists are suggested treatment not only for patients with T2DM and atherosclerotic cardiovascular disease, but also in those with manifest HF, despite a lack of evidence for the latter recommendation. Although glucagon-like peptide-1 receptor agonists may be appropriate to use in patients at risk for HF, mechanistic insights and observations from randomized trials suggest no clear benefit on HF-related outcomes and even uncertainty regarding the safety in those with HF with reduced ejection fraction. Conversely, theoretical rationales suggest that these agents may benefit patients with HF with preserved ejection fraction. Considering that millions of patients with T2DM have HF, these concerns have public health implications that necessitate the thoughtful use of these therapies. Achieving this aim will require dedicated trials with these drugs in both patients who have HF with reduced ejection fraction and HF with preserved ejection fraction with T2DM to assess their efficacy, safety, and risk-benefit profile.

scholarly journals Effects of SGLT2 inhibitors on cardiovascular outcomes in patients with stage 3/4 CKD: A meta-analysis

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261986
Author(s):  
Ning Li ◽  
Guowei Zhou ◽  
Yawei Zheng ◽  
Dan Lv ◽  
Xiangjun Zhu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Ejection Fraction ◽  
Cardiovascular Outcomes ◽  
Sglt2 Inhibitors ◽  
Atherosclerotic Cardiovascular Disease ◽  
Reduced Ejection Fraction ◽  
Stage 4

Introduction After stage 3 CKD, the risk of adverse cardiovascular events increased significantly. Therefore, we performed a meta-analysis to investigate the cardiovascular protective effect of SGLT2 inhibitors in patients with stage 3/4 CKD with different baseline kidney function or underlying diseases. Method To identify eligible trials, we systematically searched the Embase, PubMed, Web of Science, and Cochrane library databases from inception to April 15, 2021. The primary cardiovascular outcome was defined as a combination of cardiovascular mortality and hospitalization due to heart failure. Baseline kidney functions (stage 3a CKD: eGFR45-59mL/min per 1.73m2, stage 3b CKD: eGFR30-44mL/min per 1.73m2, stage 4 CKD: eGFR<30mL/min per 1.73m2) and underlying diseases (Type 2 diabetes, heart failure (Preserved ejection fraction or reduced ejection fraction), atherosclerotic cardiovascular disease) were used to stratify efficacy and safety outcomes. The results were subjected to a sensitivity analysis to ensure that they were reliable. Results In the present study, a total of eleven trials were included that involved a total of 27,823 patients with stage 3/4 CKD. The treatment and control groups contained 14,451 and 13,372 patients, respectively. In individuals with stage 3/4 CKD, SGLT2 inhibitors reduced the risk of primary cardiovascular outcomes by 26% (HR 0.74, [95% CI 0.69–0.80], I2 = 0.00%), by 30% in patients with stage 3a CKD (HR 0.70, [95% CI 0.59–0.84], I2 = 18.70%), by 23% in patients with stage 3b CKD (HR 0.77, [95% CI 0.66–0.90], I2 = 2.12%), and by 29% in patients with stage 4 CKD (HR 0.71, [95% CI 0.53–0.96], I2 = 0.00%). The risk of primary outcomes was reduced by 29% (HR 0.71, [95% CI 0.63–0.80], I2 = 0.00%) in patients with type 2 diabetes, by 28% (HR 0.72, [95% CI 0.56–0.93], I2 = 37.23%) in patients with heart failure with preserved ejection fraction, by 21% (HR 0.79, [95% CI 0.70–0.89], I2 = 0.00%) in patients with heart failure with reduced ejection fraction, and by 25% (HR 0.75, [95% CI 0.64–0.88], I2 = 0.00%) in patients with atherosclerotic cardiovascular disease. Conclusions For stage 3/4 CKD, SGLT2 inhibitors significantly decreased the risk of primary cardiovascular outcomes, and these benefits were consistent throughout the spectrum of different kidney functions, even in stage 4 CKD. There was no evidence of increased adverse outcomes across different baseline clinical complications, such as type 2 diabetes, heart failure, or atherosclerotic cardiovascular disease.

scholarly journals Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 141 (3) ◽  
Author(s):  
Jo Ann S. Carson ◽  
Alice H. Lichtenstein ◽  
Cheryl A.M. Anderson ◽  
Lawrence J. Appel ◽  
Penny M. Kris-Etherton ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Dietary Patterns ◽  
Cardiovascular Health ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Low Density Lipoprotein ◽  
Dietary Cholesterol ◽  
Density Lipoprotein ◽  
Heart Association ◽  
Meta Analyses

The elimination of specific dietary cholesterol target recommendations in recent guidelines has raised questions about its role with respect to cardiovascular disease. This advisory was developed after a review of human studies on the relationship of dietary cholesterol with blood lipids, lipoproteins, and cardiovascular disease risk to address questions about the relevance of dietary cholesterol guidance for heart health. Evidence from observational studies conducted in several countries generally does not indicate a significant association with cardiovascular disease risk. Although meta-analyses of intervention studies differ in their findings, most associate intakes of cholesterol that exceed current average levels with elevated total or low-density lipoprotein cholesterol concentrations. Dietary guidance should focus on healthy dietary patterns (eg, Mediterranean-style and DASH [Dietary Approaches to Stop Hypertension]–style diets) that are inherently relatively low in cholesterol with typical levels similar to the current US intake. These patterns emphasize fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and liquid vegetable oils. A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health.

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