Anemia an Old Player or a Cut-Throat in Patients with Coronary Artery Disease or Chronic Heart Failure.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3762-3762
Author(s):  
Giorgio Corinaldesi ◽  
Christian Corinaldesi
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Chronic Heart Failure ◽  
Apoptotic Cell ◽  
Binding Capacity ◽  
Left Ventricular ◽  
Functional Class ◽  
Peak Oxygen Consumption ◽  
Artery Disease

Abstract Anemia is associated with an increased number of adverse cardiovascular events (CVD) in particular with coronary artery disease (CAD), and chronic heart failure (CHF), and it is also correlated with gender, aging, renal insufficiency, low BMI. Anemia involves inflammatory cytokines (C-reactive protein, IL-6, MCP-1, TNF-alfa), it reduces marrow response to erythropoietin (EPO) and heme-oxygenases-1(HO-1), it also reduces red cells life span and it may impairs reuse of iron, it mostly reduces, the peak VO-2 (peak aerobic power). The latter appears to be an independent factor that may be associated with an adverse outcome, in fact, for a reduction of one gram of heamoglobin (Hb) the risk of morbility and mortality increase respectively by 32% and 18%. The aim of the study was to determine the clinical implication of anemia in patients with CHF or CAD; we have studied 48 patients (32 male, 16 female) with CHF, and 52 patients (34 male, 18 female) with CAD, with a range of Hb concentration included between 9.4gr/dl and 12.6gr/dl. We have evaluated moreover the tolerance to exercise on a treadmill and six minute walk distance (210+/− 32 m in CAD), (180+/− 28 m in HF), the presence of rest dyspnea, the presence of supraventricular or ventricular arrhythmias (atrial/or ventricular premature beats, sinus tachycardia, or ventricular tachycardia, atrial fibrillation); lower levels of Hb, Fe, TIBC correlate with a greater tendency to develop ventricular arrhytmias instead of supraventricular arrhytmias. Anaemia management included erythropoietin stimulating protein, blood transfusion; we have used darbopoietin 50 mcg every week, and this treatment is associated to a significant improvement in functional class and cardiac and renal function. Epo has a strong cardioprotective effect: reducing left ventricular hypertrophy, infarct size, a higher beta natriuretic peptide level, apoptotic cell death, increase FE and capillary vessels; we have remarked a longer endurance time of exercise testing a greater distance walked (282+/− 64 m in CAD), (248+/− 32m in CHF), a significant increased in the peak oxygen consumption VO2 from 12.6+/− 2.4 to 16.2+/− 2.8 mL/Kg x min. in CAD, 9.8+/− 2.0 to 13.2 +/− 3.4 mL/Kg x min. in CHF. Our data also confirm the link between an increased tendency to develop CVD and a decreased level of Hb. RISK FACTORS CAD CHF Sex (M/F) 32/16 34/18 Age (Years) 62+/− 6 66+/− 4 Hb (g/dl) 10.8+/− 1.8 10.6+/− 1.2 MCV (fl) 82.6+/− 4.4 77+/− 4.2 Iron (mg/dl) (Fe) 42.8+/− 10.2 36+/− 9.4 Total Iron Binding Capacity (TIBC) 316+/− 68.8 280+/− 62.8

scholarly journals Atorvastatin in patients with coronary artery disease and left ventricular systolic dysfunction

2019 ◽  
pp. 28-33
Author(s):  
E. V. Filippov ◽  
K. A. Moseychuk
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Chronic Heart Failure ◽  
Randomized Clinical Trials ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Coronary Artery Atherosclerosis ◽  
Artery Disease

Coronary artery disease (CAD) can manifest as a classic chest pain, or atypical angina. At the same time, the prevalence of CAD in a group of male patients with atypical angina over the age of 60 can reach 59--78%. It should be noted that the clinic manifestation of the chronic heart failure (CHF), which will be the main limiting factor, may take centre stage in diffuse coronary artery atherosclerosis. In patients with coronary artery disease and heart failure, who take atorvastatin, one should expect a decrease in the risk of adverse outcomes and hospitalizations due to heart failure. However, this does not negate the need for treatment and optimization of heart failure, if necessary. The therapy of these patients is based on the administration of high doses of angiotensin converting enzyme inhibitors (ACE inhibitors), beta-blockers (BB) and statins. The routine use of statins in heart failure with low ejection fraction (EF) is not recommended for the management of patients with heart failure from clinical guidelines point of view. This conclusion is based on two multicenter randomized clinical trials that have purposefully studied the use of statins in heart failure (CORONA and GISSI-HF). However, this document recommends the use of statins to prevent heart failure in patients with coronary artery disease. Continuing statin therapy in patients, who are already receiving these drugs for coronary artery disease or hyperlipidemia, should also be discussed. Thus, the use of atorvastatin in patients with coronary artery disease and systolic left ventricular myocardial dysfunction can reduce the risk of adverse outcomes and hospitalizations due to heart failure. In patients with non-ischemic heart failure, taking statins is not associated with improved survival. Thus, the decision to prescribe this group of drugs in patients with chronic heart failure should take into account the specific clinical situation and be strictly individualized.

scholarly journals Statin administration is associated with higher IGF-1 levels in patients without diabetes mellitus

2018 ◽  
Vol 64 (4) ◽  
pp. 200-207
Author(s):  
Olga V. Shpagina ◽  
Irina Z. Bondarenko ◽  
Galina S. Kolesnikova
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Chronic Heart Failure ◽  
Total Cholesterol ◽  
Statin Therapy ◽  
Left Ventricular ◽  
Control Group ◽  
Artery Disease ◽  
Group 1

Background: Research makes it clear that the IGF-1 level correlates with cardiovascular disease, chronic heart failure, and mortality. Yet, little is known about the effect of statins on IGF-1. Aims: to evaluate the effect of statin treatment on IGF-1 and its association with a cardiovascular risk. Material and methods: The study included 115 patients (mean age, 55.8±6.1 years) who either were overweight or had mild obesity (body mass index 28.6±3.8 kg/m2) without diabetes. Group 1 consisted of 70 patients with verified coronary artery disease receiving statin therapy; group 2 included 45 healthy subjects. Coronary angiography and treadmill test were used to diagnose coronary artery disease. Impaired glucose tolerance and total cholesterol, triglycerides, LPHD, LPLD, fibrinogen, and IGF-1 levels were evaluated in all the subjects. Heart chamber geometry was assessed by echocardiography. Results: The IGF-1 level was significantly higher in group 1 compared to the control group (196 and 167 ng/ml, respectively; р=0.014). Serum levels of IGF-1 were associated with duration of statin therapy (R=0.311; p=0.000), stage of hypertension (R=0.187; p=0.04), fibrinogen (R=0.274; p=0.033), TG (R=0.316; p=0.006), total cholesterol (R=–0.213; p=0.016), LPLD (R=–0.184; p=0.038), smoking (R=0.3; p=0.009), ejection fraction (R=0.298; p=0.041), end-diastolic volume (R=0.422; p=0.036), end-systolic volume (R=0.407; p=0.042), end-diastolic dimension (R=0.27; p=0.014), interventricular septal thickness (R=0.247; p=0.02), and left ventricular posterior wall thickness (R=0.258; p=0.019). Rosuvastatin dose positively correlated with the IGF-1 level (R=0.521; p=0.028). Conclusions: Statin administration is associated with higher IGF-1 levels in patients without diabetes. High IGF-1 level correlates with the risk factors of coronary artery disease: hypertension, lipid profile, and fibrinogen level and has an adverse effect on chronic heart failure by altering the cardiac remodeling.

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