scholarly journals Proteomic mechanistic profile of patients with diabetes at risk of developing heart failure: insights from the HOMAGE trial

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Job A. J. Verdonschot ◽  
João Pedro Ferreira ◽  
Pierpaolo Pellicori ◽  
Hans-Peter Brunner-La Rocca ◽  
Andrew L. Clark ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Plasma Concentrations ◽  
Diabetic Patients ◽  
Proteomic Profile ◽  
Developing Heart ◽  
Diabetes Status ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Patients At Risk

Abstract Background Patients with diabetes mellitus (DM) are at increased risk of developing heart failure (HF). The “Heart OMics in AGEing” (HOMAGE) trial suggested that spironolactone had beneficial effect on fibrosis and cardiac remodelling in an at risk population, potentially slowing the progression towards HF. We compared the proteomic profile of patients with and without diabetes among patients at risk for HF in the HOMAGE trial. Methods Protein biomarkers (n = 276) from the Olink®Proseek-Multiplex cardiovascular and inflammation panels were measured in plasma collected at baseline and 9 months (or last visit) from HOMAGE trial participants including 217 patients with, and 310 without, diabetes. Results Twenty-one biomarkers were increased and five decreased in patients with diabetes compared to non-diabetics at baseline. The markers clustered mainly within inflammatory and proteolytic pathways, with granulin as the key-hub, as revealed by knowledge-induced network and subsequent gene enrichment analysis. Treatment with spironolactone in diabetic patients did not lead to large changes in biomarkers. The effects of spironolactone on NTproBNP, fibrosis biomarkers and echocardiographic measures of diastolic function were similar in patients with and without diabetes (all interaction analyses p > 0.05). Conclusions Amongst patients at risk for HF, those with diabetes have higher plasma concentrations of proteins involved in inflammation and proteolysis. Diabetes does not influence the effects of spironolactone on the proteomic profile, and spironolactone produced anti-fibrotic, anti-remodelling, blood pressure and natriuretic peptide lowering effects regardless of diabetes status.  Trial registration NCT02556450.

scholarly journals The Management of Diabetic Patients with Heart Failure

2017 ◽  
Vol 10 ◽  
Author(s):  
Giuseppe Rosano ◽  
Petar Seferovic
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Therapeutic Agents ◽  
Diabetic Patients ◽  
Developing Heart ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
Patients With Diabetes ◽  
Reduction Of Mortality

Patients with diabetes mellitus have an increased risk of developing heart failure and diabetes mellitus is highly prevalent amongst patients with heart failure, especially those with HFpEF. Diabetic patients with heart failure have an increased mortality and an increased risk of hospitalisations and the use of certain anti- diabetic agents increase the risk of mortality and hospitalisation in heart failure. Conversely, newer therapeutic agents have shown a significant reduction of mortality, morbidity and risk of developing heart failure in diabetic patients with proven cardiovascular disease. This highly important area is reviewed in this paper.

scholarly journals Incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Amy Groenewegen ◽  
Victor W. Zwartkruis ◽  
Betül Cekic ◽  
Rudolf. A. de Boer ◽  
Michiel Rienstra ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Incidence Rate ◽  
Diabetes Status ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Rate Ratios ◽  
Age And Sex

Abstract Background Diabetes has strongly been linked to atrial fibrillation, ischaemic heart disease and heart failure. The epidemiology of these cardiovascular diseases is changing, however, due to changes in prevalence of obesity-related conditions and preventive measures. Recent population studies on incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes are needed. Methods A dynamic longitudinal cohort study was performed using primary care databases of the Julius General Practitioners’ Network. Diabetes status was determined at baseline (1 January 2014 or upon entering the cohort) and participants were followed-up for atrial fibrillation, ischaemic heart disease and heart failure until 1 February 2019. Age and sex-specific incidence and incidence rate ratios were calculated. Results Mean follow-up was 4.2 years, 12,168 patients were included in the diabetes group, and 130,143 individuals in the background group. Incidence rate ratios, adjusted for age and sex, were 1.17 (95% confidence interval 1.06–1.30) for atrial fibrillation, 1.66 (1.55–1.83) for ischaemic heart disease, and 2.36 (2.10–2.64) for heart failure. Overall, incidence rate ratios were highest in the younger age categories, converging thereafter. Conclusion There is a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably with heart failure with a more than twice increased risk.

Impaired HDL Function Predicts Subclinical Myocardial Necrosis in Patients at Risk of Developing Heart Failure

2011 ◽  
Vol 17 (8) ◽  
pp. S24
Author(s):  
Zhili Shao ◽  
Yuping Wu ◽  
Yi Lu ◽  
Stanley L. Hazen ◽  
W.H. Wilson Tang
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Myocardial Necrosis ◽  
Hdl Function ◽  
Developing Heart ◽  
Patients At Risk

The prevalence and clinical associations of ultrasound measures of congestion in patients at risk of developing heart failure

2021 ◽  
Author(s):  
Joseph J. Cuthbert ◽  
Pierpaolo Pellicori ◽  
Rachel Flockton ◽  
Anna Kallvikbacka‐Bennett ◽  
Javed Khan ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Developing Heart ◽  
Patients At Risk ◽  
Clinical Associations

A multiparametric ICD algorithm for heart failure risk stratification and management: an analysis in clinical practice

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
L Calo" ◽  
V Bianchi ◽  
D Ferraioli ◽  
L Santini ◽  
A Dello Russo ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Clinical Practice ◽  
Risk Stratification ◽  
Management Strategies ◽  
Cardiac Resynchronization ◽  
Office Visits ◽  
Increased Risk ◽  
Patients At Risk ◽  
Observation Period

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The HeartLogic algorithm combines multiple implantable cardioverter defibrillator (ICD) sensors to identify patients at risk of heart failure (HF) events. Purpose We sought to evaluate the risk stratification ability of this algorithm in clinical practice. We also analyzed the alert management strategies adopted in the study group and their association with the occurrence of HF events. Methods The HeartLogic feature was activated in 366 ICD and cardiac resynchronization therapy ICD patients at 22 centers. The HeartLogic algorithm automatically calculates a daily HF index and identifies periods IN or OUT of an alert state on the basis of a configurable threshold (in this analysis set to 16). Results The HeartLogic index crossed the threshold value 273 times (0.76 alerts/patient-year) in 150 patients over a median follow-up of 11 months [25-75 percentile: 6-16]. Overall, the time IN the alert state was 11% of the total observation period. Patients experienced 36 HF hospitalizations and 8 patients died of HF (rate: 0.12 events/patient-year) during the observation period. Thirty-five events were associated with the IN alert state (0.92 events/patient-year versus 0.03 events/patient-year in the OUT of alert state). The hazard ratio in the IN/OUT of alert state comparison was (HR: 24.53, 95% CI: 8.55-70.38, p < 0.001), after adjustment for baseline clinical confounders. Alerts followed by clinical actions were associated with a lower rate of HF events (HR: 0.37, 95% CI: 0.14-0.99, p = 0.047). No differences in event rates were observed between in-office and remote alert management. By contrast, verification of HF symptoms during post-alert examination was associated with a higher risk of HF events (HR: 5.23, 95% CI: 1.98-13.83, p < 0.001). Conclusions This multiparametric ICD algorithm identifies patients during periods of significantly increased risk of HF events. The rate of HF events seemed lower when clinical actions were undertaken in response to alerts. Extra in-office visits did not seem to be required in order to effectively manage HeartLogic alerts, while post-alert verification of symptoms seemed useful in order to better stratify patients at risk of HF events.

scholarly journals Gender Effect on the Relation between Diabetes and Hospitalization for Heart Failure

2011 ◽  
Vol 120 (01) ◽  
pp. 51-55 ◽  
Author(s):  
C. Seghieri ◽  
P. Francesconi ◽  
S. Cipriani ◽  
M. Rapanà ◽  
R. Anichini ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Medical Records ◽  
Gender Effect ◽  
Diabetic Patients ◽  
Male And Female ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
The One ◽  
Number Of Individuals

AbstractCardiovascular risk among diabetic patients is at least twice as much the one for non-diabetic individuals and even greater when diabetic women are considered. Heart failure (HF) is a common unfavorable outcome of cardiovascular disease in diabetes. However, since the comparison among sexes of heart failure prevalence in diabetic patients remains limited, this study is aimed at expanding the information about this point.We have evaluated the association between diabetes and HF by reviewing the medical records of all subjects discharged from the Internal Medicine and Cardiology Units of all hospitals in the Tuscany region, Italy, during the period January 2002 through December 2008. In particular we sought concomitance of ICD-9-CM codes for diabetes and HF.Patients discharged by Internal Medicine were on average older, more represented by women, and had a lesser number of individuals coded as diabetic (p<0.05 for all). Relative risk for HF (95% CI) was significantly higher in patients with diabetes, irrespective of gender 1.39 (1.36–1.41) in males; 1.40 (1.37–1.42) in females. When the diabetes-HF association was analyzed according to decades of age, a “horse-shoe” pattern was apparent with an increased risk in 40–59 years old in female patients discharged by Internal Medicine.Although there is not a difference in the overall HF risk between hospitalized male and female diabetic patients, women have an excess risk at perimenopausal age.

scholarly journals Inflammation and neurohormonal activation is increased at hospital admission in patients with ST-elevation myocardial infarction with diabetes compared to non-diabetic patients

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
JB Kunkel ◽  
C Hassager ◽  
JE Moeller ◽  
L Holmvang ◽  
LO Jensen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Admission ◽  
Plasma Concentrations ◽  
Diabetic Patients ◽  
Neurohormonal Activation ◽  
Funding Sources ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
St Elevation ◽  
Poor Outcomes

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Rigshospitalets Forskningsfond. The Lundbeck Foundation. Background Patients with diabetes have an increased risk of coronary artery disease (CAD). In patients with myocardial infarction (MI), diabetes is associated with a poor outcome. Inflammation and neurohormonal activation have previously been shown to be associated with poor outcomes in patients with ST-elevation MI (STEMI). We therefore sought to assess whether STEMI-patients with diabetes (DM) had increased levels of inflammation and neurohormonal activation upon hospital admission. Methods In 1892 consecutive STEMI-patients from two danish tertiary heart centres, biomarkers reflecting neurohormonal activation (pro-atrial natriuretic peptide (proANP) and mid-regional pro-adrenomedullin (MRproADM)) and inflammation (soluble suppression of tumorigenicity 2 (sST2) and C-reactive peptide (CRP)) were measured upon admission before angiography. Patients were stratified according to DM or not. Results In total, 245 (13%) patients had DM. DM patients were older (mean (SD) 66 (11) vs 63 (13) years old, p = 0.0002), had more comorbidities (hypertension, previous stroke/TIA, ischemic heart disease (IHD), chronic kidney dysfunction (CKD)), and higher body mass index (BMI). In addition, DM patients had a longer time from symptom debut to angiography and more often multivessel disease (MVD). We found no difference in admission troponin plasma concentrations. Upon hospital admission, DM patients had higher concentrations of MRproADM (median (IQR) 0.88 (0.64-1.20) vs. 0.71 (0.58-0.90) nmol/L, p &lt; 0.0001), sST2 (41 (64-31) vs. 39 (55-28) ng/ml, p = 0.01), and CRP (4.5 (1.9-12.1) vs. 3.4 (1.4-8.3) mg/L, p = 0.001) but not proANP (figure). When adjusted for age, BMI, CKD, IHD, time from symptom debut to angiography, and MVD, DM remained associated with increased MRproADM (OR (95% CI) 1.35 (1.05; 1.74), p = 0.02) and sST2 (1.20 (1.02; 1.41), p = 0.03), but no longer with CRP. Patients with DM had a higher one-year all-cause mortality rate (12% vs. 9.4%, p = 0.03). Conclusion STEMI patients with diabetes have increased neurohormonal activation and inflammation at hospital admission compared to patients without diabetes. This may play a role in the increased mortality in STEMI patients with diabetes. Abstract Figure.

Sign in / Sign up

Export Citation Format

Share Document