Pub Date : 2024-11-19DOI: 10.1007/s11897-024-00689-3
Silvio N Augusto, Abhilash Suresh, W H Wilson Tang
Purpose of review: Ceramides are lipid species that play several physiological roles in the body, including stress response, inflammation, and apoptosis, and their involvement in lipid metabolism and energy production makes them crucial in the pathophysiology of heart failure (HF).
Recent findings: Several species of ceramides and ceramide signatures have recently been investigated as possible biomarkers of cardiovascular disease (CVD), and risk scores have demonstrated prognostic value in stratifying patients by risk and possibly predicting adverse cardiac events. With growing interest in targeting metabolic dysfunction, understanding the role of ceramides in CVD also opens the possibility of novel therapeutics that target ceramide metabolism to improve cardiac function and cardiac outcomes in patients. Understanding the role of ceramides in CVD opens the possibility of novel diagnostics and theragnostic targeting ceramide metabolism to improve cardiac function and cardiac outcomes in patients with heart failure.
{"title":"Ceramides as Biomarkers of Cardiovascular Diseases and Heart Failure.","authors":"Silvio N Augusto, Abhilash Suresh, W H Wilson Tang","doi":"10.1007/s11897-024-00689-3","DOIUrl":"10.1007/s11897-024-00689-3","url":null,"abstract":"<p><strong>Purpose of review: </strong> Ceramides are lipid species that play several physiological roles in the body, including stress response, inflammation, and apoptosis, and their involvement in lipid metabolism and energy production makes them crucial in the pathophysiology of heart failure (HF).</p><p><strong>Recent findings: </strong> Several species of ceramides and ceramide signatures have recently been investigated as possible biomarkers of cardiovascular disease (CVD), and risk scores have demonstrated prognostic value in stratifying patients by risk and possibly predicting adverse cardiac events. With growing interest in targeting metabolic dysfunction, understanding the role of ceramides in CVD also opens the possibility of novel therapeutics that target ceramide metabolism to improve cardiac function and cardiac outcomes in patients. Understanding the role of ceramides in CVD opens the possibility of novel diagnostics and theragnostic targeting ceramide metabolism to improve cardiac function and cardiac outcomes in patients with heart failure.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"22 1","pages":"2"},"PeriodicalIF":3.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1007/s11897-024-00690-w
Vince J Catalfamo, Austin W Tutor, Adrienne Koos, Ankit Vyas, Carl J Lavie, Salvatore Carbone
Purpose of review: Since the turn of the millennium, obesity has been on the rise worldwide, and particularly so throughout the United States. Even more concerning is the rate at which persons with severe obesity continue to trend upwards. Given the detrimental effects of obesity on cardiac structure and function, it is not surprising that obesity stands as one of the leading risk factors for developing heart failure (HF). This state-of-the-art article aims to review the updated literature on the obesity paradox to help further understand its relationship to body composition, weight loss, fitness, and exercise.
Recent findings: An intriguing phenomenon appears to exist in which obesity is associated with a better prognosis in those with HF, compared to patients with lesser body mass. Recent studies suggest, however, that weight loss induced by pharmacologic strategies might be beneficial in patients with HF with preserved ejection fraction. Despite the presence of an obesity paradox, recent data suggest that obesity could be targeted in HF, however, long-term data are currently lacking. Consequently, definitive guidelines for managing obesity, and specifically the body composition of these patients, remain amiss.
{"title":"Obesity, Metabolic Syndrome, and Obesity Paradox in Heart Failure: A Critical Evaluation.","authors":"Vince J Catalfamo, Austin W Tutor, Adrienne Koos, Ankit Vyas, Carl J Lavie, Salvatore Carbone","doi":"10.1007/s11897-024-00690-w","DOIUrl":"10.1007/s11897-024-00690-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>Since the turn of the millennium, obesity has been on the rise worldwide, and particularly so throughout the United States. Even more concerning is the rate at which persons with severe obesity continue to trend upwards. Given the detrimental effects of obesity on cardiac structure and function, it is not surprising that obesity stands as one of the leading risk factors for developing heart failure (HF). This state-of-the-art article aims to review the updated literature on the obesity paradox to help further understand its relationship to body composition, weight loss, fitness, and exercise.</p><p><strong>Recent findings: </strong>An intriguing phenomenon appears to exist in which obesity is associated with a better prognosis in those with HF, compared to patients with lesser body mass. Recent studies suggest, however, that weight loss induced by pharmacologic strategies might be beneficial in patients with HF with preserved ejection fraction. Despite the presence of an obesity paradox, recent data suggest that obesity could be targeted in HF, however, long-term data are currently lacking. Consequently, definitive guidelines for managing obesity, and specifically the body composition of these patients, remain amiss.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":"22 1","pages":"1"},"PeriodicalIF":3.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-07-23DOI: 10.1007/s11897-024-00677-7
Juan Simon Rico-Mesa, Justin Haloot, B K Anupama, Suman Atluri, Jing Liu, Umair Khalid
Purpose of review: This review examines the pathophysiological interactions between COVID-19 and heart failure, highlighting the exacerbation of heart failure in COVID-19 patients. It focuses on the complex mechanisms driving worse outcomes in these patients.
Recent findings: Patients with pre-existing heart failure experience more severe symptoms and higher mortality rates due to mechanisms such as cytokine storms, myocardial infarction, myocarditis, microvascular dysfunction, thrombosis, and stress cardiomyopathy. Elevated biomarkers like troponin and natriuretic peptides correlate with severe disease. Long-term cardiovascular risks for COVID-19 survivors include increased incidence of heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock. COVID-19 significantly impacts patients with pre-existing heart failure, leading to severe symptoms and higher mortality. Elevated cardiac biomarkers are indicators of severe disease. Acute and long-term cardiovascular complications are common, calling for ongoing research into targeted therapies and improved management strategies to better prevent, diagnose, and treat heart failure in the context of COVID-19.
{"title":"The Role and Implications of COVID-19 in Incident and Prevalent Heart Failure.","authors":"Juan Simon Rico-Mesa, Justin Haloot, B K Anupama, Suman Atluri, Jing Liu, Umair Khalid","doi":"10.1007/s11897-024-00677-7","DOIUrl":"10.1007/s11897-024-00677-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines the pathophysiological interactions between COVID-19 and heart failure, highlighting the exacerbation of heart failure in COVID-19 patients. It focuses on the complex mechanisms driving worse outcomes in these patients.</p><p><strong>Recent findings: </strong>Patients with pre-existing heart failure experience more severe symptoms and higher mortality rates due to mechanisms such as cytokine storms, myocardial infarction, myocarditis, microvascular dysfunction, thrombosis, and stress cardiomyopathy. Elevated biomarkers like troponin and natriuretic peptides correlate with severe disease. Long-term cardiovascular risks for COVID-19 survivors include increased incidence of heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock. COVID-19 significantly impacts patients with pre-existing heart failure, leading to severe symptoms and higher mortality. Elevated cardiac biomarkers are indicators of severe disease. Acute and long-term cardiovascular complications are common, calling for ongoing research into targeted therapies and improved management strategies to better prevent, diagnose, and treat heart failure in the context of COVID-19.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":" ","pages":"485-497"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-09-03DOI: 10.1007/s11897-024-00679-5
Chayakrit Krittanawong, William Michael Britt, Affan Rizwan, Rehma Siddiqui, Muzamil Khawaja, Rabisa Khan, Pouya Joolharzadeh, Noah Newman, Mario Rodriguez Rivera, W H Wilson Tang
Purpose of review: To review the most recent clinical trials and data regarding epidemiology, pathophysiology, diagnosis, and treatment of heart failure with preserved ejection fraction with an emphasis on the recent trends in cardiometabolic interventions.
Recent findings: Heart failure with preserved ejection fraction makes up approximately half of overall heart failure and is associated with significant morbidity, mortality, and overall burden on the healthcare system. It is a complex, heterogenous syndrome and clinical trials, to this point, have not revealed quite as many effective treatment options when compared to heart failure with reduced ejection fraction. Nevertheless, there is an expanding amount of data insight into the pathogenesis of this disease and the potential for newer therapies and management strategies. Heart failure with preserved ejection fraction pathology has been found to be linked to abnormal energetics, myocyte hypertrophy, cell signaling, inflammation, ischemia, and fibrosis. These mechanisms also intricately overlap with the significant comorbidities often associated with heart failure with preserved ejection fraction including, but not limited to, atrial fibrillation, chronic kidney disease, hypertension, obesity and coronary artery disease. Treatment of this disease, therefore, should focus on the management and strict regulation of these comorbidities by pharmacologic and nonpharmacologic means. In this review, a clinical update is provided reviewing the most recent clinical trials and data regarding epidemiology, pathophysiology, diagnosis, and treatment of heart failure with preserved ejection fraction with an emphasis on the recent trend in cardiometabolic interventions.
{"title":"Clinical Update in Heart Failure with Preserved Ejection Fraction.","authors":"Chayakrit Krittanawong, William Michael Britt, Affan Rizwan, Rehma Siddiqui, Muzamil Khawaja, Rabisa Khan, Pouya Joolharzadeh, Noah Newman, Mario Rodriguez Rivera, W H Wilson Tang","doi":"10.1007/s11897-024-00679-5","DOIUrl":"10.1007/s11897-024-00679-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review the most recent clinical trials and data regarding epidemiology, pathophysiology, diagnosis, and treatment of heart failure with preserved ejection fraction with an emphasis on the recent trends in cardiometabolic interventions.</p><p><strong>Recent findings: </strong>Heart failure with preserved ejection fraction makes up approximately half of overall heart failure and is associated with significant morbidity, mortality, and overall burden on the healthcare system. It is a complex, heterogenous syndrome and clinical trials, to this point, have not revealed quite as many effective treatment options when compared to heart failure with reduced ejection fraction. Nevertheless, there is an expanding amount of data insight into the pathogenesis of this disease and the potential for newer therapies and management strategies. Heart failure with preserved ejection fraction pathology has been found to be linked to abnormal energetics, myocyte hypertrophy, cell signaling, inflammation, ischemia, and fibrosis. These mechanisms also intricately overlap with the significant comorbidities often associated with heart failure with preserved ejection fraction including, but not limited to, atrial fibrillation, chronic kidney disease, hypertension, obesity and coronary artery disease. Treatment of this disease, therefore, should focus on the management and strict regulation of these comorbidities by pharmacologic and nonpharmacologic means. In this review, a clinical update is provided reviewing the most recent clinical trials and data regarding epidemiology, pathophysiology, diagnosis, and treatment of heart failure with preserved ejection fraction with an emphasis on the recent trend in cardiometabolic interventions.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":" ","pages":"461-484"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-09-07DOI: 10.1007/s11897-024-00678-6
Michael W Foster, Joshua M Riley, Praneet C Kaki, Amine Al Soueidy, Ehson Aligholiazadeh, J Eduardo Rame
Purpose of review: The development and progression of heart failure is characterized by metabolic and physiologic adaptations allowing patients to cope with cardiac insufficiency. This review explores the changes in metabolism in heart failure and the potential role of biomarkers, particularly ketone bodies, in staging and prognosticating heart failure progression.
Recent findings: Recent insights into myocardial metabolism shed light on the heart's response to stress, highlighting the shift towards reliance on ketone bodies as an alternative fuel source. Elevated blood ketone levels have been shown to correlate with the severity of cardiac dysfunction, emphasizing their potential as prognostic indicators. Furthermore, studies exploring therapeutic interventions targeting specific metabolic pathways offer promise for improving outcomes in heart failure. Ketones have prognostic utility in heart failure, and potentially, an avenue for therapeutic intervention. Challenges remain in deciphering the optimal balance between metabolic support and exacerbating cardiac remodeling. Future research endeavors must address these complexities to advance personalized approaches in managing heart failure.
{"title":"Metabolic Adaptation in Heart Failure and the Role of Ketone Bodies as Biomarkers.","authors":"Michael W Foster, Joshua M Riley, Praneet C Kaki, Amine Al Soueidy, Ehson Aligholiazadeh, J Eduardo Rame","doi":"10.1007/s11897-024-00678-6","DOIUrl":"10.1007/s11897-024-00678-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>The development and progression of heart failure is characterized by metabolic and physiologic adaptations allowing patients to cope with cardiac insufficiency. This review explores the changes in metabolism in heart failure and the potential role of biomarkers, particularly ketone bodies, in staging and prognosticating heart failure progression.</p><p><strong>Recent findings: </strong>Recent insights into myocardial metabolism shed light on the heart's response to stress, highlighting the shift towards reliance on ketone bodies as an alternative fuel source. Elevated blood ketone levels have been shown to correlate with the severity of cardiac dysfunction, emphasizing their potential as prognostic indicators. Furthermore, studies exploring therapeutic interventions targeting specific metabolic pathways offer promise for improving outcomes in heart failure. Ketones have prognostic utility in heart failure, and potentially, an avenue for therapeutic intervention. Challenges remain in deciphering the optimal balance between metabolic support and exacerbating cardiac remodeling. Future research endeavors must address these complexities to advance personalized approaches in managing heart failure.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":" ","pages":"498-503"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-05-29DOI: 10.1007/s11897-024-00669-7
Julia Vogel, Alexander Carpinteiro, Peter Luedike, Florian Buehning, Simon Wernhart, Tienush Rassaf, Lars Michel
Purpose of review: Cardiac amyloidosis (CA) is a condition characterized by misfolding and extracellular deposition of proteins, leading to organ dysfunction. While numerous forms of CA exist, two subtypes dominate clinical prevalence: Transthyretin amyloid (ATTR) and immunoglobulin light chain amyloid.
Recent findings: The current scientific landscape reflects the urgency to advance therapeutic interventions with over 100 ongoing clinical trials. Heart failure treatment is affected by CA phenotype with poor tolerance of otherwise frequently used medications. Treating comorbidities including atrial fibrillation and valvular disease remains a challenge in CA, driven by technical difficulties and uncertain outcomes. Tafamidis is the first ATTR-stabilizer approved with a rapidly growing rate of clinical use. In parallel, various new therapeutic classes are in late-stage clinical trials including silencers, antibodies and genetic therapy. Managing CA is a critical challenge for future heart failure care. This review delineates the current standard-of-care and scientific landscape of CA therapy.
综述的目的:心脏淀粉样变性(CA)是一种以蛋白质错误折叠和细胞外沉积为特征的疾病,可导致器官功能障碍。虽然存在多种形式的 CA,但有两种亚型在临床流行中占主导地位:最近的发现:目前的科学现状反映了推进治疗干预的紧迫性,有 100 多项临床试验正在进行中。心力衰竭的治疗受到 CA 表型的影响,患者对其他常用药物的耐受性较差。治疗合并症(包括心房颤动和瓣膜病)仍是CA的一项挑战,原因是技术困难和结果不确定。Tafamidis 是首个获得批准的 ATTR 稳定剂,其临床使用率正在快速增长。与此同时,各种新的治疗类别也已进入后期临床试验阶段,包括沉默剂、抗体和基因疗法。管理 CA 是未来心衰治疗的关键挑战。本综述描述了当前 CA 治疗的护理标准和科学前景。
{"title":"Current Therapies and Future Horizons in Cardiac Amyloidosis Treatment.","authors":"Julia Vogel, Alexander Carpinteiro, Peter Luedike, Florian Buehning, Simon Wernhart, Tienush Rassaf, Lars Michel","doi":"10.1007/s11897-024-00669-7","DOIUrl":"10.1007/s11897-024-00669-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiac amyloidosis (CA) is a condition characterized by misfolding and extracellular deposition of proteins, leading to organ dysfunction. While numerous forms of CA exist, two subtypes dominate clinical prevalence: Transthyretin amyloid (ATTR) and immunoglobulin light chain amyloid.</p><p><strong>Recent findings: </strong>The current scientific landscape reflects the urgency to advance therapeutic interventions with over 100 ongoing clinical trials. Heart failure treatment is affected by CA phenotype with poor tolerance of otherwise frequently used medications. Treating comorbidities including atrial fibrillation and valvular disease remains a challenge in CA, driven by technical difficulties and uncertain outcomes. Tafamidis is the first ATTR-stabilizer approved with a rapidly growing rate of clinical use. In parallel, various new therapeutic classes are in late-stage clinical trials including silencers, antibodies and genetic therapy. Managing CA is a critical challenge for future heart failure care. This review delineates the current standard-of-care and scientific landscape of CA therapy.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":" ","pages":"305-321"},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141160288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-05-03DOI: 10.1007/s11897-024-00666-w
Sara Álvarez-Zaballos, Manuel Martínez-Sellés
Purpose of review: Heart failure (HF) is a complex clinical syndrome with a growing global health burden. This review explores the intersection of HF, diabetes mellitus, and sex, highlighting epidemiological patterns, pathophysiological mechanisms, and treatment implications.
Recent findings: Despite similar HF prevalence in men and women, diabetes mellitus (DM) appears to exert a more pronounced impact on HF outcomes in women. Pathophysiological differences involve cardiovascular risk factors, severe left ventricular dysfunction, and coronary artery disease, as well as hormonal influences and inflammatory markers. Diabetic cardiomyopathy introduces a sex-specific challenge, with women experiencing common adverse outcomes related to increased fibrosis and myocardial remodeling. Treatment strategies, particularly sodium-glucose cotransporter 2 inhibitors, exhibit cardiovascular benefits, but their response may differ in women. The link between HF and DM is bidirectional, with diabetes significantly increasing the risk of HF, and vice versa. Additionally, the impact of diabetes on mortality appears more pronounced in women than in men, leading to a modification of the traditional gender gap observed in HF outcomes. A personalized approach is crucial, and further research to improve outcomes in the complex interplay of HF, diabetes, and sex is needed.
{"title":"Impact of Sex and Diabetes in Patients with Heart Failure.","authors":"Sara Álvarez-Zaballos, Manuel Martínez-Sellés","doi":"10.1007/s11897-024-00666-w","DOIUrl":"10.1007/s11897-024-00666-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>Heart failure (HF) is a complex clinical syndrome with a growing global health burden. This review explores the intersection of HF, diabetes mellitus, and sex, highlighting epidemiological patterns, pathophysiological mechanisms, and treatment implications.</p><p><strong>Recent findings: </strong>Despite similar HF prevalence in men and women, diabetes mellitus (DM) appears to exert a more pronounced impact on HF outcomes in women. Pathophysiological differences involve cardiovascular risk factors, severe left ventricular dysfunction, and coronary artery disease, as well as hormonal influences and inflammatory markers. Diabetic cardiomyopathy introduces a sex-specific challenge, with women experiencing common adverse outcomes related to increased fibrosis and myocardial remodeling. Treatment strategies, particularly sodium-glucose cotransporter 2 inhibitors, exhibit cardiovascular benefits, but their response may differ in women. The link between HF and DM is bidirectional, with diabetes significantly increasing the risk of HF, and vice versa. Additionally, the impact of diabetes on mortality appears more pronounced in women than in men, leading to a modification of the traditional gender gap observed in HF outcomes. A personalized approach is crucial, and further research to improve outcomes in the complex interplay of HF, diabetes, and sex is needed.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":" ","pages":"389-395"},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-03DOI: 10.1007/s11897-024-00673-x
Rocío Del Pilar Falcón Fleytas, Osmar Antonio Centurión, Javier Galeano Figueredo, Hugo González Saldivar, Jorge E Martínez
Purpose of review: Heart failure (HF) represents a pathology in constant growth, but, despite the fact that a significant proportion of its population is comprised of elderly patients, they are not adequately represented in clinical trials or registries. They constitute a heterogeneous population with their particularities and interaction of the multiple comorbidities that characterize this age group, which makes the clinical course, prognosis and outcomes of the disease different.
Recent findings: Compared to men, women with HF tend to be older, with a greater burden of non-cardiovascular comorbidities, less ischemic heart disease and preserved ventricular function in most cases. This fact translates into worse self-perceived quality of life, with lower hospitalization and mortality rates. Moreover, paradoxically, women are less likely to receive treatment recommended by clinical practice guidelines, including revascularization and device placement. As there are not enough representative studies of this population, the reasons for these results with better prognosis and relatively benign impact in the elderly female population are unknown, which is why it is necessary to continue with research in order to obtain greater evidence of the exposed gaps.
{"title":"Profile and Prognostic Impact of Multimorbidity in Elderly Patients with Heart Failure: Are there Differences between Men and Women?","authors":"Rocío Del Pilar Falcón Fleytas, Osmar Antonio Centurión, Javier Galeano Figueredo, Hugo González Saldivar, Jorge E Martínez","doi":"10.1007/s11897-024-00673-x","DOIUrl":"10.1007/s11897-024-00673-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>Heart failure (HF) represents a pathology in constant growth, but, despite the fact that a significant proportion of its population is comprised of elderly patients, they are not adequately represented in clinical trials or registries. They constitute a heterogeneous population with their particularities and interaction of the multiple comorbidities that characterize this age group, which makes the clinical course, prognosis and outcomes of the disease different.</p><p><strong>Recent findings: </strong>Compared to men, women with HF tend to be older, with a greater burden of non-cardiovascular comorbidities, less ischemic heart disease and preserved ventricular function in most cases. This fact translates into worse self-perceived quality of life, with lower hospitalization and mortality rates. Moreover, paradoxically, women are less likely to receive treatment recommended by clinical practice guidelines, including revascularization and device placement. As there are not enough representative studies of this population, the reasons for these results with better prognosis and relatively benign impact in the elderly female population are unknown, which is why it is necessary to continue with research in order to obtain greater evidence of the exposed gaps.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":" ","pages":"337-343"},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-05-22DOI: 10.1007/s11897-024-00667-9
Silvia Vilches, María Martínez-Avial, Irene Méndez, Cristina Gómez González, María Ángeles Espinosa
Transthyretin cardiac amyloidosis (ATTR-CA) is characterised by the deposition of transthyretin amyloid fibrils in the heart. ATTR-CA affects both men and women although there is evidence of sex differences in prevalence and clinical presentation. PURPOSE OF REVIEW: This review paper aims to comprehensively examine and synthesise the existing literature on sex differences in ATTR-CA. RECENT FINDINGS: The prevalence of ATTR-CA is higher in males although the male predominance is more apparent in older patients in the wild type form and in TTR genetic variants that predominantly result in a cardiac phenotype in the hereditary variant. Women tend to have less left ventricular hypertrophy (LVH) and a higher ejection fraction at clinical presentation which may contribute to a later diagnosis although the prognosis appears to be similar in both sexes. Female sex is a predictor of a good response to tafamidis 20 mg in TTR polyneuropathy but otherwise there are no data on sex differences in the efficacy of other treatments for ATTR-CA. It is crucial to define specific sex differences in ATTR-CA. A lower cut-off value for LVH in women may be needed to improve diagnosis. It is necessary to increase female representation in clinical trials to better understand possible sex differences in therapeutic management.
{"title":"Sex Differences in Transthyretin Cardiac Amyloidosis: Unraveling the Complexities in Epidemiology, Pathophysiology, Diagnosis, and Treatment.","authors":"Silvia Vilches, María Martínez-Avial, Irene Méndez, Cristina Gómez González, María Ángeles Espinosa","doi":"10.1007/s11897-024-00667-9","DOIUrl":"10.1007/s11897-024-00667-9","url":null,"abstract":"<p><p>Transthyretin cardiac amyloidosis (ATTR-CA) is characterised by the deposition of transthyretin amyloid fibrils in the heart. ATTR-CA affects both men and women although there is evidence of sex differences in prevalence and clinical presentation. PURPOSE OF REVIEW: This review paper aims to comprehensively examine and synthesise the existing literature on sex differences in ATTR-CA. RECENT FINDINGS: The prevalence of ATTR-CA is higher in males although the male predominance is more apparent in older patients in the wild type form and in TTR genetic variants that predominantly result in a cardiac phenotype in the hereditary variant. Women tend to have less left ventricular hypertrophy (LVH) and a higher ejection fraction at clinical presentation which may contribute to a later diagnosis although the prognosis appears to be similar in both sexes. Female sex is a predictor of a good response to tafamidis 20 mg in TTR polyneuropathy but otherwise there are no data on sex differences in the efficacy of other treatments for ATTR-CA. It is crucial to define specific sex differences in ATTR-CA. A lower cut-off value for LVH in women may be needed to improve diagnosis. It is necessary to increase female representation in clinical trials to better understand possible sex differences in therapeutic management.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":" ","pages":"344-353"},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-06-11DOI: 10.1007/s11897-024-00672-y
Simeng Li, Isabella Tan, Emily Atkins, Aletta E Schutte, Sonali R Gnanenthiran
Purpose of review: We summarise the physiological changes and risk factors for hypertension in females, potential sex-specific management approaches, and long-term prognosis.
Key findings: Pregnancy and menopause are two key phases of the life cycle where females undergo significant biological and physical changes, making them more prone to developing hypertension. Gestational hypertension occurs from changes in maternal cardiac output, kidney function, metabolism, or placental vasculature, with one in ten experiencing pregnancy complications such as intrauterine growth restriction and delivery complications such as premature birth. Post-menopausal hypertension occurs as the protective effects of oestrogen are reduced and the sympathetic nervous system becomes over-activated with ageing. Increasing evidence suggests that post-menopausal females with high blood pressure (BP) experience greater risk of cardiovascular events at lower BP thresholds, and greater vulnerability to treatment-related adverse effects. Hypertension is a key risk factor for cardiovascular disease in females. Current BP treatment guidelines and recommendations are similar for both sexes, without addressing sex-specific factors. Future investigations into ideal diagnostic thresholds, BP control targets and treatment regimens in females are needed.
{"title":"The Pathophysiology, Prognosis and Treatment of Hypertension in Females from Pregnancy to Post-menopause: A Review.","authors":"Simeng Li, Isabella Tan, Emily Atkins, Aletta E Schutte, Sonali R Gnanenthiran","doi":"10.1007/s11897-024-00672-y","DOIUrl":"10.1007/s11897-024-00672-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>We summarise the physiological changes and risk factors for hypertension in females, potential sex-specific management approaches, and long-term prognosis.</p><p><strong>Key findings: </strong>Pregnancy and menopause are two key phases of the life cycle where females undergo significant biological and physical changes, making them more prone to developing hypertension. Gestational hypertension occurs from changes in maternal cardiac output, kidney function, metabolism, or placental vasculature, with one in ten experiencing pregnancy complications such as intrauterine growth restriction and delivery complications such as premature birth. Post-menopausal hypertension occurs as the protective effects of oestrogen are reduced and the sympathetic nervous system becomes over-activated with ageing. Increasing evidence suggests that post-menopausal females with high blood pressure (BP) experience greater risk of cardiovascular events at lower BP thresholds, and greater vulnerability to treatment-related adverse effects. Hypertension is a key risk factor for cardiovascular disease in females. Current BP treatment guidelines and recommendations are similar for both sexes, without addressing sex-specific factors. Future investigations into ideal diagnostic thresholds, BP control targets and treatment regimens in females are needed.</p>","PeriodicalId":10830,"journal":{"name":"Current Heart Failure Reports","volume":" ","pages":"322-336"},"PeriodicalIF":3.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}