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Ceramides as Biomarkers of Cardiovascular Diseases and Heart Failure. 神经酰胺作为心血管疾病和心力衰竭的生物标志物。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-19 DOI: 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.

综述的目的: 神经酰胺是在体内发挥多种生理作用的脂质种类,包括应激反应、炎症和细胞凋亡,它们参与脂质代谢和能量产生,因此在心力衰竭(HF)的病理生理学中至关重要: 最近的研究结果表明,几种神经酰胺和神经酰胺特征可作为心血管疾病(CVD)的生物标志物,而风险评分在对患者进行风险分层和预测不良心脏事件方面具有预后价值。随着人们对靶向代谢功能障碍的兴趣与日俱增,了解神经酰胺在心血管疾病中的作用也为靶向神经酰胺代谢的新型疗法提供了可能性,从而改善患者的心脏功能和心脏预后。 了解神经酰胺在心血管疾病中的作用,就有可能开发出针对神经酰胺代谢的新型诊断和治疗方法,从而改善心衰患者的心脏功能和心脏预后。
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引用次数: 0
Obesity, Metabolic Syndrome, and Obesity Paradox in Heart Failure: A Critical Evaluation. 肥胖、代谢综合征和心力衰竭的肥胖悖论:批判性评估。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-15 DOI: 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.

审查目的:进入新千年以来,肥胖症在全球范围内呈上升趋势,在美国尤其如此。更令人担忧的是,重度肥胖者的比例继续呈上升趋势。鉴于肥胖对心脏结构和功能的不利影响,肥胖成为心力衰竭(HF)的主要危险因素之一也就不足为奇了。这篇最新文章旨在回顾有关肥胖悖论的最新文献,以帮助进一步了解肥胖悖论与身体成分、减肥、健身和运动的关系:与体重较轻的患者相比,肥胖与心房颤动患者较好的预后有关,这似乎是一个耐人寻味的现象。但最近的研究表明,通过药物治疗减轻体重可能对射血分数保留的心房颤动患者有益。尽管存在肥胖悖论,但最近的数据表明,肥胖可以成为心房颤动患者的治疗目标,然而目前还缺乏长期数据。因此,管理肥胖症,特别是管理这些患者身体成分的明确指南仍然缺失。
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引用次数: 0
The Role and Implications of COVID-19 in Incident and Prevalent Heart Failure. COVID-19 在心力衰竭发病率和流行率中的作用和意义。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 Epub Date: 2024-07-23 DOI: 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.

综述目的:本综述探讨了 COVID-19 与心力衰竭之间的病理生理学相互作用,强调了 COVID-19 患者心力衰竭的加重。研究重点是导致这些患者预后恶化的复杂机制:最新研究结果:由于细胞因子风暴、心肌梗塞、心肌炎、微血管功能障碍、血栓形成和应激性心肌病等机制,原有心衰的患者会出现更严重的症状和更高的死亡率。肌钙蛋白和钠尿肽等生物标志物的升高与病情严重有关。COVID-19 存活者的长期心血管风险包括心力衰竭、非缺血性心肌病、心脏骤停和心源性休克的发病率增加。COVID-19 对原有心力衰竭的患者影响很大,会导致严重的症状和更高的死亡率。心脏生物标志物升高是病情严重的指标。急性和长期心血管并发症很常见,因此需要不断研究靶向疗法和改进管理策略,以便在 COVID-19 的背景下更好地预防、诊断和治疗心力衰竭。
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引用次数: 0
Clinical Update in Heart Failure with Preserved Ejection Fraction. 射血分数保留型心力衰竭的临床最新进展。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 Epub Date: 2024-09-03 DOI: 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.

综述目的:回顾有关射血分数保留型心力衰竭的流行病学、病理生理学、诊断和治疗的最新临床试验和数据,重点关注心脏代谢干预的最新趋势:射血分数保留型心力衰竭约占整个心力衰竭的一半,与严重的发病率、死亡率和医疗系统的总体负担有关。这是一种复杂的异质性综合征,与射血分数减低的心力衰竭相比,目前的临床试验还没有发现多少有效的治疗方案。然而,越来越多的数据显示,人们对这种疾病的发病机制以及更新的疗法和管理策略的潜力有了深入的了解。研究发现,射血分数保留型心衰的病理机制与能量异常、心肌细胞肥大、细胞信号传导、炎症、缺血和纤维化有关。这些机制还与通常与射血分数保留型心力衰竭相关的重要合并症错综复杂地重叠在一起,这些合并症包括但不限于心房颤动、慢性肾病、高血压、肥胖和冠状动脉疾病。因此,这种疾病的治疗应侧重于通过药物和非药物手段管理和严格调节这些合并症。在这篇综述中,我们将对射血分数保留型心力衰竭的流行病学、病理生理学、诊断和治疗方面的最新临床试验和数据进行临床更新,并重点介绍心脏代谢干预的最新趋势。
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引用次数: 0
Metabolic Adaptation in Heart Failure and the Role of Ketone Bodies as Biomarkers. 心力衰竭的代谢适应和酮体作为生物标记物的作用。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 Epub Date: 2024-09-07 DOI: 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.

综述的目的:心力衰竭的发生和发展以代谢和生理适应为特征,使患者能够应对心功能不全。这篇综述探讨了心力衰竭时新陈代谢的变化以及生物标志物(尤其是酮体)在心力衰竭分期和预后中的潜在作用:最近对心肌新陈代谢的深入研究揭示了心脏对压力的反应,突出了依赖酮体作为替代燃料来源的转变。血液酮体水平的升高已被证明与心功能不全的严重程度相关,强调了其作为预后指标的潜力。此外,针对特定代谢途径的治疗干预研究也为改善心力衰竭的预后带来了希望。酮体对心力衰竭有预后作用,并有可能成为治疗干预的途径。要在新陈代谢支持和加重心脏重塑之间取得最佳平衡,仍然存在挑战。未来的研究工作必须解决这些复杂问题,以推进管理心力衰竭的个性化方法。
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引用次数: 0
Current Therapies and Future Horizons in Cardiac Amyloidosis Treatment. 心脏淀粉样变性治疗的当前疗法和未来前景。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-05-29 DOI: 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}
引用次数: 0
Impact of Sex and Diabetes in Patients with Heart Failure. 性别和糖尿病对心力衰竭患者的影响
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-05-03 DOI: 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.

综述目的:心力衰竭(HF)是一种复杂的临床综合征,对全球健康造成日益沉重的负担。这篇综述探讨了心力衰竭、糖尿病和性别之间的相互关系,突出强调了流行病学模式、病理生理学机制和治疗意义:最近的研究结果:尽管男性和女性的高血压发病率相似,但糖尿病(DM)似乎对女性的高血压预后产生了更明显的影响。病理生理学差异涉及心血管风险因素、严重左心室功能障碍和冠状动脉疾病,以及激素影响和炎症标志物。糖尿病心肌病是一项具有性别特异性的挑战,女性常见的不良后果与纤维化加重和心肌重塑有关。治疗策略,尤其是钠-葡萄糖共转运体 2 抑制剂,对心血管有益,但对女性的反应可能有所不同。心房颤动与糖尿病之间的联系是双向的,糖尿病会显著增加心房颤动的风险,反之亦然。此外,糖尿病对死亡率的影响在女性中似乎比在男性中更明显,从而改变了在心房颤动结果中观察到的传统性别差距。个性化的治疗方法至关重要,需要进一步研究如何在心房颤动、糖尿病和性别的复杂相互作用中改善预后。
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引用次数: 0
Profile and Prognostic Impact of Multimorbidity in Elderly Patients with Heart Failure: Are there Differences between Men and Women? 老年心力衰竭患者的多病特征和预后影响:男女之间是否存在差异?
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-07-03 DOI: 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.

综述目的:心力衰竭(HF)是一种不断发展的病理现象,尽管老年患者在心力衰竭患者中所占比例很大,但在临床试验或登记中却没有得到充分的体现。老年心力衰竭患者是一个异质性群体,他们有自己的特点,而且这个年龄段的患者有多种并发症,这使得疾病的临床过程、预后和治疗效果都不尽相同:与男性相比,患有心房颤动的女性往往年龄较大,非心血管并发症较多,缺血性心脏病较少,心室功能在大多数情况下得以保留。这一事实导致患者的自我感觉生活质量较差,住院率和死亡率较低。此外,矛盾的是,女性接受临床实践指南推荐的治疗(包括血管重建和装置植入)的可能性较低。由于对这一人群的代表性研究还不够多,这些结果在老年女性人群中具有更好的预后和相对良性影响的原因尚不清楚,这就是为什么有必要继续开展研究,以便获得更多证据来证明暴露出的差距。
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引用次数: 0
Sex Differences in Transthyretin Cardiac Amyloidosis: Unraveling the Complexities in Epidemiology, Pathophysiology, Diagnosis, and Treatment. 转甲状腺素心脏淀粉样变性的性别差异:揭开流行病学、病理生理学、诊断和治疗的复杂面纱》。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-05-22 DOI: 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.

转甲状腺素心脏淀粉样变性(ATTR-CA)的特征是转甲状腺素淀粉样纤维沉积在心脏中。虽然有证据表明 ATTR-CA 在发病率和临床表现上存在性别差异,但男女均可患病。综述目的:本综述旨在全面研究和总结有关 ATTR-CA 性别差异的现有文献。最新发现:ATTR-CA 的发病率在男性中较高,但在野生型和 TTR 基因变异型中,男性在老年患者中的优势更为明显,在遗传变异型中,男性主要导致心脏表型。女性在临床表现时左心室肥厚(LVH)程度较轻,射血分数较高,这可能会导致诊断较晚,但男女患者的预后似乎相似。女性是TTR多发性神经病患者对他法米地20毫克治疗反应良好的一个预测因素,但除此之外,尚无其他治疗ATTR-CA疗效方面性别差异的数据。确定 ATTR-CA 的具体性别差异至关重要。可能需要降低女性 LVH 的临界值,以提高诊断率。有必要增加女性在临床试验中的代表性,以更好地了解治疗管理中可能存在的性别差异。
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引用次数: 0
The Pathophysiology, Prognosis and Treatment of Hypertension in Females from Pregnancy to Post-menopause: A Review. 从妊娠到绝经后女性高血压的病理生理学、预后和治疗:综述。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-06-11 DOI: 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.

综述的目的:我们总结了女性高血压的生理变化和风险因素、潜在的性别特异性管理方法以及长期预后:妊娠和更年期是女性生命周期中的两个关键阶段,在这两个阶段中,女性的生理和体质会发生重大变化,从而更容易患上高血压。妊娠期高血压是由母体心输出量、肾功能、新陈代谢或胎盘血管的变化引起的,每十个人中就有一人出现妊娠并发症,如宫内生长受限和分娩并发症,如早产。绝经后高血压的发生是由于雌激素的保护作用减弱,交感神经系统随着年龄的增长而过度激活。越来越多的证据表明,绝经后女性高血压患者在较低的血压阈值下发生心血管事件的风险更大,也更容易受到与治疗相关的不良反应的影响。高血压是女性罹患心血管疾病的主要风险因素。目前针对男女两性的血压治疗指南和建议相似,但没有考虑到性别特异性因素。未来需要对女性的理想诊断阈值、血压控制目标和治疗方案进行研究。
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引用次数: 0
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Current Heart Failure Reports
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