Heart Disease and Stroke Statistics—2014 Update

Go, Alan S.; Mozaffarian, Dariush; Roger, Véronique L.; Benjamin, Emelia J.; Berry, Jarett D.; Blaha, Michael J.; Dai, Shifan; Ford, Earl S.; Fox, Caroline S.; Franco, Sheila; Fullerton, Heather J.; Gillespie, Cathleen; Hailpern, Susan M.; Heit, John A.; Howard, Virginia J.; Huffman, Mark D.; Judd, Suzanne E.; Kissela, Brett M.; Kittner, Steven J.; Lackland, Daniel T.; Lichtman, Judith H.; Lisabeth, Lynda D.; Mackey, Rachel H.; Magid, David J.; Marcus, Gregory M.; Marelli, Ariane J.; Matchar, David B.; McGuire, Darren K.; Mohler, Emile R.; Moy, Claudia S.; Mussolino, Michael E.; Neumar, Robert W.; Nichol, Graham; Pandey, Dilip K.; Paynter, Nina P.; Reeves, Matthew J.; Sorlie, Paul D.; Stein, Joel; Towfighi, Amytis; Turan, Tanya N.; Virani, Salim S.; Wong, Nathan D.; Woo, Daniel; Turner, Melanie B.

doi:10.1161/01.cir.0000441139.02102.80

Cited by 4,344 publications

(2,468 citation statements)

References 1,314 publications

(869 reference statements)

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“…Consequently, our results regarding SCD concur in direction, if not in magnitude, with results from prior larger studies. Importantly, our findings also support the hypothesis that the customarily high intake of fish as part of the MedDiet in Spain might contribute to explain the paradox of low rates of both incident CHD and cardiac death,17, 23, 24 despite a high burden of cardiovascular risk factors 25…”

Section: Discussionsupporting

confidence: 82%

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Sala‐Vila¹,

Guasch‐Ferré²,

Hu³

et al. 2016

JAHA

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BackgroundEpidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day).Methods and ResultsWe longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]).ConclusionsIn participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids.Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639.

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Section: Discussionsupporting

confidence: 82%

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Sala‐Vila¹,

Guasch‐Ferré²,

Hu³

et al. 2016

JAHA

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“…Body mass index (BMI) was calculated as weight/height 2. A standardised survey on pre‐existing illnesses, dietary habits and several lifestyle factors was completed by all patients and controls and a standardised interview was performed.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, its increasing prevalence leads to huge economic burden, making HF a major challenge of the future 2. Therefore, deeper insights into the pathophysiology of the disease are urgently needed, since these efforts might give rise to new disease concepts and ultimately novel therapeutic prospects.…”

Section: Introductionmentioning

confidence: 99%

Heart failure is associated with depletion of core intestinal microbiota

Luedde¹,

et al. 2017

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AimsIn spite of current medical treatment approaches, mortality of chronic heart failure (HF) remains high and novel treatment modalities are thus urgently needed. A recent theory proposes a possible impact of the intestinal microbiome on the incidence and clinical course of heart failure. This study sought to systematically investigate, if there are specific changes of the intestinal microbiome in heart failure patients.Methods and resultsThe intestinal microbiome of 20 patients with heart failure with reduced ejection fraction due to ischemic or dilated cardiomyopathy was investigated by applying high‐throughput sequencing of the bacterial 16S rRNA gene. Microbial profiles were compared to those of matched controls in which heart failure was ruled out by clinical assessment and NT‐proBNP serum levels (n = 20). According to the Shannon diversity index (which measures the intra‐individual alpha‐diversity) based on the distribution of operational taxonomic units (OTUs), HF cases showed a nominally significantly lower diversity index compared to controls (P nom. = 0.01), and testing for genera abundance showed a tendency towards a decreased alpha diversity of HF patients. Beta‐diversity measures (inter‐individual diversity) revealed a highly significant separation of HF cases and controls, (e.g. P weighted UniFracv = 0.004). Assessing the individual abundance of core measurable microbiota (CMM), a significant decrease of Coriobacteriaceae, Erysipelotrichaceae and Ruminococcaceae was observed on the family level. In line with that, Blautia, Collinsella, uncl. Erysipelotrichaceae and uncl. Ruminococcaceae showed a significant decrease in HF cases compared to controls on the genus level.ConclusionsHeart failure patients showed a significantly decreased diversity of the intestinal microbiome as well as a downregulation of key intestinal bacterial groups. Our data point to an altered intestinal microbiome as a potential player in the pathogenesis and progression of heart failure.

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“…In 2010, more than 15 000 deaths were directly caused by aortic valve disease (AVD) in the USA, making it the second‐leading cause of cardiovascular mortality (Go et al ., 2014). The prevalence of moderate or severe aortic stenosis in the general population > 75 years old is 2.8%.…”

Section: Introductionmentioning

confidence: 99%

“…The development of transcatheter AVR provides a less‐invasive approach than surgical replacement. However, this option is currently only available for patients who were not surgical candidates for AVR, and the 2‐year mortality and hospitalization rates are > 50% (Go et al ., 2014). The prevalence of AVD is an increasing burden on the healthcare system as global life expectancy increases (Nkomo et al ., 2006; Go et al ., 2014).…”

Section: Introductionmentioning

confidence: 99%

Deficiency in the anti‐aging gene Klotho promotes aortic valve fibrosis through AMPK α‐mediated activation of RUNX 2

2016

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SummaryFibrotic aortic valve disease (FAVD) is an important cause of aortic stenosis, yet currently there is no effective treatment for FAVD due to its unknown etiology. The purpose of this study was to investigate whether deficiency in the anti‐aging Klotho gene (KL) promotes high‐fat‐diet‐induced FAVD and to explore the underlying molecular mechanism. Heterozygous Klotho‐deficient (KL +/−) mice and WT littermates were fed with a high‐fat diet (HFD) or normal diet for 13 weeks, followed by treatment with the AMPKα activator (AICAR) for an additional 2 weeks. A HFD caused a greater increase in collagen levels in the aortic valves of KL +/− mice than of WT mice, indicating that Klotho deficiency promotes HFD‐induced aortic valve fibrosis (AVF). AMPKα activity (pAMPKα) was decreased, while protein expression of collagen I and RUNX2 was increased in the aortic valves of KL +/− mice fed with a HFD. Treatment with AICAR markedly attenuated HFD‐induced AVF in KL +/− mice. AICAR not only abolished the downregulation of pAMPKα but also eliminated the upregulation of collagen I and RUNX2 in the aortic valves of KL +/− mice fed with HFD. In cultured porcine aortic valve interstitial cells, Klotho‐deficient serum plus cholesterol increased RUNX2 and collagen I protein expression, which were attenuated by activation of AMPKα by AICAR. Interestingly, silencing of RUNX2 abolished the stimulatory effect of Klotho deficiency on cholesterol‐induced upregulation of matrix proteins, including collagen I and osteocalcin. In conclusion, Klotho gene deficiency promotes HFD‐induced fibrosis in aortic valves, likely through the AMPKα–RUNX2 pathway.

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Heart Disease and Stroke Statistics—2014 Update

Cited by 4,344 publications

References 1,314 publications

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Heart failure is associated with depletion of core intestinal microbiota

Deficiency in the anti‐aging gene Klotho promotes aortic valve fibrosis through AMPK α‐mediated activation of RUNX 2

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