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Presentation given by Sonia Eiras from the Health Research Institute of Santiago de Compostela (IDIS) in the framework of the Emergence Forum Barcelona Biocat organized the Barcelona Emergence Forum (April 10-11th, 2014, Congress Palace, Montjuïc) supported by the TRANSBIO SUDOE, a translational cooperation project dedicated to innovation in life sciences in South-West Europe. The Barcelona Emergence Forum contributed to bringing together Academics, Companies, Investment Entities, Technology Platforms and Technology Transfer Offices from Spain, France and Portugal to set up collaborative projects on Human Health & Agro-food Innovation. More information at: http://www.b2match.eu/emergenceforum2014
Citation preview
New therapeutic targets for stages of
heart failure based on diet compounds
and local fat development
Cardiology Group
(Health Research Institute)
Sonia Eiras Penas
Deaths by cause in men and women, Europe
European Cardiovascular Disease Statistics 2012
Coronary Heart
Disease 20%
Stroke 10%
Other CVD 12%
Stomach cancer
2% Colo-rectal
cancer 2%
Lung cancer
4%
Other cancer
13% Respiratory disease
7%
Injuries and
poisoning 10%
All other causes
20%
Coronary Heart
Disease 22%
Stroke 15%
Other CVD 15%
Stomach cancer
1% Colo-rectal
cancer 2%
Lung cancer
2%
Breast cancer
3%
Other cancer
10%
Respiratory disease
6%
Injuries and
poisoning 4%
All other causes
20%
52%
Heart Failure
The main cause of morbidity in the world and remains the most
frequent cause of hospitalization for patients over 65 years old.
Braunschweig F et al. Europace 2011;13:ii13-ii17
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author
2011. For permissions please email: journals.permissions@oup.com.
Costs for heart failure in the USA from 2003 to 2010
Stages, Phenotypes and Treatment of HF
STAGE AAt high risk for HF but
without structural heart
disease or symptoms of HF
STAGE BStructural heart disease
but without signs or
symptoms of HF
THERAPY
Goals
· Control symptoms
· Improve HRQOL
· Prevent hospitalization
· Prevent mortality
Strategies
· Identification of comorbidities
Treatment
· Diuresis to relieve symptoms
of congestion
· Follow guideline driven
indications for comorbidities,
e.g., HTN, AF, CAD, DM
· Revascularization or valvular
surgery as appropriate
STAGE CStructural heart disease
with prior or current
symptoms of HF
THERAPYGoals· Control symptoms· Patient education· Prevent hospitalization· Prevent mortality
Drugs for routine use· Diuretics for fluid retention· ACEI or ARB· Beta blockers· Aldosterone antagonists
Drugs for use in selected patients· Hydralazine/isosorbide dinitrate· ACEI and ARB· Digoxin
In selected patients· CRT· ICD· Revascularization or valvular
surgery as appropriate
STAGE DRefractory HF
THERAPY
Goals
· Prevent HF symptoms
· Prevent further cardiac
remodeling
Drugs
· ACEI or ARB as
appropriate
· Beta blockers as
appropriate
In selected patients
· ICD
· Revascularization or
valvular surgery as
appropriate
e.g., Patients with:
· Known structural heart disease and
· HF signs and symptoms
HFpEF HFrEF
THERAPY
Goals
· Heart healthy lifestyle
· Prevent vascular,
coronary disease
· Prevent LV structural
abnormalities
Drugs
· ACEI or ARB in
appropriate patients for
vascular disease or DM
· Statins as appropriate
THERAPYGoals· Control symptoms· Improve HRQOL· Reduce hospital
readmissions· Establish patient’s end-
of-life goals
Options· Advanced care
measures· Heart transplant· Chronic inotropes· Temporary or permanent
MCS· Experimental surgery or
drugs· Palliative care and
hospice· ICD deactivation
Refractory symptoms of HF at rest, despite GDMT
At Risk for Heart Failure Heart Failure
e.g., Patients with:
· Marked HF symptoms at
rest
· Recurrent hospitalizations
despite GDMT
e.g., Patients with:
· Previous MI
· LV remodeling including
LVH and low EF
· Asymptomatic valvular
disease
e.g., Patients with:
· HTN
· Atherosclerotic disease
· DM
· Obesity
· Metabolic syndrome
or
Patients
· Using cardiotoxins
· With family history of
cardiomyopathy
Development of
symptoms of HFStructural heart
disease
Heart Failure and Diet
Associations of
Mediterranean and Dietary
Approaches to Stop
Hypertension (DASH)
Improve the
cardiovascular risk
factors
Mediterranean diet 1 year (The
PREDIMED Study)
Vitamins B, C and E,
coenzyme Q10, alpha-lipoic
acid, chromium, omega-3
polyunsaturated fatty acids,
L-carnitine, and quercetin
Antioxidants in diet Improve the cardiovascular
risk factors
Cardiovascular health in the American Heart Association 2020 goals, US
children aged 12 to 19 years, National Health and Nutrition Examination
Survey (NHANES) 2009-2010* (available data as of June 1, 2012). *Healthy
Diet Score reflects 2007-2008 NHANES data.
Go A S et al. Circulation. 2013;127:e6-e245
Copyright © American Heart Association, Inc. All rights reserved
MM Lima- Martinez et al. (2011)
Hipertension y riesgo cadiovascular 28
(80%)
Epicardial adipose tissue
Epicardial adipose tissue and heart
failure
Diet compounds
Volume
Prognosis and quality of life
Endocrine or paracrine function
Metabolic Activity
Oxidative Stress
Coronaries and myocardium
Epicardial adipose tissue and
coronary artery disease
Jin-Sun Park e tal. (2013) Atherosclerosis 226; 134 - 139
Necrotic core
Dense calcium
Fibrous
Fibrofatty
>3,5 mm
<3,5 mm
Epicardial adipose tissue volume and
ventricle function
Short-axis views. Compared to healthy controls (A1/2), patients with DCM and moderately (B1/2)
and severely (C1/2) reduced left ventricular ejection fraction showed equally diminished indexed
EAT mass.
Doesch et al. (2013) Obesity 23: E253
Heart Failure
• Develop important changes in body composition and the disease course is marked by periodic
episodes of clinical decompensation.
• An altered balance between catabolism and anabolism is known to contribute to disease
progression and the transition from non-wasted heart failure to cardiac cachexia.
Controls HF EF <55% p Value HF EF 35–55% HF EF <35% p Value
(n =321) (n = 60) (n = 43) (n =17)
Epicardial fat volume
(cm3) 114,5 ±98,5 83,5 ± 67,1
<0,04 96,0 ± 73,9 52,2 ± 29,7
<0,05
Total calcium score 522 ± 1,324 656 ± 889 0,59 765 ± 1,030 445 ± 508 0,36
Khawaja T. et al. (2011) Am J Cardiol;108:397– 401
Epicardial fat volume (EFV)
Khawaja T. et al (2011) Am J Cardiol 108:397– 401
Request and Offers
• Inclusion in
organized projects
related with diet
• Functional food
expertise
• Nutraceutical/Pharmac
eutical Enterprize
• Table diets expertise
• Chemical analyzers
• Inclusion in organized
projects for
preclinical assays
Cardiology group. Health Research
Institute. Santiago de Compostela
Head: José Ramón González Juanatey
Researchers
Plataforms (Proteomics, Microscopy,
Luminex, Image)
Enterprise?
Students
Clinical Staff
Expertise
Three human cardiovascular systems:
• Cardiomyocytes
• Endothelial cells
• Epicardial adipose tissue cells
Animal models
For testing the effect of nutraceutical, chemical
products, diet compunds on metabolic function of the
cardiovascular systems.
Cardiology group. Health Research
Institute
Head: José Ramón González Juanatey
0
25
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100
125
150
175
200
225
250
Totalimpactfactor
Q1 Q2 Q3 Q4
Total impact factor
Q1
Q2
Q3
Q4
2013
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50
100
150
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300
350
400
Totalpublications
Heartfailure
Epicardialfat
Total publications
Heart failure
Epicardial fat
1984-2013
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