Sonia Eiras / New therapeutic targets for heart failure stages based on diet compounds and local fat development


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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.
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Sonia Eiras / New therapeutic targets for heart failure stages based on diet compounds and local fat development

  1. 1. New therapeutic targets for stages of heart failure based on diet compounds and local fat development Cardiology Group (Health Research Institute) Sonia Eiras Penas
  2. 2. 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% Respirator y 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% Respirator y disease 6% Injuries and poisoning 4% All other causes 20% 52%
  3. 3. 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: Costs for heart failure in the USA from 2003 to 2010
  4. 4. Stages, Phenotypes and Treatment of HF STAGE A At high risk for HF but without structural heart disease or symptoms of HF STAGE B Structural 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 C Structural heart disease with prior or current symptoms of HF THERAPY Goals · 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 D Refractory 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 THERAPY Goals · 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 HF Structural heart disease
  5. 5. 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
  6. 6. 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
  7. 7. MM Lima- Martinez et al. (2011) Hipertension y riesgo cadiovascular 28 (80%) Epicardial adipose tissue
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. Epicardial fat volume (EFV) Khawaja T. et al (2011) Am J Cardiol 108:397– 401
  13. 13. 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
  14. 14. Cardiology group. Health Research Institute. Santiago de Compostela Head: José Ramón González Juanatey Researchers Plataforms (Proteomics, Microscopy, Luminex, Image) Enterprise? Students Clinical Staff
  15. 15. 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.
  16. 16. Cardiology group. Health Research Institute Head: José Ramón González Juanatey 0 25 50 75 100 125 150 175 200 225 250 Total impact factor Q1 Q2 Q3 Q4 Total impact factor Q1 Q2 Q3 Q4 2013 0 50 100 150 200 250 300 350 400 Total publications Heart failure Epicardial fat Total publications Heart failure Epicardial fat 1984-2013