JULY 28, 2020
People with higher levels of a specific
inflammatory marker may have a greater risk of developing a form of heart
failure, according to new research that could help predict who might develop
the disease.
The biomarker, called GlycA, is an indicator
of inflammation throughout the body. Inflammation is thought to play a pivotal
role in heart failure, a chronic condition when
the heart muscle doesn't pump as well as it
should. It affects an estimated 6.2 million U.S. adults.
The new study, published Tuesday in the
American Heart Association journal Circulation: Heart Failure, sought to find
out if high levels of GlycA in the blood might predict two subsets of heart
failure: heart failure that occurs despite having a preserved—or
normal—ejection fraction, and heart failure that occurs with a reduced ejection
fraction. Ejection fraction refers to how much blood the left ventricle pumps
out into the body.
Researchers studied about 14 years' worth of
data from 6,507 middle-age and older people who did not have cardiovascular
disease or heart failure at the start of the study. After accounting for
various factors—including high blood pressure and
diabetes—researchers discovered people with the highest levels of GlycA had
more than double the risk of developing heart failure with preserved ejection
fraction compared to those with the lowest levels. However, having higher
biomarker levels did not impact the risk of developing the other subtype—heart
failure with reduced ejection fraction.
Preserved ejection fraction is when the heart
contracts normally but the left ventricle doesn't relax properly. Reduced
ejection fraction is when the heart muscle does not contract effectively.
"They're really two different entities,
so one (treatment) approach doesn't fit all," said Dr. Erin Michos, the
study's senior author.
The study's findings are particularly
important, she said, because treating preserved ejection fraction is more
difficult than treating reduced ejection fraction.
"We don't really have any good therapies
for heart failure with preserved ejection fraction," said Michos,
associate director of preventive cardiology at the Johns Hopkins Ciccarone
Center for the Prevention of Heart Disease in Baltimore. "The best
intervention is trying to prevent it from happening in the first place through
maintaining a normal weight, exercising, eating a healthy
diet and controlling blood pressure and blood glucose."
Since the study was observational, "we
can't show that the inflammation actually directly caused the heart
failure," she said. "Maybe having much inflammation in the body is
just a marker of someone who's sicker in general."
Still, Michos said she'd like to see GlycA
testing become more routine. She also called for future research to delve into
whether heart failure can be prevented by lowering GlycA levels.
Dr. Ferhaan Ahmad, who was not involved in the
research, called it a "novel" study that offers a new way to predict
who might develop heart failure with preserved ejection fraction.
"It's a perplexing disorder about which
not much is understood. The contractile function of the heart appears to be
normal, and yet patients still have pretty severe heart failure symptoms,"
said Ahmad, director of the Cardiovascular Genetics Program at the University
of Iowa in Iowa City.
Figuring out what causes heart failure
with preserved ejection fraction will be extremely
challenging, he said. But at least the new study gives doctors something to
work with.
"The big takeaway is that this may be a
superior method to identify patients at higher risk of this pretty intractable
disease," Ahmad said. "And then we can intervene early to reduce the
risk factors we know already—obesity, diabetes, hypertension. If we can target
those, we can reduce the future risk of developing the disease."
American Heart Association News covers
heart and brain health. Not all views expressed in this story reflect the
official position of the American Heart Association. Copyright is owned or held
by the American Heart Association, Inc., and all rights are reserved.
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