Newman Kevin P, Bhattacharya Syamal K, Munir Ahmad, Davis Richard C, Soberman Judith E, Ramanathan Kodangudi B
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
Vasc Health Risk Manag. 2007;3(5):743-7.
Not all patients with heart failure, defined as a reduced ejection fraction, will have an activation of the RAAS, salt and water retention, or the congestive heart failure (CHF) syndrome. Beyond this cardiorenal perspective, CHF is accompanied by a systemic illness that includes oxidative stress, a proinflammatory phenotype, and a wasting of soft tissues and bone. A dyshomeostasis of calcium, magnesium, zinc, selenium, and vitamin D contribute to the appearance of oxidative stress and to compromised endogenous defenses that combat it. A propensity for hypovitaminosis D, given that melanin is a natural sunscreen, and for secondary hyperparathyroidism in African-Americans make them more susceptible to these systemic manifestations of CHF-a situation which is further threatened by the calcium and magnesium wasting that accompanies the secondary aldosteronism of CHF and the use of loop diuretics.
并非所有射血分数降低定义的心力衰竭患者都会出现肾素-血管紧张素-醛固酮系统（RAAS）激活、水钠潴留或充血性心力衰竭（CHF）综合征。除了这种心肾方面的情况，CHF还伴有全身性疾病，包括氧化应激、促炎表型以及软组织和骨骼的消耗。钙、镁、锌、硒和维生素D的内环境稳态失调会导致氧化应激的出现，并削弱对抗氧化应激的内源性防御机制。鉴于黑色素是一种天然防晒剂，非裔美国人有维生素D缺乏症的倾向以及继发性甲状旁腺功能亢进，这使得他们更容易出现CHF的这些全身表现——而CHF继发性醛固酮增多症和使用袢利尿剂所伴随的钙和镁消耗会进一步威胁这种情况。
