Bock Matthias, von Schacky Clemens, Scherr Johannes, Lorenz Elke, Lechner Benjamin, Krannich Alexander, Wachter Rolf, Duvinage André, Edelmann Frank, Lechner Katharina
Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich, Germany.
J Clin Med. 2023 Jul 27;12(15):4938. doi: 10.3390/jcm12154938.
De novo lipogenesis (DNL)-related monounsaturated fatty acids (MUFAs) in the blood are associated with incident heart failure (HF). This observation's biological plausibility may be due to the potential of these MUFAs to induce proinflammatory pathways, endoplasmic reticulum stress, and insulin resistance, which are pathophysiologically relevant in HF. The associations of circulating MUFAs with cardiometabolic phenotypes in patients with heart failure with a preserved ejection fraction (HFpEF) are unknown. In this secondary analysis of the Aldosterone in Diastolic Heart Failure trial, circulating MUFAs were analysed in 404 patients using the HS-Omega-3-Index methodology. Patients were 67 ± 8 years old, 53% female, NYHA II/III (87/13%). The ejection fraction was ≥50%, E/e' 7.1 ± 1.5, and the median NT-proBNP 158 ng/L (IQR 82-298). Associations of MUFAs with metabolic, functional, and echocardiographic patient characteristics at baseline/12 months follow-up (12 mFU) were analysed using Spearman's correlation coefficients and linear regression analyses, using sex/age as covariates. Circulating levels of C16:1n7 and C18:1n9 were positively associated with BMI/truncal adiposity and associated traits (dysglycemia, atherogenic dyslipidemia, and biomarkers suggestive of non-alcoholic-fatty liver disease). They were furthermore inversely associated with functional capacity at baseline/12 mFU. In contrast, higher levels of C20:1n9 and C24:1n9 were associated with lower cardiometabolic risk and higher exercise capacity at baseline/12 mFU. In patients with HFpEF, circulating levels of individual MUFAs were differentially associated with cardiovascular risk factors. Our findings speak against categorizing FA based on physicochemical properties. Circulating MUFAs may warrant further investigation as prognostic markers in HFpEF.
血液中与从头脂肪生成（DNL）相关的单不饱和脂肪酸（MUFA）与新发心力衰竭（HF）相关。这一观察结果的生物学合理性可能是由于这些MUFA具有诱导促炎途径、内质网应激和胰岛素抵抗的潜力，而这些在HF的病理生理过程中具有相关性。射血分数保留的心力衰竭（HFpEF）患者中循环MUFA与心脏代谢表型之间的关联尚不清楚。在这项舒张性心力衰竭试验中醛固酮的二次分析中，使用HS-Omega-3-指数方法对404例患者的循环MUFA进行了分析。患者年龄为67±8岁，女性占53%，纽约心脏协会（NYHA）心功能分级为II/III级（87/13%）。射血分数≥50%，E/e'为7.1±1.5，NT-proBNP中位数为158 ng/L（四分位间距82 - 298）。使用Spearman相关系数和线性回归分析，以性别/年龄作为协变量，分析了基线/12个月随访（12 mFU）时MUFA与患者代谢、功能和超声心动图特征之间的关联。C16:1n7和C18:1n9的循环水平与体重指数/躯干肥胖及相关特征（血糖异常、致动脉粥样硬化血脂异常和提示非酒精性脂肪性肝病的生物标志物）呈正相关。此外，它们与基线/12 mFU时的功能能力呈负相关。相比之下，较高水平的C20:1n9和C24:1n9与较低的心脏代谢风险及基线/12 mFU时较高的运动能力相关。在HFpEF患者中，个体MUFA的循环水平与心血管危险因素存在差异关联。我们的研究结果不支持根据物理化学性质对脂肪酸进行分类。循环MUFA可能值得作为HFpEF的预后标志物进行进一步研究。
