背景:工业加工的反式脂肪酸(IP-TFA)与脂蛋白代谢改变有关,炎症和NT-proBNP升高。在射血分数保留(HFpEF)的心力衰竭患者中,TFA血液水平与患者特征的关联尚不清楚。
方法:这是Aldo-DHF-RCT的二次分析。来自422名患者,在n=404中,使用HS-Omega-3-Index®方法学在基线分析个体血液TFA。患者特征为:67±8岁,53%女性,NYHAII/III(87/13%),射血分数≥50%,E/e7.1±1.5;NT-proBNP158ng/L(IQR82-298)。进行了主成分分析,但未用于进一步分析,因为前两个PC的累积方差较低。斯皮尔曼相关系数和线性回归分析,使用性别和年龄作为协变量,用于描述全血TFA与代谢表型的关联,功能能力,基线和12个月后LVDF和神经体液激活的超声心动图标记物。
结果:天然存在的TFAC16:1n-7t的血液水平与血脂异常呈负相关,体重指数/躯干肥胖,基线/12个月时非酒精性脂肪性肝病和炎症的替代标志物。相反,IP-TFAC18:1n9t,C18:2n6tt和C18:2n6tc与血脂异常呈正相关,异构体C18:2n6ct与血糖异常呈正相关。C18:2n6tt和C18:2n6ct与基线/12个月的次最大有氧能力成反比。在TFA和心脏功能之间没有发现显著的关联。
结论:在HFpEF患者中,IP-TFA的血液水平较高,但不是天然存在的TFA,与血脂异常有关,血糖异常和功能能力下降。血液TFA,特别是C16:1n-7t,值得进一步研究作为HFpEF的预后标志物。工业加工的TFA的血液水平较高,但不是天然存在的TFAC16:1n-7t,在HFpEF患者中与较高风险的心脏代谢表型和较低有氧能力的预后相关。
BACKGROUND: Industrially processed trans-fatty acids (IP-TFA) have been linked to altered lipoprotein metabolism, inflammation and increased NT-proBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown.
METHODS: This is a secondary analysis of the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n = 404 using the HS-Omega-3-Index® methodology. Patient characteristics were: 67 ± 8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥ 50%, E/e\' 7.1 ± 1.5; NT-proBNP 158 ng/L (IQR 82-298). A principal component analysis was conducted but not used for further analysis as cumulative variance for the first two PCs was low. Spearman\'s correlation coefficients as well as linear regression analyses, using sex and age as covariates, were used to describe associations of whole blood TFA with metabolic phenotype, functional capacity, echocardiographic markers for LVDF and neurohumoral activation at baseline and after 12 months.
RESULTS: Blood levels of the naturally occurring TFA C16:1n-7t were inversely associated with dyslipidemia, body mass index/truncal adiposity, surrogate markers for non-alcoholic fatty liver disease and inflammation at baseline/12 months. Conversely, IP-TFA C18:1n9t, C18:2n6tt and C18:2n6tc were positively associated with dyslipidemia and isomer C18:2n6ct with dysglycemia. C18:2n6tt and C18:2n6ct were inversely associated with submaximal aerobic capacity at baseline/12 months. No significant association was found between TFA and cardiac function.
CONCLUSIONS: In HFpEF patients, higher blood levels of IP-TFA, but not naturally occurring TFA, were associated with dyslipidemia, dysglycemia and lower functional capacity. Blood TFAs, in particular C16:1n-7t, warrant further investigation as prognostic markers in HFpEF. Higher blood levels of industrially processed TFA, but not of the naturally occurring TFA C16:1n-7t, are associated with a higher risk cardiometabolic phenotype and prognostic of lower aerobic capacity in patients with HFpEF.