Copyright © 1998 by the European Society of Cardiology.
Influence of age on neurohormonal activation and prognosis in patients with chronic heart failure
a Department of Cardiology/Thoraxcenter, University Hospital Groningen, Groningen
b COEUR/Department of Internal Medicine, University Hospital Dijkzigt, Rotterdam, The Netherlands
c Department of Cardiovascular Medicine, Queen’s Medical Centre, Nottingham, U.K.
accepted October 30, 1997
Aims
Heart failure is a major medical problem in the elderly. Neurohormonal activation plays a role in the pathophysiology of heart failure, but is also affected by ageing. The present study was carried out to examine the influence of age on neurohormonal activation and prognosis in patients with chronic heart failure.
Methods and Results
We studied 372 patients with moderate to severe chronic heart failure (New York Heart Association [NYHA] functional class III–IV), who were treated with angiotensin converting enzyme (ACE) inhibitors (95%), diuretics (99%), and digoxin (59%). Their mean age was 68±8 years (range 38–80), left ventricular ejection fraction 0·23±0·08, and 77% were males. The relationship between age and plasma neurohormones (norepineprine, epinephrine, dopamine, renin, aldosterone, atrial natriuretic peptide, N-terminal atrial natriuretic peptide, and endothelin), and age and prognosis was examined. Only atrial natriuretic peptide and N-terminal atrial natriuretic peptide showed an independent, positive correlation with age (P<0·0001). On univariate analysis, norepinephrine also increased, while renin and aldosterone decreased (allP<0·05). As regards mortality (25%), there was no linear increase with ageing for the group as a whole during follow-up, but patients in the highest age quartile (>74 years) had a significantly higher mortality (risk ratio 1·9) than younger patients (P<0·05).
Conclusions
Although several plasma neurohormones are affected by ageing on univariate analysis, only atrial natriuretic peptide and N-terminal atrial natriuretic peptide show a highly significant increase with ageing on multi-variate analysis. There is no linear increase in mortality with ageing, but in the truly elderly heart failure patients (>74 years), age alone was an independent predictor for mortality.
Key Words: Heart failure • ageing • prognosis and neurohormones
f1 Correspondence: Dr D. J. van Veldhuisen, Department of Cardiology/Thoraxcenter, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. H. de Borst, M. M. van Timmeren, V. S. Vaidya, R. A. de Boer, M. B. A. van Dalen, A. B. Kramer, T. A. Schuurs, J. V. Bonventre, G. Navis, and H. van Goor Induction of kidney injury molecule-1 in homozygous Ren2 rats is attenuated by blockade of the renin-angiotensin system or p38 MAP kinase Am J Physiol Renal Physiol, January 1, 2007; 292(1): F313 - F320. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Rienstra, I. C. Van Gelder, M. P. Van den Berg, F. Boomsma, and D. J. Van Veldhuisen Natriuretic peptides in patients with atrial fibrillation and advanced chronic heart failure: determinants and prognostic value of (NT-)ANP and (NT-pro)BNP Europace, July 1, 2006; 8(7): 482 - 487. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Westendorp, R. G. Schoemaker, H. Buikema, F. Boomsma, D. J. van Veldhuisen, and W. H. van Gilst Progressive left ventricular hypertrophy after withdrawal of long-term ACE inhibition following experimental myocardial infarction Eur J Heart Fail, March 1, 2006; 8(2): 122 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Westendorp, R. G. Schoemaker, H. Buikema, D. de Zeeuw, F. Boomsma, W. H. van Gilst, and D. J. van Veldhuisen Beneficial effects of add-on hydrochlorothiazide in rats with myocardial infarction optimally treated with quinapril Eur J Heart Fail, December 1, 2005; 7(7): 1085 - 1094. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hogenhuis, A. A. Voors, T. Jaarsma, H. L. Hillege, F. Boomsma, and D. J. van Veldhuisen Influence of age on natriuretic peptides in patients with chronic heart failure: a comparison between ANP/NT-ANP and BNP/NT-proBNP Eur J Heart Fail, January 1, 2005; 7(1): 81 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Gustafsson, C. Torp-Pedersen, M. Seibaek, H. Burchardt, L. Kober, and for the DIAMOND study group Effect of age on short and long-term mortality in patients admitted to hospital with congestive heart failure Eur. Heart J., October 1, 2004; 25(19): 1711 - 1717. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. de Boer, Y. M. Pinto, A. J.H. Suurmeijer, S. Pokharel, E. Scholtens, M. Humler, J. M. Saavedra, F. Boomsma, W. H. van Gilst, and D. J. van Veldhuisen Increased expression of cardiac angiotensin II type 1 (AT1) receptors decreases myocardial microvessel density after experimental myocardial infarction Cardiovasc Res, February 1, 2003; 57(2): 434 - 442. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J.W. van Kraaij, R. W.M.M. Jansen, F. C.G.J. Sweep, and W. H.L. Hoefnagels Neurohormonal effects of furosemide withdrawal in elderly heart failure patients with normal systolic function Eur J Heart Fail, January 1, 2003; 5(1): 47 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. P. van den Berg, G. Tjeerdsma, P. J. de Kam, F. Boomsma, H. J.G.M. Crijns, and D. J. van Veldhuisen Longstanding atrial fibrillation causes depletion of atrial natriuretic peptide in patients with advanced congestive heart failure Eur J Heart Fail, June 1, 2002; 4(3): 255 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Boomsma and A. H. van den Meiracker Plasma A- and B-type natriuretic peptides: physiology, methodology and clinical use Cardiovasc Res, August 15, 2001; 51(3): 442 - 449. [Full Text] [PDF]
|
|
|
|
 |
|
 I I Tulevski, M Groenink, E E van der Wall, D J van Veldhuisen, F Boomsma, J Stoker, A Hirsch, J S Lemkes, and B J M Mulder Increased brain and atrial natriuretic peptides in patients with chronic right ventricular pressure overload: correlation between plasma neurohormones and right ventricular dysfunction Heart, July 1, 2001; 86(1): 27 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F Boomsma, P.J de Kam, G Tjeerdsma, A.H van Den Meiracker, and D.J van Veldhuisen Plasma semicarbazide-sensitive amine oxidase (SSAO) is an independent prognostic marker for mortality in chronic heart failure Eur. Heart J., November 2, 2000; 21(22): 1859 - 1863. [Abstract] [PDF]
|
|
|
|
|
|
H.J.G.M Crijns, G Tjeerdsma, P.J de Kam, F Boomsma, I.C van Gelder, M.P van den Berg, and D.J van Veldhuisen Prognostic value of the presence and development of atrial fibrillation in patients with advanced chronic heart failure Eur. Heart J., August 1, 2000; 21(15): 1238 - 1245. [Abstract] [PDF]
|
|
|
|
 |
|
 H. L. Hillege, A. R. J. Girbes, P. J. de Kam, F. Boomsma, D. de Zeeuw, A. Charlesworth, J. R. Hampton, and D. J. van Veldhuisen Renal Function, Neurohormonal Activation, and Survival in Patients With Chronic Heart Failure Circulation, July 11, 2000; 102(2): 203 - 210. [Abstract] [Full Text] [PDF]
|
|