Relation of fasting insulin related to insertion/deletion polymorphism of angiotensin-converting enzyme-gone and cardiac mass in never-treated patients with systemic hypertension

Left ventricular (LV) mass that develops as cardiac adaptive remodeling represents a powerful independent predictor of cardiovascular morbidity and mortality in the general population and in several clinical conditions, including essential hypertension. However, many studies have shown that blood pressure explains only 10% to 25% of the variation in LV mass, supporting the hypothesis that other factors, such as genetics or metabolics (insulin-resistance/hyperinsulinemia), are involved in the cardiac growth in human hypertension. Essential hypertension is also characterized by insulin-resistance/hyperinsulinemia, which may directly induce LV hypertrophy through the stimulation of insulin-like growth factor-1 receptors, abundantly expressed in myocardium. Taken together, we investigated the growth effect of fasting insulin, associated with angiotensin-converting enzyme-gene polymorphism, on cardiac mass in a group of previously untreated ' hypertensive patients. (C)2003 by Excerpta Medica, Inc

Regular Wine Consumption in Chronic Heart Failure: Impact on Outcomes, Quality of Life, and Circulating Biomarkers

Background-Moderate, regular alcohol consumption is generally associated with a lower risk of cardiovascular events but data in patients with chronic heart failure are scarce. We evaluated the relations between wine consumption, health status, circulating biomarkers, and clinical outcomes in a large Italian population of patients with chronic heart failure enrolled in a multicenter clinical trial. Methods and Results-A brief questionnaire on dietary habits was administered at baseline to 6973 patients enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) trial. The relations between wine consumption, fatal and nonfatal clinical end points, quality of life, symptoms of depression, and circulating biomarkers of cardiac function and inflammation (in subsets of patients) were evaluated with simple and multivariable-adjusted statistical models. Almost 56% of the patients reported drinking at least 1 glass of wine per day. After adjustment, clinical outcomes were not significantly different in the predefined 4 groups of wine consumption. However, patients with more frequent wine consumption had a significantly better perception of health status (Kansas City Cardiomyopathy Questionnaire score, adjusted P<0.0001), less frequent symptoms of depression (Geriatric Depression Scale, adjusted P=0.01), and lower plasma levels of biomarkers of vascular inflammation (osteoprotegerin and C-terminal proendothelin-1, adjusted P<0.0001, and pentraxin-3, P=0.01) after adjusting for possible confounders. Conclusions-We show for the first time in a large cohort of patients with chronic heart failure that moderate wine consumption is associated with a better perceived and objective health status, lower prevalence of depression, and less vascular inflammation, but does not translate into more favorable clinical 4-year outcomes. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT0033633