PMID- 9717009
OWN - NLM
STAT- MEDLINE
DCOM- 19981211
LR  - 20190512
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 19
IP  - 5
DP  - 1998 May
TI  - Influence of age on neurohormonal activation and prognosis in patients with 
      chronic heart failure.
PG  - 753-60
AB  - 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 
      (all P < 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 multivariate 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.
FAU - van Veldhuisen, D J
AU  - van Veldhuisen DJ
AD  - Department of Cardiology/Thoraxcenter, University Hospital, Groningen, The 
      Netherlands.
FAU - Boomsma, F
AU  - Boomsma F
FAU - de Kam, P J
AU  - de Kam PJ
FAU - Man in't Veld, A J
AU  - Man in't Veld AJ
FAU - Crijns, H J
AU  - Crijns HJ
FAU - Hampton, J R
AU  - Hampton JR
FAU - Lie, K I
AU  - Lie KI
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Diuretics)
RN  - 0 (Neurotransmitter Agents)
RN  - 73K4184T59 (Digoxin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Digoxin/therapeutic use
MH  - Diuretics/therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/drug therapy/mortality/*physiopathology
MH  - Hemodynamics/drug effects/physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neurotransmitter Agents/*blood
MH  - Survival Rate
EDAT- 1998/08/26 00:00
MHDA- 1998/08/26 00:01
CRDT- 1998/08/26 00:00
PHST- 1998/08/26 00:00 [pubmed]
PHST- 1998/08/26 00:01 [medline]
PHST- 1998/08/26 00:00 [entrez]
AID - S0195668X9790840X [pii]
AID - 10.1053/euhj.1997.0840 [doi]
PST - ppublish
SO  - Eur Heart J. 1998 May;19(5):753-60. doi: 10.1053/euhj.1997.0840.