Chronic heart failure patients show individual therapy response to ACE inhibitor treatment

May 22, 2018 by Johannes Angerer, Medical University of Vienna

A cross-sectional study conducted at MedUni Vienna including patients with chronic systolic heart failure has demonstrated great variations in patients' individual therapy response to ACE inhibitors, the first-line therapy for heart failure. It seems possible that the clinical picture is composed of various subgroups characterized by the over-activation of different endogenous systems. The results provide an explanatory approach to the question, why not all patients benefit equally from ACE inhibitors. The study supports ongoing efforts to develop a targeted, individualised therapy for heart failure patients (precision medicine). Vienna will be the venue for two cardiology congresses taking place at the end of May 2018, that cardiologists from throughout the world will attend.

Chronic represents a growing socioeconomic challenge. Quality of life and survival are poor similar to cancer and prevalence is as high as of the "big four"—diabetes, hypertension, coronary artery disease or cancer. For heart failure, though not the other diseases, therapeutic options have changed dramatically in recent years, resulting in large improvements of mortality and morbidity.

ACE-I (angiotensin-converting-enzyme inhibitors) have been the first-line therapy for heart failure for the last 25 years. The drug inhibits the renin-angiotensin-system (RAS), a main hormone system responsible for the regulation of fluid homeostasis and blood pressure. Over-activation of the RAS is a significant mechanism promoting further progression of the disease. The use of ACE inhibitors not only improves ' symptoms and physical capacity but also reduces hospital admissions and increases survival. The prescription of ACE-I for all patients suffering from heart failure is therefor generally recommended by current guidelines. However, at the same time physicians are also aware, that these drugs may not save everyone. Obviously different phenotypes of heart failure must exist, and these phenotypes consequently affect individual therapy response.

A cross-sectional study conducted by Noemi Pavo and colleagues at the heart failure outpatient clinic of the Division of Cardiology, MedUni Vienna/Vienna General Hospital aimed on the characterization of the entire RAS in patients with chronic receiving ACE-I treatment. Analysis and mapping of the entire hormone system was made possible by a novel complex mass spectrometry method developed by Attoquant/Austria. Interestingly, individual patients exhibited huge variations in their response to ACE-I treatment at the molecular level of the RAS, despite comparable dosage of medications and different severities of heart failure.

The activation of the effector peptides can be predicted by renin concentrations, which can easily be determined, making future studies including large numbers of patients realizable. One main surprising finding is that many exhibit no or only minimal activation of RAS, contrary to assumptions based on the predominant pathophysiologic model of heart failure. This could explain why not all patients benefit equally from ACE-I. Here, pathophysiologic changes are probably dominated by the over-activation of other endogenous systems than RAS. On the other hand, many patients show an excessive activation of the RAS, and these patients may benefit from a more aggressive treatment. Further studies investigating these new questions are already on their way.

Precision medicine for heart failure

The study supports the efforts for developing an individualized therapy for heart failure, providing rationale for adapted treatment options by existing substances as a function of the disease phenotype. At the same time the findings raise further questions about the regulation of the RAS, possibly unveiling new therapeutic targets for the treatment of heart failure.

Chronic heart failure is a growing challenge for Western societies. For this reason, is one of the main interests of the European Society of Cardiology. In May this year, more than 5,000 cardiologists are expected to visit Vienna to attend the specialist congresses dedicated to this condition.

Explore further: Investigational heart failure therapy seeks to stimulate body's natural healing response

More information: Noemi Pavo et al. Low- and High-renin Heart Failure Phenotypes with Clinical Implications, Clinical Chemistry (2017). DOI: 10.1373/clinchem.2017.278705

Related Stories

Investigational heart failure therapy seeks to stimulate body's natural healing response

May 2, 2018
The University of Minnesota is the first institution in the state to participate in the phase III clinical trial for CardiAmp Therapy. Previous clinical studies of this therapy have been promising and have shown improvements ...

In LVSD, diabetes tied to higher risk of heart failure

April 20, 2018
(HealthDay)—In patients with asymptomatic left ventricular systolic dysfunction, diabetes is associated with an increased risk of developing heart failure, according to a study published online April 6 in Diabetes Care.

No higher cancer risk seen for heart failure patients

April 12, 2018
(HealthDay)—Heart failure is not associated with an increased risk of cancer, according to a study published in the April 10 issue of the Journal of the American College of Cardiology.

Study highlights need for better treatment of heart failure patients

March 27, 2018
A new study by researchers from the Universities of Leicester and Keele, has highlighted the need for better treatment of heart disease patients suffering from additional chronic conditions.

Heart's pumping function is not an indicator of heart failure survival rates

November 12, 2017
Contrary to popular practice, a measure of the heart's pumping function known as "left ventricular ejection fraction" is not associated with the long-term outcomes of hospitalized heart failure patients, a UCLA-led study ...

Diabetes may have important effects in patients with acute heart failure

June 26, 2017
Researchers have found that patients with acute heart failure and diabetes, compared with those without diabetes, have distinct markers related to inflammation, cardiovascular function, and kidney health.

Recommended for you

Gout could increase heart disease risk

August 17, 2018
Having a type of inflammatory arthritis called gout may worsen heart-related outcomes for people being treated for coronary artery disease, according to new research.

Stroke patients treated at a teaching hospital are less likely to be readmitted

August 17, 2018
Stroke patients appear to receive better care at teaching hospitals with less of a chance of landing back in a hospital during the early stages of recovery, according to new research from The University of Texas Health Science ...

Cardiovascular disease related to type 2 diabetes can be reduced significantly

August 16, 2018
Properly composed treatment and refraining from cigarette consumption can significantly reduce the risk of cardiovascular disease resulting from type 2 diabetes, according to a study published in the New England Journal of ...

Genomic autopsy can help solve unexplained cardiac death

August 15, 2018
Molecular autopsies can reveal genetic risk factors in young people who unexpectedly die, but proper interpretation of the results can be challenging, according to a recent study published in Circulation.

Neonatal pig hearts can heal from heart attack

August 15, 2018
While pigs still cannot fly, researchers have discovered that the hearts of newborn piglets do have one remarkable ability. They can almost completely heal themselves after experimental heart attacks.

Fifty percent of cardiovascular patients suffer from multiple diseases

August 15, 2018
New research led by The University of Western Australia has revealed that one in two patients admitted to hospital with a cardiovascular disease is suffering from multiple chronic medical conditions which required complex ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.