Cor Vasa 2016, 58(4):e374-e378 | DOI: 10.1016/j.crvasa.2015.10.001

Reducing cardiac after-load by lowering blood viscosity in patients with familial hypercholesterolemia - A pilot study. Possible mechanism for occurrence of anemia in chronic heart failure patients?

Gheorghe A. M. Popa,*, Menko-Jan de Boera, Anton F. Stalenhoefb
a Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
b Department of Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

Anemia is present in more than 40% of the patients with chronic heart failure (CHF), especially in those with reduced ejection fraction. The etiology is not yet understood. Hematocrit is a major determinant of whole blood viscosity, which is an important factor of the total peripheral resistance for the heart. Therefore, lowering blood viscosity may reduce after-load for the failing heart. Patients with homozygous familial hypercholesterolemia (HFH) are characterized by markedly elevated low-density lipoprotein (LDL) cholesterol levels and premature ischemic heart disease. Selective LDL-cholesterol apheresis in HFH patients to remove LDL from the circulation is the recommended treatment of this condition and has been shown to reduce whole blood viscosity. The level of B-type Natriuretic Peptide (BNP) is a parameter of filling conditions in the heart and is predominantly induced by cardiac after-load. BNP was measured in 4 consecutive HFH patients before and after treatment with selective LDL-apheresis. We observed that 20% reduction of blood viscosity by LDL-apheresis in these patients resulted in 40% lower levels of BNP. In chronic heart failure patients anemia might be a compensatory mechanism of the organism in order to reduce after-load for the failing heart by lowering blood viscosity.

Keywords: Anemia; Blood viscosity; BNP; Heart failure; Hypercholesterolemia

Received: July 14, 2015; Revised: September 15, 2015; Accepted: October 5, 2015; Published: August 1, 2016  Show citation

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Pop GAM, de Boer M, Stalenhoef AF. Reducing cardiac after-load by lowering blood viscosity in patients with familial hypercholesterolemia - A pilot study. Possible mechanism for occurrence of anemia in chronic heart failure patients? Cor Vasa. 2016;58(4):e374-378. doi: 10.1016/j.crvasa.2015.10.001.
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    References

    1. J.A. Ezekowitz, F.A. McAlister, P.W. Armstrong, Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failure, Circulation 107 (2003) 223-225. Go to original source...
    2. Y.D. Tang, S.D. Katz, Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options, Circulation 113 (2006) 2454-2461 (Review). Go to original source... Go to PubMed...
    3. D. Mozaffarian, R. Nye, W.C. Levy, Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE), Journal of the American College of Cardiology 41 (2003) 1933-1939. Go to original source... Go to PubMed...
    4. T.B. Horwich, G.C. Fonarow, M.A. Hamilton, et al., Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure, Journal of the American College of Cardiology 39 (2002) 1780-1786. Go to original source... Go to PubMed...
    5. I.S. Anand, Anemia and chronic heart failure implications and treatment options, Journal of the American College of Cardiology 52 (2008) 501-511 (Review). Go to original source... Go to PubMed...
    6. E.F. Unger, A.M. Thompson, M.J. Blank, R. Temple, Erythropoiesis stimulating agents-time for a reevaluation, New England Journal of Medicine 362 (2010) 189-192. Go to original source... Go to PubMed...
    7. G. Pop, D.J. Duncker, M. Gardien, et al., The clinical significance of whole blood viscosity in (cardio-)vascular medicine, Netherlands Heart Journal 10 (2002) 512-516. Go to PubMed...
    8. S.K. Jeong, Y.I. Cho, M. Duey, R.S. Rosenson, Cardiovascular risks of anemia correction with erythrocyte stimulating agents: should blood viscosity be monitored for risk assessment? Cardiovascular Drugs and Therapy 24 (2010) 151-160. Go to original source... Go to PubMed...
    9. G.R. Thompson, M. Barbir, D. Davies, et al., Efficacy criteria and cholesterol targets for LDL apheresis, Atherosclerosis 208 (2010) 317-321 (Review). Go to original source... Go to PubMed...
    10. A.A. Kroon, W.R. Aengevaeren, T. van der Werf, et al., LDL-Apheresis Atherosclerosis Regression Study (LAARS). Effect of aggressive versus conventional lipid lowering treatment on coronary atherosclerosis, Circulation 93 (1996) 1826-1835. Go to original source...
    11. M. Cuchel, E. Bruckert, H.N. Ginsberg, et al., Homozygous familial hypercholesterolaemia: new insights and guidance for clinicians to improve detection and clinical management. A position paper from the Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society, European Heart Journal 35 (2014) 2146-2157. Go to original source... Go to PubMed...
    12. P.M. Moriarty, C.A. Gibson, K.R. Kensey, W. Hogenauer, Effect of low-density lipoprotein cholesterol apheresis on blood viscosity, American Journal of Cardiology 93 (2004) 1044-1046. Go to original source... Go to PubMed...
    13. K. Toischer, H. Kogler, G. Tenderich, et al., Elevated afterload, neuroendocrine stimulation, and human heart failure increase BNP levels and inhibit pre-load dependent SERCA upregulation, Circulation: Heart Failure 1 (2008) 265-271. Go to original source... Go to PubMed...
    14. S. Chien, J. Dormandy, E. Ernst, A. Matrai, Clinical hemorheology. Applications in cardiovascular and hematological disease, in: Diabetes, Surgery and Gynecology, Dordrecht: Martinus Nijhoff Publishers, 1989.
    15. J.P. Rocchiccioli, J.J.V. McMurray, A.F. Dominiczak, Biomarkers in heart failure: a clinical review, Heart Failure Reviews 15 (2010) 251-273. Go to original source... Go to PubMed...
    16. Y. Cinar, G. Demir, M. Pac, A.B. Cinar, Effect of hematocrit on blood pressure via hyperviscosity, American Journal of Hypertension 12 (1999) 739-743. Go to original source...
    17. R.B. Devereux, J.I.M. Drayer, S. Chien, Whole blood viscosity as a determinant of cardiac hypertrophy in systemic hypertension, American Journal of Cardiology 54 (1984) 592-596. Go to original source... Go to PubMed...
    18. A. Luchner, T.L. Stevens, D.D. Borgeson, et al., Differential atrial and ventricular expression of myocardial BNP during evolution of heart failure, American Journal of Physiology. Heart and Circulatory Physiology 274 (1998) 1684-1689. Go to original source...
    19. E.M. Kallergis, E.G. Manios, E.M. Kanoupakis, et al., Effect of sinus rhythm restoration after electrical cardioversion on apelin and brain natriuretic peptide prohormone levels in patients with persistent atrial fibrillation, American Journal of Cardiology 105 (2010) 90-94. Go to original source... Go to PubMed...
    20. C.G. Koch, L. Li, D.R. Van Wagoner, et al., Red cell transfusion is associated with an increased risk for postoperative atrial fibrillation, Annals of Thoracic Surgery 82 (2006) 1747-1756. Go to original source... Go to PubMed...
    21. S. Chien, S. Usami, R.J. Dellenback, M.I. Gregersen, Blood viscosity: influence of erythrocyte aggregation, Science 157 (1967) 829-831. Go to original source... Go to PubMed...
    22. B.D. Westenbrink, A.A. Voors, R.A. de Boer, et al., Bone marrow dysfunction in chronic heart failure patients, European Journal of Heart Failure 12 (2010) 676-684. Go to original source... Go to PubMed...
    23. W.H. Reinhart, Molecular biology and self-regulatory mechanisms of blood viscosity, Biorheology 38 (2001) 203-212. Go to PubMed...
    24. D. Preiss, R.T. Campbell, H.M. Murray, et al., The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials, European Heart Journal 36 (2015) 1536-1546. Go to original source... Go to PubMed...
    25. C. Berry, K.K. Poppe, G.D. Gamble, et al., Prognostic significance of anaemia in patients with heart failure with preserved and reduced ejection fraction: results from the MAGGIC individual patient data meta-analysis, QJM 109 (2016) 377-382. Go to original source... Go to PubMed...

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