Direct oral anticoagulants and vitamin K antagonists are linked to differential profiles of cardiac function and lipid metabolism
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Direct oral anticoagulants and vitamin K antagonists are linked to differential profiles of cardiac function and lipid metabolism. / Eggebrecht, Lisa; Prochaska, Jürgen H; Tröbs, Sven-Oliver; Schwuchow-Thonke, Sören; Göbel, Sebastian; Diestelmeier, Simon; Schulz, Andreas; Arnold, Natalie; Panova-Noeva, Marina; Koeck, Thomas; Rapp, Steffen; Gori, Tommaso; Lackner, Karl J; Ten Cate, Hugo; Münzel, Thomas; Wild, Philipp Sebastian.
in: CLIN RES CARDIOL, Jahrgang 108, Nr. 7, 07.2019, S. 787-796.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung
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TY - JOUR
T1 - Direct oral anticoagulants and vitamin K antagonists are linked to differential profiles of cardiac function and lipid metabolism
AU - Eggebrecht, Lisa
AU - Prochaska, Jürgen H
AU - Tröbs, Sven-Oliver
AU - Schwuchow-Thonke, Sören
AU - Göbel, Sebastian
AU - Diestelmeier, Simon
AU - Schulz, Andreas
AU - Arnold, Natalie
AU - Panova-Noeva, Marina
AU - Koeck, Thomas
AU - Rapp, Steffen
AU - Gori, Tommaso
AU - Lackner, Karl J
AU - Ten Cate, Hugo
AU - Münzel, Thomas
AU - Wild, Philipp Sebastian
PY - 2019/7
Y1 - 2019/7
N2 - BACKGROUND: Experimental data indicate that direct acting oral anticoagulants (DOAC) and vitamin K antagonists (VKA) may exert differential effects on cardiovascular disease.METHODS: Data from the prospective, observational, single-center MyoVasc Study were used to examine associations of DOAC as compared to VKA with subclinical markers of cardiovascular disease, cardiac function, and humoral biomarkers in heart failure (HF).RESULTS: Multivariable analysis adjusted for age, sex, traditional cardiovascular risk factors, comorbidities, and medications with correction for multiple testing demonstrated that DOAC therapy was among all investigated parameters an independent significant predictor of better diastolic function (E/E': β - 0.24 [- 0.36/- 0.12]; P < 0.0001) and higher levels of ApoA1 (β + 0.11 g/L [0.036/0.18]; P = 0.0038) compared to VKA therapy. In propensity score-weighted analyses, the most pronounced differences between DOAC and VKA-based therapy were also observed for E/E' (∆ - 2.36) and ApoA1 (∆ + 0.06 g/L). Sensitivity analyses in more homogeneous subsamples of (i) individuals with AF and (ii) individuals with asymptomatic HF confirmed the consistency and robustness of these findings. In the comparison of factor IIa and Xa-directed oral anticoagulation, no differences were observed regarding cardiac function (E/E' ratio: βIIa inhibitor - 0.22 [- 0.36/- 0.08] vs. βXa inhibitor - 0.24 [- 0.37/- 0.11]) and lipid metabolism (ApoA1: βIIa inhibitor 0.10 [0.01/0.18] vs. βXa inhibitor 0.12 [0.04/0.20]) compared to VKA therapy.CONCLUSION: This study provides the first evidence for differential, non-conventional associations of oral anticoagulants on cardiac function and lipid metabolism in humans. The potentially beneficial effect of DOACs in the highly vulnerable population of HF individuals needs to be further elucidated and may have implications for individually tailored anticoagulation therapy.
AB - BACKGROUND: Experimental data indicate that direct acting oral anticoagulants (DOAC) and vitamin K antagonists (VKA) may exert differential effects on cardiovascular disease.METHODS: Data from the prospective, observational, single-center MyoVasc Study were used to examine associations of DOAC as compared to VKA with subclinical markers of cardiovascular disease, cardiac function, and humoral biomarkers in heart failure (HF).RESULTS: Multivariable analysis adjusted for age, sex, traditional cardiovascular risk factors, comorbidities, and medications with correction for multiple testing demonstrated that DOAC therapy was among all investigated parameters an independent significant predictor of better diastolic function (E/E': β - 0.24 [- 0.36/- 0.12]; P < 0.0001) and higher levels of ApoA1 (β + 0.11 g/L [0.036/0.18]; P = 0.0038) compared to VKA therapy. In propensity score-weighted analyses, the most pronounced differences between DOAC and VKA-based therapy were also observed for E/E' (∆ - 2.36) and ApoA1 (∆ + 0.06 g/L). Sensitivity analyses in more homogeneous subsamples of (i) individuals with AF and (ii) individuals with asymptomatic HF confirmed the consistency and robustness of these findings. In the comparison of factor IIa and Xa-directed oral anticoagulation, no differences were observed regarding cardiac function (E/E' ratio: βIIa inhibitor - 0.22 [- 0.36/- 0.08] vs. βXa inhibitor - 0.24 [- 0.37/- 0.11]) and lipid metabolism (ApoA1: βIIa inhibitor 0.10 [0.01/0.18] vs. βXa inhibitor 0.12 [0.04/0.20]) compared to VKA therapy.CONCLUSION: This study provides the first evidence for differential, non-conventional associations of oral anticoagulants on cardiac function and lipid metabolism in humans. The potentially beneficial effect of DOACs in the highly vulnerable population of HF individuals needs to be further elucidated and may have implications for individually tailored anticoagulation therapy.
KW - Administration, Oral
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Anticoagulants/administration & dosage
KW - Biomarkers/blood
KW - Female
KW - Follow-Up Studies
KW - Heart Failure/blood
KW - Heart Ventricles/drug effects
KW - Humans
KW - Lipid Metabolism/drug effects
KW - Lipids/blood
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Stroke Volume/drug effects
KW - Treatment Outcome
KW - Ventricular Function, Left/drug effects
KW - Vitamin K/antagonists & inhibitors
U2 - 10.1007/s00392-018-1408-y
DO - 10.1007/s00392-018-1408-y
M3 - SCORING: Journal article
C2 - 30604046
VL - 108
SP - 787
EP - 796
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 7
ER -
