Abstract
Heart failure (HF) patients often suffer from multiple comorbidities, such as diabetes, atrial fibrillation, depression, chronic obstructive pulmonary disease, and chronic kidney disease. The coexistance of comorbidities usually leads to multi morbidity and poor prognosis. Treatments for HF patients with multi morbidity are still an unmet clinical need, and finding an effective therapy strategy is of great value. HF can lead to comorbidity, and in return, comorbidity may promote the progression of HF, creating a vicious cycle. This reciprocal correlation indicates there may be some common causes and biological mechanisms. Metabolism remodeling and chronic inflammation play a vital role in the pathophysiological processes of HF and comorbidities, indicating metabolism and inflammation may be the links between HF and comorbidities. In this review, we comprehensively discuss the major underlying mechanisms and therapeutic implications for comorbidities of HF. We first summarize the potential role of metabolism and inflammation in HF. Then, we give an overview of the linkage between common comorbidities and HF, from the perspective of epidemiological evidence to the underlying metabolism and inflammation mechanisms. Moreover, with the help of bioinformatics, we summarize the shared risk factors, signal pathways, and therapeutic targets between HF and comorbidities. Metabolic syndrome, aging, deleterious lifestyles (sedentary behavior, poor dietary patterns, smoking, etc.), and other risk factors common to HF and comorbidities are all associated with common mechanisms. Impaired mitochondrial biogenesis, autophagy, insulin resistance, and oxidative stress, are among the major mechanisms of both HF and comorbidities. Gene enrichment analysis showed the PI3K/AKT pathway may probably play a central role in multi morbidity. Additionally, drug targets common to HF and several common comorbidities were found by network analysis. Such analysis has already been instrumental in drug repurposing to treat HF and comorbidity. And the result suggests sodium-glucose transporter-2 (SGLT-2) inhibitors, IL-1β inhibitors, and metformin may be promising drugs for repurposing to treat multi morbidity. We propose that targeting the metabolic and inflammatory pathways that are common to HF and comorbidities may provide a promising therapeutic strategy.
Highlights
Heart failure (HF) is a global public health problem that affects more than 26 million people worldwide and causes a heavy health burden [1, 2]
We summarized the role of metabolism and inflammation in HF and its most common comorbidities, and review their possible links, including shared risk factors, signal pathways, and therapeutic targets
Under non-ischemic conditions, more than 95% of the ATP in the normal heart comes from oxidative phosphorylation of fatty acid (FA), glucose, and lactate in mitochondria, while in a fasting state, as the energy demand increases, there is a substrate shift from FAs to glucose (FAs produce about 70% of the ATP and glucose produces 20%) [17]
Summary
Heart failure (HF) is a global public health problem that affects more than 26 million people worldwide and causes a heavy health burden [1, 2]. Metabolism and inflammation play an essential role in the pathophysiology of HF and its associated comorbidities, which may be the link between them. We summarized the role of metabolism and inflammation in HF and its most common comorbidities, and review their possible links, including shared risk factors, signal pathways, and therapeutic targets. METABOLIC REMODELING FROM NORMAL TO FAILING HEART IS BOTH CAUSE AND EFFECT OF HEART FAILURE. We give an overview of the pathological cardiac metabolic remodeling from physiological condition to heart failure, including glucose, fatty acid (FA), amino acid, and ions metabolisms. These metabolic changes all affect cardiac energy metabolism either by directly participating in or indirectly regulating mitochondrial metabolism
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