Zusammenfassung
Die MONICA/KORA-Surveys sind durch eine sorgfältige und breite Erhebung zahlreicher kardiovaskulärer Phänotypen gekennzeichnet. Insbesondere wiederholte, verblindete Blutdruckmessungen, umfassende echokardiographische und elektrokardiographische Ableitungen sowie die Differenzierung zwischen Fett und fettfreier Körpermasse haben zu vielfältigen innovativen Beobachtungen Anlass gegeben. So konnten genetische und serologische Marker des Renin-Angiotensin-Systems mit Bluthochdruck und linksventrikulärer Hypertrophie assoziiert werden. Gleiches gilt für die Bedeutung von Parametern der Körperkomposition, wie Adipositas und Muskelmasse. Zudem konnte erstmalig die Prävalenz der Herzinsuffizienz auf Bevölkerungsebene in Deutschland determiniert werden. Daneben gelangen genaue Prävalenzangaben für die linksventrikuläre systolische bzw. diastolische Dysfunktion in der Studienregion exemplarisch für die Bundesrepublik. Schließlich wurden die Studien in der Bevölkerungsstichprobe für die Definition von Normalwerten der natriuretischen Peptide genutzt. Zusammenfassend betrachtet erlaubte die Evaluation kardiovaskulärer Phänotypen in den MONICA/KORA-Studien eine im europäischen Raum einmalige Dokumentation kardiovaskulärer Funktionsparameter in der Normalbevölkerung. Darüber hinaus gelangen vielfältige epidemiologische Beobachtungen zu pathophysiologisch relevanten Themen von Herz- und Gefäßerkrankungen.
Abstract
The MONICA/KORA surveys are characterized by a careful and broad investigation of multiple cardiovascular phenotypes. Particularly, repeated blinded measurements of blood pressure, comprehensive echocardiographic and electrocardiographic evaluations as well as differentiation between fat and fat-free body mass have led to manifold innovative observations. Specifically, genetic and serological markers of the renin angiotensin system could be associated with high blood pressure and left ventricular hypertrophy. The same applies to the importance of parameters of body composition as obesity and muscular mass. Moreover, the prevalence of heart failure in the general population could be determined for the first time in Germany. Additionally, the prevalence of left ventricular systolic and diastolic dysfunction could be obtained in the region of the survey, exemplarily for the Federal Republic of Germany. Finally, the surveys of the population random sample were used to define normal serum levels of natriuretic peptides. In summary, the evaluation of cardiovascular phenotypes in the MONICA/KORA surveys resulted in a - in the European region unique - documentation of cardiovascular functional parameters in the general population. Moreover, multiple epidemiological observations as to pathophysiologically relevant topics of heart and vascular diseases could be studied in extraordinary details.
Schlüsselwörter
Linksventrikuläre Hypertrophie - Herzinsuffizienz - Genetik - Adipositas
Key words
Left ventricular hypertrophy - heart failure - genetics - obesity
References
1
Schunkert H, Ingelfinger J R, Hirsch A T. et al .
Evidence for tissue specific activation of renal angiotensinogen mRNA expression in chronic stable experimental heart failure.
J Clin Invest.
1992;
90
1523-1529
2
Schunkert H, Jackson B, Tang S S. et al .
Distribution and functional significance of cardiac angiotensin converting enzyme in hypertrophied rat hearts.
Circulation.
1993;
87
1328-1339
3
Schunkert H, Hense H W, Holmer S R. et al .
Association between a deletion polymorphism of the angiotensin-converting-enzyme gene and left ventricular hypertrophy.
New Engl J Med.
1994;
330
1634-1638
4
Danser A H, Schalekamp M A, Bax W A. et al .
Angiotensin-converting enzyme in the human heart. Effect of the deletion/insertion polymorphism.
Circulation.
1995;
92 (6)
1387-1388
5
Muscholl M W, Schunkert H, Muders F. et al .
Neurohormonal activity and left ventricular geometry in patients with essential arterial hypertension.
Am Heart J.
1998;
135
58-66
6
Schunkert H, Hense H W, Muscholl M. et al .
Associations between circulating components of the renin-angiotensin-aldosterone system and left ventricular mass.
Heart.
1997;
77
24-31
7
Schunkert H, Hense H W.
Molekulare Genetik kardiovaskulärer Erkrankungen.
Dtsch med Wschr.
1995;
120
533-539
8
Lindholm L H, Ibsen H, Dahlof B. et al .
Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.
Lancet.
2002;
359 (9311)
1004-1010
9
Muscholl M W, Hense H W, Brockel U. et al .
Changes in left ventricular structure and function in patients with white coat hypertension: cross sectional survey.
BMJ.
1998;
317
565-570
10
Kuch B, Muscholl M, Luchner A. et al .
Geschlechtsunterschiede in der Beziehung zwischen Übergewicht und Hypertonie mit linksventrikulärer Masse und Hypertrophie.
Z Kardiol.
1996;
85
334-342
11
Hense H W, Gneiting B, Muscholl M. et al .
The associations of body size and body composition with left ventricular mass: impact for indexation in adults.
J Am Coll Cardiol.
1998;
32
451-457
12
Kuch B, Hense H W, Gneiting B. et al .
Body composition and prevalence of left ventricular hypertrophy.
Circulation.
2000;
102
405-410
13
Kuch B, Gneiting B, Döring A. et al .
Indexation of left ventricular mass in adults with a novel approximation for fat free mass.
J Hypertens.
2001;
19
135-142
14
Kuch B, Muscholl M, Luchner A. et al .
Gender specific differences in left ventricular adaptation to obesity and hypertension.
J Hum Hypertens.
1998;
12
685-691
15
Hense H W, Schunkert H.
Relations of left ventricular mass to fat-free and adipose body mass.
Circulation.
1999;
100
e145 [electronic pages]
16
Schunkert H, Hense H W, Muscholl M. et al .
Association of angiotensin converting enzyme activity and arterial blood pressure in a population-based sample.
J Hypertens.
1996;
14
571-575
17
Schunkert H, Hense H W, Andus T. et al .
Relation between dehydroepiandrosterone sulfate and blood pressure levels in a population-based sample.
Am J Hypertens.
1999;
12 (11 Pt 1)
1140-1143
18
Luchner A, Burnett J C Jr, Jougasaki M. et al .
Evaluation of brain natriuretic peptide as marker of left ventricular dysfunction and hypertrophy in the population.
J Hypertens.
2000;
18
1121-1128
19
Luchner A, Brockel U, Muscholl M. et al .
Gender-specific differences of cardiac remodeling in subjects with left ventricular dysfunction: a population-based study.
Cardiovasc Res.
2002;
53
720-727
20
Luchner A, Hengstenberg C, Lowel H. et al .
N-terminal pro-brain natriuretic peptide after myocardial infarction: a marker of cardio-renal function.
Hypertension.
2002;
39 (1)
99-104
21
Schunkert H, Danser A H, Hense H W. et al .
Effects of estrogen replacement therapy on the renin angiotensin system in postmenopausal women.
Circulation.
1997;
95
39-45
22
Frohlich M, Schunkert H, Hense H W. et al .
Effects of hormone replacement therapies on fibrinogen and plasma viscosity in postmenopausal women.
Br J Haematol.
1998;
100
577-581
23
Holmer S R, Hense H W, Danser A H. et al .
Beta-adrenergic blockers lower renin in patients treated with ACE inhibitors and diuretics.
Heart.
1998;
80
45-48
24
Luchner A, Burnett J C Jr, Jougasaki M. et al .
Augmentation of the cardiac natriuretic peptides by beta-receptor antagonism: evidence from a population-based study.
J Am Coll Cardiol.
1998;
32
1839-1844
25
Schunkert H, Hense H W, Brockel U. et al .
Differential effects of antihypertensive drugs on neurohormonal activation: insights from a population-based sample.
J Int Med.
1998;
244
109-119
26
Straub R H, Hense H W, Andus T. et al .
Hormone replacement therapy and interrelation between serum interleukin 6 and body mass index in postmenopausal women: a population-based study.
J Clin Endocrinol Metab.
2000;
85
1340-1344
27
Schunkert H, Hense H W, Gimenez-Roqueplo A P. et al .
The angiotensinogen T235 variant and the use of antihypertensive drugs in a population-based cohort.
Hypertension.
1997;
29
628-633
28
Hengstenberg C, Schunkert H, Mayer B. et al .
Association between a polymorphism in the G protein beta3 subunit gene (GNB3) with arterial hypertension but not with myocardial infarction.
Cardiovasc Res.
2001;
49
820-827
29
Jamshidi Y, Montgomery H E, Hense H W. et al .
Peroxisome proliferator - activated receptor alpha gene regulates left ventricular growth in response to exercise and hypertension.
Circulation.
2002;
105
950-955
30
Schunkert H, Hense H W, Döring A. et al .
Association between a polymorphism in the G protein beta3 subunit gene and lower renin and elevated diastolic blood pressure levels.
Hypertension.
1998;
32
510-513
31
Danser A H, Derkx F H, Hense H W. et al .
Angiotensinogen (M235T) and angiotensinogen-converting enzyme (I/D) polymorphisms in association with plasma renin and prorenin levels.
J Hypertens.
1998;
16
1879-1883
32
Schunkert H, Hengstenberg C, Holmer S R. et al .
Lack of association between a polymorphism of the aldosterone synthase gene and left ventricular structure.
Circulation.
1999;
99
2255-2260
33
Hengstenberg C, Holmer S R, Mayer B. et al .
Evaluation of the aldosterone synthase (CYP11B2) gene polymorphism in patients with myocardial infarction.
Hypertension.
2000;
35
704-709
34
Zhang X, Erdmann J, Regitz-Zagrosek V. et al .
Evaluation of three polymorphisms in the promoter region of the angiotensin II type I receptor gene.
J Hypertens.
2000;
18
267-272
35
Sedlacek K, Fischer M, Erdmann J. et al .
Relation of the G protein beta3-subunit polymorphism with left ventricle structure and function.
Hypertension.
2002;
40
162-167
36
Schunkert H, Brockel U, Hengstenberg C. et al .
Familial predisposition of left ventricular hypertrophy.
J Am Coll Cardiol.
1999;
33
1685-1691
37
Schunkert H, Broeckel U, Hense H W. et al .
Left-ventricular dysfunction.
Lancet.
1998;
351
372 [letter]
38
Fischer M, Baessler A, Holmer S R. et al .
Epidemiology of left ventricular systolic dysfunction in the general population of Germany: results of an echocardiographic study of a large population-based sample.
Z Kardiol.
2003;
92
294-302
39
Fischer M, Baessler A, Hense H W. et al .
Prevalence of left ventricular diastolic dysfunction in the community: Results from a Doppler echocardiographic-based survey of a population sample.
Eur Heart J.
2003;
24
320-328
40
Schunkert H, Hense H W.
A heart price to pay for anaemia.
Nephrol Dial Transplant.
2001;
16
445-448 (editorial)
41
Schunkert H, Koenig W, Brockel U. et al .
Haematocrit profoundly affects left ventricular diastolic filling as assessed by Doppler echocardiography.
J Hypertens.
2000;
18
1483-1488
Prof. Dr. H. Schunkert
Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Medizinische Klinik II
Ratzeburger Allee 160
23538 Lübeck, Germany