期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 54, 期 5, 页码 432-444出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2009.05.009
关键词
heart failure; beta-blocker; gene polymorphism; beta adrenergic receptor; G-protein receptor kinase
资金
- NCATS NIH HHS [UL1 TR000448] Funding Source: Medline
- NCRR NIH HHS [UL1 RR024992] Funding Source: Medline
- NHLBI NIH HHS [R01 HL059888-07, R01 HL088577, R01 HL059888-05, R01 HL059888, R01 HL059888-10, R01 HL080008-04, R01 HL080008-03, R01 HL087871-01, P50 HL077101-010002, P50 HL077101-019001, R01 HL059888-04, R01 HL059888-06, P50 HL077113, R01 HL080008-02, R01 HL080008, R01 HL059888-09A1, P50 HL077101, R01 HL059888-08, R01 HL087871-04, P50 HL077101-01, R01 HL087871-03, R01 HL059888-03, R01 HL059888-02, R01 HL059888-01A1, R01 HL087871-02, R01 HL087871, R01 HL080008-01A1] Funding Source: Medline
Objectives This study sought to identify genetic modifiers of beta-blocker response and long-term survival in heart failure (HF). Background Differences in beta-blocker treatment effect between Caucasians and African Americans with HF have been reported. Methods This was a prospective cohort study of 2,460 patients (711 African American, 1,749 Caucasian) enrolled between 1999 and 2007; 2,039 patients (81.7%) were treated with a beta-blocker. Each was genotyped for beta 1-adrenergic receptor (ADRB1) Arg389>Gly and G-protein receptor kinase 5 (GRK5) Gln41>Leu polymorphisms, which are more prevalent among African Americans than Caucasians. The primary end point was survival time from HF onset. Results There were 765 deaths during follow-up (median 46 months). beta-blocker treatment increased survival in Caucasians (log-rank p = 0.00038) but not African Americans (log-rank p = 0.327). Among patients not taking beta-blockers, ADRB1 Gly389 was associated with decreased survival in Caucasians (hazard ratio [HR]: 1.98, 95% confidence interval [CI]: 1.1 to 3.7, p = 0.03) whereas GRK5 Leu41 was associated with improved survival in African Americans (HR: 0.325, CI: 0.133 to 0.796, p = 0.01). African Americans with ADRB1 Gly389Gly GRK5 Gln41Gln derived a similar survival benefit from beta-blocker therapy (HR: 0.385, 95% CI: 0.182 to 0.813, p = 0.012) as Caucasians with the same genotype (HR: 0.529, 95% CI: 0.326 to 0.858, p = 0.0098). Conclusions These data show that differences caused by beta-adrenergic receptor signaling pathway gene polymorphisms, rather than race, are the major factors contributing to apparent differences in the beta-blocker treatment effect between Caucasians and African Americans; proper evaluation of treatment response should account for genetic variance. (J Am Coll Cardiol 2009; 54:432-44) (C) 2009 by the American College of Cardiology Foundation
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