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Increased Secondary/Primary Bile Acid-Ratio in Chronic Heart Failure

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Cristiane C.K. Mayerhofer, Thor Ueland, Kaspar Broch, Royce P. Vincent, Gemma F. Cross, Christen P Dahl, Pål Aukrust, Lars Gullestad, Johannes R. Hov, Marius Trøseid

Original languageEnglish
JournalJournal of Cardiac Failure
Early online date5 Jul 2017
Accepted/In press29 Jun 2017
E-pub ahead of print5 Jul 2017


King's Authors


Aims: Bile acids (BAs) are now recognized as signaling molecules and emerging evidence suggests that BAs affect cardiovascular function. The gut microbiota has recently been linked to the severity of heart failure (HF), and microbial metabolism has a major impact on BA homeostasis. We aimed to investigate the pattern of BAs, and in particular microbiota-transformed (secondary) BAs, in patients with chronic HF. 
Methods and Results: This was a prospective, observational, single-center study including 142 patients with chronic HF and 20 age- and sex-matched healthy control subjects. We measured plasma levels of primary, secondary and total BAs, and explored their associations with clinical characteristics and survival. Plasma levels of primary BAs were lower (p<0.01) and the ratio of secondary to primary BAs was higher (p<0.001) in patients with HF compared to controls. Approximately 40% of patients in the upper tertile of the ratio of secondary to primary BAs died during 5.6 years of follow-up (unadjusted Cox-regression: HR 1.93, 95% Confidence Interval 1.01-3.68 compared to the lower tertiles). However, this association was attenuated and no longer significant in multivariate analyses. 
Conclusions: Levels of primary BAs were reduced and specific secondary BAs increased in patients with chronic HF. This pattern was associated with reduced overall survival in univariate analysis, but not in multivariate analyses. Future studies should assess the regulation and potential role of BA metabolism in HF.

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