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Metabolics of PH - an update
Allyson L Hughes1, Anna R Hemnes2
1The Department of Medicine, University of Tennessee Health Science Center, Saint Thomas-UT Internal Medicine.
Current Opinion in Pulmonary Medicine
|June 15, 2021
Summary
Metabolic alterations, including insulin resistance and obesity, are increasingly recognized in pulmonary hypertension. Therapies targeting metabolism show promise for improving patient outcomes in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Metabolic Disease
Background:
- Pulmonary hypertension (PH) has a longstanding association with metabolic disease.
- Recent research has translated basic science findings into human disease, focusing on metabolic therapy in pulmonary arterial hypertension (PAH).
Purpose of the Study:
- To review recent advancements in understanding metabolic disease in PH.
- To discuss novel clinical trials and therapeutic strategies targeting metabolism in PH.
Main Methods:
- Review of recent publications and clinical trials.
- Analysis of mechanisms of insulin resistance and obesity in PH.
- Exploration of metabolic alterations in PAH and chronic thromboembolic pulmonary hypertension (CTEPH).
Main Results:
- Insulin resistance in PAH is linked to the lipid axis, with systemic manifestations like right ventricular lipotoxicity.
- Obesity is associated with elevated right ventricular systolic pressure, even in healthy individuals.
- Metabolic therapies in PAH demonstrate potential for improving exercise capacity, right ventricular function, and reducing visceral adiposity.
- Emerging data suggest metabolic alterations in CTEPH, potentially differing from PAH.
Conclusions:
- Metabolic dysfunction is a critical factor in the pathogenesis and progression of pulmonary hypertension.
- Targeting metabolic pathways offers a promising therapeutic avenue for PAH and CTEPH.
- Further research is needed to elucidate specific metabolic alterations in CTEPH and optimize metabolic interventions.
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