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The J-Curve Relationship between Free Carnitine Levels and Cardiovascular Events in Patients with Heart Failure
Shingo Watanabe1, Junichi Onuma1, Michio Usui1
1Department of Cardiology, Tokyo Yamate Medical Center.
Journal of Nutritional Science and Vitaminology
|April 29, 2025
Summary
Free carnitine levels in heart failure patients show a J-curve effect on outcomes. Both low and high free carnitine levels are associated with increased cardiac mortality and heart failure rehospitalization.
Area of Science:
- Cardiology
- Biochemistry
- Metabolic Disorders
Background:
- Carnitine is crucial for mitochondrial fatty acid metabolism.
- Hypocarnitinemia may worsen heart failure by impairing mitochondrial function and increasing oxidative stress.
- Limited data exist on free carnitine levels and heart failure outcomes.
Purpose of the Study:
- To investigate the association between free carnitine levels and clinical outcomes in hospitalized heart failure patients.
- To determine if free carnitine levels predict mortality and rehospitalization in heart failure.
Main Methods:
- Retrospective study of 271 patients hospitalized for acute heart failure.
- Patients categorized into four quartiles based on serum free carnitine levels.
- Primary endpoints included 1-year cardiac mortality and heart failure rehospitalization.
Main Results:
- Higher creatinine levels observed in the highest free carnitine quartile.
- 1-year mortality was significantly higher in the lowest and highest free carnitine quartiles.
- The highest free carnitine quartile showed significantly increased heart failure rehospitalization rates.
Conclusions:
- The relationship between free carnitine levels and heart failure outcomes follows a J-curve pattern.
- Both very low and very high free carnitine levels are associated with adverse clinical outcomes.
- Extreme free carnitine levels may indicate increased risk in heart failure patients.
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