The Cardiology Group at the Health Research Institute studies new therapeutic targets for heart failure based on diet compounds and local fat development. The group has expertise culturing three human cardiovascular cell types and uses animal models to test nutraceuticals, chemicals, and diet compounds' effects on cardiovascular metabolism. Led by Dr. José Ramón González Juanatey, the group publishes in high impact journals and seeks collaboration on organized projects related to functional foods, nutraceuticals, and diet therapies.

1. New therapeutic targets for stages of
heart failure based on diet compounds
and local fat development
Cardiology Group
(Health Research Institute)
Sonia Eiras Penas

2. Deaths by cause in men and women, Europe
European Cardiovascular Disease Statistics 2012
Coronary
Heart
Disease
20%
Stroke
10%
Other CVD
12%
Stomach
cancer
2%
Colo-
rectal
cancer
2%
Lung
cancer
4%
Other
cancer
13%
Respirator
y disease
7%
Injuries
and
poisoning
10%
All other
causes
20%
Coronary
Heart
Disease
22%
Stroke
15%
Other
CVD
15%
Stomach
cancer
1%Colo-
rectal
cancer
2%
Lung
cancer
2%
Breast
cancer
3%
Other
cancer
10%
Respirator
y disease
6%
Injuries
and
poisoning
4%
All other
causes
20%
52%

3. Heart Failure
The main cause of morbidity in the world and remains the most
frequent cause of hospitalization for patients over 65 years old.
Braunschweig F et al. Europace 2011;13:ii13-ii17
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author
2011. For permissions please email: journals.permissions@oup.com.
Costs for heart failure in the USA from 2003 to 2010

4. Stages, Phenotypes and Treatment of HF
STAGE A
At high risk for HF but
without structural heart
disease or symptoms of HF
STAGE B
Structural heart disease
but without signs or
symptoms of HF
THERAPY
Goals
· Control symptoms
· Improve HRQOL
· Prevent hospitalization
· Prevent mortality
Strategies
· Identification of comorbidities
Treatment
· Diuresis to relieve symptoms
of congestion
· Follow guideline driven
indications for comorbidities,
e.g., HTN, AF, CAD, DM
· Revascularization or valvular
surgery as appropriate
STAGE C
Structural heart disease
with prior or current
symptoms of HF
THERAPY
Goals
· Control symptoms
· Patient education
· Prevent hospitalization
· Prevent mortality
Drugs for routine use
· Diuretics for fluid retention
· ACEI or ARB
· Beta blockers
· Aldosterone antagonists
Drugs for use in selected patients
· Hydralazine/isosorbide dinitrate
· ACEI and ARB
· Digoxin
In selected patients
· CRT
· ICD
· Revascularization or valvular
surgery as appropriate
STAGE D
Refractory HF
THERAPY
Goals
· Prevent HF symptoms
· Prevent further cardiac
remodeling
Drugs
· ACEI or ARB as
appropriate
· Beta blockers as
appropriate
In selected patients
· ICD
· Revascularization or
valvular surgery as
appropriate
e.g., Patients with:
· Known structural heart disease and
· HF signs and symptoms
HFpEF HFrEF
THERAPY
Goals
· Heart healthy lifestyle
· Prevent vascular,
coronary disease
· Prevent LV structural
abnormalities
Drugs
· ACEI or ARB in
appropriate patients for
vascular disease or DM
· Statins as appropriate
THERAPY
Goals
· Control symptoms
· Improve HRQOL
· Reduce hospital
readmissions
· Establish patient’s end-
of-life goals
Options
· Advanced care
measures
· Heart transplant
· Chronic inotropes
· Temporary or permanent
MCS
· Experimental surgery or
drugs
· Palliative care and
hospice
· ICD deactivation
Refractory
symptoms of HF
at rest, despite
GDMT
At Risk for Heart Failure Heart Failure
e.g., Patients with:
· Marked HF symptoms at
rest
· Recurrent hospitalizations
despite GDMT
e.g., Patients with:
· Previous MI
· LV remodeling including
LVH and low EF
· Asymptomatic valvular
disease
e.g., Patients with:
· HTN
· Atherosclerotic disease
· DM
· Obesity
· Metabolic syndrome
or
Patients
· Using cardiotoxins
· With family history of
cardiomyopathy
Development of
symptoms of HF
Structural heart
disease

5. Heart Failure and Diet
Associations of
Mediterranean and Dietary
Approaches to Stop
Hypertension (DASH)
Improve the
cardiovascular risk
factors
Mediterranean diet 1 year (The
PREDIMED Study)
Vitamins B, C and E,
coenzyme Q10, alpha-lipoic
acid, chromium, omega-3
polyunsaturated fatty acids,
L-carnitine, and quercetin
Antioxidants in diet
Improve the cardiovascular
risk factors

6. Cardiovascular health in the American Heart Association 2020 goals, US
children aged 12 to 19 years, National Health and Nutrition Examination
Survey (NHANES) 2009-2010* (available data as of June 1, 2012). *Healthy
Diet Score reflects 2007-2008 NHANES data.
Go A S et al. Circulation. 2013;127:e6-e245
Copyright © American Heart Association, Inc. All rights reserved

7. MM Lima- Martinez et al. (2011)
Hipertension y riesgo cadiovascular 28
(80%)
Epicardial adipose tissue

8. Epicardial adipose tissue and heart
failure
Diet compounds
Volume
Prognosis and
quality of life
Endocrine or paracrine function
Metabolic Activity
Oxidative Stress
Coronaries and myocardium

9. Epicardial adipose tissue and
coronary artery disease
Jin-Sun Park e tal. (2013) Atherosclerosis 226; 134 - 139
Necrotic core
Dense calcium
Fibrous
Fibrofatty
>3,5 mm
<3,5 mm

10. Epicardial adipose tissue volume and
ventricle function
Short-axis views. Compared to healthy controls (A1/2), patients with DCM and moderately (B1/2)
and severely (C1/2) reduced left ventricular ejection fraction showed equally diminished indexed
EAT mass.
Doesch et al. (2013) Obesity 23: E253

11. Heart Failure
• Develop important changes in body composition and the disease course is marked by periodic
episodes of clinical decompensation.
• An altered balance between catabolism and anabolism is known to contribute to disease
progression and the transition from non-wasted heart failure to cardiac cachexia.
Controls HF EF <55% p Value HF EF 35–55% HF EF <35% p Value
(n =321) (n = 60) (n = 43) (n =17)
Epicardial fat volume
(cm3) 114,5 ±98,5 83,5 ± 67,1 <0,04 96,0 ± 73,9 52,2 ± 29,7 <0,05
Total calcium score 522 ± 1,324 656 ± 889 0,59 765 ± 1,030 445 ± 508 0,36
Khawaja T. et al. (2011) Am J Cardiol;108:397– 401

12. Epicardial fat volume (EFV)
Khawaja T. et al (2011) Am J Cardiol 108:397– 401

13. Request and Offers
• Inclusion in
organized projects
related with diet
• Functional food
expertise
• Nutraceutical/Pharmac
eutical Enterprize
• Table diets expertise
• Chemical analyzers
• Inclusion in organized
projects for
preclinical assays

14. Cardiology group. Health Research
Institute. Santiago de Compostela
Head: José Ramón González Juanatey
Researchers
Plataforms
(Proteomics,
Microscopy,
Luminex,
Image)
Enterprise?
Students
Clinical Staff

15. Expertise
Three human cardiovascular systems:
• Cardiomyocytes
• Endothelial cells
• Epicardial adipose tissue cells
Animal models
For testing the effect of nutraceutical, chemical
products, diet compunds on metabolic function of the
cardiovascular systems.

16. Cardiology group. Health Research
Institute
Head: José Ramón González Juanatey
0
25
50
75
100
125
150
175
200
225
250
Total
impact
factor
Q1 Q2 Q3 Q4
Total impact factor
Q1
Q2
Q3
Q4
2013
0
50
100
150
200
250
300
350
400
Total
publications
Heart
failure
Epicardial
fat
Total publications
Heart failure
Epicardial fat
1984-2013