Association between leukocyte telomere length and heart failure: a meta-analysis
N Cahuapaza-Gutierrez, C Calderon-Hernandez, F Runzer-ColmenaresAbstract
Background
Telomere length has been associated with the onset and progression of heart failure (HF). In this context, telomere shortening, measured by leukocyte telomere length (LTL), may reflect biological ageing processes and cellular damage involved in the pathophysiology of HF.
Aims
To synthesise and analyse the association between leukocyte telomere length (LTL) and heart failure.
Methods
Studies assessing LTL as the ratio between the number of telomere repeat copies (T) and a single-copy gene (S) in peripheral blood leukocyte DNA, determined by quantitative polymerase chain reaction (T/S ratio), were included. Observational studies and clinical trials were considered. Case reports, letters to the editor, reviews, and other non-original publications were excluded. A systematic literature search was conducted in PubMed, Scopus, EMBASE, and Web of Science. The standardised mean difference (SMD) was used as the effect measure for continuous outcomes, applying an inverse-variance random-effects model and estimating 95% confidence intervals (CI). Statistical analyses were performed using Review Manager software, version 5.4.1.
Results
Five studies were included, comprising a total of 1,661 participants, of whom 1,050 were patients with heart failure and 611 were healthy controls. When comparing LTL between groups, the random-effects meta-analysis showed that patients with HF had significantly shorter telomeres than controls (SMD –0.64; 95% CI –1.19 to –0.09; Z = 2.29; p = 0.02), corresponding to a moderate effect size. Substantial heterogeneity was observed among the included studies (I² = 96%; Tau² = 0.36; Chi² = 89.65), suggesting considerable clinical (HF phenotypes, ejection fraction) and methodological variability. Nevertheless, the direction of the effect was consistent, favouring shorter telomere length in patients with heart failure.
Conclusions
Overall, the findings of this meta-analysis indicate that heart failure is associated with a significant reduction in leukocyte telomere length compared with healthy controls. However, the high heterogeneity observed across studies suggests that this association may be influenced by clinical and methodological differences, which should be considered when interpreting the magnitude of the observed effect.