CARDIOVASCULAR MEDICINE

Insulin resistance and inflammatory activation in older patients with systolic and diastolic heart failure

N Wisniacki¹, W Taylor², M Lye³ and J P H Wilding¹

¹ Diabetes and Endocrinology Research Group, Department of Medicine, University of Liverpool, Liverpool, UK
² Department of Clinical Chemistry, University of Liverpool
³ Geriatric Medicine, University of Liverpool

Correspondence to:
Correspondence to:
Dr Nicolas Wisniacki
University Clinical Department, The Duncan Building, Daulby Street, Liverpool L69 3GA, UK n.wisniacki{at}liv.ac.uk

Objective: To evaluate insulin resistance and systemic inflammation in older patients with systolic (SHF) or diastolic heart failure (DHF).

Patients: 52 non-diabetic patients (> 70 and < 90 years old) with chronic heart failure (CHF) and hospitalised within the previous six months for heart failure were studied, together with a control group of older healthy volunteers (n = 26). On the basis of Doppler echocardiographic criteria patients were classed as having SHF (n = 27) or DHF (n = 25).

Main outcome measures: Fasting glucose, insulin, C reactive protein, interleukin 6, and tumour necrosis factor soluble receptor II (TNF-SRII) concentrations were determined. Insulin resistance was estimated by the homeostasis model assessment (HOMA).

Results: HOMA index (median, interquartile range) was higher in patients with DHF (1.77, 1.06–2.26) than in patients with SHF (0.97, 0.81–1.85) or healthy volunteers (1.04, 0.76–1.44; p = 0.01). After adjustment for body mass index, age, and use of angiotensin converting enzyme inhibitors, both groups of patients with CHF were more insulin resistant than were healthy volunteers (p = 0.02). C reactive protein, interleukin 6, and TNF-SRII were all significantly (p < 0.001) higher in patients with DHF and SHF than in healthy volunteers. All markers of systemic inflammation were independently associated with the presence of clinical CHF.

Conclusion: Insulin resistance and inflammatory activation are present in older patients with SHF and DHF.

Abbreviations: ACE, angiotensin converting enzyme; BMI, body mass index; CHF, chronic heart failure; CRP, C reactive protein; DHF, diastolic heart failure; ELISA, enzyme linked immunosorbent assay; HOMA, homeostasis model assessment; IL-6, interleukin 6; IR, insulin resistance; LV, left ventricular; NYHA, New York Heart Association; SC, standardised coefficient; SHF, systolic heart failure; TNF-SRII, tumour necrosis factor soluble receptor II

Keywords: heart failure; diastole; cytokines; insulin

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