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Insulin resistance and inflammatory activation in older patients with systolic and diastolic heart failure
  1. N Wisniacki1,
  2. W Taylor2,
  3. M Lye3,
  4. J P H Wilding1
  1. 1Diabetes and Endocrinology Research Group, Department of Medicine, University of Liverpool, Liverpool, UK
  2. 2Department of Clinical Chemistry, University of Liverpool
  3. 3Geriatric Medicine, University of Liverpool
  1. Correspondence to:
    Dr Nicolas Wisniacki
    University Clinical Department, The Duncan Building, Daulby Street, Liverpool L69 3GA, 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 α soluble receptor II (TNF-αSRII) 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-αSRII 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.

  • 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-αSRII, tumour necrosis factor α soluble receptor II
  • heart failure
  • diastole
  • cytokines
  • insulin

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