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

Abstract

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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