Insulin resistance and inflammatory activation in older patients with systolic and diastolic heart failure.
OBJECTIVE
To evaluate insulin resistance and systemic inflammation in older patients with systolic (SHF) or diastolic heart failure (DHF).


METHODS
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).


METHODS
Fasting glucose, insulin, C reactive protein, interleukin 6, and tumour necrosis factor alpha soluble receptor II (TNF-alphaSRII) 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-alphaSRII 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.


CONCLUSIONS
Insulin resistance and inflammatory activation are present in older patients with SHF and DHF.
Wisniacki
N
N
Diabetes and Endocrinology Research Group, Department of Medicine, University of Liverpool, Liverpool, UK. n.wisniacki@liv.ac.uk
Taylor
W
W
Lye
M
M
Wilding
J P H
JP
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D018836:Inflammation Mediators / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D009638:Norepinephrine / Q000097:blood; D012720:Severity of Illness Index; D013599:Systole
D018836:Inflammation Mediators; D009638:Norepinephrine