Circulating endothelial-derived apoptotic microparticles and insulin resistance in non-diabetic patients with chronic
Insights
Insulin resistance (IR) is linked to higher levels of apoptotic endothelial-derived microparticles (EMPs) in chronic heart failure (CHF) patients. This association suggests IR may contribute to EMPs in non-diabetic CHF individuals.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Biomarkers
Background:
- Chronic heart failure (CHF) is a complex condition with multiple contributing factors.
- Endothelial dysfunction plays a significant role in the pathophysiology of CHF.
- Insulin resistance (IR) is increasingly recognized as a potential contributor to cardiovascular disease progression.
Purpose of the Study:
- To investigate the relationship between insulin resistance (IR) and apoptotic endothelial-derived microparticles (EMPs) in patients with chronic heart failure (CHF).
- To determine if IR is an independent predictor of elevated EMP levels in CHF.
- To assess the clinical utility of IR assessment in predicting EMP levels in CHF patients.
Main Methods:
- The study included 300 patients diagnosed with chronic heart failure (CHF) and coronary artery disease or myocardial infarction.
- Insulin resistance was quantified using the homeostasis model assessment for insulin resistance (HOMA-IR).
- Flow cytofluorometry was employed to determine the phenotype and levels of circulating endothelial-derived microparticles (EMPs).
Main Results:
- Patients with IR (HOMA-IR > 2.77) exhibited significantly higher levels of circulating EMPs compared to those without IR.
- EMPs showed a direct correlation with NYHA functional class, HOMA-IR, NT-pro-BNP, hs-CRP, and BMI.
- Multivariate analysis identified NYHA class, NT-pro-BNP, hs-CRP, and LVEF as independent predictors of increased EMPs, with HOMA-IR improving predictive models.
Conclusions:
- Insulin resistance (IR) may be a significant contributing factor to elevated circulating levels of apoptotic endothelial-derived microparticles (EMPs) in patients with chronic heart failure (CHF).
- These findings suggest that targeting IR could be a potential therapeutic strategy to reduce endothelial damage in non-diabetic CHF patients.
Background:
The objective of this study was to assess the relationship between insulin resistance and apoptotic endothelial-derived microparticles (EMPs) in patients with chronic heart failure (CHF).
Methods:
The study involved 300 CHF patients (186 males) aged 48-62 years with angiographically proven coronary artery disease and/or previously defined myocardial infarction. Insulin resistance was assessed by the homeostasis model assessment for insulin resistance (HOMA-IR). EMPs phenotype was determined by flow cytofluorometry.
Results:
Depending on HOMA-IR cut-off point (over and <2.77 mmol/L×μU/mL) all patients were divided into two cohorts with (n=171) or without (n=129) IR, respectively. Circulating EMPs were higher in CHF patients with IR than in patients without IR. Interestingly, EMPs were directly related to NYHA functional class of CHF, HOMA-IR, NT-pro-BNP, hs-CRP and BMI. There was a significant association between the level of EMPs and HbA1c, gender (r=0.318, p<0.001 for male), age and smoking. On univariate and multivariate regression analysis we found that the NYHA class of CHF,NT-pro-BNP, hs-CRP, and left ventricular ejection fraction (LVEF) appeared to be independent predictors of increased circulatory apoptotic EMPs. The addition of HOMA-IR to the standard model (NYHA class CHF) improved the relative IDI by 19.9% for increased EMPs. For category-free NRI, 10% of events and 24% of non-events were correctly reclassified by the addition of HOMA-IR to the standard model for increased circulating EMPs.
Conclusions:
IR may be a contributing factor increasing circulating levels of apoptotic EMPs in non-diabetic CHF patients.
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