Biomarkers of endothelial dysfunction are elevated and related to prognosis in chronic heart failure patients with diabetes but not in those without diabetes

Abstract

Background: Biomarkers of endothelial dysfunction, such as soluble E-selectin, and von Willebrand factor (vWf) are elevated in patients with chronic heart failure (CHF). The impact of diabetes mellitus (DM) on these biomarkers, and their relation to prognosis remains unknown. Aims: to investigate the impact of DM on plasma levels and the prognostic value of E-selectin and vWf in patients with CHF. Methods and results: Plasma levels of E-selectin and vWf were measured in 195 CHF patients with (n = 48, 24.5%), and without DM, and in 116 age-matched healthy controls. Compared with controls, median plasma E-selectin levels were higher in CHF patients with DM (P = 0.012), but not in CHF patients without DM (P = 0.45); vWf levels were also higher in CHF patients with DM (P b 0.001), but not without DM (P = 0.108). E-selectin was associated with risk of recurrent ischaemic cardiovascular events among CHF patients with DM (HR 2.60; P = 0.009), but not among patients without DM (HR 1.09; P = 0.60) per 1 SD increment in log transformed variable. vWf was not related with outcome in CHF patients with or without DM. Conclusions: Plasma levels of E-selectin and vWf are elevated in CHF patients with DM but not in those without DM. High E-selectin levels may be associated with ischaemic events in patients with DM.

Albuminuria in heart failure: what do we really know?

“…Kistorp et al [43 ] have prospectively studied during a median of 2.5 years whether albuminuria and other biomarkers of endothelial dysfunction at baseline are related to prognosis in patients with heart failure with and without diabetes. The authors found that among the diabetic heart failure patients albuminuria, plasma Eselectin and fasting blood glucose predicted the risk of ischemic events, but this association was not observed in nondiabetic heart failure patients.…”

“…Despite the high prevalence of microalbuminuria in heart failure, only two studies have prospectively studied the relationship between albuminuria and clinical outcomes in heart failure patients (Table 2) [42,43 ].…”

Renal Vascular Structure and Rarefaction

“…Furthermore, endothelial dysfunction also plays a role in favoring inflammation and thrombosis via upregulation of adhesion molecules and generation of chemokines. Endothelial dysfunction has been implicated in the pathophysiology of hypertension (63), coronary artery disease (159), chronic heart failure (104), peripheral artery disease (64), diabetes (92), and chronic renal disease (144). …”

Von Willebrand Factor: Drug and Drug Target

“…For example, individuals carrying blood group O are associated with low VWF levels (77±27 U/dL), which was recently shown to be attributable to a shorter VWF survival [64], whereas higher VWF levels (137±34 U/dL) are linked to the AB blood group [65]. In diabetics, VWF levels are higher (120 U/dL) than in non-diabetics (89 U/dL) [66]. Since almost all acute coronary syndromes result from arterial thrombus formation after plaque rupture in diseased arteries and since VWF has a pivotal role in thrombus build-up, it seems logic to suspect that high plasma VWF levels might contribute to the pathogenesis of cardiovascular disease (CVD).…”