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Abstract
Type 2 diabetes mellitus (T2DM) significantly increases the risk of cardiovascular diseases (in particular, heart failure) and creates a significant financial burden for society. At the same time, the immune mechanisms underlying the comorbid course of T2DM and heart failure (HF) remain poorly understood. Materials and methods. The study was conducted with the involvement of 147 patients with T2DM, who were divided into 2 groups: 120 patients with T2DM + HF comorbidity and 27 patients with T2DM alone. The immune response of the organism was determined by the detection of markers of inflammation and myocardial remodelling (galectin-3, sST2, CRP) and inflammation indices (NLR, PLR, SII, SIRI). Endothelial function was determined by
the FMD method. Results. In the group of patients with T2DM and HF (n=120), there was no statistically significant difference in age (59.50 [54.00; 66.00] vs. 57.00 [51.00; 64.00] years, p=0.173) and gender distribution (p=0.746) compared with the group of patients with T2DM alone (n=27). At the same time, comorbid patients had a higher BMI (28.19 [25.75; 31.31] kg/m² vs. 26.65 [23.49; 28.30] kg/m²; p=0.013) and a tendency to have increased SBP and DBP, as well as a significant increase in markers of myocardial remodelling (galectin-3, sST2) and inflammation (CRP). Inflammation indices — NLR, PLR, SII and SIRI — were
also significantly higher in the group with T2DM + HF. In addition, patients with combined pathology had more severe endothelial dysfunction (FMD=8.08 [6.67; 10.02]%) compared with patients with T2DM alone (10.66 [9.02; 12.12]%; p<0.001). Conclusions. Concomitant heart failure in patients with T2DM is associated with increased systemic inflammation (higher NLR, PLR, SII, SIRI, sST2, galectin-3 and CRP) and worsening
of endothelial dysfunction.
References
Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, et al. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. 2023;402(10397):203-34. DOI: 10.1016/S0140-6736(23)01301-6.
Patel MR, Anthony Tolentino D, Smith A, Heisler M. Economic burden, financial stress, and cost-related coping among people with uncontrolled diabetes in the U.S. Prev Med Rep. 2023;34:102246. DOI: 10.1016/J.PMEDR.2023.102246.
Ma CX, Ma XN, Guan CH, Li YD, Mauricio D, Fu SB. Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management. Cardiovasc Diabetol. 2022;21(1):74. DOI: 10.1186/s12933-022-01516-6.
Pop-Busui R, Januzzi JL, Bruemmer D, Butalia S, Green JB, Horton WB, et al. Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association. Diabetes Care [Internet]. 2022 [cited 2023 Dec 22];45(7):1670-90. Available from: https://pubmed.ncbi.nlm.nih.gov/35796765/ DOI: 10.2337/DCI22-0014
McAllister DA, Read SH, Kerssens J, Livingstone S, McGurnaghan S, Jhund P, et al. Incidence of Hospitalization for Heart Failure and Case-Fatality Among 3.25 Million People With and Without Diabetes Mellitus. Circulation [Internet]. 2018 [cited 2023 Dec 22];138(24):2774-86. Available from: https://pubmed.ncbi.nlm. nih.gov/29950404/ DOI: 10.1161/CIRCULATIONAHA.118.034986
Уніфікований клінічний протокол первинної, вторинної (спеціалізованої) та третинної (високоспеціалізованої) медичної допомоги (УКПМД) «Цукровий діабет ІІ типу». Наказ МОЗ України № 1118 від 21.12.2012 року.
Уніфікований клінічний протокол первинної, вторинної (спеціалізованої) та третинної (високоспеціалізованої) медичної допомоги (УКПМД) «Стабільна ішемічна хвороба серця». Наказ Міністерства охорони здоров’я України від 23.12.2021 № 2857.
Anastasiou M, Oikonomou E, Zagouri F, Siasos G, Antonopoulos AS, Psaltopoulou T, et al. Flow-Mediated Dilation of Brachial Artery as a Screening Tool for Anthracycline-Induced Cardiotoxicity. J Am Coll Cardiol. 2017;70(24):3072. DOI: 10.1016/j.jacc.2017.09.1140.
Budzianowski J, Pieszko K, Burchardt P, Rzeźniczak J, Hiczkiewicz J. The Role of Hematological Indices in Patients with Acute Coronary Syndrome. Dis Markers. 2017;2017. DOI: 10.1155/2017/3041565.
Curran FM, Bhalraam U, Mohan M, Singh JS, Anker SD, Dickstein K, et al. Neutrophil-to-lymphocyte ratio and outcomes in patients with new-onset or worsening heart failure with reduced and preserved ejection fraction. ESC Heart Fail [Internet]. 2021 [cited 2023 Dec 22];8(4):3168-79. Available from: https://pubmed.ncbi. nlm.nih.gov/33998162/ DOI: 10.1002/EHF2.13424
Vakhshoori M, Nemati S, Sabouhi S, Yavari B, Shakarami M, Bondariyan N, et al. Neutrophil to lymphocyte ratio (NLR) prognostic effects on heart failure; a systematic review and meta-analysis. BMC Cardiovasc Disord [Internet]. 2023 [cited 2023 Dec 22];23(1). Available from: https://pubmed.ncbi.nlm.nih. gov/37957565/ DOI: 10.1186/S12872-023-03572-6.