An Association of Insulin Resistance with Numerous of Circulating Microparticles Originated from Endothelial Cells in Cardiac Failure Individuals without History of Diabetes Mellitus

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ACEI: Angiotensin-Converting Enzyme Inhibitors; ARBs: Angiotensin Receptor Blockers; AUC: Area Under Curve; BMI: Body Mass Index; BNP: Brain Natriuretic Peptide; CHF: Chronic Heart Failure; CV: Cardiovascular; EMPs: Endothelial-Derived Microparticles; GFR: Glomerular Filtration Rate; hs-CRP: High Sensitive C-Reactive Protein; HbA1c: Glycated Hemoglobin; HDL-C: High-Density Lipoprotein Cholesterol; HFpEF: CHF with Precerved LVEF; HFrEF: CHF with Reduced LVEF; IR: Insulin Resistance; LDL-C: Low-Density Lipoprotein Cholesterol; LVEF: Left Ventricular Ejection Fraction; MetS: Metabolic Syndrome; T2DM: Type 2 Diabetes Mellitus.

 Chronic heart failure (CHF) remains a major public health problem worldwide leading to growth of cardiovascular (CV) morbidity and mortality. During the past decades prevalence and incidence of CHF has increased. Despite contemporary understanding of the underlying disease mechanisms of CHF there is knowledge gap with respect to nature evolution CHF under influence of co-existing CV risk factors. Indeed, the results of few population-based and epidemiological investigations have shown that multiple actual CV risk factors and various metabolic comorbidities presented in CHF patients may affect cardiac failure development. There is still debate in the scientific community about whether identification of numerous of CV risk factors / the metabolic co-morbidities improves ability to predict CHF development beyond use of single risk factor.

Recent clinical investigations have revealed insulin resistance (IR) is as a distinct cause of cardiac dysfunction and CHF in diabetic and non-diabetic patients. IR mediates excessive or inadequate proliferation of the extracellular matrix accelerates apoptosis via increased oxidative stress, neurohumoral and inflammatory activation that effect cardiac remodeling and endothelial function. Despite IR is considered a main component of metabolic syndrome (MetS) and type two diabetes mellitus (T2DM), a lot of individuals with CHF may present IR prior to other dysmetabolic conditions including MetS / T2DM. However, IR is persisted component of CV risk factors and it role in CHF development in the patients without history of T2DM is still unclear.