Кардиоваскулярная терапия и профилактика (Apr 2019)
Identification of latent disorders of carbohydrate metabolism in conjunction with neurohormonal status in hospitalized patients with chronic heart failure of ischemic etiology
Abstract
Aim. To reveal latent disorders of carbohydrate metabolism (CHM) in conjunction with neurohormonal status in hospitalized patients with chronic heart failure (CHF) of ischemic etiology.Material and methods. We analyzed 174 patients with NYHA class II-IV CHF of ischemic etiology who received the same standard CHF therapy (P-adrenergic blockers, mineralocorticoid receptor antagonists, angiotensin-converting enzyme inhibitors, diuretics), did not have disorders of CHM and never took hypoglycemic agent. We conducted oral glucose tolerance test (OGTT) and general clinical examination. The levels of brain natriuretic peptide, aldosterone and insulin was determined by enzyme immunoassay. Insulin resistance (IR) is assessed using the HOMA-IR index.Results. Among 174 hospitalized patients with NYHA class II-IV CHF of ischemic etiology disorders of CHM was detected in 52,3% of patients: 33,9% of those had impaired glucose tolerance (IGT), 1,7% — impaired fasting glucose (IFG), 16,7% — newly diagnosed type 2 diabetes mellitus (DM), in 47,7% of the patients disorders of CHM was not found. In all patients with CHF, along with elevated levels of brain natriuretic peptide and aldosterone, insulin levels were also increased. IR elevated with the increase in the severity of disorders of CHM (in the group without disorders of CHM — 10,78 (8,9-12,2), IGT — 14,6 (11,2-18,2), newly diagnosed type 2 DM — 18,6 (15,19-26,7). Also the concentration of aldosterone was higher in the group with DM, compared with the ITG group (p2-3<0,01).Conclusion. The presence and progression of IR in patients with CHF of ischemic etiology in conjunction with neurohormonal status emphasizes the importance of timely detection of latent CHM disorders with its future management.
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