Insulin Resistance and Ischemic Etiology Heart Failure: Is There an Interrelationship in Clinical Practice?

Abstract

Background. IR promotes the development of early atherosclerosis and may increase the risk of cardiovascular complications, which is of great importance in patients with CHF. Thus, the assessment of the relationship between IR and clinical indicators of CHF is relevant in the clinical aspect and needs more detailed research. Objective: To evaluate the relationship between IR and clinical parameters in hospitalized ischemic etiology CHF patients without concomitant CMD. Methods. The study included 174 hospitalized patients with a stable course of CHF FC III (NYHA) and CAD from 18 to 65 years old, without previously identified CMD. Anthropological, clinical, laboratory examination was carried out. The neurohormonal profile included insulin (IR by HOMA- IR), aldosterone, and Nt-proBNP levels. To study the relationship of IR with clinical parameters in CHF and CAD patients, a correlation analysis was performed. Results. A statistically significant relationship between IR and the following parameters was revealed: BMI (r = 0.186, p = 0.045), total FINDRISC score (r = 0.386, p = 0.000), SBP (r = 0.247, p = 0.007), DBP (r = 0.173, p = 0.063), HbA1c (r = 0.388, p = 0.000), insulin concentration (r = 0.833, p = 0.000). To identify independent predictors influencing IR, we carried out multivariate linear regression analysis with stepwise inclusion of indicators in the model, in which HOMA-IR was used as a dependent variable, and BMI, total FINDRISK scores, SBP, DBP, HbA1c levels were included as independent variables. It turned out that the independent factors associated with IR are: HbA1c (β = 0.144; p = 0.000) and the FINDRISK scale points (β = 0.064; p = 0.05). Conclusions. In patients with CHF and CAD, IR is interrelated with such indicators as BMI, FINDRISC total points, SBP, DBP, HbA1c. Independent predictors influencing IR are HbA1c and the FINDRISK total points.