Perticone Maria, Maio Raffaele, Gigliotti Simona, Shehaj Ermal, Toscani Alfredo Francesco, Capomolla Antonella, Fabiani Ginevra, Sciacqua Angela, Perticone Francesco
Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy.
Geriatrics Unit, Azienda Ospedaliero-Universitaria Renato Dulbecco, 88100 Catanzaro, Italy.
Biomedicines. 2023 Aug 3;11(8):2188. doi: 10.3390/biomedicines11082188.
Insulin resistance and endothelial dysfunction are associated with heart failure (HF). Our objective was to investigate whether endothelial dysfunction and insulin resistance are independent predictors of incident HF and if a possible interaction exists between them. We enrolled 705 white never-treated hypertensives. Endothelium-dependent vasodilation was investigated by intra-arterial infusion of acetylcholine. During the follow-up [median: 117 months (range: 31-211)], we documented 223 new cases of HF (3.3 events/100 patient-years). We stratified the study population into progressors and non-progressors; progressors showed an older age and a higher prevalence of females, as well as higher mean values of baseline glucose, insulin, homeostasis model assessment (HOMA), creatinine, and high-sensitivity C-reactive protein (hs-CRP), whereas the estimated glomerular filtration rate (e-GFR) and endothelium-dependent vasodilation were lower. In the multiple Cox regression analysis, serum hs-CRP (HR = 1.362, (95% CI = 1.208-1.536), HOMA (HR = 1.293, 95% CI = 1.142-1.465), maximal acetylcholine (Ach)-stimulated forearm blood flow (FBF) (100% increment, HR = 0.807, 95% CI = 0.697-0.934), and e-GFR (10 mL/min/1.73 m increment, HR = 0.552, 95% CI = 0.483-0.603) maintained an independent association with incident HF. HOMA and endothelial dysfunction interact between them in a competitive manner (HR = 6.548, 95% CI = 4.034-10.629), also showing a mutual effect modification. Our findings demonstrate that both endothelial dysfunction and HOMA are independent and strong predictors of incident HF in hypertensives, these two risk factors interact between them with a competitive mechanism.
胰岛素抵抗和内皮功能障碍与心力衰竭（HF）相关。我们的目的是研究内皮功能障碍和胰岛素抵抗是否是新发HF的独立预测因素，以及它们之间是否存在可能的相互作用。我们纳入了705名未经治疗的白人高血压患者。通过动脉内输注乙酰胆碱来研究内皮依赖性血管舒张。在随访期间[中位数：117个月（范围：31 - 211个月）]，我们记录了223例新发HF病例（3.3例/100患者年）。我们将研究人群分为病情进展者和非进展者；病情进展者年龄较大，女性患病率较高，同时基线血糖、胰岛素、稳态模型评估（HOMA）、肌酐和高敏C反应蛋白（hs - CRP）的平均值较高，而估算肾小球滤过率（e - GFR）和内皮依赖性血管舒张较低。在多因素Cox回归分析中，血清hs - CRP（风险比[HR] = 1.362，95%置信区间[CI] = 1.208 - 1.536）、HOMA（HR = 1.293，95% CI = 1.142 - 1.465）、最大乙酰胆碱（Ach）刺激的前臂血流量（FBF）（增加100%，HR = 0.807，95% CI = 0.697 - 0.934）和e - GFR（增加10 mL/min/1.73 m²，HR = 0.552，95% CI = 0.483 - 0.603）与新发HF保持独立关联。HOMA和内皮功能障碍以竞争方式相互作用（HR = 6.548，95% CI = 4.034 - 10.629），也显示出相互效应修正。我们的研究结果表明，内皮功能障碍和HOMA都是高血压患者新发HF的独立且强有力的预测因素，这两个危险因素通过竞争机制相互作用。
