Biomarkers of endothelial dysfunction are elevated and related to prognosis in chronic heart failure patients with diabetes but not in those without diabetes

doi:10.1016/j.ejheart.2008.02.012

European Journal of Heart Failure 2008 10(4):380-387; doi:10.1016/j.ejheart.2008.02.012

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Biomarkers of endothelial dysfunction are elevated and related to prognosis in chronic heart failure patients with diabetes but not in those without diabetes

Caroline Kistorp^a^,*, Aun Y. Chong^b, Finn Gustafsson^c, Søren Galatius^d, Ilan Raymond^d, Jens Faber^a, Gregory Y.H. Lip^b and Per Hildebrandt^e

^a Department of Endocrinology, Herlev University Hospital Copenhagen, Denmark
^b Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital Birmingham, United Kingdom
^c Department of Cardiology, State University Hospital (Rigshospitalet) Copenhagen, Denmark
^d Department of Cardiology, Gentofte University Hospital Denmark
^e Department of Medicine, Roskilde University Hospital Denmark

^* Corresponding author. Department of Endocrinology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark. Tel.: +45 22475699; fax: +45 39633634. E-mail address: cnkistorp{at}dadlnet.dk (C. Kistorp).

Abstract

Background: Biomarkers of endothelial dysfunction, such as soluble E-selectin,and von Willebrand factor (vWf) are elevated in patients withchronic heart failure (CHF). The impact of diabetes mellitus(DM) on these biomarkers, and their relation to prognosis remainsunknown.

Aims: to investigate the impact of DM on plasma levels and the prognosticvalue of E-selectin and vWf in patients with CHF.

Methods and results: Plasma levels of E-selectin and vWf were measured in 195 CHFpatients with (n = 48, 24.5%), and without DM, and in 116 age-matchedhealthy controls. Compared with controls, median plasma E-selectinlevels were higher in CHF patients with DM (P = 0.012), butnot in CHF patients without DM (P = 0.45); vWf levels were alsohigher in CHF patients with DM (P < 0.001), but not withoutDM (P = 0.108). E-selectin was associated with risk of recurrentischaemic cardiovascular events among CHF patients with DM (HR2.60; P = 0.009), but not among patients without DM (HR 1.09;P = 0.60) per 1 SD increment in log transformed variable. vWfwas not related with outcome in CHF patients with or withoutDM.

Conclusions: Plasma levels of E-selectin and vWf are elevated in CHF patientswith DM but not in those without DM. High E-selectin levelsmay be associated with ischaemic events in patients with DM.

Key Words: Endothelial dysfunction • Diabetes • Prognosis

Received June 25, 2007; Revised December 30, 2007; Accepted February 19, 2008

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