Impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction: insights from the TOPCAT trial
Abstract Aims Diabetes mellitus (DM) is common in heart failure with preserved ejection fraction (HFpEF). Patients with DM and heart failure with reduced ejection fraction have higher levels of cardiac, profibrotic, and proinflammatory biomarkers relative to non‐diabetics. Limited data are available...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-04-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13153 |
| _version_ | 1819168343620321280 |
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| author | Corrado De Marco Brian L. Claggett Simon deDenus Michael R. Zile Thao Huynh Akshay S. Desai Martin G. Sirois Scott D. Solomon Bertram Pitt Jean L. Rouleau Marc A. Pfeffer Eileen O'Meara |
| author_facet | Corrado De Marco Brian L. Claggett Simon deDenus Michael R. Zile Thao Huynh Akshay S. Desai Martin G. Sirois Scott D. Solomon Bertram Pitt Jean L. Rouleau Marc A. Pfeffer Eileen O'Meara |
| author_sort | Corrado De Marco |
| collection | DOAJ |
| description | Abstract Aims Diabetes mellitus (DM) is common in heart failure with preserved ejection fraction (HFpEF). Patients with DM and heart failure with reduced ejection fraction have higher levels of cardiac, profibrotic, and proinflammatory biomarkers relative to non‐diabetics. Limited data are available regarding the biomarker profiles of HFpEF patients with diabetes (DM) vs. no diabetes (non‐DM) and the impact of spironolactone on these biomarkers. This study aims to address such gaps in the literature. Methods and results Biomarkers were measured at randomization and at 12 months in 248 patients enrolled in Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist's North American cohort. At baseline, DM patients had significantly lower estimated glomerular filtration rate and higher high‐sensitivity C‐reactive protein, pro‐collagen type III amino‐terminal peptide, tissue inhibitor of metalloproteinase 1 (TIMP‐1), and galectin‐3 levels than those without diabetes. There was a significantly larger 12 month increase in levels of high‐sensitivity troponin T (hs‐TnT), a marker of myocyte death, in DM patients. Elevated pro‐collagen type III amino‐terminal peptide and galectin‐3 levels were associated with an increased risk of the primary outcome (cardiovascular mortality, aborted cardiac arrest, or heart failure hospitalization) in DM patients, but not in those without diabetes. A statistically significant interaction between spironolactone and diabetes status was observed for hs‐TnT and for TIMP‐1, with greater biomarker reductions among those with diabetes treated with spironolactone. Conclusions The presence of diabetes is associated with higher levels of cardiac, profibrotic, and proinflammatory biomarkers in HFpEF. Spironolactone appears to alter the determinants of extracellular matrix remodelling in an anti‐fibrotic fashion in patients with diabetes, reflected by changes in hs‐TnT and TIMP‐1 levels over time. |
| first_indexed | 2024-12-22T19:02:06Z |
| format | Article |
| id | doaj.art-b070388439fb4ff99e7b2abea15e1756 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-22T19:02:06Z |
| publishDate | 2021-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-b070388439fb4ff99e7b2abea15e17562022-12-21T18:15:54ZengWileyESC Heart Failure2055-58222021-04-01821130113810.1002/ehf2.13153Impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction: insights from the TOPCAT trialCorrado De Marco0Brian L. Claggett1Simon deDenus2Michael R. Zile3Thao Huynh4Akshay S. Desai5Martin G. Sirois6Scott D. Solomon7Bertram Pitt8Jean L. Rouleau9Marc A. Pfeffer10Eileen O'Meara11Division of Cardiology Montreal Heart Institute and Université de Montréal 5000 rue Bélanger Montreal QC H1T 1C8 CanadaCardiovascular Division Brigham and Women's Hospital Boston MA USADivision of Cardiology Montreal Heart Institute and Université de Montréal 5000 rue Bélanger Montreal QC H1T 1C8 CanadaDivision of Cardiology Medical University of South Carolina Charleston SC USAMcGill University Health Centre and McGill University Montreal QC CanadaCardiovascular Division Brigham and Women's Hospital Boston MA USADivision of Cardiology Montreal Heart Institute and Université de Montréal 5000 rue Bélanger Montreal QC H1T 1C8 CanadaCardiovascular Division Brigham and Women's Hospital Boston MA USAUniversity of Michigan School of Medicine Ann Arbor MI USADivision of Cardiology Montreal Heart Institute and Université de Montréal 5000 rue Bélanger Montreal QC H1T 1C8 CanadaCardiovascular Division Brigham and Women's Hospital Boston MA USADivision of Cardiology Montreal Heart Institute and Université de Montréal 5000 rue Bélanger Montreal QC H1T 1C8 CanadaAbstract Aims Diabetes mellitus (DM) is common in heart failure with preserved ejection fraction (HFpEF). Patients with DM and heart failure with reduced ejection fraction have higher levels of cardiac, profibrotic, and proinflammatory biomarkers relative to non‐diabetics. Limited data are available regarding the biomarker profiles of HFpEF patients with diabetes (DM) vs. no diabetes (non‐DM) and the impact of spironolactone on these biomarkers. This study aims to address such gaps in the literature. Methods and results Biomarkers were measured at randomization and at 12 months in 248 patients enrolled in Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist's North American cohort. At baseline, DM patients had significantly lower estimated glomerular filtration rate and higher high‐sensitivity C‐reactive protein, pro‐collagen type III amino‐terminal peptide, tissue inhibitor of metalloproteinase 1 (TIMP‐1), and galectin‐3 levels than those without diabetes. There was a significantly larger 12 month increase in levels of high‐sensitivity troponin T (hs‐TnT), a marker of myocyte death, in DM patients. Elevated pro‐collagen type III amino‐terminal peptide and galectin‐3 levels were associated with an increased risk of the primary outcome (cardiovascular mortality, aborted cardiac arrest, or heart failure hospitalization) in DM patients, but not in those without diabetes. A statistically significant interaction between spironolactone and diabetes status was observed for hs‐TnT and for TIMP‐1, with greater biomarker reductions among those with diabetes treated with spironolactone. Conclusions The presence of diabetes is associated with higher levels of cardiac, profibrotic, and proinflammatory biomarkers in HFpEF. Spironolactone appears to alter the determinants of extracellular matrix remodelling in an anti‐fibrotic fashion in patients with diabetes, reflected by changes in hs‐TnT and TIMP‐1 levels over time.https://doi.org/10.1002/ehf2.13153Heart failurePreserved left ventricular functionDiabetesBiomarkerSpironolactone |
| spellingShingle | Corrado De Marco Brian L. Claggett Simon deDenus Michael R. Zile Thao Huynh Akshay S. Desai Martin G. Sirois Scott D. Solomon Bertram Pitt Jean L. Rouleau Marc A. Pfeffer Eileen O'Meara Impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction: insights from the TOPCAT trial ESC Heart Failure Heart failure Preserved left ventricular function Diabetes Biomarker Spironolactone |
| title | Impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction: insights from the TOPCAT trial |
| title_full | Impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction: insights from the TOPCAT trial |
| title_fullStr | Impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction: insights from the TOPCAT trial |
| title_full_unstemmed | Impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction: insights from the TOPCAT trial |
| title_short | Impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction: insights from the TOPCAT trial |
| title_sort | impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction insights from the topcat trial |
| topic | Heart failure Preserved left ventricular function Diabetes Biomarker Spironolactone |
| url | https://doi.org/10.1002/ehf2.13153 |
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