GRONINGEN, THE NETHERLANDS – How diabetes affects pathophysiological processes among patients with acute heart failure (AHF) is unclear, according to a new study published in the European Journal of Heart Failure.1

To add to that information, a study team led by the University of Groningen in The Netherlands and including participation from the San Francisco VAMC, analyzed a panel of 48 circulating biomarkers measured within 24 hours of admission for AHF in a subset of patients enrolled in the PROTECT trial. In patients with and without diabetes, the researchers performed a network analysis to identify correlations between measured biomarkers.

Results suggested that, compared with the 1,111 patients without diabetes, the 922 with diabetes had a higher prevalence of ischemic heart disease and traditional coronary risk factors. After multivariable adjustment, patients with and without diabetes had significantly different levels of biomarkers across a spectrum of pathophysiological domains, including inflammation (TNFR-1a, periostin), cardiomyocyte stretch (BNP), angiogenesis (VEGFR, angiogenin), and renal function (NGAL, KIM-1) (adjusted P-value <0.05).

Among patients with diabetes, network analysis revealed that periostin strongly clustered with C-reactive protein and interleukin-6. Renal markers (creatinine and NGAL) were found to be closely associated with potassium and glucose. Those findings were not seen among patients without diabetes, the researchers pointed out.

“Patients with AHF and diabetes, compared with those without diabetes, have distinct biomarker profiles,” study authors concluded. “Network analysis suggests that cardiac remodeling, inflammation, and fibrosis are closely associated with each other in patients with diabetes. Furthermore, potassium levels may be sensitive to changes in renal function as reflected by the strong renal-potassium-glucose correlation. These findings were not seen among patients without diabetes and may suggest distinct pathophysiological processes among AHF patients with diabetes.”

1. Sharma A, Demissei BG, Tromp J, Hillege HL, Cleland JG, O’Connor CM, Metra M, Ponikowski P, Telerik JR, Davison BA, Givers MM, Bloomfield DM, Dittrich H, van Veldhuisen DJ, Cotter G, Zeolite JA, Khan MAF, Boors AA. A network analysis to compare biomarker profiles in patients with and without diabetes mellitus in acute heart failure. Euro J Heart Fail. 2017 Jun 21. doi: 10.1002/ejhf.912. [Epub ahead of print] PubMed PMID: 28639369.