Background: Both Diabetes Mellitus (DM) and heart failure (HF) are becoming diseases of epidemic proportions. In patients with DM and HF, symptoms seem to be more severe compared to similar HF patients without DM. There are several possible explanations for this. In recent years, the accumulation of AGEs is recognized as an important factor in the development and progression of chronic HF. Amongst several other properties, AGEs stimulate collagen crosslink formation. This crosslink formation might induce stiffening of the myocardium, leading to diastolic HF. In the vascular smooth muscle cells, collagen crosslink formation might contribute to vascular stiffening, leading to decreased vascular compliance, and therefore increased afterload. Previous studies show that AGE levels are increased in patients with DM. However, the relation between AGE levels, quality of life, diastolic function and vascular elasticity in patients with chronic HF with or without DM is unknown. We hypothesize that patients with high AGE levels have more often DM, have more severe symptoms which can impair quality of life, and have a more impaired diastolic cardiac function and vascular elasticity. Methods: We collected clinical and laboratory data, non-invasive pulse wave measurements and echocardiographic parameters for diastolic function of 42 patients with chronic HF, of whom 21 also had DM type II. Patients performed a cardiopulmonary exercise test (VO2max) and fill in a Minnesota Living with Heart Failure Questionnaire (MLHFQ), a questionnaire that reflects quality of life in patients with heart failure. Results: Patients with high AGE levels had more often DM (70% vs. 30%, p=0.01). Age and gender were similar. No association was found between AGE levels, diastolic function and vascular elasticity. However, MLHFQ and peak VO2 were associated with AGE levels (r=0.49; p=0.001 and r=-0.44; p=0.006, respectively). Univariate regression analysis showed that AGE levels were associated with age (p=0.04), DM (p=0.05), smoking (p=0.02) and MLHFQ (p=0.001). For MLHFQ and smoking, this relation continued after correcting for confounding variables (p= 0.001 and p=0.01, respectively). Conclusion: Chronic HF patients with high AGE levels have more often DM and have a more impaired quality of life and than similar patients with low AGE levels. No relation was found between AGE levels and diastolic and vascular function.
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