Co-morbidity factors in heart failure
Chronic heart failure (CHF) is an ongoing condition associated with abnormal cardiac function. Diabetes and obesity increase the risk of developing CHF, rendering it a significant clinical and socioeconomic problem. Given the co-morbidities of CHF, disease pathophysiology is highly complex and may require different treatments. The development of successful strategies for cardiac tissue protection and repair would require a joint effort with multi-disciplinary expertise. The EU-funded SICA-HF (Studies investigating co-morbidities aggravating heart failure) project brought together European heart failure clinicians and basic researchers to work on CHF biomarkers. The consortium recruited more than 1469 CHF patients, 255 patients with type 2 diabetes but no heart failure, and 167 healthy control subjects. Skeletal muscle and fat tissue biopsies enabled scientists to identify skeletal muscle wasting as a novel and frequent co-morbidity among patients with CHF. Nearly 20 % of the cohort presented with clinical signs of sarcopenia. CHF patients with insulin resistance presented a reduced lipolytic response to insulin infusion. This indicated that insulin resistance and increased levels of fatty acids might be detrimental for cardiac function. Following analysis, scientists demonstrated that several pathways were implicated in heart failure with or without co-morbidities and identified new biomarkers (C-terminal agrin fragment (CAF), GDF-15) that might be helpful in clinical settings. In addition, they found an apolipoprotein C3 gene polymorphism to occur twice as frequently in patients with diabetic heart failure than in patients with heart failure. Collectively, the SICA-HF study provided novel biomarkers, genetic targets and criteria that could help stratify CHF patients based on the associated co-morbidity. The strong association of CHF with cachexia or altered metabolism due to obesity or diabetes opens new avenues for therapies.
Keywords
Biomarkers, chronic heart failure, diabetes, obesity, insulin resistance, apolipoprotein C3