Vasomotor arterial endothelial dysfunction and hyperhomocysteinemia as diastolic heart failure progression risk factors in case of carbohydrate metabolism disorders

Aim. To evaluate significance of hyperhomocysteinemia and arterial endothelial dysfunction in the progression of diastolic heart failure in case of carbohydrate metabolism disorders.

Methods. The study included 134 patients (63 men and 71 women), mean age - 59.3±4.7 years. The first group included patients with ischemic heart disease associated with type 2 diabetes mellitus (n=46). The second group included patients with type 2 diabetes mellitus and hypertension (n=48). The control group (n=40) included healthy volunteers without carbohydrate metabolism disorders and history of cardiovascular diseases.

Results. Homocysteine concentration was 19.7±5.2 mmol/l in patients with type 2 diabetes mellitus, and was significantly higher than in the control group - 10.77±3.9 mmol/l (p <0.001). Hyperhomocysteinemia was diagnosed in 38 (82.6%) patients of the first group, in 8 cases values were normal. Homocysteine above-limit values were diagnosed in 28 (58.3%) patients in the second group, in the control group hyperhomocysteinemia was observed in 6 (15%) patients. Vasomotor endothelial dysfunction was diagnosed in all patients with type 2 diabetes mellitus when evaluating the endothelial mechanism of vascular tone regulation: endothelium-dependent vasodilation of the brachial artery was 3.7±1.3% in the first group, in the second group - 7.3±2.1%, what is significantly lower compared with that in the control group - 12.3±2.2% (p <0.03). There was no increase in the brachial artery diameter in response to reactive hyperemia test in 30.4% of cases and abnormal vasoconstriction was observed in 10.9% of cases in the first group.

Conclusion. Endothelial dysfunction leads to failure of regulatory mechanisms, contributes to the formation and progression of cardiovascular events: myocardial ischemia and left ventricular diastolic dysfunction in patients with diabetes mellitus associated with the hyperglycemia and hyperhomocysteinemia.