Gender features of metabolic disorders in elderly patients with heart failure with mid-range ejection fraction
Background: Today, it is important to pay special attention to the increased incidence of heart failure developing with age. Pathogenetic mechanisms detected in metabolic syndrome and atherosclerosis indicate the relationship of these processes, while every second patient with cardiovascular disease shows signs of metabolic syndrome. The clinical significance of the assessment of metabolic syndrome and its individual components to predict the risk of development of heart failure with mid-range ejection fraction (HFmrEF) ischemic etiology remains unclear. The aim of the study: To find out the relationship between metabolic syndrome and its components with the risk of developing HFmrEF in elderly patients and to identify gender pathophysiological differences between elderly HFmrEF patients with metabolic syndrome. Materials and methods: 120 patients with HFmrEF (40-49%) of functional class II according to NYHA were examined, the age was 66.5±7.8 years. We studied the level of glucose, glycated hemoglobin, insulin, and leptin in the blood serum, and calculated the HOMA-IR index. The lipid spectrum was assessed – the level of total cholesterol, low-and high-density lipoproteins (LDL, HDL-C), and triglycerides. Results: There was a noticeable positive correlation between abdominal obesity and leptin levels (r=0.56, р<0.05), with the concentration of insulin (r=0.54, р<0.05) and the HOMA-IR index (r=0.53, р<0.05). There was also a high positive association between abdominal obesity and the level of total cholesterol (r=0.86, р<0.001), a moderate association with the level of triglycerides (r=0.46), and a moderate negative correlation with HDL (r=-0.34, р<0.05). The study of gender characteristics of metabolic syndrome in patients with HFmrEF revealed a higher concentration of insulin (∆17%), leptin (∆33%) in the blood of women than in men. Women demonstrated a higher content LDL (∆10%) and lower content of HDL-C (∆12%), compared to men. Conclusion: Women with HFmrEF on the background of metabolic syndrome have the most pronounced abdominal obesity compared to men, associated with higher levels of blood leptin and insulin resistance, higher levels of LDL cholesterol and lower levels of HDL.