Microvascular endothelial dysfunction in skin is associated with higher risk of heart failure with preserved ejection fraction in women with type 2 diabetes: the Hoorn Diabetes Care System Cohort
Authors' conclusion
Impaired microvascular responses to insulin and acetylcholine in skin confers a higher risk of HFpEF in women with type 2 diabetes. In vivo measures of systemic MVD could represent novel risk markers for HFpEF, opening new avenues for the prevention of HFpEF in type 2 diabetes.
Study context
- Population
- Adults with T2D from the Hoorn Diabetes Care System Cohort; mean age 67 ± 6y, mean HbA1c 7.6 ± 1.3%50% women
- Participants
- 154 adults
- Exposure
- Skin microvascular perfusion responses to insulin, acetylcholine and sodium nitroprusside (SNP) vs left ventricular diastolic dysfunction (LVDD) markers and H2FPEF score
- Outcome
- Association of skin MVD (perfusion responses) with echocardiographic and clinical markers of LVDD and the H2FPEF score
Methodological detailscross-sectional analysis within a prospective cohort, multivariable linear regression adjusted for confounders, stratified by sex, microvascular dysfunction (MVD) assessed by laser speckle contrast analysis with iontophoresis of insulin, acetylcholine and SNP
- Cross-sectional analysis within a prospective cohort
- Multivariable linear regression adjusted for confounders
- Stratified by sex
- MVD assessed by laser speckle contrast analysis with iontophoresis of insulin, acetylcholine and SNP
Main finding
As reported in the abstract
H2FPEF score per 10% decreased perfusion response
Women: insulin response, increase of H2FPEF score
5.8%
95% CI 2.3;9.4%
Women: acetylcholine response, increase of H2FPEF score
5.9%
95% CI 1.7;10.1%
Observational data: associations, not effects.
Further findings
Events
| Outcome | Women | Men |
|---|---|---|
| HFpEF diagnosis | 11 | 3 |
Heart failure with preserved ejection fraction (HFpEF) diagnosis
- Patients with HFpEF showed lower perfusion response to insulin than those without HFpEF
Sex differences in clinical characteristics
- Obesity, women vs men
- 54.5 vs. 35.1%
- NT-proBNP (pg/ml), women vs men
- 80, IQR:34-165 vs. 46, 27-117
- E/E', women vs men
- 13.3 ± 4.3 vs. 11.4 ± 3.0
Other echocardiographic markers
- Lower SNP response associated with higher pulmonary arterial systolic pressure in men
- Lower acetylcholine response associated with higher LV mass index in women and worse LV longitudinal strain in total population
- No significant associations between perfusion responses and conventional LVDD markers
Original publication
Microvascular endothelial dysfunction in skin is associated with higher risk of heart failure with preserved ejection fraction in women with type 2 diabetes: the Hoorn Diabetes Care System Cohort. Cardiovasc Diabetol. Published 1 September 2023. doi:10.
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