Association between interleukin-6, suPAR, and hsCRP with subclinical left ventricular dysfunction in type 1 diabetes: The Thousand & 1 study

Abstract

Aims

To investigate the association between chronic inflammation and subclinical left ventricular dysfunction in type 1 diabetes (T1D).

Methods

In a cross-sectional study of individuals with T1D without known heart disease, interleukin-6 (IL-6), soluble-urokinase-plasminogen-activator-receptor (suPAR), and high-sensitivity C-reactive-protein (hsCRP) were examined for associations with echocardiographic E/e′ (primary outcome) and global longitudinal strain (GLS) (secondary outcome). We adjusted for several clinical variables in linear regression analysis, including N-terminal pro–B-type natriuretic peptide (NT-proBNP). The biomarkers were categorized as elevated/non-elevated based on their upper quartiles.

Results

Of 962 individuals (52 % male, mean age 49 ± 14 years), mean E/e′ was 7 ± 3 and GLS 18 ± 3. In fully adjusted models, all biomarkers were each associated with increased E/e′: beta coefficients for IL-6 0.2 (95 % confidence intervals: 0.1–0.3, P = 0.001), suPAR 0.5 (0.1–0.7, P = 0.011), and hsCRP 0.1 (0.0–0.2, P = 0.023). Combining biomarkers showed stronger associations: elevated IL-6 and suPAR 1.3 (0.7–2.0, P < 0.001), elevated all three 1.9 (1.1–2.7, P < 0.001). Results were similar for decreased GLS with IL-6–0.4 (−0.7 to 0.0, P = 0.039), IL-6 and hsCRP −1.0 (−1.7 to −0.4, P = 0.007), all three −1.1 (−2.0 to −0.3, P = 0.009).

Conclusions

Inflammatory biomarkers are independently associated with subclinical left ventricular dysfunction. Chronic inflammation may contribute to the development of myocardial dysfunction in T1D.