CLINICAL AND PATHOGENIC RELATIONSHIP BETWEEN CHRONIC HEART FAILURE, TYPE 2 DIABETES MELLITUS AND OSTEOPOROSIS
Aim. To study clinical and pathogenic relationships between the development of chronic heart failure (CHF) of ischemic genesis associated with type 2 diabetes mellitus (DM) and osteoporosis in postmenopausal women and to evaluate the effects of anti-osteoporotic therapy on CHF. Methods. A total of 178 women were recruited in the study. All patients were assigned to three groups: Group 1 (n = 48) - women with CHF and type 2 DM, Group 2 (n = 93) - women with osteoporosis and CHF, Group 3 (n = 37) - women with osteoporosis, heart failure and type 2 diabetes mellitus. The control group comprised 35 healthy women in postmenopausal period without clinical signs and symptoms of cardiovascular disease, diabetes and osteoporotic process. 35 patients in Group 2 received bisphosphonates for the treatment of osteoporosis. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and osteoprotegerin were measured with the ELISA. Results. A significant inverse correlation between levels of total cholesterol, triglycerides and low-density lipoproteins, blood pressure, and bone mineral density has been found. Levels of TNF-α and IL-1β were significantly higher in Group 3 compared with patients in Groups 1 and 2. Women in the control group had significantly lower levels of cytokines compared with patients in all study groups. All women with comorbidities had significantly higher levels of osteoprotegerin compared with the control group. A significant inverse correlation between levels of TNF-α, IL-1β, osteoprotegerin and glycated hemoglobin and bone mineral density has been determined, as well as a direct correlation with the severity of CHF. A significant association between levels of TNF-α and IL-1β, and reduced bone mineral density and unfavorable course of CHF has been established as well. A significant association between bisphosphonates therapy and a favorable course of CHF has been identified. Conclusion. Increased production of cytokines and osteoprotegerin is of crucial importance for the development of comorbidities, including CHF, type 2 diabetes mellitus and osteoporosis. Understanding of the key mechanisms determining the relationships between these diseases is essential for the development of novel approaches for evaluating risk factors and new methods for prevention and treatment of these diseases.