Does type 2 diabetes mellitus increase the expression of inflammatory and coagulation markers in the aortic valves of patients with severe aortic stenosis?
Type 2 diabetes is associated with enhanced inflammation within aortic valves in patients with severe aortic stenosis, which may contribute to faster disease progression.
Diabetes predisposes to aortic stenosis (AS). We aimed to investigate if diabetes affects the expression of selected coagulation proteins and inflammatory markers in AS valves. Twenty patients with severe AS and concomitant type 2 diabetes mellitus (DM) and 40 well-matched patients without DM scheduled for valve replacement were recruited. Valvular tissue factor (TF), TF pathway inhibitor (TFPI), prothrombin, C-reactive protein (CRP) expression were evaluated by immunostaining and TF, prothrombin, and CRP transcripts were analyzed by real-time PCR. DM patients had elevated plasma CRP (9.2 0.74-51.9 mg/l vs. 4.7 0.59-23.14 mg/l, p = 0.009) and TF (293.06 192.32-386.12 pg/ml vs. 140 104.17-177.76 pg/ml, p = 0.003) compared to non-DM patients. In DM group, TF-, TFPI-, and prothrombin expression within valves was not related to demographics, body mass index, and concomitant diseases, whereas increased expression related to DM was found for CRP on both protein (2.87 0.5-9% vs. 0.94 0-4%, p = 0.01) and transcript levels (1.3 ± 0.61 vs. 0.22 ± 0.43, p = 0.009). CRP-positive areas were positively correlated with mRNA TF (r = 0.84, p = 0.036). Diabetes mellitus is associated with enhanced inflammation within AS valves, measured by CRP expression, which may contribute to faster AS progression.
Natorska et al. (2011) studied this question.