Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Insulin resistance in chronic heart failure
*Wynn Institute for Metabolic Research London NW8 9SQ, U.K
Department of Cardiology London NW8 9SQ, U.K
National Heart and Lung Institute London NW8 9SQ, U.K
Received 8 February 1994; revised 24 May 1994; .
Correspondence: Dr J. W. Swan, The Wynn Institute for Metabolic Research, National Heart and Lung Institute, London NW8 9SQ, U K.
Abstract
The objective of this study was to investigate the existence of abnormalities of insulin sensitivity in patients with chronic heart failure. Glucose metabolism and insulin resistance were assessed in 10 male patients with severe, chronic heart failure and in 10 matched control subjects. Glucose, insulin and C-peptide concentration profiles were measured following a 0.5g. kg–1 intravenous glucose tolerance test. Insulin sensitivity (inversely related to insulin resistance) was estimated by minimal modelling analysis of the glucose and insulin profiles.
Heart failure patients had similar mean fasting plasma glucose concentration to controls but a significantly greater mean fasting plasma insulin concentration (P=0.002) and C-peptide concentration (P=0.02). Plasma glucose response profile was similar in the two groups but the incremental plasma insulin response profile of the heart failure group was significantly greater (P=0.004). Mean insulin sensitivity was 73% lower in the heart failure patients (P=0.003).
These findings show that patients with severe chronic heart failure are hyperinsulinaemic and insulin resistant compared with a matched healthy group. This insulin resistance and hyperinsulinaemia may contribute to the progressive deterioration in myocardial function and associated clinical features of fatigue and reduced exercise tolerance seen in heart failure. Interventions designed to overcome or reduce insulin resistance warrant further investigation.
Key Words: Heart failure • insulin resistance • minimal model
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