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European Heart Journal 1998 19(3):476-480; doi:10.1053/euhj.1997.0774
Copyright © 1998 by the European Society of Cardiology.
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Endogenous insulin and insulin sensitivity. An important determinant of skeletal muscle blood flow in chronic heart failure?

A.R. Houghtonf1, M. Harrison, A.J. Perry, A.J. Evans and A.J. Cowley

Department of Cardiovascular Medicine, University Hospital, Queen’s Medical Centre, Nottingham, U.K.

accepted September 5, 1997

Aim

Patients with heart failure have a reduced sensitivity to insulin’s actions on glucose metabolism and a compen-satory increase in endogenous plasma insulin levels. As insulin has a selective vasodilatory action in skeletal muscle, we have studied the association between insulin sensitivity and central and regional haemodynamics in patients with heart failure.

Methods

Ten patients with stable symptomatic heart failure were studied. We used non-invasive techniques to measure cardiac output, forearm blood flow, superior mesenteric artery blood flow and right renal artery blood flow. Blood samples were assayed for noradrenaline, renin and atrial natriuretic peptide levels. Insulin sensitivity was assessed using the low dose short insulin tolerance test.

Results

There was a significant inverse correlation between forearm blood flow and insulin sensitivity (r=–0·67, P=0·03), patients with lesser degrees of insulin sensitivity having the greater forearm blood flows. There was no correlation with the other haemodynamic or neurohumoral parameters. Patients with greater insulin resistance tended to have higher circulating endogenous insulin levels, although this relationship did not reach statistical significance (r=–0·53, P=0·12).

Conclusions

Insulin sensitivity appears to be an important determinant of skeletal muscle blood flow in heart failure. We speculate that this is secondary to the increased circulating endogenous insulin levels, and suggest that the therapeutic potential of exogenous insulin merits further investigation.

Key Words: Insulin resistance • heart failure • forearm blood flow • Haemodynamics

f1 Correspondence: A. R. Houghton, Department of Cardiovascular Medicine, D Floor, South Block, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, U.K.


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