European Heart Journal

European Heart Journal 2000 21(16):1368-1375; doi:10.1053/euhj.1999.2043
Copyright © 2000 by the European Society of Cardiology.

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Glucose and insulin abnormalities relate to functional capacity in patients with congestive heart failure

N Suskin^a, R.S McKelvie^b,c,f1, R.J Burns^d, R Latini^e, D Pericak^b, J Probstfield^f, J.L Rouleau^g, C Sigouin^b, C.B Solymoss^g, R Tsuyuki^h, WhiteM ^g and YusufS ^b,i

^a London Health Sciences Centre, London, Canada
^b HGH-McMaster Clinic, Hamilton, Canada
^c Career Scientist of the Ontario Ministry of Health, Ontario, Canada
^d University of Toronto Centre for Cardiovascular Research, Toronto, Canada
^e Istituto "Mario Negri" Milano, Italy
^f University of Washington School of Medicine and Public Health, Washington, DC, U.S.A.
^g Montreal Heart Institute, Montreal, Canada
^h University of Alberta, Edmonton, Canada
ⁱ Career Scientist of the Medical Research Council of Canada, Heart and Stroke Foundation of Ontario Endowed Research Chair

revised November 29, 1999; accepted December 1, 1999

Abstract

Aims In addition to diabetes mellitus, less severe abnormalities of glucose and insulin metabolism may be related to functional status in patients with heart failure. We examined the relationship of hyperglycaemia (6·1mmol.l^–1) and hyperinsulinaemia (11·2mU.l^–1) to functional status and cardiac function in patients with heart failure.

Methods and Results Fasting plasma glucose and insulin levels were obtained in 663 heart failure patients. The average left ventricular ejection fraction was 0·28±0·07, 63% were in New York Heart Association Functional Class (NYHA-FC) I/II and 37% were in NYHA-FC III/IV. Twenty seven percent had diabetes mellitus, but an additional 8% had undiagnosed diabetes mellitus (glucose 7mmol.l^–1) and 9% had glucose levels between 6·1 and 7mmol.l^–1, so that a total of 43% (287) of patients had elevated glucose levels (6·1mmol.l^–1). In general, more diabetic patients had NYHA-FC III/IV symptoms, shorter 6min walk distances, but similar left ventricular ejection fractions compared to non-diabetic patients. The non-diabetic patients in NYHA-FC III/IV had higher glucose and insulin levels than patients in NYHA-FC I/II (6·3±0·2 vs 5·6±0·1mmol.l^–1,P <0·001 and 19·6±2·3 vs 10·2±0·6mU.l^–1, P<0·001). Non-diabetic patients with elevated glucose levels had shorter 6min walk distances compared to those with normal glucose levels (368·2±8m vs 389·±4m, P=0·02), however, left ventricular ejection fraction was similar.

Conclusion Glucose abnormalities are extremely common in heart failure patients (43% of patients). Diabetes mellitus and hyperglycaemia or hyperlinsulinaemia in non-diabetic patients were related to worse symptomatic status but not worsening left ventricular ejection fraction compared to patients with normal glucose and insulin levels.

Key Words: Glucose, insulin resistance, heart failure

^f1 Correspondence: Dr R. S. McKelvie, Rm 341 McMaster Clinic, Hamilton Health Sciences Corporation—General Site, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada.

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