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.

References

1. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham Study. JAMA. 1979;241:2035–2038[Abstract/Free Full Text]
2. Shindler DM, Castelli WP. Diabetes Mellitus, a predictor of morbidity and mortality in the Studies of Left Ventricular Dysfunction (SOLVD) Trials and Registry. JAMA. 1996;77:1017–1020
3. Abbud ZA, Shindler DM, Wilson AC. Effect of diabetes mellitus on short and long term mortality rates of patients with acute myocardial infarction: a statewide study. Am Heart J. 1995;130:51–58[CrossRef][Web of Science][Medline]
4. Savage PJ. Cardiovascular complications of diabetes mellitus. What we know and what we need to know about their prevention. Ann Intern Med. 1996;124:123–126[Abstract/Free Full Text]
5. Shehadeh A, Regan TJ. Cardiac consequences of diabetes mellitus. Clin Cardiol. 1994;18:301–305[Web of Science]
6. Galderisi M, Keaven KM, Wilson PWF, Levy D. Echocardiographic evidence for the existence of a distinct diabetic cardiomyopathy (The Framingham Heart Study). Am J Cardiol. 1991;68:85–89[CrossRef][Web of Science][Medline]
7. Wilson JR, Martin JL, Schwartz D, Ferraro N. Exercise intolerance in patients with chronic heart failure: role of impaired nutritive flow to skeletal muscle. Circulation. 1984;69:1079–1087[Abstract/Free Full Text]
8. Gerstein HD, Yusuf S. Dysglycemia and the risk of cardiovascular disease. Lancet. 1996;347:949–950[CrossRef][Web of Science][Medline]
9. Diabetes Care. 1997;20:1183–1197[Web of Science][Medline]
10. Julius S, Gudbrandsson T. Early association of sympathetic overactivity, hypertension, insulin resistence, and coronary risk. J Cardiovasc Pharmacol. 1992;20:S40–S48
11. Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities: the role of insulin resistance and the sympathetic adrenal system. N Engl J Med. 1996;334:374–381[Free Full Text]
12. Swan JW, Anker SD, Walton C. Insulin resistance in chronic heart failure: Relation to severity and etiology of heart failure. J Am Coll Cardiol. 1997;30:527–532[Abstract]
13. Scherrer U, Sartori C. Insulin as a vascular and sympathoexcitatory hormone. Implications for blood pressure regulation, insulin sensitivity, and cardiovascular morbidity. Circulation. 1997;96:4104–4113[Abstract/Free Full Text]
14. Paolissa G, De Riu S, Marrazzo G. Insulin resistance and hyperinsulinemia in patients with chronic congestive heart failure. Metabolism. 1991;40:972–977[CrossRef][Web of Science][Medline]
15. Tsuyuki RT, Yusuf S, Rouleau JL. Combination neurohormonal blockade with ACE inhibitors, angiotensin II antagonists and beta blockers in patients with congestive heart failure: Design of the Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) Pilot Study. Can J Cardiol. 1997;13:1166–1174[Web of Science][Medline]
16. Goldman L, Hashimoto B, Cook EF, Loscalzo A. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: Advantage of a new specific activity scale. Circulation. 1981;64:1227[Abstract/Free Full Text]
17. Guyatt GH, Pugsley SO, Sullivan MJ. Effect of encouragement on walking test performance. Thorax. 1984;39:818–822[Abstract/Free Full Text]
18. Duncan MH, Singh BM, Wise PH, Carter G, Allaghband-Zadeh J. A simple measure of insulin resistance. Lancet. 1995;346:120–121[CrossRef][Web of Science][Medline]
19. Sundsfjord JA, Thibault G, Larochelle P, Cantin M. Identification and plasma concentrations of the N-terminal fragment of proatrial natriuretic factor in man. J Clin Endocrinol Metab. 1988;66:605–610[Abstract/Free Full Text]
20. Burns RJ, Nitkin R, Weisel RD. Optimized count-based scintigraphic left ventricular volume measurement. Can J Cardiol. 1985;1:42–46[Medline]
21. N Engl J Med. 1992;327:685–691[Abstract]
22. N Engl J Med. 1991;325:293–302[Abstract]
23. Massie BM, Conway M, Rajagopalan B. Skeletal muscle metabolism during exercise under ischemic conditions in congestive heart failure. Evidence for abnormalities unrelated to blood flow. Circulation. 1988;78:326–329
24. Lopaschuk GD, Belke DD, Gamble J, Toshiyuki I, Schonekess BO. Regulation of fatty acid oxidation in the mammalian heart in health and disease. Biochemica et Biophysica Acta. 1994;1213:263–276[Medline]
25. Oliver MF, Opie LH. Effects of glucose and fatty acids on myocardial ischemia and arrhythmias. Lancet. 1994;343:155–158[CrossRef][Web of Science][Medline]
26. Kelly RA, Smith TW. Nitric oxide and nitrovasodilators: similarities, differences, and interactions. Am J Cardiol. 1996;77:2C–7C[CrossRef][Medline]
27. McKelvie RS, Benedict C, Yusuf S. Prevention of Congestive Heart Failure. Yusuf S, Cairns JA, Camm AJ, Fallen EL, Gersh BJ. Evidence Based Cardiology. London: BMJ; 1998. p. 703–721
28. Cowie MR, Struthers AD, Wood DA. Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care. Lancet. 1997;350:1349–1353[CrossRef][Web of Science][Medline]
29. Benedict CR, Weiner DH, Johnstone DE. Comparative neurhormonal responses in patients with preserved and impaired left ventricular ejection fraction: results of the Studies of Left Ventricular Dysfunction (SOLVD) Registry. J Am Coll Cardiol. 1993;22:146A–153A[Medline]
30. Luchner A, Hense HW, Jougasaki M, Burnett JC Jr, Riegger GA, Schunkert H. Augmentation of natriuretic peptides by beta receptor antagonism: Evidence from a population based study. Circulation. 1997;96:I-92–I-93

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