Impaired insulin sensitivity as an independent risk factor for mortality in patients with stable chronic heart failure
Open accessAbstract
Objectives The aim of this study was to determine the significance of insulin resistance as an independent risk factor for impaired prognosis in patients with chronic heart failure (CHF).Background In CHF, impaired insulin sensitivity (S(I)) indicates abnormal energy metabolism and is related to decreased exercise capacity and muscle fatigue. The relationship between insulin resistance (i.e., low S(I)) and survival in patients with CHF has not been established.Methods We prospectively studied 105 male patients with CHF due to ischemic (63%) or non-ischemic (37%) etiology. All patients were in clinically stable condition (age 62 +/- 1 year, New York Heart Association [NYHA] functional class 2.6 +/- 0.1, left ventricular ejection fraction [LVEF] 28 +/- 2%, peak oxygen uptake [Vo(2)] 18.2 +/- 0.7 ml/kg/min). Insulin sensitivity was assessed from glucose and insulin dynamic profiles during an intravenous glucose tolerance test using the minimal model technique.Results During a mean follow-up period of 44 +/- 4 months, 53 patients (50%) died. Patients with S(I) below the median value (median: 1.82 min(-1) x microU x ml(-1).10(4); n = 52) had worse survival (at two years 61% [range 47% to 74%]) than patients with S(I) above the median value (n = 53; at two years 83% [range 73% to 93%]; risk ratio [RR] 0.38, 95% confidence interval [CI] 0.21 to 0.67; p = 0.001). Both patient groups were similar in terms of age, NYHA functional class, and body composition parameters (dual-energy X-ray absorptiometric scan; p > 0.2), but patients with a lower S(I) had a lower LVEF (24 +/- 2% vs. 33 +/- 3%) and peak Vo(2) (16.8 +/- 1.0 ml/kg/min vs. 19.7 +/- 1.0 ml/kg/min; both p < 0.05). On univariate Cox analysis, higher S(I) predicted better survival (RR 0.56, 95% CI 0.35 to 0.89; p = 0.015). On stepwise multivariate analysis, S(I) predicted mortality independently of other variables.Conclusions In patients with CHF, lower S(I) relates to higher mortality, independent of body composition and established prognosticators. Impaired S(I) may have implications in the pathophysiology of CHF disease progression. Therapeutically targeting impaired insulin sensitivity may potentially be beneficial in patients with CHF.
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Resistance to insulin occurs in chronic heart failure and is related to prognosis.
“Resistance to insulin occurs in chronic heart failure (CHF) and is related to prognosis.”
From The Effect of Testosterone on Insulin Sensitivity in Men with Heart Failure (2007) · cites this paper as [9]
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- Authors
- Doehner, W., Rauchhaus, M., Ponikowski, P., Godsland, I. F., von Haehling, S., Okonko, D. O., Leyva, F., Proudler, A. J., Coats, A. J. S., & Anker, S. D.
- Affiliations
- Stiftung Charité (DE)
- Imperial College London (GB)
- The University of Sydney (AU)
- Corresponding author
- Doehner, Wolfram
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-09
- Volume
- 46
- Issue
- 6
- Pages
- 1019-1026
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2015774467
- Cited by
- 294
- References
- 31
- Citations by year
- 2025: 12 · 2024: 20 · 2023: 10 · 2022: 12 · 2021: 13 · 2020: 11 · 2019: 11 · 2018: 9 · 2017: 12 · 2016: 21 · 2015: 16 · 2014: 15 · 2013: 16 · 2012: 20
- FWCI
- 9.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- insulin sensitivity, insulin resistance, chronic heart failure, mortality risk, prognosis, survival, energy metabolism, exercise capacity, left ventricular ejection fraction, ischemic heart failure, non-ischemic heart failure, intravenous glucose tolerance test, body composition, muscle fatigue, energy expenditure, energy intake, energy balance, lean body mass, fat-free mass
- MeSH terms
- Chronic Disease, Follow-Up Studies, Heart Failure, Humans, Insulin Resistance, Male, Middle Aged, Prognosis, Prospective Studies, Risk Factors
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