Insulin Resistance Is Highly Prevalent and Is Associated With Reduced Exercise Tolerance in Nondiabetic Patients With Heart Failure

Matlooba A. ALZadjali, Valerie Godfrey, Faisel Khan, Anna Maria Choy, Alexander S. Doney, Aaron K. Wong, John R. Petrie, Allan D. Struthers, Chim C. Lang (Lead / Corresponding author)

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    Abstract

    Objectives The purpose of this study was to establish the prevalence of insulin resistance (IR) among nondiabetic chronic heart failure (CHF) patients and to seek factors associated with IR in CHF, including the relationship of IR to functional class, exercise capacity, and disease severity in CHF. Background Several lines of evidence suggest that CHF is an IR state. The prevalence of IR in CHF and its relation to CHF have not been fully defined.

    Methods Fasting insulin resistance index (FIRI) was assessed in a cohort of 129 consecutive CHF patients (mean age 69.2 +/- 10.4 years; 76% males; body mass index 27.4 +/- 4.4 kg/m(2)). Patients underwent cardiopulmonary exercise testing and peripheral endothelial function testing by reactive hyperemia peripheral arterial tonometry (RH-PAT).

    Results Prevalence of IR as defined by FIRI >= 2.7 was 61% in our cohort of CHF patients. There was a significant correlation between IR and waist circumference (r = 0.37; p < 0.01), serum triglycerides (r = 0.34; p < 0.01), high-density lipoprotein cholesterol (r = -0.22; p = 0.02), and serum leptin (r = 0.39; p = 0.03). Insulin resistance increased significantly with worsening New York Heart Association functional class (p < 0.01). The CHF patients with IR had a significantly lower exercise capacity and peak oxygen consumption than patients with an FIRI < 2.7. The RH-PAT ratio was significantly lower in CHF patients with IR compared with CHF patients with an FIRI < 2.7 (1.6 +/- 0.3 vs. 2.0 +/- 0.5; p < 0.05).

    Conclusions Insulin resistance is highly prevalent among nondiabetic CHF patients and is associated with decreased exercise capacity in patients with CHF. (Insulin Resistance: Heart Failure; NCT00486967). (J Am Coll Cardiol 2009; 53: 747-53) (C) 2009 by the American College of Cardiology Foundation

    Original languageEnglish
    Pages (from-to)747-753
    Number of pages7
    JournalJournal of the American College of Cardiology
    Volume53
    Issue number9
    DOIs
    Publication statusPublished - 3 Mar 2009

    Keywords

    • heart failure
    • insulin resistance
    • exercise capacity
    • endothelial dysfunction
    • GLUCOSE-UPTAKE
    • ABNORMALITIES
    • ADIPONECTIN
    • CAPACITY
    • DISEASE
    • LEPTIN
    • ALPHA

    Cite this

    @article{a95d4a1cd48c494a8e0ea87aa3b7b3d6,
    title = "Insulin Resistance Is Highly Prevalent and Is Associated With Reduced Exercise Tolerance in Nondiabetic Patients With Heart Failure",
    abstract = "Objectives The purpose of this study was to establish the prevalence of insulin resistance (IR) among nondiabetic chronic heart failure (CHF) patients and to seek factors associated with IR in CHF, including the relationship of IR to functional class, exercise capacity, and disease severity in CHF. Background Several lines of evidence suggest that CHF is an IR state. The prevalence of IR in CHF and its relation to CHF have not been fully defined.Methods Fasting insulin resistance index (FIRI) was assessed in a cohort of 129 consecutive CHF patients (mean age 69.2 +/- 10.4 years; 76{\%} males; body mass index 27.4 +/- 4.4 kg/m(2)). Patients underwent cardiopulmonary exercise testing and peripheral endothelial function testing by reactive hyperemia peripheral arterial tonometry (RH-PAT).Results Prevalence of IR as defined by FIRI >= 2.7 was 61{\%} in our cohort of CHF patients. There was a significant correlation between IR and waist circumference (r = 0.37; p < 0.01), serum triglycerides (r = 0.34; p < 0.01), high-density lipoprotein cholesterol (r = -0.22; p = 0.02), and serum leptin (r = 0.39; p = 0.03). Insulin resistance increased significantly with worsening New York Heart Association functional class (p < 0.01). The CHF patients with IR had a significantly lower exercise capacity and peak oxygen consumption than patients with an FIRI < 2.7. The RH-PAT ratio was significantly lower in CHF patients with IR compared with CHF patients with an FIRI < 2.7 (1.6 +/- 0.3 vs. 2.0 +/- 0.5; p < 0.05).Conclusions Insulin resistance is highly prevalent among nondiabetic CHF patients and is associated with decreased exercise capacity in patients with CHF. (Insulin Resistance: Heart Failure; NCT00486967). (J Am Coll Cardiol 2009; 53: 747-53) (C) 2009 by the American College of Cardiology Foundation",
    keywords = "heart failure, insulin resistance, exercise capacity, endothelial dysfunction, GLUCOSE-UPTAKE, ABNORMALITIES, ADIPONECTIN, CAPACITY, DISEASE, LEPTIN, ALPHA",
    author = "ALZadjali, {Matlooba A.} and Valerie Godfrey and Faisel Khan and Choy, {Anna Maria} and Doney, {Alexander S.} and Wong, {Aaron K.} and Petrie, {John R.} and Struthers, {Allan D.} and Lang, {Chim C.}",
    year = "2009",
    month = "3",
    day = "3",
    doi = "10.1016/j.jacc.2008.08.081",
    language = "English",
    volume = "53",
    pages = "747--753",
    journal = "Journal of the American College of Cardiology",
    issn = "0735-1097",
    publisher = "Elsevier",
    number = "9",

    }

    TY - JOUR

    T1 - Insulin Resistance Is Highly Prevalent and Is Associated With Reduced Exercise Tolerance in Nondiabetic Patients With Heart Failure

    AU - ALZadjali, Matlooba A.

    AU - Godfrey, Valerie

    AU - Khan, Faisel

    AU - Choy, Anna Maria

    AU - Doney, Alexander S.

    AU - Wong, Aaron K.

    AU - Petrie, John R.

    AU - Struthers, Allan D.

    AU - Lang, Chim C.

    PY - 2009/3/3

    Y1 - 2009/3/3

    N2 - Objectives The purpose of this study was to establish the prevalence of insulin resistance (IR) among nondiabetic chronic heart failure (CHF) patients and to seek factors associated with IR in CHF, including the relationship of IR to functional class, exercise capacity, and disease severity in CHF. Background Several lines of evidence suggest that CHF is an IR state. The prevalence of IR in CHF and its relation to CHF have not been fully defined.Methods Fasting insulin resistance index (FIRI) was assessed in a cohort of 129 consecutive CHF patients (mean age 69.2 +/- 10.4 years; 76% males; body mass index 27.4 +/- 4.4 kg/m(2)). Patients underwent cardiopulmonary exercise testing and peripheral endothelial function testing by reactive hyperemia peripheral arterial tonometry (RH-PAT).Results Prevalence of IR as defined by FIRI >= 2.7 was 61% in our cohort of CHF patients. There was a significant correlation between IR and waist circumference (r = 0.37; p < 0.01), serum triglycerides (r = 0.34; p < 0.01), high-density lipoprotein cholesterol (r = -0.22; p = 0.02), and serum leptin (r = 0.39; p = 0.03). Insulin resistance increased significantly with worsening New York Heart Association functional class (p < 0.01). The CHF patients with IR had a significantly lower exercise capacity and peak oxygen consumption than patients with an FIRI < 2.7. The RH-PAT ratio was significantly lower in CHF patients with IR compared with CHF patients with an FIRI < 2.7 (1.6 +/- 0.3 vs. 2.0 +/- 0.5; p < 0.05).Conclusions Insulin resistance is highly prevalent among nondiabetic CHF patients and is associated with decreased exercise capacity in patients with CHF. (Insulin Resistance: Heart Failure; NCT00486967). (J Am Coll Cardiol 2009; 53: 747-53) (C) 2009 by the American College of Cardiology Foundation

    AB - Objectives The purpose of this study was to establish the prevalence of insulin resistance (IR) among nondiabetic chronic heart failure (CHF) patients and to seek factors associated with IR in CHF, including the relationship of IR to functional class, exercise capacity, and disease severity in CHF. Background Several lines of evidence suggest that CHF is an IR state. The prevalence of IR in CHF and its relation to CHF have not been fully defined.Methods Fasting insulin resistance index (FIRI) was assessed in a cohort of 129 consecutive CHF patients (mean age 69.2 +/- 10.4 years; 76% males; body mass index 27.4 +/- 4.4 kg/m(2)). Patients underwent cardiopulmonary exercise testing and peripheral endothelial function testing by reactive hyperemia peripheral arterial tonometry (RH-PAT).Results Prevalence of IR as defined by FIRI >= 2.7 was 61% in our cohort of CHF patients. There was a significant correlation between IR and waist circumference (r = 0.37; p < 0.01), serum triglycerides (r = 0.34; p < 0.01), high-density lipoprotein cholesterol (r = -0.22; p = 0.02), and serum leptin (r = 0.39; p = 0.03). Insulin resistance increased significantly with worsening New York Heart Association functional class (p < 0.01). The CHF patients with IR had a significantly lower exercise capacity and peak oxygen consumption than patients with an FIRI < 2.7. The RH-PAT ratio was significantly lower in CHF patients with IR compared with CHF patients with an FIRI < 2.7 (1.6 +/- 0.3 vs. 2.0 +/- 0.5; p < 0.05).Conclusions Insulin resistance is highly prevalent among nondiabetic CHF patients and is associated with decreased exercise capacity in patients with CHF. (Insulin Resistance: Heart Failure; NCT00486967). (J Am Coll Cardiol 2009; 53: 747-53) (C) 2009 by the American College of Cardiology Foundation

    KW - heart failure

    KW - insulin resistance

    KW - exercise capacity

    KW - endothelial dysfunction

    KW - GLUCOSE-UPTAKE

    KW - ABNORMALITIES

    KW - ADIPONECTIN

    KW - CAPACITY

    KW - DISEASE

    KW - LEPTIN

    KW - ALPHA

    UR - http://www.scopus.com/inward/record.url?scp=60449096969&partnerID=8YFLogxK

    U2 - 10.1016/j.jacc.2008.08.081

    DO - 10.1016/j.jacc.2008.08.081

    M3 - Article

    VL - 53

    SP - 747

    EP - 753

    JO - Journal of the American College of Cardiology

    JF - Journal of the American College of Cardiology

    SN - 0735-1097

    IS - 9

    ER -