Insulin Resistance Is Highly Prevalent and Is Associated With Reduced Exercise Tolerance in Nondiabetic Patients With Heart Failure
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....
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| Veröffentlicht in: | Journal of the American College of Cardiology 2009-03, Vol.53 (9), p.747-753 |
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| creator | ALZadjali, Matlooba A., MD, MPH Godfrey, Valerie, PhD Khan, Faisel, PhD Choy, AnnaMaria, FRCP, FACC Doney, Alexander S., MD Wong, Aaron K., MBChB, MRCP Petrie, John R., MD, FRCP Struthers, Allan D., MD, FRCP Lang, Chim C., MD, FACC |
| description | 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/m2 ). 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 |
| doi_str_mv | 10.1016/j.jacc.2008.08.081 |
| format | Article |
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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/m2 ). 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 ).]]></description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2008.08.081</identifier><identifier>PMID: 19245964</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Biological and medical sciences ; Blood pressure ; Body fat ; Body mass index ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cholesterol, HDL - blood ; Cohort Studies ; Confidence intervals ; Diabetes ; endothelial dysfunction ; Endothelium, Vascular - metabolism ; Endothelium, Vascular - physiopathology ; Enzymes ; exercise capacity ; Exercise Tolerance ; Female ; Glucose ; Heart ; Heart failure ; Heart Failure - blood ; Heart Failure - metabolism ; Heart Failure - physiopathology ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; Insulin ; Insulin Resistance ; Internal Medicine ; Leptin - blood ; Logistic Models ; Male ; Medical sciences ; Oxygen Consumption ; Plasma ; Prevalence ; Studies ; Triglycerides - blood ; United States - epidemiology</subject><ispartof>Journal of the American College of Cardiology, 2009-03, Vol.53 (9), p.747-753</ispartof><rights>American College of Cardiology Foundation</rights><rights>2009 American College of Cardiology Foundation</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Elsevier Limited Mar 3, 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c532t-5d830de267af89233dd8c0bce49ced20a2fe378d8c899a4388935a05eb73fc4d3</citedby><cites>FETCH-LOGICAL-c532t-5d830de267af89233dd8c0bce49ced20a2fe378d8c899a4388935a05eb73fc4d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109708039326$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21200866$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19245964$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>ALZadjali, Matlooba A., MD, MPH</creatorcontrib><creatorcontrib>Godfrey, Valerie, PhD</creatorcontrib><creatorcontrib>Khan, Faisel, PhD</creatorcontrib><creatorcontrib>Choy, AnnaMaria, FRCP, FACC</creatorcontrib><creatorcontrib>Doney, Alexander S., MD</creatorcontrib><creatorcontrib>Wong, Aaron K., MBChB, MRCP</creatorcontrib><creatorcontrib>Petrie, John R., MD, FRCP</creatorcontrib><creatorcontrib>Struthers, Allan D., MD, FRCP</creatorcontrib><creatorcontrib>Lang, Chim C., MD, FACC</creatorcontrib><title>Insulin Resistance Is Highly Prevalent and Is Associated With Reduced Exercise Tolerance in Nondiabetic Patients With Heart Failure</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description><![CDATA[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/m2 ). 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 ).]]></description><subject>Biological and medical sciences</subject><subject>Blood pressure</subject><subject>Body fat</subject><subject>Body mass index</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cholesterol, HDL - blood</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Diabetes</subject><subject>endothelial dysfunction</subject><subject>Endothelium, Vascular - metabolism</subject><subject>Endothelium, Vascular - physiopathology</subject><subject>Enzymes</subject><subject>exercise capacity</subject><subject>Exercise Tolerance</subject><subject>Female</subject><subject>Glucose</subject><subject>Heart</subject><subject>Heart failure</subject><subject>Heart Failure - blood</subject><subject>Heart Failure - metabolism</subject><subject>Heart Failure - physiopathology</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Humans</subject><subject>Insulin</subject><subject>Insulin Resistance</subject><subject>Internal Medicine</subject><subject>Leptin - blood</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Oxygen Consumption</subject><subject>Plasma</subject><subject>Prevalence</subject><subject>Studies</subject><subject>Triglycerides - blood</subject><subject>United States - epidemiology</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl9rFDEUxYModq1-AR9kQPRt1vyZZBKQQimtu1C0aMXHkE3u2KyzMzV3prjPfnEzu4uFPigEQi6_c5Lccwl5yeicUaberedr5_2cU6rnu8UekRmTUpdCmvoxmdFayJJRUx-RZ4hrSqnSzDwlR8zwShpVzcjvZYdjG7viM2DEwXUeiiUWi_j9pt0WVwnuXAvdULguTPVTxN5HN0AovsXhJqvC6PPh_BckHxGK676FtHPJnh_7LkS3giH64soNMRvhXrcAl4biwsV2TPCcPGlci_DisB-Trxfn12eL8vLTh-XZ6WXppeBDKYMWNABXtWu04UKEoD1deahMfgKnjjcgap2L2hhXCa2NkI5KWNWi8VUQx-Tt3vc29T9HwMFuInpoW9dBP6JVytRMavlfkFNZUcZEBl8_ANf9mLr8CcskVbxSjFaZ4nvKpx4xQWNvU9y4tLWM2ilJu7ZTknZK0u4Wy6JXB-txtYFwLzlEl4E3B8Chd20zdT3iX46zyU2pzL3fc5BbexchWfQ5idyymMAPNvTx3-84eSD3eVxivvEHbAHv_2uRW2q_TDM3jRzVVBjBlfgDIB_RBw</recordid><startdate>20090303</startdate><enddate>20090303</enddate><creator>ALZadjali, Matlooba A., MD, MPH</creator><creator>Godfrey, Valerie, PhD</creator><creator>Khan, Faisel, PhD</creator><creator>Choy, AnnaMaria, FRCP, FACC</creator><creator>Doney, Alexander S., MD</creator><creator>Wong, Aaron K., MBChB, MRCP</creator><creator>Petrie, John R., MD, FRCP</creator><creator>Struthers, Allan D., MD, FRCP</creator><creator>Lang, Chim C., MD, FACC</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7TS</scope><scope>7X8</scope></search><sort><creationdate>20090303</creationdate><title>Insulin Resistance Is Highly Prevalent and Is Associated With Reduced Exercise Tolerance in Nondiabetic Patients With Heart Failure</title><author>ALZadjali, Matlooba A., MD, MPH ; Godfrey, Valerie, PhD ; Khan, Faisel, PhD ; Choy, AnnaMaria, FRCP, FACC ; Doney, Alexander S., MD ; Wong, Aaron K., MBChB, MRCP ; Petrie, John R., MD, FRCP ; Struthers, Allan D., MD, FRCP ; Lang, Chim C., MD, FACC</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c532t-5d830de267af89233dd8c0bce49ced20a2fe378d8c899a4388935a05eb73fc4d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Biological and medical sciences</topic><topic>Blood pressure</topic><topic>Body fat</topic><topic>Body mass index</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cholesterol, HDL - blood</topic><topic>Cohort Studies</topic><topic>Confidence intervals</topic><topic>Diabetes</topic><topic>endothelial dysfunction</topic><topic>Endothelium, Vascular - metabolism</topic><topic>Endothelium, Vascular - physiopathology</topic><topic>Enzymes</topic><topic>exercise capacity</topic><topic>Exercise Tolerance</topic><topic>Female</topic><topic>Glucose</topic><topic>Heart</topic><topic>Heart failure</topic><topic>Heart Failure - blood</topic><topic>Heart Failure - metabolism</topic><topic>Heart Failure - physiopathology</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Humans</topic><topic>Insulin</topic><topic>Insulin Resistance</topic><topic>Internal Medicine</topic><topic>Leptin - blood</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Oxygen Consumption</topic><topic>Plasma</topic><topic>Prevalence</topic><topic>Studies</topic><topic>Triglycerides - blood</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>ALZadjali, Matlooba A., MD, MPH</creatorcontrib><creatorcontrib>Godfrey, Valerie, PhD</creatorcontrib><creatorcontrib>Khan, Faisel, PhD</creatorcontrib><creatorcontrib>Choy, AnnaMaria, FRCP, FACC</creatorcontrib><creatorcontrib>Doney, Alexander S., MD</creatorcontrib><creatorcontrib>Wong, Aaron K., MBChB, MRCP</creatorcontrib><creatorcontrib>Petrie, John R., MD, FRCP</creatorcontrib><creatorcontrib>Struthers, Allan D., MD, FRCP</creatorcontrib><creatorcontrib>Lang, Chim C., MD, FACC</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Physical Education Index</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>ALZadjali, Matlooba A., MD, MPH</au><au>Godfrey, Valerie, PhD</au><au>Khan, Faisel, PhD</au><au>Choy, AnnaMaria, FRCP, FACC</au><au>Doney, Alexander S., MD</au><au>Wong, Aaron K., MBChB, MRCP</au><au>Petrie, John R., MD, FRCP</au><au>Struthers, Allan D., MD, FRCP</au><au>Lang, Chim C., MD, FACC</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Insulin Resistance Is Highly Prevalent and Is Associated With Reduced Exercise Tolerance in Nondiabetic Patients With Heart Failure</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2009-03-03</date><risdate>2009</risdate><volume>53</volume><issue>9</issue><spage>747</spage><epage>753</epage><pages>747-753</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract><![CDATA[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/m2 ). 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 ).]]></abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>19245964</pmid><doi>10.1016/j.jacc.2008.08.081</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Blood pressure Body fat Body mass index Cardiology Cardiology. Vascular system Cardiovascular Cholesterol, HDL - blood Cohort Studies Confidence intervals Diabetes endothelial dysfunction Endothelium, Vascular - metabolism Endothelium, Vascular - physiopathology Enzymes exercise capacity Exercise Tolerance Female Glucose Heart Heart failure Heart Failure - blood Heart Failure - metabolism Heart Failure - physiopathology Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans Insulin Insulin Resistance Internal Medicine Leptin - blood Logistic Models Male Medical sciences Oxygen Consumption Plasma Prevalence Studies Triglycerides - blood United States - epidemiology |
| title | Insulin Resistance Is Highly Prevalent and Is Associated With Reduced Exercise Tolerance in Nondiabetic Patients With Heart Failure |
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