Determinants of insulin sensitivity in chronic heart failure.
OBJECTIVE
To describe the determinants of insulin sensitivity (IS) in chronic heart failure (CHF), we created a model in which the influence of lifestyle factors and etiology of heart failure on IS were incorporated concomitantly with age, left ventricular ejection fraction (LVEF) and parameters of body composition.


METHODS
Observational cohort study.


METHODS
Outpatient clinic for chronic heart failure.


METHODS
Fifty-seven male CHF patients [NYHA class II-III, age 61+/-9 years, body mass index (BMI) 26.9+/-3.3 kg/m2 (mean+/-S.D.)].


METHODS
Euglycemic hyperinsulinemic clamp, cycle ergometry, anthropometric measurements, LVEF and a physical activity questionnaire.


METHODS
A model explaining the variance of IS in CHF.


RESULTS
IS was 18.2+/-8.6 microg.kg(-1).min(-1).mU(-1).l(-1), fasting insulin level was 15.9+/-11.0 mU/l and fasting glucose level was 5.5+/-0.6 mmol/l. Peak VO2 was 19.1+/-4.9 ml.kg(-1).min(-1) and LVEF 26.2+/-7.1%. IS was inversely associated with fasting insulin concentration (r=-0.50, P<0.001) and BMI (r=-0.54, P<0.001). After controlling for BMI, IS also revealed a correlation with age (r=-0.36, P<0.01). The model explained 60% of variance in IS: BMI contributed 20%, smoking 17%, age 17% and physical activity in daily life (DPA) 16% (all P<0.05) to the variance of IS, whereas LVEF (9%) and etiology of heart failure (8%) contributed moderately.


CONCLUSIONS
In CHF patients, IS is for a major part predicted by BMI, smoking, age, daily physical activity, LVEF and etiology of heart failure.
Sabelis
L W E
LW
Department of Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. l.w.esabelis@med.uu.nl
Senden
P J
PJ
Zonderland
M L
ML
van de Wiel
A
A
Wielders
J P M
JP
Huisveld
I A
IA
van Haeften
T W
TW
Mosterd
W L
WL
D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000886:Anthropometry; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002908:Chronic Disease; D015331:Cohort Studies; D016552:Ergometry; D015444:Exercise; D005215:Fasting; D015309:Glucose Clamp Technique; D006333:Heart Failure / Q000097:blood* / Q000209:etiology; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000503:physiopathology; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D016277:Ventricular Function, Left
D001786:Blood Glucose; D007328:Insulin