title: Insulin resistance is highly prevalent and is associated with reduced exercise tolerance in nondiabetic patients with heart failure.
abstract: OBJECTIVE
  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 > or =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).
authors.affiliation: University of Dundee, Ninewells Hospital and Medical School, United Kingdom.
authors.forename: Matlooba A
authors.initials: MA
authors.lastname: AlZadjali
authors.forename: Valerie
authors.initials: V
authors.lastname: Godfrey
authors.forename: Faisel
authors.initials: F
authors.lastname: Khan
authors.forename: AnnaMaria
authors.initials: A
authors.lastname: Choy
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Doney
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Wong
authors.forename: John R
authors.initials: JR
authors.lastname: Petrie
authors.forename: Allan D
authors.initials: AD
authors.lastname: Struthers
authors.forename: Chim C
authors.initials: CC
authors.lastname: Lang
mesh_terms: D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology*; D006801:Humans; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood; D016015:Logistic Models; D008297:Male; D010101:Oxygen Consumption; D015995:Prevalence; D014280:Triglycerides / Q000097:blood; D014481:United States / Q000453:epidemiology
chemical_list: D008076:Cholesterol, HDL; D020738:Leptin; D014280:Triglycerides