Impaired glucose tolerance and insulin resistance in heart failure: underrecognized and undertreated?
BACKGROUND
A link between diabetes mellitus (DM) and heart failure (HF) has been well-recognized for more than a century. HF is also closely linked to abnormal glucose regulation (AGR) and insulin resistance (IR) in patients without DM and, similarly, these conditions commonly coexist. In epidemiological studies, each condition appears to predict the other. The prevalence of AGR/IR in HF patients without DM is significantly underrecognized and, as yet, the optimal method for screening for these abnormalities in the outpatient setting is unclear.


RESULTS
The purpose of this review is to overview the prevalence and prognostic impact of AGR and IR in HF patients without DM and discuss potential pathophysiological pathways that link these conditions with HF. The severity of glucose intolerance in patients with HF correlates with functional and clinical severity of HF and is an independent predictor of an adverse outcome. It is thought that changes in cardiac metabolism, including a switch from glucose metabolism toward fatty acid metabolism, may in part contribute to the pathophysiological processes associated with HF patients with AGR/IR.


CONCLUSIONS
We discuss how pharmacological targeting of metabolic pathways in the myocardium of these patients with HF may represent novel therapeutic strategies in these at-risk patients.
Mamas
Mamas A
MA
Manchester Royal Infirmary, Biomedical Research Centre, Manchester, UK. mamasmamas1@yahoo.co.uk
Deaton
Christi
C
Rutter
Martin K
MK
Yuille
Martin
M
Williams
Simon G
SG
Ray
Simon G
SG
New
John
J
Gibson
J Martin
JM
Neyses
Ludwig
L
D001786:Blood Glucose / Q000378:metabolism; D005227:Fatty Acids / Q000378:metabolism; D018149:Glucose Intolerance / Q000503:physiopathology*; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D054795:Incretins / Q000627:therapeutic use; D007333:Insulin Resistance / Q000502:physiology; D024821:Metabolic Syndrome / Q000503:physiopathology*; D008687:Metformin / Q000627:therapeutic use; D009206:Myocardium / Q000378:metabolism; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
D001786:Blood Glucose; D005227:Fatty Acids; D007004:Hypoglycemic Agents; D054795:Incretins; D008687:Metformin