title: Addition of losartan to angiotensin-converting enzyme inhibitors improves insulin resistance in patients with chronic heart failure treated without β-blockers.
abstract: BACKGROUND
  Angiotensin II and insulin resistance (IR) have clinical implications in the pathophysiology of chronic heart failure (CHF). However, it is still unclear whether the combination of an angiotensin-receptor blocker and angiotensin-converting enzyme inhibitor (ACEI) improves IR in CHF patients who do not receive β-blockers. Thus, the aim of the present study was to evaluate the effects of losartan on glucose metabolism and inflammatory cytokines in CHF patients treated with ACEI but not β-blockers.
  
  
  RESULTS
  The effect of losartan treatment for 16 weeks on IR was analyzed in 16 CHF patients in a randomized crossover trial. Insulin level and homeostasis model IR index (HOMA-IR) decreased significantly (P<0.05), but fasting plasma glucose did not change significantly. Serum tumor necrosis factor (TNF)-α, interleukin (IL)-6, and monocyte chemoattractant protein (MCP)-1 levels were significantly decreased with losartan (P<0.05). Furthermore, the changes in IL-6 and MCP-1 levels were significantly correlated with the reduction in HOMA-IR (P<0.05), but the change in TNF-α levels was not significantly correlated.
  
  
  CONCLUSIONS
  The addition of losartan to ACEI therapy improved IR and decreased inflammatory cytokines in CHF patients who did not receive β-blockers.
authors.affiliation: Center for Clinical Residency Program, Tottori University Hospital, Yonago, Japan.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Ogino
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kato
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Furuse
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kinugasa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kaetsu
authors.forename: Einosuke
authors.initials: E
authors.lastname: Mizuta
authors.forename: Shinobu
authors.initials: S
authors.lastname: Sugihara
authors.forename: Katsunori
authors.initials: K
authors.lastname: Ishida
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hisatome
authors.forename: Chiaki
authors.initials: C
authors.lastname: Shigemasa
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D018932:Chemokine CCL2 / Q000097:blood; D002908:Chronic Disease; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D048289:Imidazolidines / Q000627:therapeutic use; D018836:Inflammation Mediators / Q000097:blood; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D015850:Interleukin-6 / Q000097:blood; D007564:Japan; D017706:Lisinopril / Q000627:therapeutic use; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D001786:Blood Glucose; C111835:CCL2 protein, human; D018932:Chemokine CCL2; C508600:IL6 protein, human; D048289:Imidazolidines; D018836:Inflammation Mediators; D007328:Insulin; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D004656:Enalapril; C065166:imidapril; D017706:Lisinopril; D019808:Losartan