title: The effect of chronic heart failure and type 2 diabetes on insulin-stimulated endothelial function is similar and additive.
abstract: OBJECTIVE
  Chronic heart failure is associated with endothelial dysfunction and insulin resistance. The aim of this investigation was to study insulin-stimulated endothelial function and glucose uptake in skeletal muscles in patients with heart failure in comparison to patients with type 2 diabetes.
  
  
  METHODS
  Twenty-three patients with systolic heart failure and no history of diabetes, seven patients with both systolic heart failure and type 2 diabetes, 19 patients with type 2 diabetes, and ten healthy controls were included in the study. Endothelial function was studied by venous occlusion plethysmography. Insulin-stimulated endothelial function was assessed after intra-arterial infusion of insulin followed by co-infusion with serotonin in three different dosages. Forearm glucose uptake was measured during the insulin infusion.
  
  
  RESULTS
  Patients with systolic heart failure had impaired insulin-stimulated endothelial function. The percentage increase in blood flow during co-infusion with insulin and serotonin dose response study was 24.74% ± 6.16%, 23.50% ± 8.32%, and 22.29% ± 10.77% at the three doses respectively, compared to the healthy control group 45.96% ± 11.56%, 67.40% ± 18.11% and 84.57% ± 25.73% (P = 0.01). Insulin-stimulated endothelial function was similar in heart failure patients and patients with type 2 diabetes, while it was further deteriorated in patients suffering from both heart failure and diabetes with a percentage increase in blood flow of 19.15% ± 7.81%, -2.35% ± 11.76%, and 5.82% ± 17.70% at the three doses of serotonin, respectively. Forearm glucose uptake was impaired in patients with heart failure compared to healthy controls (P = 0.03) and tended to be further impaired by co-existence of diabetes (P = 0.08).
  
  
  CONCLUSIONS
  Systolic heart failure and type 2 diabetes result in similar vascular insulin resistance and reduced muscular insulin-stimulated glucose uptake. The effects of systolic heart failure and type 2 diabetes appear to be additive.
authors.affiliation: Department of Cardiology, Gentofte Hospital, Denmark. bk@heart.dk
authors.forename: Britt
authors.initials: B
authors.lastname: Falskov
authors.forename: Thomas Steffen
authors.initials: TS
authors.lastname: Hermann
authors.forename: Christian
authors.initials: C
authors.lastname: Rask-Madsen
authors.forename: Atheline
authors.initials: A
authors.lastname: Major-Pedersen
authors.forename: Buris
authors.initials: B
authors.lastname: Christiansen
authors.forename: Jakob
authors.initials: J
authors.lastname: Raunsø
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Helena
authors.initials: H
authors.lastname: Dominguez
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D005542:Forearm / Q000098:blood supply; D005947:Glucose / Q000378:metabolism; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007261:Infusions, Intra-Arterial; D007328:Insulin / Q000008:administration & dosage*; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism; D010991:Plethysmography; D012039:Regional Blood Flow / Q000187:drug effects; D012701:Serotonin / Q000008:administration & dosage; D017366:Serotonin Receptor Agonists / Q000008:administration & dosage; D014664:Vasodilation / Q000187:drug effects
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D017366:Serotonin Receptor Agonists; D012701:Serotonin; D005947:Glucose