Cardiovascular benefits of exogenous insulin.
BACKGROUND
Recent studies on mediators of inflammation, experimental models of atherosclerosis, and acute ischemia have identified novel mechanisms through which insulin may exert cardiovascular protective effects. This review aims to summarize current knowledge regarding the cardiovascular, antiinflammatory, and antiatherogenic effects of insulin, and the effect of intensive glycemic control in acute cardiovascular disease.


METHODS
Publications of interest were identified using preselected MeSH terminology and keywords to search online databases such as PubMed and OVID for the period January 1988 to February 2012. Relevant publications were obtained and reviewed by two independent observers, then evaluated a priori against the following criteria: study quality, main clinical outcomes, and applicability to clinical practice.


RESULTS
Insulin has been shown to exert vasodilatory, antiinflammatory, and antiatherogenic effects in experimental models, independent of its glucose-lowering effects. Additionally, glucose is known to exert potent proinflammatory, prothrombotic, and proapoptotic effects during myocardial infarct, indicative that hyperglycemia is likely to be injurious to the heart. In this context, through its nonmetabolic and metabolic (glucose-lowering) effects, insulin is likely to be cardioprotective and to improve clinical outcomes in acute myocardial infarction.


CONCLUSIONS
Despite promising experimental data and evidence of benefit from single-center randomized clinical trials, clinical evidence supporting the cardioprotective effects of insulin from a multicenter randomized clinical trial is still lacking. Future prospective studies with insulin infused at adequate concentrations, individually titrated to achieve and maintain euglycemia (blood glucose < 140 mg/dl) and minimize hypoglycemia, are required to investigate the role of insulin in the management of patients with acute cardiovascular disease.
Diabetes-Endocrinology Center of Western New York, Division of Endocrinology, Kaleida Health/Millard Fillmore Hospital, Buffalo, New York, USA.
Ajay
A
Chaudhuri
Paresh
P
Dandona
Vivian
V
Fonseca
D000818:Animals; D050197:Atherosclerosis / Q000517:prevention & control; D001775:Blood Circulation / Q000187:drug effects; D001786:Blood Glucose / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D019090:Case Management; D003422:Critical Care; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D004730:Endothelium, Vascular / Q000187:drug effects; D005947:Glucose / Q000502:physiology; D006321:Heart / Q000503:physiopathology; D006334:Heart Function Tests; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009131:Muscle, Smooth, Vascular / Q000502:physiology; D009203:Myocardial Infarction / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors; D015398:Signal Transduction; D014664:Vasodilation / Q000502:physiology
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D010975:Platelet Aggregation Inhibitors; D005947:Glucose