Insulin Resistance Predicts Mortality in Chronic Heart Failure

Impaired insulin sensitivity independently predicts mortality in patients with otherwise stable chronic heart failure (CHF).

Impaired insulin sensitivity commonly complicates chronic heart failure, the authors explain, but its clinical significance remains unclear. Dr. Wolfram Doehner from Charite Medical School, Campus Virchow-Klinikum, Berlin, and colleagues investigated whether insulin resistance independently impaired prognosis in 105 men with ischemic (63%) or nonischemic (37%) CHF.
Patients who died during follow-up had 42% lower baseline insulin sensitivity than patients who survived, the authors report. Insulin sensitivity also showed stepwise decreases as the New York Heart Association (NYHA) functional class worsened and as left ventricular ejection fraction decreased, the report indicates.

In multivariate analyses, insulin sensitivity predicted mortality independently of all other clinical parameters, the researchers note, with decreasing insulin sensitivity consistently predicting impaired survival.

Two-year survival was 83% in patients with insulin sensitivity above the median, the results indicate, whereas survival was only 61% in patients with insulin sensitivity below the median. The difference was even more marked at 4 years (73% versus 37%, respectively).

"Insulin resistance provides additional prognostic information independent of well-established prognosticators, such as clinical status, age, left ventricular ejection fraction, and exercise capacity, as well as body composition measures," the investigators write.

"From the present data, it seems promising to test in future studies whether early detection and therapeutic targeting of insulin resistance in CHF may improve the outcome in these patients," the authors conclude.

"These studies suggest a possibility of improving heart failure outcomes by treating insulin resistance," agrees Dr. Javed Butler from Vanderbilt University Medical Center, Nashville, Tennessee in a related editorial.

"Indeed, a recent study showed significant benefit with insulin sensitizers in heart failure patients with diabetes," Dr. Butler continues. "If these results are replicated, it would not be surprising that such drugs like thiazolidinediones may become part of the therapeutic armamentarium for heart failure."
J Am Coll Cardiol 2005;46:1019-1028.

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