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Determinants of insulin sensitivity in chronic heart failure
L W E Sabelis1, P J Senden, M L Zonderland
1Department of Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. l.w.esabelis@med.uu.nl
Insights
Insulin sensitivity in chronic heart failure is significantly influenced by body mass index, smoking, age, and daily physical activity. These factors collectively predict insulin sensitivity in heart failure patients.
Area of Science:
- Cardiology
- Metabolic Health
- Exercise Physiology
Background:
- Insulin resistance is a common comorbidity in chronic heart failure (CHF).
- Understanding the determinants of insulin sensitivity (IS) is crucial for managing CHF patients.
- Lifestyle and clinical factors may significantly impact IS in this population.
Purpose of the Study:
- To develop a comprehensive model predicting insulin sensitivity (IS) in patients with chronic heart failure (CHF).
- To investigate the combined influence of lifestyle factors, heart failure etiology, age, left ventricular ejection fraction (LVEF), and body composition on IS.
Main Methods:
- An observational cohort study was conducted in an outpatient CHF clinic.
- Fifty-seven male CHF patients (NYHA class II-III) underwent euglycemic hyperinsulinemic clamp, cycle ergometry, anthropometric measurements, and LVEF assessment.
- A predictive model for IS variance was developed incorporating lifestyle and clinical parameters.
Main Results:
- Insulin sensitivity (IS) was inversely associated with body mass index (BMI) and fasting insulin levels.
- After adjusting for BMI, age also showed a significant inverse correlation with IS.
- The final model explained 60% of the variance in IS, with BMI (20%), smoking (17%), age (17%), and daily physical activity (16%) being major contributors.
Conclusions:
- Insulin sensitivity in CHF patients is substantially predicted by a combination of factors.
- Key determinants include body mass index, smoking status, age, and daily physical activity.
- Left ventricular ejection fraction and heart failure etiology also moderately contribute to predicting insulin sensitivity.
Objective:
To describe the determinants of insulin sensitivity (IS) in chronic heart failure (CHF), we created a model in which the influence of lifestyle factors and etiology of heart failure on IS were incorporated concomitantly with age, left ventricular ejection fraction (LVEF) and parameters of body composition.
Design:
Observational cohort study.
Setting:
Outpatient clinic for chronic heart failure.
Patients:
Fifty-seven male CHF patients [NYHA class II-III, age 61+/-9 years, body mass index (BMI) 26.9+/-3.3 kg/m2 (mean+/-S.D.)].
Interventions:
Euglycemic hyperinsulinemic clamp, cycle ergometry, anthropometric measurements, LVEF and a physical activity questionnaire.
Main Outcome Measures:
A model explaining the variance of IS in CHF.
Results:
IS was 18.2+/-8.6 microg.kg(-1).min(-1).mU(-1).l(-1), fasting insulin level was 15.9+/-11.0 mU/l and fasting glucose level was 5.5+/-0.6 mmol/l. Peak VO2 was 19.1+/-4.9 ml.kg(-1).min(-1) and LVEF 26.2+/-7.1%. IS was inversely associated with fasting insulin concentration (r=-0.50, P<0.001) and BMI (r=-0.54, P<0.001). After controlling for BMI, IS also revealed a correlation with age (r=-0.36, P<0.01). The model explained 60% of variance in IS: BMI contributed 20%, smoking 17%, age 17% and physical activity in daily life (DPA) 16% (all P<0.05) to the variance of IS, whereas LVEF (9%) and etiology of heart failure (8%) contributed moderately.
Conclusions:
In CHF patients, IS is for a major part predicted by BMI, smoking, age, daily physical activity, LVEF and etiology of heart failure.