[Insulin: cardiovascular effects and therapeutic applications]

Several studies have suggested a beneficial role of insulin and glucose infusions after myocardial infarction and in critically ill diabetic and non-diabetic patients. However, the insulin-glucose infusions are not routinely given to these patients, since no large randomized control trial was carried out, mechanisms involved in the benefits obtained are poorly understood, infusion protocols are complex and finally, health professionals need to change their cultural premises to apply them in their practice. Insulin has beneficial cardiovascular effects, such as the optimization of substrate use by cardiomyocites, coronary vasodilation, anti-inflammatory action and direct anti-apoptotic effects on myocardial cells. In this context, clinical studies of glucose and insulin infusions after myocardial infarction and cardiovascular surgery are reviewed, as well as possible pathophysiologic mechanisms leading to these benefits, and finally, a practical algorithm is proposed for use in intensive care and cardiovascular postoperative care units.