INSULIN RESISTANCE IN PATIENTS WITH CHRONIC HEART FAILURE
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Insulin resistance may be present in patients with heart failure and has a potential to reduce myocardial as well as skeletal muscle activity. We have assessed insulin resistance as measured by fasting insulin resistance index (FIR!) in 23 patients with chronic heart failure (CHF) [9 valvular disease, 6 DCM and 8 IHD] and 10 control subjects of similar age and BMI. Fasting glucose, insulin, C-peptide and lipid profile were estimated. CHF patients had similar mean fasting plasma glucose concentration to control but significantly higher mean plasma insulin (10.57 vs 6.14 mU//L, P< 0.001) and C-peptide (119.4 vs 63.2, P <0.001). Significant insulin resistance could be detected in patients with CHF as assessed by FIR! (P <0.001 vs control). Analysis of variance showed that FIR1 was not related to the etiology of CHF but to its severity as awased by NYHA functional classification (P < . 0.05). Both EF% and CI were not correlated to FIR!. Our fmdings show that patients with CHF are • insulin resistant with increased insulin secretion and hyperinsulinetnia compared to matched healthy sedentary control group. The degree of insulin resistance was correlated to severity of heart failure (NYHA classification) but not to ventricular systolic pump dysfunction or the cause of CHF. The mechanisms underlying insulin resistance in these cases as well as possible therapeutic implications , remain to be further investigated in future studies.