© 2003 European Society of Cardiology
Determinants of insulin sensitivity in chronic heart failure
a Department of Sports Medicine, University Medical Center Utrecht Utrecht, The Netherlands
b Department of Internal Medicine, University Medical Center Utrecht Utrecht, The Netherlands
c Department of Cardiology, Meander Medical Center Amersfoort, The Netherlands
d Department of Internal Medicine, Meander Medical Center Amersfoort, The Netherlands
e Department of Laboratory Medicine, Meander Medical Center Amersfoort, The Netherlands
* Corresponding author. Tel.: +31-30-253-8925; fax: +31-30-253-9036 E-mail address: l.w.esabelis{at}med.uu.nl
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Abstract |
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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 µg·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 
o2 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.
Key Words: Chronic heart failure • Insulin sensitivity • Exercise tolerance
Received April 2, 2003; Revised May 8, 2003; Accepted July 31, 2003
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