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Impaired Insulin Sensitivity as an Independent Risk Factor for Mortality in Patients With Stable Chronic Heart Failure

Wolfram Doehner, MD, PhD^_*,,_*, Mathias Rauchhaus, MD, PhD, Piotr Ponikowski, MD, PhD, Ian F. Godsland, PhD, Stephan von Haehling, MD^_*,,,, Darlington O. Okonko, BSc^_*, Francisco Leyva, MD^_*,, Anthony J. Proudler, PhD, Andrew J.S. Coats, DM^|| and Stefan D. Anker, MD, PhD^_*,

^_* Department of Clinical Cardiology, National Heart and Lung Institute, Imperial College, London, United Kingdom
Division of Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
Cardiology Department, Clinical Military Hospital, Wroclaw, Poland
Wynn Department of Metabolic Medicine, Division of Medicine, Imperial College, London, United Kingdom
^|| Faculty of Medicine, University of Sydney, Sydney, Australia.

View larger version (23K): [in a new window]   Figure 1 Insulin sensitivity in patients with chronic heart failure according to New York Heart Association (NYHA) functional class, as compared with healthy control subjects. Box plot displaying the 10th, 25th, 50th, 75th, and 90th percentiles. The p values for the Fisher post-hoc test of mean square-root transformed insulin sensitivity. *p < 0.05 and **p < 0.005 vs. controls.

View larger version (18K): [in a new window]   Figure 2 Survival in stable, ambulatory chronic heart failure patients (n = 105), classified according to the degree of impairment of insulin sensitivity (SI) (i.e., above [n = 53] or below [n = 52] median SI of 1.82 min–1·µU·ml–1·104). Kaplan-Meier survival curve for four-year survival.

View larger version (22K): [in a new window]   Figure 3 Survival in stable, ambulatory chronic heart failure patients in a two-risk factor model using insulin sensitivity (SI) and peak oxygen uptake (VO2) as dichotomized variables: interaction of impaired SI (below median of 1.82 min–1·µU·ml–1·104), with the presence of low peak VO2 (peak VO2 <14 ml/kg/min) (patients with no risk factor: n = 41, 6 deaths; one risk factor: n = 44, 23 deaths; two risk factors: n = 20, 15 deaths). Kaplan-Meier survival curve for four-year survival.