J Card Fail. 2010;16(9):761-8.
BACKGROUND: A link between diabetes mellitus (DM) and heart failure (HF) has been
well-recognized for more than a century. HF is also closely linked to abnormal glucose
regulation (AGR) and insulin resistance (IR) in patients without DM and, similarly,
these conditions commonly coexist. In epidemiological studies, each condition appears
to predict the other. The prevalence of AGR/IR in HF patients without DM is significantly
underrecognized and, as yet, the optimal method for screening for these abnormalities
in the outpatient setting is unclear. METHODS AND RESULTS: The purpose of this review
is to overview the prevalence and prognostic impact of AGR and IR in HF patients without
DM and discuss potential pathophysiological pathways that link these conditions with
HF. The severity of glucose intolerance in patients with HF correlates with functional
and clinical severity of HF and is an independent predictor of an adverse outcome.
It is thought that changes in cardiac metabolism, including a switch from glucose
metabolism toward fatty acid metabolism, may in part contribute to the pathophysiological
processes associated with HF patients with AGR/IR. CONCLUSIONS: We discuss how pharmacological
targeting of metabolic pathways in the myocardium of these patients with HF may represent
novel therapeutic strategies in these at-risk patients.