The Negative Impact of Insulin Resistance/Hyperinsulinemia on Chronic Heart Failure and the Potential Benefits of Its Screening and Treatment

Abstract

This opinion article highlights the potential alterations caused by insulin resistance and hyperinsulinemia on the cardiovascular system and their negative impact on heart failure (HF), and describes the potential benefits of an early screening with consequent prompt treatment. HF is the final event of several different cardiovascular diseases. Its incidence has been increasing over the last decades because of increased survival from ischemic heart disease thanks to improvements in its treatment (including myocardial revascularization interventions) and the increase in life span. In particular, incidence of HF with preserved ejection fraction (HFpEF) is significantly increasing, and patients with HFpEF often are also affected by diabetes mellitus and insulin resistance (IR), with a prevalence > 45%. Concentric left ventricular (LV) remodeling and diastolic dysfunction are the main structural abnormalities that characterize HFpEF. It is well documented in the literature that IR with chronic hyperinsulinemia, besides causing type 2 diabetes mellitus, can cause numerous cardiovascular alterations, including endothelial dysfunction and increased wall thicknesses of the left ventricle with concentric remodeling and diastolic dysfunction. Therefore, it is conceivable that IR might play a major role in the pathophysiology and the progressive worsening of HF. To date, several substances have been shown to reduce IR/hyperinsulinemia and have beneficial clinical effects in patients with HF, including SGLT2 inhibitors, metformin, and berberine. For this reason, an early screening of IR could be advisable in subjects at risk and in patients with heart failure, to promptly intervene with appropriate therapy. Future studies aimed at comparing the efficacy of the substances used both alone and in association are needed.

Association of triglyceride glucose index and triglyceride glucose-body mass index with sudden cardiac arrest in the general population

“…Dyslipidemia, a consequence of IR, is characterised by elevated TG levels and reduced HDL cholesterol levels, both significant risk factors for CVD [ 47 ]. Hyperglycemia and hyperinsulinemia resulting from IR may further burden the cardiovascular system [ 48 ]. Concurrently, increased inflammation, commonly observed in IR, plays a pivotal role in atherosclerosis development, a core mechanism underlying sudden cardiac death [ 49 ].…”

Insulin Resistance/Hyperinsulinemia as an Independent Risk Factor That Has Been Overlooked for Too Long

“…We have already described in detail the alterations that IR/Hypein can cause to the cardiovascular system, so we will not go into further detail [29,30]. IR/Hypein exists in 30-70% of patients with heart failure (HF) and may be a significant contributory cause of the development and worsening of heart failure with preserved ejection fraction (HFpEF), which is characterized by a concentric remodeling of the left ventricle with diastolic dysfunction, increased filling pressures, and pulmonary and systemic congestion [26].…”