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Insulin Resistance Linked to Non-Ischemic Heart Failure

Blocks heart's normal response to injury

WEDNESDAY, Jan. 9 (HealthDay News) -- Insulin resistance may lead to non-ischemic heart failure by blocking the heart's ability to alter metabolism and increase energy efficiency after injury, according to a review article in the Jan. 15 issue of the Journal of the American College of Cardiology.

Ronald M. Witteles, M.D., of Stanford University School of Medicine in Stanford, Calif., and a colleague reviewed the literature for evidence from basic science, animal experiments and human clinical data supporting the proposal that insulin resistance is involved in the development of non-ischemic heart failure, as well as treatment options.

The researchers note that insulin resistance prevents the myocardium from altering substrate metabolism to increase energy efficiency after injury. This can lead to further injury such as lipotoxicity, inflammation, oxidative stress, fibrosis, and upregulation of the sympathetic nervous system. Animal and clinical studies have supported a link between insulin resistance, cardiomyopathy and heart failure. Insulin resistance is common in patients with non-ischemic heart failure and is associated with a worse prognosis. Treatment may include drugs to modulate metabolism and diabetes.

"Almost certainly, insulin resistance itself is not enough to cause dilated cardiomyopathy; the very fact that the vast majority of patients with insulin resistance do not develop dilated cardiomyopathies highlights this point," the authors conclude. "Delineation and appreciation of the role of insulin resistance as a fundamental cause of non-ischemic cardiomyopathy should allow for the development of new therapies aimed at insulin resistance and metabolic modulation."

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