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Please use this identifier to cite or link to this item: http://hdl.handle.net/10564/3991

Title: Low Insulin Is an Independent Predictor of All-Cause and Cardiovascular Death in Acute Decompensated Heart Failure Patients Without Diabetes Mellitus.
Other Titles: 低インスリン血症は、非糖尿病急性非代償性心不全患者において、全死亡、心血管死の独立した予後予測因子である
Authors: Nogi, Maki
Kawakami, Rika
Ishihara, Satomi
Hirai, Kaeko
Nakada, Yasuki
Nakagawa, Hitoshi
Ueda, Tomoya
Nishida, Taku
Onoue, Kenji
Soeda, Tsunenari
Okayama, Satoshi
Watanabe, Makoto
Saito, Yoshihiko
Keywords: acute heart failure
insulin
prognosis
diabetes mellitus
Issue Date: May-2020
Publisher: American Heart Association
Citation: Journal of the American Heart Association Vol.9 No.10 Article No.e015393 (2020 May)
Abstract: Background Insulin beneficially affects myocardial functions during myocardial ischemia. It increases glucose-derived ATP production, decreases oxygen consumption, suppresses apoptosis of cardiomyocytes, and promotes the survival of cardiomyocytes. Patients with chronic heart failure generally have high insulin resistance, which is correlated with poor outcomes. The role of insulin in acute decompensated heart failure (ADHF) remains unclear. This study aimed to investigate the prognostic value of serum insulin level at the time of admission for long-term outcomes in patients with ADHF. Methods and Results We enrolled 1074 consecutive patients who were admitted to our department for ADHF. Of these 1074 patients, we studied the impact of insulin on the prognosis of ADHF in 241 patients without diabetes mellitus. The patients were divided into groups according to low, intermediate, and high tertiles of serum insulin levels. Primary end points were all-cause death and cardiovascular death. During a mean follow-up of 21.8 months, 71 all-cause deaths and 38 cardiovascular deaths occurred. Kaplan-Meier analysis showed that all-cause and cardiovascular mortality was significantly higher in the low-insulin group than those in the intermediate- and high-insulin groups (log-rank P=0.0046 and P=0.038, respectively). Moreover, according to the multivariable analysis, low serum insulin was an independent predictor of all-cause and cardiovascular mortality (hazard ratio, 2.37 [95% CI, 1.24-4.65; P=0.009] and 2.94 [95% CI, 1.12-8.19; P=0.028], respectively). Conclusions Low serum insulin levels were associated with increased risk of all-cause and cardiovascular death in ADHF patients without diabetes mellitus.
Description: 博士(医学)・甲第808号・令和4年3月15日
© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License(https://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
URI: http://hdl.handle.net/10564/3991
ISSN: 20479980
Academic Degrees and number: 24601A808
Degree-granting date: 2022-03-15
Degree name: 博士(医学)
Degree-granting institutions: 奈良県立医科大学
Appears in Collections:2021年度

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