Insulin resistance and heart failure.

Despite recent therapeutic advances, heart failure remains a leading cause of morbidity and mortality. The prevalence of heart failure continues to rise, and the importance of cardiac energetics underlying myocardial dysfunction is increasingly recognized. The rise in obesity and type 2 diabetes with associated insulin resistance results in abnormal glucose and fatty acid metabolism of the myocardium and the entire body, serving to highlight the fact that deranged metabolism may provide a therapeutic target beyond existing neuroendocrine inhibition. Evidence from clinical studies often conflict, but it appears that the association between heart failure and insulin resistance is interdependent and complex. Drugs that improve glucose metabolism may harm myocardial performance under stress, and the use of metabolic treatment in patients with heart failure must be targeted on the individual and based on evidence from carefully designed clinical trials.