Insulin resistance in pulmonary arterial hypertension

• Published in: The European respiratory journal Vol. 33; no. 2; pp. 318 - 324
• Main Authors: Zamanian, R. T, Hansmann, G, Snook, S, Lilienfeld, D, Rappaport, K. M, Reaven, G. M, Rabinovitch, M, Doyle, R. L
• Format: Journal Article
• Language: English
• Published: Leeds Eur Respiratory Soc 01.02.2009; Maney
• Subjects: Adult; Aged; Biological and medical sciences; Case-Control Studies; Disease-Free Survival; Female; Hemodynamics; Humans; Hypertension, Pulmonary - metabolism; Hypertension, Pulmonary - pathology; Insulin Resistance; Medical sciences; Metabolic diseases; Middle Aged; Obesity; Pneumology; Pulmonary Artery - pathology; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Risk Factors; Time Factors; Treatment Outcome; Triglycerides - metabolism; Endocrinopathy; Obesity; Respiratory disease; Nutrition disorder; Metabolic diseases; Cardiovascular disease; Artery; Pulmonary hypertension; Target tissue resistance; Insulin resistance; pulmonary arterial hypertension; Nutritional status; Pneumology
• ISSN: 0903-1936; 1399-3003
• DOI: 10.1183/09031936.00000508

Although obesity, dyslipidemia and insulin resistance (IR) are well known risk factors for systemic cardiovascular disease, their impact on pulmonary arterial hypertension (PAH) is unknown. The present authors' previous studies indicate that IR may be a risk factor for PAH. The current study has investigated the prevalence of IR in PAH and explored its relationship with disease severity. Clinical data and fasting blood samples were evaluated in 81 nondiabetic PAH females. In total, 967 National Health and Nutrition Examination Surveys (NHANES) females served as controls. The fasting triglyceride to high-density lipoprotein cholesterol ratio was used as a surrogate of insulin sensitivity. While body mass index was similar in NHANES versus PAH females (28.6 versus 28.7 kg.m(-2)), PAH females were more likely to have IR (45.7 versus 21.5%) and less likely to be insulin sensitive (IS; 43.2 versus 57.8%). PAH females mostly (82.7%) had New York Heart Association (NYHA) class II and III symptoms. Aetiology, NYHA class, 6-min walk-distance and haemodynamics did not differ between IR and IS PAH groups. However, the presence of IR and a higher NYHA class was associated with poorer 6-months event-free survival (58 versus 79%). Insulin resistance appears to be more common in pulmonary arterial hypertension females than in the general population, and may be a novel risk factor or disease modifier that might impact on survival.