© 2003 by European Society of Cardiology
Copyright © 2003, European Society of Cardiology
Insulin and myocardial blood flow
Turku PET Centre, Turku University Central Hospital, P.O. Box 52, FIN-20521 Turku, Finland
* Corresponding author. Tel.: +358-2-313-0000; fax: +358-2-231-8191. jan.sundell{at}utu.fi
The renaissance of glucose–insulin–potassium infusion (GIK) as a treatment of acute myocardial infarction both in diabetic and nondiabetic subjects has raised new interests to clarify the effects and mechanisms of insulin on myocardium. Although the action of insulin on substrate metabolism is quite well studied in heart, the cardiovascular effects were until recent years poorly known. Insulin induces skeletal muscle vasodilation mainly via the endothelium-dependent mechanism and appears to have an important role in normal vascular function. There is increasing amount of evidence that insulin acts as a vasodilatory hormone also in coronary arteries. Insulin enhances myocardial blood flow and decreases coronary vascular resistance in a dose-dependent manner in healthy subjects. Moreover, insulin is able to increase myocardial blood flow also in subjects who are characterized by coronary dysfunction such as subjects with obesity, type 1 diabetes and coronary artery disease. However, vasodilatory effect of insulin may be blunted in these patients. Since already very small increase in myocardial blood flow can reduce significantly myocardial ischemia, these vasodilatory actions of insulin in coronary arteries might partly contribute to beneficial effects of GIK therapy. On the other hand, in contrast to these acute beneficial effect of insulin, epidemiological studies have indentified chronic hyperinsulinemia, a common feature in subjects with insulin resistance to glucose uptake, as an independent risk factor for coronary artery disease. The present article review the physiological and pathophysiological role of insulin in cardiac vasculature and its clinical importance during myocardial ischemia and development of coronary artery disease.
KEYWORDS GIK, glucose–insulin–potassium infusion; NO, nitric oxide; L-NMMA, NG-monomethyl-L-arginine; cGMP, cyclic guanosine monophosphate; Ca2+, calcium; ET-1, endothelin-1; PET, positron emission tomography
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  E. Konduracka, A. Gackowski, P. Rostoff, D. Galicka-Latala, W. Frasik, and W. Piwowarska Diabetes-specific cardiomyopathy in type 1 diabetes mellitus: no evidence for its occurrence in the era of intensive insulin therapy Eur. Heart J., October 2, 2007; 28(20): 2465 - 2471. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Cooper, A. Whaley-Connell, J. Habibi, Y. Wei, G. Lastra, C. Manrique, S. Stas, and J. R. Sowers Renin-angiotensin-aldosterone system and oxidative stress in cardiovascular insulin resistance Am J Physiol Heart Circ Physiol, October 1, 2007; 293(4): H2009 - H2023. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Muniyappa, M. Montagnani, K. K. Koh, and M. J. Quon Cardiovascular Actions of Insulin Endocr. Rev., August 1, 2007; 28(5): 463 - 491. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T H Schindler, A D Facta, J O Prior, J Cadenas, W A Hsueh, M J Quinones, and H R Schelbert Improvement in coronary vascular dysfunction produced with euglycaemic control in patients with type 2 diabetes Heart, March 1, 2007; 93(3): 345 - 349. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Ma, H.-F. Zhang, L. Yu, Q.-J. Zhang, J. Li, J.-H. Huo, X. Li, W.-Y. Guo, H.-C. Wang, and F. Gao Vasculoprotective effect of insulin in the ischemic/reperfused canine heart: Role of Akt-stimulated NO production Cardiovasc Res, January 1, 2006; 69(1): 57 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H Satoh, H Terada, A Uehara, H Katoh, M Matsunaga, K Yamazaki, F Matoh, and H Hayashi Post-challenge hyperinsulinaemia rather than hyperglycaemia is associated with the severity of coronary artery disease in patients without a previous diagnosis of diabetes mellitus Heart, June 1, 2005; 91(6): 731 - 736. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Caumo and L. Luzi First-phase insulin secretion: does it exist in real life? Considerations on shape and function Am J Physiol Endocrinol Metab, September 1, 2004; 287(3): E371 - E385. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. S Lewis, S. L Kane-Gill, M. B. Bobek, and J. F Dasta Intensive Insulin Therapy for Critically Ill Patients Ann. Pharmacother., July 1, 2004; 38(7): 1243 - 1251. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Westerbacka, R. Bergholm, M. Tiikkainen, and H. Yki-Jarvinen Glargine and Regular Human Insulin Similarly Acutely Enhance Endothelium-Dependent Vasodilatation in Normal Subjects Arterioscler Thromb Vasc Biol, February 1, 2004; 24(2): 320 - 324. [Abstract] [Full Text]
|
|