Glucose, insulin and myocardial ischaemia

Details

Serval ID
serval:BIB_85D6D80794C8
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Glucose, insulin and myocardial ischaemia
Journal
Current Opinion in Clinical Nutrition and Metabolic Care
Author(s)
Devos  P., Chiolero  R., Van den Berghe  G., Preiser  J. C.
ISSN
1363-1950 (Print)
Publication state
Published
Issued date
03/2006
Volume
9
Number
2
Pages
131-9
Notes
Journal Article
Review --- Old month value: Mar
Abstract
PURPOSE OF REVIEW: The importance of glucose metabolism and insulin therapy during myocardial ischaemia is increasingly being investigated. Insulin is used to achieve a tight glucose control or as part of glucose-insulin-potassium therapy. We have reviewed (1) the physiological and physiopathological consequences of hyperglycaemia focusing on potential machanisms of myocardial ischaemia, (2) the effects of insulin on vascular tone, on the release of free fatty acids, on inflammatory pathways, on the switch of energy source and on apoptosis, and (3) clinical data reporting the effects of intensive insulin therapy and glucose-insulin-potassium solutions during myocardial ischaemia and ischaemic heart failure. RECENT FINDINGS: In addition to its known toxic cellular effects, hyperglycaemia increases the activity of inducible nitric oxide synthase and promotes inflammation. Conversely insulin exerts anti-inflammatory and anti-apoptotic effects. Glucose-insulin-potassium solutions could improve survival after acute myocardial infarction or after surgery, according to recent meta-analyses, but confirmation of these data is eagerly awaited. SUMMARY: Hyperglycaemia is toxic, while insulin is beneficial during acute myocardial ischaemia. Some recent evidence confirms a substantial benefit of insulin administered either alone to achieve a tight glucose control or as a component of glucose-insulin-potassium therapy. Further research is needed to confirm that tendency and to define the threshold of tight glucose control.
Keywords
Blood Glucose/*metabolism Humans *Hyperglycemia/drug therapy/metabolism/physiopathology Hypoglycemic Agents/metabolism/*therapeutic use Insulin/metabolism/*therapeutic use Myocardial Ischemia/*metabolism Potassium/metabolism
Pubmed
Web of science
Create date
24/01/2008 16:52
Last modification date
20/08/2019 14:45
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