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November 23/30, 2005

Insulin Resistance and Congestive Heart Failure—Reply

JAMA. 2005;294(20):2578. doi:10.1001/jama.294.20.2578-b

In Reply: We agree with Dr Stefan and colleagues that adiponectin may play an important role in the associations between obesity, insulin resistance, and CHF. In a recent animal study, the links between low adiponectin levels, insulin resistance, and heart failure were investigated.1 In adiponectin knockout mice, there were increases in insulin resistance, cardiac mass, left ventricular dimensions, and pulmonary congestion compared with control mice. These results are consistent with those of the study by Shibata et al2 and add to the evidence of an association between insulin resistance, adiponectin, and cardiac function. There is still a lack of human studies, but we consider this suggested mechanism at least as reasonable as the ones we suggested in our article. However, there is a need for further studies to elucidate the causative relations and mechanisms involved in the associations between obesity, insulin resistance, and CHF. These mechanisms could include adiponectin deficiency, but that still has to be proved.