Effect of Irbesartan on Insulin Sensitivity in Chronic Heart Failure

This study has been completed.
Sponsor:
Collaborator:
Bristol-Myers Squibb
Information provided by:
Charite University, Berlin, Germany
ClinicalTrials.gov Identifier:
NCT00347087
First received: June 29, 2006
Last updated: October 30, 2007
Last verified: October 2007
  Purpose

To test whether treatment with the angiotensin II receptor antagonist Irbesartan improves insulin sensitivity and metabolic profile in patients with chronic heart failure.


Condition Intervention Phase
Chronic Heart Failure
Drug: Irbesartan
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Effect of the Angiotensin II Receptor Antagonist Irbesartan on Insulin Sensitivity and Metabolic Profile in Patients With Chronic Heart Failure

Resource links provided by NLM:


Further study details as provided by Charite University, Berlin, Germany:

Primary Outcome Measures:
  • Insulin sensitivity assessment using intravenous glucose tolerance testing [ Time Frame: 3 months ]

Secondary Outcome Measures:
  • Assessment of body composition using dual energy x-ray absorptiometry [ Time Frame: 3 months ]
  • Assessment of exercise capacity on a treadmill including respiratory gas analysis [ Time Frame: 3 months ]

Enrollment: 36
Study Start Date: July 2004
Study Completion Date: June 2007
Intervention Details:
    Drug: Irbesartan
    up-titration over 4 weeks to target dose 300 mg od
Detailed Description:

In CHF impaired insulin sensitivity is a common finding characterised by elevated fasting insulin levels and impaired effectiveness of insulin to utilise glucose in peripheral tissues, mainly in skeletal muscle tissue. Additionally, impaired insulin sensitivity, i.e. insulin resistance, progresses in parallel to severity of CHF and relates to major clinical symptoms such as reduced exercise capacity and muscle fatigue. In survival analyses, insulin resistance is a significant predictor of mortality, independently of and additionally to other established prognostic markers such as age, NYHA class, peak oxygen consumption, or LVEF. These findings indicate that insulin resistance is involved in CHF pathophysiology. Importantly, insulin resistance in CHF occurs independently of ischemic etiology. In ischaemic heart disease, however, insulin resistance as part of the metabolic syndrome is also an important prerequisite for the development of arteriosclerosis. Accordingly insulin resistance was found worst in CHF patients with ischemic etiology compared to patients with CHF due to dilated cardiomyopathy and those with ischaemic heart disease without heart failure. On the basis of these findings we hypothesise that therapeutically improving insulin sensitivity may have additional beneficial effects on energy utilisation and therefore improve clinical symptoms such as reduced exercise capacity and muscle fatigue.

  Eligibility

Ages Eligible for Study:   21 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. ambulatory patients with symptomatic chronic heart failure (NAHY II-IV)
  2. ischemic etiology
  3. LVEF ≤ 45%
  4. standard medical treatment for CHF (such as diuretics, beta blockers, ACE inhibitors, aspirin or warfarin). Patients should be treated with ACI inhibitor for at least 12 months prior to enrolment into the study. Patients should not be treated with angiotensin II receptor antagonists during the study other than the trial medication. Further medical treatment such as spironolactone, amiodarone and others are allowed if the patient is on a stable dose at the beginning of the trial. Dosages should be kept stable during the trial except adjustment is judged necessary for clinical reason.
  5. Patient should be hospitalised due to deterioration of the cardiac disease at least once in the last 12 months under ACE-I therapy.
  6. age > 21 years
  7. informed consent

Exclusion Criteria:

  1. hospitalisation with intervention within 2 weeks of intended randomisation
  2. unstable IHD or Myocardial infarction < 2 months
  3. open diagnosed diabetes mellitus / antidiabetic treatment with insulin, metformin, sulfonylurea, glinides
  4. COPD treated with steroids
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00347087

Locations
Germany
Applied Cachexia Research, Cardiology Dept. Charite Medical School, Virchow Klinikum
Berlin, Germany
Sponsors and Collaborators
Charite University, Berlin, Germany
Bristol-Myers Squibb
Investigators
Principal Investigator: Wolfram Doehner, MD, PhD Applied Cachexia Research, Cardiology, Charite, Campus Virchow Klinikum
  More Information

No publications provided by Charite University, Berlin, Germany

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
ClinicalTrials.gov Identifier: NCT00347087     History of Changes
Other Study ID Numbers: IRIS HF 7/04
Study First Received: June 29, 2006
Last Updated: October 30, 2007
Health Authority: Germany: Federal Institute for Drugs and Medical Devices

Keywords provided by Charite University, Berlin, Germany:
Insulin sensitivity
chronic heart failure
metabolism

Additional relevant MeSH terms:
Heart Failure
Insulin Resistance
Heart Diseases
Cardiovascular Diseases
Hyperinsulinism
Glucose Metabolism Disorders
Metabolic Diseases
Insulin
Irbesartan
Hypoglycemic Agents
Physiological Effects of Drugs
Pharmacologic Actions
Antihypertensive Agents
Cardiovascular Agents
Therapeutic Uses
Angiotensin II Type 1 Receptor Blockers
Angiotensin Receptor Antagonists
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on October 01, 2014