Evidence map›Paper›PMID 36942494›Full record

ArticleESC heart failure2023

Effects of angiotensin receptor-neprilysin inhibitor on insulin resistance in patients with heart failure.

Yusuke Kashiwagi, Tomohisa Nagoshi, Haruka Kimura, Yoshiro Tanaka, Yuhei Oi, Yasunori Inoue, Kazuo Ogawa, Makoto Kawai, Michihiro Yoshimura

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In one paragraph

Article in ESC heart failure, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Effects of Sacubitril/Allisartan versus Olmesartan on serum uric acid in Chinese patients with hypertension and hyperuricaemia.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Trial
  3. Article
  4. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Yusuke KashiwagiDivision of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Tomohisa NagoshiDivision of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Haruka KimuraDivision of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Yoshiro TanakaDivision of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Yuhei OiDivision of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Yasunori InoueDivision of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Kazuo OgawaDivision of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Makoto KawaiDivision of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Michihiro YoshimuraDivision of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsAlthough the haemodynamic effects of angiotensin receptor-neprilysin inhibitor (ARNI) on patients with heart failure have been demonstrated, the effect on glucose metabolism has not been fully elucidated. We retrospectively investigated the effect of ARNI on abnormal glucose metabolism in patients with stable chronic heart failure using an additional structural equation model (SEM) analysis.

methodsWe analysed 34 patients who regularly visited to the outpatient department of our institute with heart failure from October 2021 and July 2022 and who were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Seventeen patients switched from ACE inhibitors or ARBs to an ARNI (ARNI group), and the other 17 patients continued treatment with ACE inhibitors or ARBs (control group).

resultsAt baseline, although the ARNI group included fewer patients with heart failure with preserved ejection fraction in comparison with the control group (P = 0.004), patients with heart failure with mildly reduced ejection fraction, and heart failure with reduced ejection fraction were mostly biased towards the ARNI group (although not statistically significant). The baseline insulin resistance in the ARNI group was already significantly higher in comparison with the control group [fasting blood insulin, 9.7 (7.4, 11.6) vs. 7.8 (5.2, 9.2) μU/mL, P = 0.033; homoeostasis model assessment of insulin resistance (HOMA-IR), 3.10 (1.95, 4.19) vs. 2.02 (1.56, 2.42), P = 0.014]. Three months later, the fasting blood insulin and the HOMA-IR levels were both found to have decreased in comparison with the baseline values [baseline to 3 months: insulin, 9.7 (7.4, 11.6) to 7.3 (4.6, 9.4) μU/mL, P < 0.001; HOMA-IR, 3.10 (1.95, 4.19) to 1.96 (1.23, 3.09), P < 0.001]. An additional SEM analysis demonstrated that the initiation of ARNI had caused a reduction in the fasting blood insulin and the HOMA-IR levels at 3 months independently of the baseline fasting blood insulin and HOMA-IR levels, respectively. Similarly, the initiation of ARNI resulted in a significant reduction in serum uric acid levels (6.28 ± 0.35 to 5.80 ± 0.30 mg/dL, P = 0.008).

conclusionsIn conclusion, even in a short period of only 3 months, the administration of ARNI improved insulin resistance and consequently reduced the serum uric acid levels in patients with stable chronic heart failure. Although the ARNI group already had high insulin resistance at baseline, an additional SEM analysis revealed that the decreased insulin resistance was truly due to the effect of ARNI.

Indexed as

Heart FailureInsulin ResistanceInsulinsVentricular Dysfunction, LeftAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAntihypertensive AgentsGlucoseHumansNeprilysinRetrospective StudiesStroke VolumeTreatment OutcomeUric AcidAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAntihypertensive AgentsGlucoseInsulinsNeprilysinUric AcidAngiotensin receptor-neprilysin inhibitorHeart failureInsulin resistanceStructural equation model analysisUric acid

Identifiers

PMID36942494
PMCPMC10192229

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.