Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure

Mads Halbirk; Helene Nørrelund; Niels Møller; Jens Juul Holst; Ole Schmitz; Bent Roni Ranghøj Nielsen; Jens Erik Nielsen-Kudsk; Søren Steen Nielsen; Torsten Toftegaard Nielsen; Hans Eiskjaer; Hans Erik Bøtker; Henrik Wiggers

doi:10.1152/ajpheart.00930.2009

Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure

Mads Halbirk, Helene Nørrelund, Niels Møller, Jens Juul Holst, Ole Schmitz, Bent Roni Ranghøj Nielsen, Jens Erik Nielsen-Kudsk, Søren Steen Nielsen, Torsten Toftegaard Nielsen, Hans Eiskjaer, Hans Erik Bøtker, Henrik Wiggers

Endocrinology and Metabolism

133 Citations (Scopus)

Abstract

The incretin hormone glucagon-like peptide-1 (GLP-1) and its analogs are currently emerging as antidiabetic medications. GLP-1 improves left ventricular ejection fraction (LVEF) in dogs with heart failure (HF) and in patients with acute myocardial infarction. We studied metabolic and cardiovascular effects of 48-h GLP-1 infusions in patients with congestive HF. In a randomized, double-blind crossover design, 20 patients without diabetes and with HF with ischemic heart disease, EF of 30 ± 2%, New York Heart Association II and III (n = 14 and 6) received 48-h GLP-1 (0.7 pmol•kg^-1 •min^-1) and placebo infusion. At 0 and 48 h, LVEF, diastolic function, tissue Doppler regional myocardial function, exercise testing, noninvasive cardiac output, and brain natriuretic peptide (BNP) were measured. Blood pressure, heart rate, and metabolic parameters were recorded. Fifteen patients completed the protocol. GLP-1 increased insulin (90 ± 17 pmol/l vs. 69 ± 12 pmol/l; P = 0.025) and lowered glucose levels (5.2 ± 0.1 mmol/l vs. 5.6 ± 0.1 mmol/l; P < 0.01). Heart rate (67 ± 2 beats/min vs. 65 ± 2 beats/min; P = 0.016) and diastolic blood pressure (71 ± 2 mmHg vs. 68 ± 2 mmHg; P = 0.008) increased during GLP-1 treatment. Cardiac index (1.5 ± 0.1 l •min^-1•m ^-2 vs. 1.7 ± 0.2 l •min^-1•m^-2; P = 0.54) and LVEF (30 ± 2% vs. 30 ± 2%; P = 0.93), tissue Doppler indexes, body weight, and BNP remained unchanged. Hypoglycemic events related to GLP-1 treatment were observed in eight patients. GLP-1 infusion increased circulating insulin levels and reduced plasma glucose concentration but had no major cardiovascular effects in patients without diabetes but with compensated HF. The impact of minor increases in heart rate and diastolic blood pressure during GLP-1 infusion requires further studies. Hypoglycemia was frequent and calls for caution in patients without diabetes but with HF.

Original language	English
Journal	American Journal of Physiology: Heart and Circulatory Physiology
Volume	298
Issue number	3
Pages (from-to)	H1096-H1102
ISSN	0363-6135
DOIs	https://doi.org/10.1152/ajpheart.00930.2009
Publication status	Published - 1 Mar 2010

Keywords

Adult
Aged
Blood Glucose
Blood Pressure
Cardiac Output
Chronic Disease
Cross-Over Studies
Dose-Response Relationship, Drug
Double-Blind Method
Exercise Tolerance
Female
Glucagon-Like Peptide 1
Heart Failure
Heart Rate
Humans
Hypoglycemic Agents
Infusions, Intravenous
Insulin
Male
Middle Aged
Treatment Outcome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1152/ajpheart.00930.2009

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Halbirk, M., Nørrelund, H., Møller, N., Holst, J. J., Schmitz, O., Nielsen, B. R. R., Nielsen-Kudsk, J. E., Nielsen, S. S., Nielsen, T. T., Eiskjaer, H., Bøtker, H. E., & Wiggers, H. (2010). Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure. American Journal of Physiology: Heart and Circulatory Physiology, 298(3), H1096-H1102. https://doi.org/10.1152/ajpheart.00930.2009

Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure. / Halbirk, Mads; Nørrelund, Helene; Møller, Niels et al.

In: American Journal of Physiology: Heart and Circulatory Physiology, Vol. 298, No. 3, 01.03.2010, p. H1096-H1102.

Research output: Contribution to journal › Journal article › Research › peer-review

Halbirk, M, Nørrelund, H, Møller, N, Holst, JJ, Schmitz, O, Nielsen, BRR, Nielsen-Kudsk, JE, Nielsen, SS, Nielsen, TT, Eiskjaer, H, Bøtker, HE & Wiggers, H 2010, 'Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure', American Journal of Physiology: Heart and Circulatory Physiology, vol. 298, no. 3, pp. H1096-H1102. https://doi.org/10.1152/ajpheart.00930.2009

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abstract = "The incretin hormone glucagon-like peptide-1 (GLP-1) and its analogs are currently emerging as antidiabetic medications. GLP-1 improves left ventricular ejection fraction (LVEF) in dogs with heart failure (HF) and in patients with acute myocardial infarction. We studied metabolic and cardiovascular effects of 48-h GLP-1 infusions in patients with congestive HF. In a randomized, double-blind crossover design, 20 patients without diabetes and with HF with ischemic heart disease, EF of 30 ± 2%, New York Heart Association II and III (n = 14 and 6) received 48-h GLP-1 (0.7 pmol•kg-1 •min-1) and placebo infusion. At 0 and 48 h, LVEF, diastolic function, tissue Doppler regional myocardial function, exercise testing, noninvasive cardiac output, and brain natriuretic peptide (BNP) were measured. Blood pressure, heart rate, and metabolic parameters were recorded. Fifteen patients completed the protocol. GLP-1 increased insulin (90 ± 17 pmol/l vs. 69 ± 12 pmol/l; P = 0.025) and lowered glucose levels (5.2 ± 0.1 mmol/l vs. 5.6 ± 0.1 mmol/l; P < 0.01). Heart rate (67 ± 2 beats/min vs. 65 ± 2 beats/min; P = 0.016) and diastolic blood pressure (71 ± 2 mmHg vs. 68 ± 2 mmHg; P = 0.008) increased during GLP-1 treatment. Cardiac index (1.5 ± 0.1 l •min-1•m -2 vs. 1.7 ± 0.2 l •min-1•m-2; P = 0.54) and LVEF (30 ± 2% vs. 30 ± 2%; P = 0.93), tissue Doppler indexes, body weight, and BNP remained unchanged. Hypoglycemic events related to GLP-1 treatment were observed in eight patients. GLP-1 infusion increased circulating insulin levels and reduced plasma glucose concentration but had no major cardiovascular effects in patients without diabetes but with compensated HF. The impact of minor increases in heart rate and diastolic blood pressure during GLP-1 infusion requires further studies. Hypoglycemia was frequent and calls for caution in patients without diabetes but with HF.",

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T1 - Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure

AU - Halbirk, Mads

AU - Nørrelund, Helene

AU - Møller, Niels

AU - Holst, Jens Juul

AU - Schmitz, Ole

AU - Nielsen, Bent Roni Ranghøj

AU - Nielsen-Kudsk, Jens Erik

AU - Nielsen, Søren Steen

AU - Nielsen, Torsten Toftegaard

AU - Eiskjaer, Hans

AU - Bøtker, Hans Erik

AU - Wiggers, Henrik

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N2 - The incretin hormone glucagon-like peptide-1 (GLP-1) and its analogs are currently emerging as antidiabetic medications. GLP-1 improves left ventricular ejection fraction (LVEF) in dogs with heart failure (HF) and in patients with acute myocardial infarction. We studied metabolic and cardiovascular effects of 48-h GLP-1 infusions in patients with congestive HF. In a randomized, double-blind crossover design, 20 patients without diabetes and with HF with ischemic heart disease, EF of 30 ± 2%, New York Heart Association II and III (n = 14 and 6) received 48-h GLP-1 (0.7 pmol•kg-1 •min-1) and placebo infusion. At 0 and 48 h, LVEF, diastolic function, tissue Doppler regional myocardial function, exercise testing, noninvasive cardiac output, and brain natriuretic peptide (BNP) were measured. Blood pressure, heart rate, and metabolic parameters were recorded. Fifteen patients completed the protocol. GLP-1 increased insulin (90 ± 17 pmol/l vs. 69 ± 12 pmol/l; P = 0.025) and lowered glucose levels (5.2 ± 0.1 mmol/l vs. 5.6 ± 0.1 mmol/l; P < 0.01). Heart rate (67 ± 2 beats/min vs. 65 ± 2 beats/min; P = 0.016) and diastolic blood pressure (71 ± 2 mmHg vs. 68 ± 2 mmHg; P = 0.008) increased during GLP-1 treatment. Cardiac index (1.5 ± 0.1 l •min-1•m -2 vs. 1.7 ± 0.2 l •min-1•m-2; P = 0.54) and LVEF (30 ± 2% vs. 30 ± 2%; P = 0.93), tissue Doppler indexes, body weight, and BNP remained unchanged. Hypoglycemic events related to GLP-1 treatment were observed in eight patients. GLP-1 infusion increased circulating insulin levels and reduced plasma glucose concentration but had no major cardiovascular effects in patients without diabetes but with compensated HF. The impact of minor increases in heart rate and diastolic blood pressure during GLP-1 infusion requires further studies. Hypoglycemia was frequent and calls for caution in patients without diabetes but with HF.

AB - The incretin hormone glucagon-like peptide-1 (GLP-1) and its analogs are currently emerging as antidiabetic medications. GLP-1 improves left ventricular ejection fraction (LVEF) in dogs with heart failure (HF) and in patients with acute myocardial infarction. We studied metabolic and cardiovascular effects of 48-h GLP-1 infusions in patients with congestive HF. In a randomized, double-blind crossover design, 20 patients without diabetes and with HF with ischemic heart disease, EF of 30 ± 2%, New York Heart Association II and III (n = 14 and 6) received 48-h GLP-1 (0.7 pmol•kg-1 •min-1) and placebo infusion. At 0 and 48 h, LVEF, diastolic function, tissue Doppler regional myocardial function, exercise testing, noninvasive cardiac output, and brain natriuretic peptide (BNP) were measured. Blood pressure, heart rate, and metabolic parameters were recorded. Fifteen patients completed the protocol. GLP-1 increased insulin (90 ± 17 pmol/l vs. 69 ± 12 pmol/l; P = 0.025) and lowered glucose levels (5.2 ± 0.1 mmol/l vs. 5.6 ± 0.1 mmol/l; P < 0.01). Heart rate (67 ± 2 beats/min vs. 65 ± 2 beats/min; P = 0.016) and diastolic blood pressure (71 ± 2 mmHg vs. 68 ± 2 mmHg; P = 0.008) increased during GLP-1 treatment. Cardiac index (1.5 ± 0.1 l •min-1•m -2 vs. 1.7 ± 0.2 l •min-1•m-2; P = 0.54) and LVEF (30 ± 2% vs. 30 ± 2%; P = 0.93), tissue Doppler indexes, body weight, and BNP remained unchanged. Hypoglycemic events related to GLP-1 treatment were observed in eight patients. GLP-1 infusion increased circulating insulin levels and reduced plasma glucose concentration but had no major cardiovascular effects in patients without diabetes but with compensated HF. The impact of minor increases in heart rate and diastolic blood pressure during GLP-1 infusion requires further studies. Hypoglycemia was frequent and calls for caution in patients without diabetes but with HF.

KW - Adult

KW - Aged

KW - Blood Glucose

KW - Blood Pressure

KW - Cardiac Output

KW - Chronic Disease

KW - Cross-Over Studies

KW - Dose-Response Relationship, Drug

KW - Double-Blind Method

KW - Exercise Tolerance

KW - Female

KW - Glucagon-Like Peptide 1

KW - Heart Failure

KW - Heart Rate

KW - Humans

KW - Hypoglycemic Agents

KW - Infusions, Intravenous

KW - Insulin

KW - Male

KW - Middle Aged

KW - Treatment Outcome

U2 - 10.1152/ajpheart.00930.2009

DO - 10.1152/ajpheart.00930.2009

M3 - Journal article

C2 - 20081109

SN - 0363-6135

VL - 298

SP - H1096-H1102

JO - American Journal of Physiology - Heart and Circulatory Physiology

JF - American Journal of Physiology - Heart and Circulatory Physiology

IS - 3

ER -

Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure

Abstract

Keywords

UN SDGs

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