AUTHOR=Cloro Cosima , Zaffina Isabella , Sacchetta Luca , Arturi Federico , Clausi Cristina , Lucà Stefania , Pelle Maria Chiara , Giofrè Federica , Armentaro Giuseppe , Forte Valentina , De Rosa Francesco Mario , Sciacqua Angela , Arturi Franco 

TITLE=Effects of sacubitril/valsartan on both metabolic parameters and insulin resistance in prediabetic non-obese patients with heart failure and reduced ejection fraction

JOURNAL=Frontiers in Endocrinology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.940654

DOI=10.3389/fendo.2022.940654

ISSN=1664-2392

ABSTRACT=<sec><title>Background</title><p>The effects of sacubitril/valsartan (sac/val) on metabolic parameters and insulin resistance (IR) in non-obese/prediabetic patients have not been previously described.</p></sec><sec><title>Aim</title><p>To evaluate the effects of sac/val on glycemic and metabolic parameters, Homeostatic Model Assessment of IR (HOMA-IR), and echocardiographic parameters in prediabetic patients with heart failure with reduced ejection fraction (HFrEF).</p></sec><sec><title>Methods</title><p>Fifty-nine patients with HFrEF (EF &lt; 35%) but without obesity and/or type 2 diabetes mellitus have been enrolled. All the patients at baseline and week 24 underwent complete anthropometrical evaluation and were subjected to an echocardiogram test. IR has been assessed by HOMA-IR.</p></sec><sec><title>Results</title><p>After 24-week of treatment with sac/val, a significant reduction in fasting plasma glucose (109 ± 9 <italic>vs</italic> 103 ± 8 mg/dl, p &lt; 0.0001), fasting plasma insulin (16 ± 4 <italic>vs</italic> 10 ± 4 UI/L), and hemoglobin A1c (HbA1c) value (6% ± 0.5% <italic>vs</italic> 5.3% ± 0.3%, p &lt; 0.0001) was observed. Similarly, we observed a significant improvement in IR (HOMA-IR, 4.4 ± 0.9 <italic>vs</italic> 2.5 ± 0.6, p &lt; 0.0001). The echocardiogram evaluation showed a significant reduction of the left ventricular end-diastolic volume (168 ± 24 <italic>vs</italic> 158 ± 22 ml, p &lt; 0.05), a significant reduction of the left ventricular end-systolic volume (111 ± 26 <italic>vs</italic> 98 ± 22 ml, p &lt; 0.005), and a significant reduction of E/e′ ratio. Sac/val use was also associated with an average 5.1% increase in ejection fraction.</p></sec><sec><title>Conclusions</title><p>Our data seem to indicate that sal/val enhances metabolic control and improves insulin resistance also in prediabetic non-obese patients with HFrEF.</p></sec>