Insulin resistance in heart failure with preserved ejection fraction:Mechanisms and advances in metabolic-targeted therapies
YANG Niao
MEI Chao-sheng
MIN Xuan
QIN Cui-min
Abstract：Heart failure with preserved ejection fraction(HFpEF)is a highly heterogeneous cardiovascular condition closely associated with insulin resistance(IR)and metabolic dysregulation,with its prevalence rising due to global population aging and the increasing of related metabolic diseases.This review systematically examines the epidemiological evidence,pathophysiological mechanisms and therapeutic strategies linking IR and hyperinsulinemia to HFpEF.IR is not only a prevalent pathological feature in HFpEF but also drives disease progression through multiple mechanisms,including inflammation,endothelial dysfunction,energy metabolism disturbances and myocardial remodeling.In recent years,sodium-glucose cotransporter 2 inhibitors(SGLT2i)and glucagon-like peptide-1 receptor agonists(GLP-1 RA)have demonstrated significant efficacy in HFpEF treatment,verifyng the potential of metabolic-targeted therapies.Future efforts should focus on precision phenotyping,combination therapies and multidisciplinary comprehensive management to further optimize clinical outcomes and deliver personalized interventions for HFpEF patients.
Keywords：Heart failure with preserved ejection fractionInsulin resistanceMetabolic heart failureSodium-glucose cotransporter 2 inhibitorsGlucagon-like peptide-1 receptor agonists
Publication Date：2025-09-20
Online Publishing Date：2025-09-30(First online date of this platform, not the publication date of the document)
Pages：6( 843-848 )