Abstract: The present invention relates to a insulin or insulin analogue for use in increasing cardiac efficiency or cardiac stroke volume in a patient at risk of developing or suffering from diabetes, as well as for use in preventing and/or treating cardiovascular diseases in patients at risk of developing or suffering from diabetes, to methods of preventing delaying, and/or treating cardiovascular diseases in patients at risk of developing or suffering from diabetes, to pharmaceutical compositions for use in increasing cardiac efficiency or cardiac stroke volume or for use in preventing and/or treating cardiovascular diseases comprising an insulin analogue, and to methods of identifying a patient who may benefit from treatment with an insulin analogue.