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Insulin resistance and risk of incident heart failure: Cardiovascular Health Study
Dipanjan Banerjee1, Mary L Biggs, Laina Mercer
1Stanford University School of Medicine, Stanford, CA 94305, USA. dipanjan@stanford.edu
Insights
High fasting insulin levels are linked to an increased risk of developing heart failure (HF). This association holds true even for individuals without prior heart attacks, suggesting insulin resistance may precede HF development.
Area of Science:
- Cardiovascular Medicine
- Metabolic Syndrome Research
Background:
- Patients with heart failure (HF) exhibit higher fasting insulin levels and insulin resistance compared to controls.
- Insulin resistance is associated with cardiac structural abnormalities like increased left atrial size and left ventricular mass.
- The role of insulin resistance in the development of HF, particularly in nonischemic heart disease, remains unclear.
Purpose of the Study:
- To investigate whether insulin resistance precedes the development of heart failure (HF).
- To examine the association between fasting insulin levels and incident HF in adults without prior myocardial infarction or treated diabetes.
Main Methods:
- Analysis of 4425 participants from the Cardiovascular Health Study, excluding those with baseline HF, myocardial infarction, or treated diabetes.
- Utilized Cox proportional hazards models to assess the risk of incident HF based on baseline fasting insulin levels.
- Adjusted for multiple cardiovascular risk factors, including age, sex, race, physical activity, lipid profile, blood pressure, and waist circumference.
Main Results:
- A positive association was observed between higher fasting insulin levels and an increased risk of incident HF (HR, 1.10 per SD change).
- This association remained significant for HF cases without antecedent myocardial infarction.
- Cardiac structural parameters (left atrial size, left ventricular mass) were linked to both insulin levels and HF risk, but did not fully explain the insulin-HF association.
Conclusions:
- Elevated fasting insulin levels are independently associated with an increased risk of developing heart failure.
- The findings suggest that insulin resistance may be a precursor to HF development, even in the absence of prior ischemic events.
- Insulin resistance is linked to adverse echocardiographic features that predict future HF risk.
Background:
Patients with heart failure (HF) have higher fasting insulin levels and a higher prevalence of insulin resistance as compared with matched controls. Insulin resistance leads to structural abnormalities in the heart, such as increased left atrial size, left ventricular mass, and alterations in transmitral velocity that can precede the diagnosis of HF. It is not known whether insulin resistance precedes the development of HF or whether the relationship between insulin resistance and HF is present among adults with HF caused by nonischemic heart disease.
Methods And Results:
We examined 4425 participants (60% women) from the Cardiovascular Health Study after excluding those with HF, myocardial infarction, or treated diabetes mellitus at baseline. We used Cox proportional hazards models to estimate the relative risk of incident HF associated with fasting insulin measured at study entry. There were 1216 cases of incident HF (1103 without antecedent myocardial infarction) during a median follow-up of 12 years (maximum, 19 years). Fasting insulin levels were positively associated with the risk of incident HF (hazard ratio, 1.10; 95% confidence interval, 1.05-1.15, per SD change) when adjusted for age, sex, race, field center, physical activity, smoking, alcohol intake, high-density lipoprotein-cholesterol, total cholesterol, systolic blood pressure, and waist circumference. The association between fasting insulin levels and incident HF was similar for HF without antecedent myocardial infarction (hazard ratio, 1.10; 95% confidence interval, 1.05-1.15). Measures of left atrial size, left ventricular mass, and peak A velocity at baseline were associated both with fasting insulin levels and with HF; however, additional statistical adjustment for these parameters did not completely attenuate the insulin-HF estimate (hazard ratio, 1.08; 95% confidence interval, 1.03-1.14 per 1-SD increase in fasting insulin).
Conclusions:
Fasting insulin was positively associated with adverse echocardiographic features and risk of subsequent HF in Cardiovascular Health Study participants, including those without an antecedent myocardial infarction.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.
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