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Prognostic Implications of Insulin Resistance in Heart Failure in Japan
Keiichiro Iwasaki1, Kazufumi Nakamura1,2, Satoshi Akagi1
1Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan.
Insights
Insulin resistance (IR), a key part of diabetes, independently predicts worse outcomes in heart failure (HF) patients. This finding highlights IR as a crucial prognostic factor for heart failure across diverse populations.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Diseases
Background:
- Diabetes Mellitus (DM) is a significant risk and prognostic factor for Heart Failure (HF).
- Insulin Resistance (IR), a core component of DM, has an unclear prognostic role in broad HF populations.
Purpose of the Study:
- To investigate the association between Insulin Resistance (IR) and clinical outcomes in a diverse Heart Failure (HF) patient cohort.
- To determine if the Homeostatic Model Assessment of IR (HOMA-IR) is an independent prognostic factor for HF patients.
Main Methods:
- Retrospective analysis of 682 Heart Failure (HF) patients treated between 2017 and 2021.
- Insulin Resistance (IR) defined as HOMA-IR index ≥ 2.5, calculated from fasting glucose and insulin.
- Primary outcome: composite of all-cause death and Heart Failure Hospitalization (HHF); median follow-up: 16.5 months.
Main Results:
- 49.4% of patients exhibited Insulin Resistance (IR).
- IR was independently associated with the primary composite outcome (HR: 1.91), all-cause death (HR: 1.86), and Heart Failure Hospitalization (HHF) (HR: 1.91).
- P-values for all associations were < 0.01, indicating statistical significance.
Conclusions:
- The Homeostatic Model Assessment of IR (HOMA-IR) is an independent predictor of adverse outcomes in a wide spectrum of Heart Failure (HF) patients.
- Identifying and managing Insulin Resistance (IR) may be crucial for improving prognosis in Heart Failure (HF) management.
Abstract:
Diabetes mellitus (DM) is a major risk and prognostic factor for heart failure (HF). Insulin resistance (IR) is an important component of DM, but the relationship between IR and HF prognosis has not yet been established across a wide variety of HF populations. We retrospectively evaluated the relationship between IR and clinical outcomes of HF patients at our hospital between 2017 and 2021. IR was defined as a homeostatic model assessment of IR (HOMA-IR) index ≥ 2.5, calculated from fasting blood glucose and insulin concentrations. The primary outcome was a composite of all-cause death and hospitalisation for HF (HHF). Among 682 patients included in the analyses, 337 (49.4%) had IR. The median age was 70 [interquartile range (IQR): 59-77] years old, and 66% of the patients were men. Among the patients, 41% had a left ventricular ejection fraction below 40%, and 32% had DM. The median follow-up period was 16.5 [IQR: 4.4-37.3] months. IR was independently associated with the primary outcome (HR: 1.91, 95% CI: 1.39-2.62, p < 0.0001), death (hazard ratio [HR]: 1.86, 95% confidence interval [CI]: 1.28-2.83, p < 0.01), and HHF (HR: 1.91, 95% CI: 1.28-2.83, p < 0.01). HOMA-IR is an independent prognostic factor of HF in a wide variety of HF populations.
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