Cumulative metabolic score for insulin resistance and heart failure risk: A prospective study

The Metabolic Score for Insulin Resistance (METS-IR) is recognized as an indicator associated with the risk of Heart Failure (HF). However, evidence regarding its long-term impact is limited. This study aimed to evaluate the association between cumulative METS-IR (cumMETS-IR) and the risk of incident HF.

We performed a prospective cohort analysis involving 51,155 participants from the Kailuan Study who underwent three health examinations (2006-2010) and were followed for incident HF until December 31, 2022. CumMETS-IR was calculated and analyzed using Cox proportional hazards models. Over a median follow-up of 12 years, higher cumMETS-IR was strongly and progressively associated with an increased risk of HF. Participants in the highest quartile had a 59% higher risk than those in the lowest. The incidence density of HF per 1000 person-years increased progressively across quartiles: Q1: 0.90 (0.76-1.07), Q2: 1.61 (1.41-1.83), Q3: 2.38 (2.14-2.64), and Q4: 3.60 (3.30-3.93). Maintaining high exposure for 2, 4, and 6 years increased risk by 23%, 49%, and 57%, respectively. Notably, these associations were significantly stronger in males and in adults aged ≥60 years. Adding cumMETS-IR to a conventional risk model also improved the prediction of HF.

Higher levels of cumMETS-IR are associated with an increased risk of HF, particularly pronounced in males and older adults. Long-term monitoring of METS-IR may facilitate the early identification of high-risk individuals.