Related Experiment Video
Updated: May 7, 2026
Extracellular Glucose Depletion as an Indirect Measure of Glucose Uptake in Cells and Tissues Ex Vivo
Published on: April 6, 2022
Glucose Disposal Rate: A Novel Measure of Insulin Resistance Associated With Myocardial Fibrosis and Incident Heart
Syed Bukhari1, Yaa A Kwapong2, Lisa R Yanek3
1Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD USA.
Insights
Lower estimated glucose disposal rate (eGDR), a marker of insulin resistance, is linked to increased heart failure (HF) risk and subclinical myocardial damage. This highlights insulin resistance as a key factor in HF development and prevention.
Area of Science:
- Cardiology
- Metabolic Syndrome
- Cardiovascular Imaging
Background:
- Heart failure (HF) is increasingly prevalent, driven by cardiometabolic risk factors like obesity and insulin resistance.
- The estimated glucose disposal rate (eGDR) quantifies insulin resistance but its association with myocardial fibrosis and HF is not well understood.
Purpose of the Study:
- To investigate the association between baseline eGDR and incident heart failure (HF) in a large, multi-ethnic cohort.
- To explore the relationship between eGDR and subclinical myocardial damage, including fibrosis and ejection fraction.
Main Methods:
- Utilized data from 6025 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) without HF at baseline.
- Calculated eGDR using body mass index, hypertension, and hemoglobin A1c; assessed cardiac structure and fibrosis via MRI.
- Employed Cox models to evaluate associations between eGDR and incident HF, stratified by diabetes status.
Main Results:
- Over 14 years, lower eGDR was significantly associated with increased risk of incident HF (aHR 1.28 per unit decrease), irrespective of diabetes.
- The association was stronger for HF with preserved ejection fraction compared to HF with reduced ejection fraction.
- Lower eGDR correlated with higher left ventricular ejection fraction and increased odds of myocardial fibrosis.
Conclusions:
- Reduced eGDR is an independent predictor of subclinical myocardial damage and future HF development.
- Insulin resistance, as indicated by lower eGDR, plays a crucial role in adverse cardiac remodeling.
- eGDR may serve as a valuable marker for early HF risk stratification and prevention strategies.
Background:
Heart failure (HF) is increasingly driven by cardiometabolic risk factors such as obesity and insulin resistance. The estimated glucose disposal rate (eGDR) is a validated surrogate marker of insulin resistance. Reduced eGDR, reflecting higher insulin resistance, has been linked to cardiovascular disease, but its associations with myocardial fibrosis and HF remain unclear.
Methods:
The study included 6025 participants in MESA (Multi-Ethnic Study of Atherosclerosis) free of HF at exam 2 (2002-2004). eGDR was calculated using body mass index, hypertension, and hemoglobin A1c. Cardiac magnetic resonance imaging (2010-2012) assessed left ventricular ejection fraction and myocardial fibrosis by late gadolinium enhancement. Associations of baseline eGDR with incident HF were evaluated using Cox models, stratified by diabetes.
Results:
Over a mean follow-up of 14±5 years, 404 participants developed HF. eGDR was inversely associated with incident HF (adjusted hazard ratio [HR] per unit decrease, 1.28 [95% CI, 1.22-1.35]), a relationship that persisted regardless of diabetes status and was more pronounced for HF with preserved ejection fraction (n=200; adjusted HR per unit decrease, 1.36 [95% CI, 1.27-1.45]) than HF with reduced ejection fraction (n=168; HR, 1.19 [95% CI, 1.11-1.27]). Lower eGDR was also associated with higher left ventricular ejection fraction (n=2899; β=0.16, [95% CI, 0.03-0.28]) and higher odds of myocardial fibrosis (n=1780; adjusted odds ratio, 1.27 [95% CI, 1.16-1.41]).
Conclusions:
Lower eGDR is independently associated with subclinical myocardial damage and incident HF, highlighting insulin resistance as a key driver of adverse remodeling and a potential marker for early HF risk stratification and prevention.
More Related Videos
Related Concept Videos
01:25Drug Dosing in Renal Diseases: Measurement of Glomerular Filtration Rate
01:29Hyperglycemia