TY - JOUR T1 - Insulin resistance and risk of incident heart failure: Cardiovascular Health Study. JF - Circ Heart Fail Y1 - 2013 A1 - Banerjee, Dipanjan A1 - Biggs, Mary L A1 - Mercer, Laina A1 - Mukamal, Kenneth A1 - Kaplan, Robert A1 - Barzilay, Joshua A1 - Kuller, Lewis A1 - Kizer, Jorge R A1 - Djoussé, Luc A1 - Tracy, Russell A1 - Zieman, Susan A1 - Lloyd-Jones, Donald A1 - Siscovick, David A1 - Carnethon, Mercedes KW - Aged KW - Female KW - Heart Atria KW - Heart Failure KW - Heart Ventricles KW - Humans KW - Incidence KW - Insulin KW - Insulin Resistance KW - Male KW - Middle Aged KW - Myocardial Infarction KW - Organ Size KW - Proportional Hazards Models KW - Prospective Studies AB -

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.

VL - 6 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23575256?dopt=Abstract ER -