Abstract 14393: Insulin Resistance and Risk of Incident Heart Failure: Cardiovascular Health Study
Background Patients with heart failure (HF) have higher fasting insulin levels and a higher prevalence of insulin resistance (IR) when compared to matched controls. IR leads to structural abnormalities in the heart, such as increased left atrial (LA) size, left ventricular (LV) mass, and alterations in transmitral velocity, that can precede the diagnosis of HF. It is not known whether IR precedes the development of HF or whether the relationship between IR and HF is similar among adults with HF due to ischemic vs. non-ischemic heart disease.
Methods We examined 4794 participants (59% female) from the Cardiovascular Health Study after excluding those with a HF diagnosis or treated diabetes at baseline. We used Cox proportional hazards models to estimate the relative risk of incident HF associated with fasting insulin measured at study entry.
Results There were 1393 cases of incident HF (529 with and 864 without antecedent MI) during a median follow-up of 12 years (maximum, 19 years). Fasting insulin levels were positively associated with the risk of incident HF (HR 1.09, 95% CI 1.04, 1.14, per1-SD increase in fasting insulin) when adjusted for age, gender, race, lipids, physical activity, smoking, alcohol intake, blood pressure and waist circumference. The association between fasting insulin levels and incident HF was similar for HF with (HR= 1.07, 95% CI 0.96, 1.17) and without antecedent MI (HR= 1.08, 95% CI 1.03, 1.14). Fasting insulin was positively associated with LA size, LV mass, and peak A velocity at baseline in both patients with and without antecedent MI ; however, additional statistical adjustment for these parameters only modestly attenuated the insulin-HF estimate (HR= 1.07, 95% CI 1.02, 1.13 per1-SD increase in fasting insulin).
Conclusion Fasting insulin was positively associated with adverse echocardiographic features and the risk of subsequent HF, and this association did not differ among those with and without an antecedent MI.
- © 2011 by American Heart Association, Inc.