Abstract 13279: The Association Between Insulin Resistance And Incident Heart Failure In The Aric Study

Abstract

Background: Diabetes mellitus (DM) increases the risk for heart failure (HF), but the association of insulin resistance (IR) and HF in population without DM is unclear. We assessed whether IR was a predictor of incident HF after adjustment for baseline covariates in non-diabetics.

Methods: We prospectively analyzed 12,606 participants from the Atherosclerosis Risk in Communities (ARIC) Study. Those with DM, prevalent HF, or a history of myocardial infarction were excluded. IR was assessed using the homeostatic model assessment of insulin resistance (HOMA-IR) equation. Associations between IR (defined as HOMA-IR > 2.5) and incident HF (defined by ICD-9 codes of hospitalization for HF or death) were assessed in Cox models adjusting for age, sex, race, obesity, smoking, hypertension, and study center. We also explored potential effect modifications by gender, obesity, and race.

Results: Participants with IR (n=4810, 39%) were older (mean age 54.6±5.8 vs 53.8±5.7, p<0.001), had higher BMI (30.5 vs. 25.3, p<0.001), more likely female (53 vs. 47%, p<0.001), more hypertensive (49 vs 23%, p<0.001), and more likely African American (33% vs. 19%, p < 0.001) as compared to those without IR. With 1455 incident HF cases during a median of 20.6 years of follow-up, IR was associated with an increased risk for incident HF in unadjusted (HR 1.68, 95% CI 1.51, 1.86) and adjusted models (HR 1.25, 95% CI 1.11, 1.40). Those with HOMA-IR > 4.0 exhibited the highest risk overall (figure) (adjusted HR 1.3, 95% CI 1.14, 1.53). Neither obesity nor gender modified the association between IR and HF risk; the association was attenuated in African Americans compared to Caucasians (Figure; p-interaction=0.004).

Conclusions: IR increased the risk for incident HF in non-diabetics even after adjustment for potentially related covariates; however, this association appears to be attenuated in African Americans. These results suggest that IR, not just frank DM, adversely affects cardiac risk in Caucasians.