Abstract 331: Insulin Resistance Is Independently Associated with Sudden Cardiac Death in the Community
Background: Insulin resistance(IR) increases atherogenesis and atherosclerotic plaque instability, but apotential association with sudden cardiac death(SCD) has not been evaluated. We assessed the relationship of triglyceride(TG)/HDL-c ratio, a simple measure of IR, with out-of-hospital SCD.
Methods: From an ongoing large community-based study in the Northwest US, SCD cases(n=529)were compared to 3174 age and gender matched-controls without history of ventricular arrhythmias from a coronary angiography database in the Western US. Medical-diagnoses, procedures, risk-factors and laboratory tests of all-individuals were obtained through medical chart-review prior and unrelated to SCD. Logistic-regression was employed to assess the relation of IR with SCD. IR was defined as TG/HDL-c ratio≥3.8. Left ventricular systolic dysfunction(LVSD) was defined as EF≤35%.
Results: The mean TG/HDL-c ratio was significantly higher in SCD compared to controls (4.24±3.76 vs. 2.71±2.69, p=0.0001). Similarly, IR was more prevalent in SCD vs. controls (39.9% vs. 19.7%, p=0.0001). After adjustment for other clinical conditions and risk factors, the relative risk of SCD conferred by IR was 1.93(95%CI 1.4-2.6) and 1.77(95%CI 1.2-2.6) in subjects with and without diabetes mellitus, respectively (p=0.001). The population risk of SCD attributable to IR was 23%. The risk of SCD increased substantially with the combination of IR with obesity, peripheral vascular disease (PVD) and LVSD (p=0.001). The area under the ROC-curve for prediction of SCD was 0.75 for PVD, 0.76 for IR, 0.80 for LVSD and 0.86 for the combination.
Conclusions: In this population, IR was an independent predictor of SCD. Furthermore, the combination of IR with PVD and LVSD substantially increased the cumulative risk of SCD.
- © 2012 by American Heart Association, Inc.