Insulin resistance and risk of incident heart failure cardiovascular health study

Dipanjan Banerjee, Mary L. Biggs, Laina Mercer, Kenneth Mukamal, Robert C. Kaplan, Joshua Barzilay, Lewis Kuller, Jorge Kizer, Luc Djousse, Russell Tracy, Susan Zieman, Donald Lloyd-Jones, David Siscovick, Mercedes Carnethon

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)364-370
Number of pages7
JournalCirculation: Heart Failure
Volume6
Issue number3
DOIs
StatePublished - May 2013

Fingerprint

Insulin Resistance
Heart Failure
Health
Fasting
Insulin
Myocardial Infarction
Confidence Intervals
Blood Pressure
Congenital Heart Defects
Waist Circumference
Women's Health
Proportional Hazards Models
HDL Cholesterol
Heart Diseases
Diabetes Mellitus
Smoking
Cholesterol
Alcohols
Exercise

Keywords

  • Epidemiology
  • Heart failure
  • Insulin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Insulin resistance and risk of incident heart failure cardiovascular health study. / Banerjee, Dipanjan; Biggs, Mary L.; Mercer, Laina; Mukamal, Kenneth; Kaplan, Robert C.; Barzilay, Joshua; Kuller, Lewis; Kizer, Jorge; Djousse, Luc; Tracy, Russell; Zieman, Susan; Lloyd-Jones, Donald; Siscovick, David; Carnethon, Mercedes.

In: Circulation: Heart Failure, Vol. 6, No. 3, 05.2013, p. 364-370.

Research output: Contribution to journalArticle

Banerjee, D, Biggs, ML, Mercer, L, Mukamal, K, Kaplan, RC, Barzilay, J, Kuller, L, Kizer, J, Djousse, L, Tracy, R, Zieman, S, Lloyd-Jones, D, Siscovick, D & Carnethon, M 2013, 'Insulin resistance and risk of incident heart failure cardiovascular health study', Circulation: Heart Failure, vol. 6, no. 3, pp. 364-370. https://doi.org/10.1161/CIRCHEARTFAILURE.112.000022
Banerjee, Dipanjan ; Biggs, Mary L. ; Mercer, Laina ; Mukamal, Kenneth ; Kaplan, Robert C. ; Barzilay, Joshua ; Kuller, Lewis ; Kizer, Jorge ; Djousse, Luc ; Tracy, Russell ; Zieman, Susan ; Lloyd-Jones, Donald ; Siscovick, David ; Carnethon, Mercedes. / Insulin resistance and risk of incident heart failure cardiovascular health study. In: Circulation: Heart Failure. 2013 ; Vol. 6, No. 3. pp. 364-370.
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abstract = "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.",
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AU - Kaplan, Robert C.

AU - Barzilay, Joshua

AU - Kuller, Lewis

AU - Kizer, Jorge

AU - Djousse, Luc

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N2 - 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.

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.

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KW - Heart failure

KW - Insulin

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