Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function: Sex-Related Differences in the Framingham Heart Study
Abstract
Background— Although insulin resistance has been implicated in the pathogenesis of left ventricular (LV) hypertrophy, previous studies have yielded inconsistent results and are limited by referral bias. Methods and Results— We examined the relations between echocardiographic LV measurements and glucose tolerance status in 2623 Framingham Study subjects (1514 women, mean age 53 years) free of myocardial infarction and heart failure. We also evaluated the relations of insulin resistance (homeostasis model, HOMA-IR) and LV and left atrial (LA) measures within the normal and abnormal glucose tolerance categories (the latter included impaired glucose tolerance, impaired fasting glucose, and newly diagnosed diabetes). LV mass (adjusted for age, height, heart rate, and systolic blood pressure) increased across categories of worsening glucose tolerance; the trend was more striking in women ( P <0.001) compared with men ( P =0.054). In subjects with normal (n=2022) and abnormal glucose tolerance (n=327), covariate-adjusted LV mass and LV wall thickness increased across HOMA-IR quartiles in women ( P <0.001) but not men. In contrast, covariate-adjusted LA size increased with worsening glucose tolerance and across HOMA-IR quartiles in the normal and abnormal glucose tolerance groups in both sexes. Adjustment for body mass index considerably attenuated the relations of LV/LA measures and HOMA-IR, rendering them statistically nonsignificant in the normal glucose tolerance group. Conclusions— In our large community-based sample, LV mass and wall thickness increased with worsening glucose intolerance, an effect that was more striking in women compared with men. Insulin resistance was associated with increased LV mass in women alone, but this relation was largely accounted for by obesity.
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In other populations, such as the STRONG heart study and Framingham heart study, diabetes or metabolic syndrome appear to be significant risk factors for LV hypertrophy.
“In other populations, such as those in the STRONG heart study (native Americans of the western United States) and the Framingham heart study, diabetes or the metabolic syndrome do appear to be significant risk factors for LV hypertrophy (272, 306, 358).”
From Cardiac remodeling in obesity (2008) · cites this paper as [306]
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- Authors
- Rutter, M. K., Parise, H., Benjamin, E. J., Levy, D., Larson, M. G., Meigs, J. B., Nesto, R. W., Wilson, P. W. F., & Vasan, R. S.
- Affiliations
- Boston University (US)
- ORCID
- Venue
- Circulation
- Published
- 2003-01-28
- Volume
- 107
- Issue
- 3
- Pages
- 448-454
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1985402074
- Cited by
- 511
- References
- 27
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 10 · 2023: 16 · 2022: 19 · 2021: 22 · 2020: 16 · 2019: 21 · 2018: 20 · 2017: 24 · 2016: 15 · 2015: 25 · 2014: 24 · 2013: 20 · 2012: 19
- FWCI
- 19.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- GlaxoSmithKline
- National Institutes of Health (n01hc25195-41-0-1)
- National Heart, Lung, and Blood Institute (N01‐HC25195, 1K24HL04334, K24HL004334)
- National Institute of Neurological Disorders and Stroke (5-R01-NS-17950, R01NS017950)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Keywords
- insulin resistance, impaired glucose tolerance, left ventricular hypertrophy, left ventricular mass, left atrial size, HOMA-IR, impaired fasting glucose, diabetes mellitus, sex differences, obesity, body mass index, Framingham Heart Study
- MeSH terms
- Cross-Sectional Studies, Female, Glucose Tolerance Test, Heart Atria, Heart Ventricles, Humans, Insulin Resistance, Male, Middle Aged, Models, Cardiovascular, Sex Factors, Ultrasonography, Ventricular Function, Left, Hypertrophy, Left Ventricular
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