Insulin Resistance and Risk of Incident Heart Failure: Cardiovascular Health Study
Open accessAbstract
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. Clinical Trial Registration—: URL:http://www.clinicaltrials.gov. Unique identifier: NCT00005133.
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Even in subjects without heart failure, myocardial infarction, and diabetes mellitus, fasting plasma insulin level was positively associated with adverse echocardiographic features, which predispose them to a risk of heart failure.
“Even in subjects without heart failure, myocardial infarction, and diabetes mellitus, fasting plasma insulin level was positively associated with adverse echocardiographic features, which predispose them to a risk of heart failure [126].”
From Sarcopenic obesity, insulin resistance, and their implications in cardiovascular and metabolic consequences (2020) · cites this paper as [126]
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- Authors
- Banerjee, D., Biggs, M. L., Mercer, L., Mukamal, K., Kaplan, R., Barzilay, J., Kuller, L., Kizer, J. R., Djousse, L., Tracy, R., Zieman, S., Lloyd-Jones, D., Siscovick, D., & Carnethon, M.
- Affiliations
- Brigham and Women's Hospital (US)
- From the Stanford University School of Medicine, Stanford, CA (D.B.); University of Washington, Seattle, WA (M.L.B., L.M., D.S.); Beth Israel Deaconess Medical Center, Boston, MA (K.M.); Albert Einstein College of Medicine, Bronx, NY (R.K.); Kaiser Permanente of Georgia, Tucker, GA (J.B.); University of Pittsburgh, Pittsburgh, PA (L.K.); Weill Cornell Medical College, New York, NY (J.R.K.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (L.D.); University of Vermont, Burlington, VT...
- University of Vermont (US)
- ORCID
- Venue
- Circulation: Heart Failure
- Published
- 2013-05
- Volume
- 6
- Issue
- 3
- Pages
- 364-370
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- PMC
- PMC3888807
- OpenAlex
- W2096189508
- Cited by
- 105
- References
- 34
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 19 · 2023: 9 · 2022: 17 · 2021: 11 · 2020: 4 · 2019: 7 · 2018: 3 · 2017: 5 · 2016: 3 · 2015: 7 · 2014: 7 · 2013: 2
- FWCI
- 4.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc085082-026, n01hc085081-021, n01hc045133-001, n01hc085079-024, n01hc015103-009, n01hc085084-005, n01hc085085-011, n01hc085083-027, n01hc085080-026, n01hc085086-022, 5r01ag031890-04, n01hc55222-0-0-0, n01hc075150-004, n01hc035129-010)
- National Institute on Aging (R01-AG-031890, AG 20098, R56AG023629, 1R01AG031890, R01AG020098, AG023629, AG027058, R56AG020098, R01AG023629, R01AG015928, R01AG027058)
- National Heart, Lung, and Blood Institute (N01-HC-85081, N01HC85085, N01 HC085086, N01HC-85083, N0-1-HC-85239, N01 HC085079, R01HL094555, N01 HC085083, N01HC85082, N01HC‐75150, N01 HC85086, N01 HC085080, HHSN 268200800007C, N01 HC035129, N01HC85080, N01 HC015103, N01 HC55222, HHSN268201200036C, N01HC085082, U01HL080295, N01 HC055222, N01 HC085081, HL080295, R01HL080295, N01 HC075150, N01 HC045133, N01-HC85079, N01-HC85084)
- 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 › Heart Failure Treatment and Management
- Keywords
- insulin resistance, fasting insulin, heart failure, incident heart failure, non-ischemic heart disease, left atrial size, left ventricular mass, echocardiographic abnormalities, Cardiovascular Health Study, cardiovascular risk factors
- MeSH terms
- Aged, Female, Heart Atria, Heart Failure, Heart Ventricles, Humans, Insulin, Insulin Resistance, Male, Middle Aged, Myocardial Infarction, Organ Size, Prospective Studies, Incidence, Proportional Hazards Models
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