title: Several factors associated with the insulin resistance syndrome are predictors of left ventricular systolic dysfunction in a male population after 20 years of follow-up.
abstract: BACKGROUND
  The epidemiologic data on heart failure are scarce. This study aimed at identifying predictors of left ventricular systolic dysfunction in a cohort of middle-aged men with a 20-year follow-up.
  
  
  METHODS
  A population-based cohort of 431 50-year-old men was examined with blood pressure and anthropometric measurements together with lipid, glucose, and insulin determinations. A reinvestigation 20 years later also included echocardiography, ambulatory blood pressure monitoring, hyperinsulinemic euglycemic clamp, and oral glucose tolerance test. Sixteen subjects were found to have left ventricular systolic dysfunction at age 70 years, defined as an ejection fraction </=0.40. A control group of 48 subjects matched on myocardial infarction, hypertension, diabetes, and use of cardiovascular medication, but with an ejection fraction >0.40, was used in a nested case-control analysis.
  
  
  RESULTS
  At age 50 years, heart rate (P <.01), plasma proinsulin (P <.05), and the proportion of dihomogammalinolenic acid in serum cholesterol esters (P <.05) were increased and serum phosphate decreased (P <.01) in the subjects identified with left ventricular systolic dysfunction at age 70 years compared with controls. No major metabolic abnormalities were associated with left ventricular systolic dysfunction at age 70 years compared with controls.
  
  
  CONCLUSIONS
  Factors associated with insulin resistance precede left ventricular systolic dysfunction independently of ischemic heart disease and hypertension after 20 years of follow-up.
authors.affiliation: Departments of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. Johan.Arnlov@pubcare.uu.se
authors.forename: J
authors.initials: J
authors.lastname: Arnlöv
authors.forename: L
authors.initials: L
authors.lastname: Lind
authors.forename: B
authors.initials: B
authors.lastname: Zethelius
authors.forename: B
authors.initials: B
authors.lastname: Andrén
authors.forename: C N
authors.initials: CN
authors.lastname: Hales
authors.forename: B
authors.initials: B
authors.lastname: Vessby
authors.forename: H
authors.initials: H
authors.lastname: Lithell
mesh_terms: D000367:Age Factors; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D015331:Cohort Studies; D004452:Echocardiography; D005500:Follow-Up Studies; D005947:Glucose / Q000378:metabolism; D006339:Heart Rate; D006801:Humans; D007333:Insulin Resistance / Q000235:genetics; D008297:Male; D024821:Metabolic Syndrome / Q000235:genetics*; D008875:Middle Aged; D011384:Proinsulin / Q000097:blood; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D011384:Proinsulin; D005947:Glucose