title: Novel metabolic risk factors for heart failure.
abstract: OBJECTIVE
  Our objectives were to explore novel metabolic risk factors for development of heart failure (HF).
  
  
  BACKGROUND
  In the past decade, considerable knowledge has been gained from limited samples regarding novel risk factors for HF, but the importance of these in the general population is largely unexplored.
  
  
  METHODS
  In a community-based prospective study of 2,321 middle-aged men free from HF and valvular disease at baseline, variables reflecting glucose and lipid metabolism and variables involved in oxidative processes were compared with established risk factors for HF (prior myocardial infarction, hypertension, diabetes, electrocardiographic left ventricular hypertrophy, smoking, obesity, and serum cholesterol) using Cox proportional hazards analyses.
  
  
  RESULTS
  During a median follow-up time of 29 years, 259 subjects developed HF. In a multivariable Cox proportional hazards backward stepwise model, a 1-SD increase of fasting proinsulin (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.15 to 1.66) and apolipoprotein B/A-I-ratio (HR 1.27, 95% CI 1.09 to 1.48) increased the risk, whereas a 1-SD increase in serum beta-carotene (HR 0.79, 95% CI 0.66 to 0.94) decreased the risk of HF. These variables also remained significant when adjusting for acute myocardial infarction during follow-up.
  
  
  CONCLUSIONS
  Novel variables reflecting insulin resistance and dyslipidemia, together with a low beta-carotene level, were found to predict HF independently of established risk factors. If confirmed, our observations could have large clinical implications, as they may offer new approaches in the prevention of HF.
authors.affiliation: Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden. erik.ingelsson@pubcare.uu.se
authors.forename: Erik
authors.initials: E
authors.lastname: Ingelsson
authors.forename: Johan
authors.initials: J
authors.lastname: Arnlöv
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
authors.forename: Björn
authors.initials: B
authors.lastname: Zethelius
authors.forename: Bengt
authors.initials: B
authors.lastname: Vessby
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
mesh_terms: D000975:Antioxidants / Q000502:physiology; D001053:Apolipoproteins / Q000097:blood; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology* / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D011379:Prognosis; D011384:Proinsulin / Q000097:blood; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D019207:beta Carotene / Q000097:blood
chemical_list: D000975:Antioxidants; D001053:Apolipoproteins; D019207:beta Carotene; D011384:Proinsulin