title: Insulin resistance and risk of incident heart failure: Cardiovascular Health Study.
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.
  
  
  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.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.
authors.affiliation: Stanford University School of Medicine, Stanford, CA 94305, USA. dipanjan@stanford.edu
authors.forename: Dipanjan
authors.initials: D
authors.lastname: Banerjee
authors.forename: Mary L
authors.initials: ML
authors.lastname: Biggs
authors.forename: Laina
authors.initials: L
authors.lastname: Mercer
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mukamal
authors.forename: Robert
authors.initials: R
authors.lastname: Kaplan
authors.forename: Joshua
authors.initials: J
authors.lastname: Barzilay
authors.forename: Lewis
authors.initials: L
authors.lastname: Kuller
authors.forename: Jorge R
authors.initials: JR
authors.lastname: Kizer
authors.forename: Luc
authors.initials: L
authors.lastname: Djousse
authors.forename: Russell
authors.initials: R
authors.lastname: Tracy
authors.forename: Susan
authors.initials: S
authors.lastname: Zieman
authors.forename: Donald
authors.initials: D
authors.lastname: Lloyd-Jones
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Mercedes
authors.initials: M
authors.lastname: Carnethon
mesh_terms: D000368:Aged; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009929:Organ Size; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D007328:Insulin
keywords: epidemiology; heart failure; insulin