title: Greater body mass index is a better predictor of subclinical cardiac damage at long-term follow-up in men than is insulin sensitivity: a prospective, population-based cohort study.
abstract: BACKGROUND
  To examine whether lower insulin sensitivity as determined by homeostatic model assessment (HOMA-%S) was associated with increased left ventricular mass (LVM) and presence of LV diastolic dysfunction at long-term follow-up, independently of body mass index (BMI), in middle-aged, otherwise healthy males.
  
  
  METHODS
  Prospective population-based cohort study with a median (IQR) follow-up time of 28 (27-28) years, in which traditional cardiovascular risk factors, including HOMA-%S and BMI, were assessed at baseline, and echocardiographic determination of LVM and LV diastolic function was performed at follow-up. Associations between risk factors and echocardiographic variables were tested using multivariable linear and binary logistic regression.
  
  
  RESULTS
  The study population comprised 247 men with a median (IQR) age of 47 (47-48) years. Mean (SD) BMI was 25.1 +/- 3.0 kg/m(2), and median (IQR) HOMA-%S was 113.0 (68.3-284.6). Subjects with low insulin sensitivity (lowest HOMA-%S quartile (Q1)) had significantly greater BMI, fasting plasma insulin, and higher fasting blood glucose (FBG) (p <0.02 for all). BMI and HOMA-%S were significantly correlated (r = -0.383, p <0.0001). At follow-up, mean (SD) LVM and LVMI were 202 +/- 61 g and 103 +/- 31 g/m(2), respectively, whereas median (IQR) E/é was 10 (8-12). Moreover, 36 % had grade 2 or 3 diastolic dysfunction. In multivariable analyses, greater BMI, but not low insulin sensitivity was independently associated with later detection of increased LVM and diastolic dysfunction.
  
  
  CONCLUSIONS
  Greater baseline BMI, but not lower insulin sensitivity was independently associated with greater LVM and diastolic dysfunction at long-term follow-up.
authors.affiliation: Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark. mettelundgren@gmail.com.
authors.forename: Mette Lundgren
authors.initials: ML
authors.lastname: Nielsen
authors.affiliation: Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark. mananpareek@dadlnet.dk.
authors.forename: Manan
authors.initials: M
authors.lastname: Pareek
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Odense and Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark. oke.gerke@rsyd.dk.
authors.forename: Oke
authors.initials: O
authors.lastname: Gerke
authors.affiliation: Department of Cardiology, Skåne University Hospital, Malmö, Sweden. margret.leosdottir@med.lu.se.
authors.forename: Margrét
authors.initials: M
authors.lastname: Leósdóttir
authors.affiliation: Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden. peter.nilsson@med.lu.se.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.affiliation: Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark. mho@dadlnet.dk.|Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa. mho@dadlnet.dk.
authors.forename: Michael Hecht
authors.initials: MH
authors.lastname: Olsen
mesh_terms: D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003971:Diastole; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin