Author + information
- Received July 12, 2013
- Revision received July 19, 2013
- Accepted July 25, 2013
- Published online December 1, 2013.
- Orly Vardeny, PharmD, MS∗∗ (, )
- Deepak K. Gupta, MD†,
- Brian Claggett, PhD†,
- Stuart Burke, PharmD∗,
- Amil Shah, MD†,
- Laura Loehr, MD, PhD‡,
- Laura Rasmussen-Torvik, PhD, MPH§,
- Elizabeth Selvin, PhD, MPH‖,
- Patricia P. Chang, MD¶,
- David Aguilar, MD# and
- Scott D. Solomon, MD†
- ∗Pharmacy Practice Division, University of Wisconsin School of Pharmacy, Madison, Wisconsin
- †Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
- ‡Department of Epidemiology, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina
- §Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- ‖Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- ¶Department of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- #Department of Medicine, Baylor College of Medicine, Houston, Texas
- ↵∗Reprint requests and correspondence:
Dr. Orly Vardeny, University of Wisconsin School of Pharmacy, 777 Highland Avenue, Madison, Wisconsin 53705-2222.
Objectives This study was designed to assess the relationship between insulin resistance and incident heart failure (HF) in a community-based cohort.
Background Diabetes mellitus increases the risk for HF, but the association between insulin resistance and HF in individuals without diabetes is unclear.
Methods We prospectively analyzed 12,606 participants without diabetes mellitus, prevalent HF, or history of myocardial infarction at baseline (1987 to 1989) from the ARIC (Atherosclerosis Risk in Communities) study. We assessed the relationship between insulin resistance and incident HF using the homeostatic model assessment of insulin resistance (HOMA-IR) equation, adjusting for age, sex, race, body mass index, smoking, hypertension, center, and interim myocardial infarction. We tested for interactions by age, sex, obesity, and race.
Results Participants with insulin resistance, defined as HOMA-IR ≥2.5 (n = 4,810, 39%), were older, more likely female, African American, hypertensive, and had a higher body mass index as compared with those without insulin resistance. There were 1,455 incident HF cases during a median of 20.6 years of follow-up. Insulin resistance defined by this threshold was not significantly associated with an increased risk for incident HF after adjustment (hazard ratio: 1.08, 95% confidence interval: 0.95 to 1.23). However, when analyzed continuously, this relationship was nonlinear, which indicated that risk increased, and was significantly associated with incident HF between HOMA-IR of 1.0 to 2.0, adjusting for baseline covariates; however, values over 2.5 were not associated with additional increased risk in adjusted models.
Conclusions In a community cohort, insulin resistance, defined by lower levels of HOMA-IR than previously considered, was associated with an increased risk for HF.
The ARIC study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 12, 2013.
- Revision received July 19, 2013.
- Accepted July 25, 2013.
- American College of Cardiology Foundation