Stanford University School of Medicine, Stanford, CA 94305, USA.
Circ Heart Fail. 2013 May;6(3):364-70. doi: 10.1161/CIRCHEARTFAILURE.112.000022. Epub 2013 Apr 10.
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.
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).
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.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.
与匹配对照相比，心力衰竭（HF）患者空腹胰岛素水平更高，胰岛素抵抗的患病率更高。胰岛素抵抗会导致心脏结构异常，例如左心房增大、左心室质量增加以及经二尖瓣速度的改变，这些改变可能先于 HF 的诊断。尚不清楚胰岛素抵抗是否先于 HF 的发生，或者在非缺血性心脏病引起的 HF 成人中，胰岛素抵抗与 HF 之间是否存在关系。
我们在排除了基线时患有 HF、心肌梗死或接受治疗的糖尿病患者后，检查了心血管健康研究中的 4425 名参与者（60%为女性）。我们使用 Cox 比例风险模型来估计空腹胰岛素在研究入组时测量的与新发 HF 相关的相对风险。在中位数为 12 年（最长 19 年）的随访期间，有 1216 例新发 HF（1103 例无先前行心肌梗死）。空腹胰岛素水平与新发 HF 的风险呈正相关（危险比，1.10；95%置信区间，1.05-1.15，每标准差变化），调整年龄、性别、种族、研究中心、体力活动、吸烟、饮酒量、高密度脂蛋白胆固醇、总胆固醇、收缩压和腰围后。空腹胰岛素水平与新发 HF 之间的关联对于无先前行心肌梗死的 HF 相似（危险比，1.10；95%置信区间，1.05-1.15）。基线时左心房大小、左心室质量和峰值 A 速度的测量值与空腹胰岛素水平和 HF 均相关；然而，对这些参数进行额外的统计学调整并不能完全减弱胰岛素-HF 估计值（危险比，1.08；95%置信区间，1.03-1.14，每增加 1-SD 的空腹胰岛素）。
空腹胰岛素与心血管健康研究参与者不良的超声心动图特征和随后 HF 的风险呈正相关，包括那些无先前行心肌梗死的患者。
