Abstract
Objective: Population data on the longitudinal changes of left ventricular (LV) structure and function in relation to insulin resistance are sparse. Therefore, we assessed in a general population whether hyperinsulinemia predicts longitudinal changes in LV and arterial characteristics.Design and method: In 627 participants (mean age 50.7 years, 51.4% women), we assessed echocardiographic indexes of LV structure and function and carotid-femoral pulse wave velocity (PWV) by applanation tonometry at baseline and after 4.7 years. We regressed longitudinal changes in these indexes on baseline fasting insulin and its change during follow-up, and reported standardized effect sizes as a percentage of the standard deviation of LV changes associated with a doubling of insulin. Results: After full adjustment, higher baseline insulin predicted a greater longitudinal increase in LV mass index (LVMI) (effect size: +15.1%) and E/e’ ratio (+22.1%), and greater decrease in e’ peak and global and basal-mid longitudinal strain (−11.2 to −17.1%). Furthermore, a greater increase in insulin during follow-up was related to a greater increase in LVMI (+10.7%) and stronger decline in ejection fraction and global and basal-mid longitudinal strain (−11.4 to −15.7%). Participants who became or remained insulin resistant during follow-up experienced worse changes in global and basal-mid LS, E/e’ and LVMI as compared to participants who didn’t develop or even improved insulin resistance over time (P < 0.033). Moreover, the multivariable-adjusted increase in PWV was higher in subjects with diabetes than in non-diabetic participants (+1.46 m/s vs +0.71 m/s; P = 0.039). Conclusions: Hyperinsulinemia at baseline and during follow-up predicted worsening of cardiac function and remodeling over time. Our findings underline the importance of management of insulin resistance in subjects at risk for heart failure.
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