Heart failure & cardiomyopathies
Disentangling the Impact of Adiposity From Insulin Resistance in Heart Failure With Preserved Ejection Fraction
Authors' conclusion
Although excess body fat is associated with IR and diabetes, cardiac remodeling, hemodynamics, and functional impairment are independently correlated with body fat, but not IR.
Study context
- Population
- PVDOMICS participants with heart failure with preserved ejection fraction (HFpEF)replication cohort n = 254
- Participants
- 276 participants
- Exposure
- Obesity vs no obesity; Insulin resistance (IR) vs no IR; diabetes vs no diabetes
- Obesityn = 166
- BMI <30 kg/m²n = 110reference
- Outcome
- Rest and exercise PCWP by obesity, IR (HOMA-IR ≥2.6) and diabetes
Methodological detailsindependent validation cohort
- Independent validation cohort
Main finding
As reported in the abstract
Rest and exercise PCWP
- Obesity
- difference +4.4 mm Hg (95% CI +2.5 to +6.4); P < 0.0001
- Obesity · adjusted for HOMA-IR
- difference +4.7 mm Hg (95% CI +2.7 to +6.7); P < 0.0001
- HOMA-IR
- association +0.01 mm Hg (95% CI −0.13 to +0.16); P = 0.84
- Greater fat mass, BMI and waist circumference associated with higher pulmonary capillary wedge pressure (PCWP) at rest and exercise
- P < 0.0009
Observational data: associations, not effects.
Further findings
| Outcome | Obesity | BMI <30 kg/m² | Association (mm Hg per kg/m²) (95% CI) | P value |
|---|---|---|---|---|
| Prevalence of adiposity, IR and diabetes | ||||
| IR | 114 (69%) | 44 (40%) | ||
| Diabetes | 75 (45%) | 27 (25%) | ||
| Replication cohort: rest and exercise PCWP · diabetes not associated | +0.19 (+0.11 to +0.27) | P < 0.0001 |
- Prevalence of adiposity, IR and diabetes — Increased waist/height ratio
- 246 (89%)
- Prevalence of adiposity, IR and diabetes: both P < 0.0001 vs obesity phenotype
Remodeling, exercise performance, quality of life by obesity
- Obesity (regardless of IR) associated with greater biventricular enlargement, worse exercise performance, poorer quality of life, higher rest and exercise PCWP
- P < 0.01
Original publication
Disentangling the Impact of Adiposity From Insulin Resistance in Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol. Published 13 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it