Elevated Endogenous Insulin and Insulin Resistance Are Associated With Progressive Diastolic Dysfunction and Worse Cardiovascular Outcomes
Authors' conclusion
Elevated endogenous insulin and insulin resistance are predictors of progressive DD and long-term mortality, even after accounting for body mass index. Metabolic dysregulation may drive myocardial stiffening before diabetes onset, identifying a potential early therapeutic window for heart failure with preserved ejection fraction prevention.
Study context
- Population
- Participants from the Olmsted County Heart Function Study who underwent echocardiography at baseline and after 4 yearsunderwent echocardiography at baseline and after 4 years, secondary outcomes assessed in 2030 participants · diastolic dysfunction (DD) progression analysis 1,191 · secondary outcomes (mortality, heart failure) 2,030
- Participants
- 1,191 participants
- Exposure
- Per 1-SD increase in log-transformed fasting insulin and homeostatic model assessment of insulin resistance
- Outcome
- DD progression
- Follow-up
- After 4 years
Main finding
As reported in the abstract
Odds ratio (95% CI)P value
Every 1-SD increase in log-transformed insulinmultivariable, adjusting for age, creatinine, and NT-proBNP
1.65(1.33–2.07)
P < 0.001Homeostatic model assessment of insulin resistance
1.66(1.34–2.08)
P < 0.001Every 1-SD increase in log-transformed insulin, as printed
- DD progression occurred in participants
- 7.5%
- Baseline fasting insulin and homeostatic model assessment of insulin resistance strongly predicted progression
- P < 0.001
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Hazard ratio (95% CI) | |
|---|---|---|
| All-cause and cardiovascular mortality (secondary analyses) · median 18.1 (95% CI, 18.0-18.2) yearsPer 1-SD elevated insulin · all-cause mortality | 1.11 (1.02–1.21) | |
| 0.512Hazard ratio (log scale) |
All-cause and cardiovascular mortality (secondary analyses) · median 18.1 (95% CI, 18.0-18.2) years
| Hazard ratio (95% CI) | ||
|---|---|---|
| Elevated insulinCardiovascular mortality | 1.16 (1.02–1.33) | |
| Homeostatic model assessment of insulin resistanceAll-cause mortality | 1.11 (1.03–1.20) | |
| Homeostatic model assessment of insulin resistanceCardiovascular mortality | 1.16 (1.02–1.32) | |
| 0.512Hazard ratio (log scale) |
Original publication
Elevated Endogenous Insulin and Insulin Resistance Are Associated With Progressive Diastolic Dysfunction and Worse Cardiovascular Outcomes. Circ Heart Fail. Published 10 August 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →