Cardiometabolic & kidneyCohort study
Elevated Endogenous Insulin and Insulin Resistance Are Associated With Progressive Diastolic Dysfunction and Worse Cardiovascular Outcomes
- community-based cohort study
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) years — per 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
| Comparison | hazard ratio (95% CI) | |
|---|---|---|
| elevated insulin · cardiovascular mortality | 1.16 (1.02–1.33) | |
| homeostatic model assessment of insulin resistance · all-cause mortality | 1.11 (1.03–1.20) | |
| homeostatic model assessment of insulin resistance · cardiovascular 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:10.1161/circheartfailure.126.014410
Summarised from the published abstract; every number is checked against it