Context: Diabetes and obesity are established risk factors for congestive heart failure(CHF) and are both associated with insulin resistance. Objective: To explore if insulin resistance may predict CHF and may provide...Context: Diabetes and obesity are established risk factors for congestive heart failure(CHF) and are both associated with insulin resistance. Objective: To explore if insulin resistance may predict CHF and may provide the link between obesity and CHF. Design, Setting, and Participants: The Uppsala Longitudinal Study of Adult Men, a prospective, community-based, observational cohort in Uppsala, Sweden. We investigated 1187 elderly(≥70 years) men free from CHF and valvular disease at baseline between 1990 and 1995, with follow-up until the end of 2002. Variables reflecting insulin sensitivity (including euglycemic insulin clamp glucose disposal rate) and obesity were analyzed together with established risk factors(prior myocardial infarction, hypertension, diabetes, electrocardiographic left ventricular hypertrophy, smoking, and serum cholesterol level) as predictors of subsequent incidence of CHF, using Cox proportional hazards analyses. Main Outcome Measure: First hospitalization for heart failure. Results: One hundred four men developed CHF during a median follow-up of 8.9(range, 0.01-11.4) years. In multivariable Cox proportional hazards models adjusted for established risk factors for CHF, increased risk of CHF was associated with a 1-SD increase in the 2-hour glucose value of an oral glucose tolerance test(hazard ratio[HR], 1.44; 95%confidence interval[CI], 1.08-1.93), fasting serum proinsulin level(HR, 1.29; 95%CI, 1.02-1.64), body mass index(HR, 1.35; 95%CI, 1.11-1.65), and waist circumference(HR, 1.36; 95%CI, 1.10-1.69), whereas a 1-SD increase in clamp glucose disposal rate decreased the risk(HR, 0.66; 95%CI, 0.51-0.86). When adding clamp glucose disposal rate to these models as a covariate, the obesity variables were no longer significant predictors of subsequent CHF. Conclusions: Insulin resistance predicted CHF incidence independently of established risk factors including diabetes in our large community-based sample of elderly men. The previously described association between obesity and subsequent CHF may be mediated largely by insulin resistance.展开更多
Context: High blood pressure is the most important risk factor for congestive heart failure(CHF) at a population level, but the relationship of an altered diurnal blood pressure pattern to risk of subsequent CHF is un...Context: High blood pressure is the most important risk factor for congestive heart failure(CHF) at a population level, but the relationship of an altered diurnal blood pressure pattern to risk of subsequent CHF is unknown. Objectives: To explore 24-hour ambulatory blood pressure characteristics as predictors of CHF incidence and to investigate whether altered diurnal blood pressure patterns confer any additional risk information beyond that provided by conventional office blood pressure measurements. Design, Setting, and Participants: Prospective, community-based, observational cohort in Uppsala, Sweden, including 951 elderly men free of CHF, valvular disease, and left ventricular hypertrophy at baseline between 1990 and 1995, followed up until the end of 2002. Twenty-four-hour ambulatory blood pressure monitoring was performed at baseline, and the blood pressure variables were analyzed as predictors of subsequent CHF. Main Outcome Measure: First hospitalization for CHF. Results: Seventy men developed heart failure during follow-up, with an incidence rate of 8.6 per 1000 person-years at risk. In multivariable Cox proportional hazards models adjusted for antihypertensive treatment and established risk factors for CHF(myocardial infarction, diabetes, smoking, body mass index, and serum cholesterol level), a 1-SD(9-mm Hg) increase in night-time ambulatory diastolic blood pressure(hazard ratio[HR], 1.26; 95%confidence interval[CI], 1.02-1.55) and the presence of “nondipping”blood pressure(night-day ambulatory blood pressure ratio ≥1; HR, 2.29; 95%CI, 1.16-4.52) were associated with an increased risk of CHF. After adjusting for office-measured systolic and diastolic blood pressures, nondipping blood pressure remained a significant predictor of CHF(HR, 2.21; 95%CI, 1.12-4.36 vs normal night-day pattern). Nighttime ambulatory diastolic blood pressure and nondipping blood pressure were also significant predictors of CHF after exclusion of all participants who had an acute myocardial infarction before baseline or during follow-up. Conclusions: Nighttime blood pressure appears to convey additional risk information about CHF beyond office-measured blood pressure and other established risk factors for CHF. The clinical value of this association remains to be established in future studies.展开更多
文摘Context: Diabetes and obesity are established risk factors for congestive heart failure(CHF) and are both associated with insulin resistance. Objective: To explore if insulin resistance may predict CHF and may provide the link between obesity and CHF. Design, Setting, and Participants: The Uppsala Longitudinal Study of Adult Men, a prospective, community-based, observational cohort in Uppsala, Sweden. We investigated 1187 elderly(≥70 years) men free from CHF and valvular disease at baseline between 1990 and 1995, with follow-up until the end of 2002. Variables reflecting insulin sensitivity (including euglycemic insulin clamp glucose disposal rate) and obesity were analyzed together with established risk factors(prior myocardial infarction, hypertension, diabetes, electrocardiographic left ventricular hypertrophy, smoking, and serum cholesterol level) as predictors of subsequent incidence of CHF, using Cox proportional hazards analyses. Main Outcome Measure: First hospitalization for heart failure. Results: One hundred four men developed CHF during a median follow-up of 8.9(range, 0.01-11.4) years. In multivariable Cox proportional hazards models adjusted for established risk factors for CHF, increased risk of CHF was associated with a 1-SD increase in the 2-hour glucose value of an oral glucose tolerance test(hazard ratio[HR], 1.44; 95%confidence interval[CI], 1.08-1.93), fasting serum proinsulin level(HR, 1.29; 95%CI, 1.02-1.64), body mass index(HR, 1.35; 95%CI, 1.11-1.65), and waist circumference(HR, 1.36; 95%CI, 1.10-1.69), whereas a 1-SD increase in clamp glucose disposal rate decreased the risk(HR, 0.66; 95%CI, 0.51-0.86). When adding clamp glucose disposal rate to these models as a covariate, the obesity variables were no longer significant predictors of subsequent CHF. Conclusions: Insulin resistance predicted CHF incidence independently of established risk factors including diabetes in our large community-based sample of elderly men. The previously described association between obesity and subsequent CHF may be mediated largely by insulin resistance.
文摘Context: High blood pressure is the most important risk factor for congestive heart failure(CHF) at a population level, but the relationship of an altered diurnal blood pressure pattern to risk of subsequent CHF is unknown. Objectives: To explore 24-hour ambulatory blood pressure characteristics as predictors of CHF incidence and to investigate whether altered diurnal blood pressure patterns confer any additional risk information beyond that provided by conventional office blood pressure measurements. Design, Setting, and Participants: Prospective, community-based, observational cohort in Uppsala, Sweden, including 951 elderly men free of CHF, valvular disease, and left ventricular hypertrophy at baseline between 1990 and 1995, followed up until the end of 2002. Twenty-four-hour ambulatory blood pressure monitoring was performed at baseline, and the blood pressure variables were analyzed as predictors of subsequent CHF. Main Outcome Measure: First hospitalization for CHF. Results: Seventy men developed heart failure during follow-up, with an incidence rate of 8.6 per 1000 person-years at risk. In multivariable Cox proportional hazards models adjusted for antihypertensive treatment and established risk factors for CHF(myocardial infarction, diabetes, smoking, body mass index, and serum cholesterol level), a 1-SD(9-mm Hg) increase in night-time ambulatory diastolic blood pressure(hazard ratio[HR], 1.26; 95%confidence interval[CI], 1.02-1.55) and the presence of “nondipping”blood pressure(night-day ambulatory blood pressure ratio ≥1; HR, 2.29; 95%CI, 1.16-4.52) were associated with an increased risk of CHF. After adjusting for office-measured systolic and diastolic blood pressures, nondipping blood pressure remained a significant predictor of CHF(HR, 2.21; 95%CI, 1.12-4.36 vs normal night-day pattern). Nighttime ambulatory diastolic blood pressure and nondipping blood pressure were also significant predictors of CHF after exclusion of all participants who had an acute myocardial infarction before baseline or during follow-up. Conclusions: Nighttime blood pressure appears to convey additional risk information about CHF beyond office-measured blood pressure and other established risk factors for CHF. The clinical value of this association remains to be established in future studies.
