Glucose Disposal Rate: A Novel Measure of Insulin Resistance Associated With Myocardial Fibrosis and Incident Heart Failure.

BACKGROUND

Heart failure (HF) is increasingly driven by cardiometabolic risk factors such as obesity and insulin resistance. The estimated glucose disposal rate (eGDR) is a validated surrogate marker of insulin resistance. Reduced eGDR, reflecting higher insulin resistance, has been linked to cardiovascular disease, but its associations with myocardial fibrosis and HF remain unclear.

METHODS

The study included 6025 participants in MESA (Multi-Ethnic Study of Atherosclerosis) free of HF at exam 2 (2002-2004). eGDR was calculated using body mass index, hypertension, and hemoglobin A1c. Cardiac magnetic resonance imaging (2010-2012) assessed left ventricular ejection fraction and myocardial fibrosis by late gadolinium enhancement. Associations of baseline eGDR with incident HF were evaluated using Cox models, stratified by diabetes.

RESULTS

Over a mean follow-up of 14±5 years, 404 participants developed HF. eGDR was inversely associated with incident HF (adjusted hazard ratio [HR] per unit decrease, 1.28 [95% CI, 1.22-1.35]), a relationship that persisted regardless of diabetes status and was more pronounced for HF with preserved ejection fraction (n=200; adjusted HR per unit decrease, 1.36 [95% CI, 1.27-1.45]) than HF with reduced ejection fraction (n=168; HR, 1.19 [95% CI, 1.11-1.27]). Lower eGDR was also associated with higher left ventricular ejection fraction (n=2899; β=0.16, [95% CI, 0.03-0.28]) and higher odds of myocardial fibrosis (n=1780; adjusted odds ratio, 1.27 [95% CI, 1.16-1.41]).

CONCLUSIONS

Lower eGDR is independently associated with subclinical myocardial damage and incident HF, highlighting insulin resistance as a key driver of adverse remodeling and a potential marker for early HF risk stratification and prevention.