Both endothelial dysfunction and insulin resistance independently predicted incident heart failure in hypertensives and interacted competitively (interaction HR 6.548; 95% CI 4.034-10.629).
Cohort (n=705)
Do insulin resistance and endothelial dysfunction predict incident heart failure in never-treated hypertensives?
Both endothelial dysfunction and insulin resistance are independent predictors of incident heart failure in hypertensive patients, with a significant competitive interaction between the two risk factors.
Effect estimate: Interaction HR 6.548 (95% CI 4.034-10.629)
Insulin resistance and endothelial dysfunction are associated with heart failure (HF). Our objective was to investigate whether endothelial dysfunction and insulin resistance are independent predictors of incident HF and if a possible interaction exists between them. We enrolled 705 white never-treated hypertensives. Endothelium-dependent vasodilation was investigated by intra-arterial infusion of acetylcholine. During the follow-up median: 117 months (range: 31–211), we documented 223 new cases of HF (3.3 events/100 patient-years). We stratified the study population into progressors and non-progressors; progressors showed an older age and a higher prevalence of females, as well as higher mean values of baseline glucose, insulin, homeostasis model assessment (HOMA), creatinine, and high-sensitivity C-reactive protein (hs-CRP), whereas the estimated glomerular filtration rate (e-GFR) and endothelium-dependent vasodilation were lower. In the multiple Cox regression analysis, serum hs-CRP (HR = 1.362, (95% CI = 1.208–1.536), HOMA (HR = 1.293, 95% CI = 1.142–1.465), maximal acetylcholine (Ach)-stimulated forearm blood flow (FBF) (100% increment, HR = 0.807, 95% CI = 0.697–0.934), and e-GFR (10 mL/min/1.73 m2 increment, HR = 0.552, 95% CI = 0.483–0.603) maintained an independent association with incident HF. HOMA and endothelial dysfunction interact between them in a competitive manner (HR = 6.548, 95% CI = 4.034–10.629), also showing a mutual effect modification. Our findings demonstrate that both endothelial dysfunction and HOMA are independent and strong predictors of incident HF in hypertensives, these two risk factors interact between them with a competitive mechanism.
Perticone et al. (Thu,) conducted a cohort in Hypertension (n=705). Insulin resistance (HOMA) and endothelial dysfunction was evaluated on Incident heart failure (Interaction HR 6.548, 95% CI 4.034-10.629). Both endothelial dysfunction and insulin resistance independently predicted incident heart failure in hypertensives and interacted competitively (interaction HR 6.548; 95% CI 4.034-10.629).