Heart failure (HF) is associated with metabolic alterations, including insulin resistance (IR) . Perturbations in lipid metabolism and insulin signaling may impact outcomes, but the relationship between IR and mortality is not well characterized. The Lipoprotein Insulin Resistance Index (LPIR) is a score (0-100; higher values signify greater IR) calculated from 6 lipoprotein subclass/size parameters measured by nuclear magnetic resonance (NMR) . We examined the association between LPIR and death in a HF community cohort. LPIR was measured by NMR LipoProfile®. Meta‐Analysis Global Group in Chronic HF (MAGGIC) scores were calculated from clinical data. Kaplan-Meier curves were used to evaluate survival; Cox regression was used to estimate risk of death by LPIR quartile. Among 1,381 community-dwelling persons with HF, the median LPIR score was 38 (IQR 21-56) . Higher LPIR was associated with younger age, diabetes, smoking, obesity, and lower MAGGIC scores, but not ejection fraction. Survival increased by LPIR quartile (p<0.001) and at 5 years was 36% [95% CI 31-42], 42% [95% CI 38-48], 51% [95% CI 46-56], and 65% [95% CI 60-70] for quartile 1-4, respectively. The association between LPIR and death was independent of MAGGIC score (Figure) . Higher LPIR was associated with better survival in HF, independently of a validated clinical risk score. More research is needed to examine this paradoxically protective association.


S. Turecamo: None. A. Wolska: None. J.D. Otvos: Employee; LabCorp. K. Conners: None. S.J. Bielinski: Consultant; Novartis Pharmaceuticals Corporation. J. St Sauver: Research Support; Exact Sciences. V.L. Roger: None.


Research was supported by the Intramural Research Program of the National Heart, Lung, and Blood Institute (NHLBI) at National Institutes of Health and by the NIH Medical Research Scholars Program, a public-private partnership supported jointly by the NIH and contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation, the American Association for Dental Research, and the Colgate-Palmolive Company.

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