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.

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Disclosure

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.

Funding

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.

© 2022 by the American Diabetes Association
2022
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