Circulation, Vol 88, 1431-1436, Copyright © 1993 by American Heart Association
Z Sasson, Y Rasooly, T Bhesania and I Rasooly
BACKGROUND. Obesity in adults is associated with increased left ventricular
(LV) mass. The mechanism for this is unclear, however. We tested the
hypothesis that insulin resistance is an important independent contributing
factor to LV mass in the healthy obese population. METHODS AND RESULTS. The
study population consisted of 40 normotensive, nondiabetic, otherwise
healthy obese subjects with body mass index (BMI) > 25 kg/m2. LV mass
was echocardiographically determined according to the Penn convention,
using the formula of Devereux and Reichek. Insulin resistance was assessed
using indices derived from Intravenous Glucose Tolerance Test (IVGTT):
insulin level at baseline, insulin level at 90 minutes of IVGTT
(insulin-90), insulin integration over 90 minutes of IVGTT, and rate of
glucose disposal (k value). Insulin-90 (r = .61, P = .0001), k value (r =
.55, P = .003), insulin integration over 90 minutes (r = .46, P = .003),
basal insulin (r = .44, P = .005), and BMI (r = .59, P = .0001) were all
strongly correlated with LV mass by univariate analysis. No significant
correlation was found with blood pressure or age. In multivariate
regression analysis, only insulin-90 and k value correlated significantly
with LV mass (P = .03, P = .02, respectively), accounting for 50% of the
variance of LV mass, whereas the association with BMI became insignificant
(P = .2). CONCLUSIONS. LV mass in the normotensive nondiabetic obese
population is strongly associated with, and may be mediated by, the degree
of insulin resistance and its associated hyperinsulinemia, independent of
BMI and blood pressure.
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Insulin resistance is an important determinant of left ventricular mass in the obese
Department of Medicine, Wellesley Hospital, University of Toronto, Ontario, Canada.
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