Elevated endogenous insulin and insulin resistance independently predict progressive diastolic dysfunction (DD) over four years, preceding overt diabetes onset.
Insulin dysregulation associates with increased long-term all-cause and cardiovascular mortality, even after adjusting for body mass index and other confounders.
Metabolic perturbations may initiate myocardial stiffening and impaired relaxation in early preclinical stages, offering a potentially actionable window to prevent heart failure with preserved ejection fraction (HFpEF).
Findings suggest integration of insulin resistance assessment in cardiovascular risk stratification and highlight the need for therapeutic strategies targeting metabolic abnormalities to halt DD progression.
Background
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