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ARTICLE

Serum Insulin-like Growth Factor I and Risk for Heart Failure in Elderly Individuals without a Previous Myocardial Infarction: The Framingham Heart Study

Ramachandran S. Vasan, MD; Lisa M. Sullivan, PhD; Ralph B. D'Agostino, PhD; Ronenn Roubenoff, MD, MHS; Tamara Harris, MD, MS; Douglas B. Sawyer, MD, PhD; Daniel Levy, MD; and Peter W.F. Wilson, MD

21 October 2003 | Volume 139 Issue 8 | Pages 642-648

Background: Several experimental investigations have emphasized the favorable effects of insulin-like growth factor I (IGF-I) on left ventricular remodeling, partly through its antiapoptotic effects. Cross-sectional clinical studies have reported that low serum IGF-I levels in patients with heart failure correlate with cachexia and severity of ventricular dysfunction. It is unclear whether low serum IGF-I is a risk factor for heart failure.

Objective: To prospectively study the association between serum IGF-I level and the incidence of congestive heart failure.

Design: Community-based, prospective cohort study.

Setting: Framingham, Massachusetts.

Participants: 717 elderly individuals (mean age, 78.4 years; 67% women) who did not have myocardial infarction and congestive heart failure at baseline.

Measurement: Incidence of a first episode of congestive heart failure on follow-up.

Results: During follow-up (mean, 5.2 years), 56 participants (35 women) developed congestive heart failure. In multivariable Cox regression models adjusting for established risk factors at baseline, there was a 27% decrease in risk for heart failure for every 1 standard deviation increment in log IGF-I. Individuals with serum IGF-I level at or above the median value (140 µg/L) had half the risk for heart failure (hazard ratio, 0.49 [95% CI, 0.26 to 0.92]) of those with serum IGF-I levels below the median. These comparisons were maintained in analyses adjusting for the occurrence of a myocardial infarction on follow-up.

Conclusions: In our prospective, community-based investigation, serum IGF-I level was inversely related to the risk for congestive heart failure in elderly people without a previous myocardial infarction. Additional investigations are warranted to confirm these findings.

Editors' Notes Context Biological research and retrospective clinical studies show that insulin-like growth factor I (IGF-I) promotes salutary left ventricular modeling. Contribution This community-based study followed 717 elderly people without known myocardial infarction or heart failure for 5 to 9 years. Participants with higher levels of IGF-I developed heart failure less often than did those with lower levels. Implications High IGF-I levels are associated with decreased risks for heart failure. Cautions High IGF-I levels are also associated with increased risks for cancer. Future research should confirm these associations and explore mechanisms to increase IGF-I levels in people at risk for heart failure without increasing the risk for cancer. –The Editors

 

Author and Article Information

From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Boston University and Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts; and National Institute on Aging and National Heart, Lung, and Blood Institute, Bethesda, Maryland.

Grant Support: In part by National Institutes of Health (NIH) and National Heart, Lung, and Blood Institute (NHLBI) contract N01-HC-25195, NHLBI grant 1K24 HL04334 (Dr. Vasan), NIH and U.S. Department of Agriculture interagency agreement Y01-AG-4-0245 (Dr. Roubenoff), and NIH grants DK02120 (Dr. Roubenoff) and AG15797 (Dr. Roubenoff).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Ramachandran S. Vasan, MD, The Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702-5803.

Current Author Addresses: Drs. Vasan and Levy: 73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702-5803.

Drs. Sullivan and D'Agostino: 111 Cummington Street, Boston, MA 02215.

Dr. Roubenoff: 75 Sidney Street, Cambridge, MA 02134.

Dr. Harris: 7201 Wisconsin Avenue, Bethesda, MD 20892-9205.

Drs. Sawyer and Wilson: 715 Albany Street, Boston, MA 02118.

Author Contributions: Conception and design: R.S. Vasan, R.B. D'Agostino, R. Roubenoff, D. Levy.

Analysis and interpretation of the data: R.S. Vasan, L.M. Sullivan, R.B. D'Agostino, D.B. Sawyer, D. Levy, P.W.F. Wilson.

Drafting of the article: R.S. Vasan, L.M. Sullivan, D.B. Sawyer, D. Levy.

Critical revision of the article for important intellectual content: R.S. Vasan, L.M. Sullivan, R.B. D'Agostino, D.B. Sawyer, D. Levy, P.W.F. Wilson.

Final approval of the article: R.S. Vasan, L.M. Sullivan, R.B. D'Agostino, T. Harris, D. Levy, P.W.F. Wilson.

Provision of study materials or patients: R. Roubenoff, T. Harris.

Statistical expertise: L.M. Sullivan.

Obtaining of funding: R. Roubenoff, T. Harris.

Administrative, technical, or logistic support: T. Harris, D. Levy, P.W.F. Wilson.

Collection and assembly of data: T. Harris.

Related articles in Annals:

Summaries for Patients
Insulin-like Growth Factor I Levels and Heart Failure Risk in Older People

Annals 2003 139: I-22. [Full Text]  

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