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

  1. Ramachandran S. Vasan, MD;
  2. Lisa M. Sullivan, PhD;
  3. Ralph B. D'Agostino, PhD;
  4. Ronenn Roubenoff, MD, MHS;
  5. Tamara Harris, MD, MS;
  6. Douglas B. Sawyer, MD, PhD;
  7. Daniel Levy, MD; and
  8. Peter W.F. Wilson, MD
  1. 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.

    Abstract

    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.

    Article and Author Information

    • 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.

    Summary for Patients

    • Summaries for Patients:Insulin-like Growth Factor I Levels and Heart Failure Risk in Older People Ann Intern Med October 21, 2003 139:I-22
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    1. Ann Intern Med October 21, 2003 vol. 139 no. 8 642-648
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