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Association of metabolic syndrome and insulin resistance with congestive heart failure: findings from the Third National Health and Nutrition Examination Survey
  1. Chaoyang Li,
  2. Earl S Ford,
  3. Lisa C McGuire,
  4. Ali H Mokdad
  1. Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to:
 Dr Chaoyang Li
 Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K66, Atlanta, GA 30341, USA; cli{at}


Objective: Congestive heart failure (CHF) has been associated with insulin resistance, but few studies have examined its relationship with metabolic syndrome (MetS). Little is known about whether insulin resistance explains the association between MetS and CHF.

Design: Population-based, cross-sectional surveys.

Setting: Third National Health and Nutrition Examination Survey (NHANES III).

Participants: Data from 5549 men and non-pregnant women aged ⩾40 years in NHANES III were analysed.

Results: About 4% of men and 3% of women had CHF between 1988 and 1994 in the US. The age-adjusted prevalence of CHF was significantly higher in African Americans (4.1%), in Mexican Americans (8.5%) and in those of other ethnic origin (6.7%) than in white people (2.5%). People with MetS had nearly twice the likelihood of self-reported CHF (adjusted odds ratio 1.8; 95% confidence interval 1.1 to 3.0) after adjustment for demographic and conventional risk factors such as sex, ethnicity, age, smoking, total cholesterol, left ventricular hypertrophy, and probable or possible myocardial infarction determined by electrocardiography. However, this association was attenuated after further adjustment for insulin resistance as measured by the homoeostasis model assessment (HOMA). >90% of the association between MetS and CHF was explained by the HOMA.

Conclusions: MetS was associated with about a twofold increased likelihood of self-reported CHF and it may serve as a surrogate indicator for the association between insulin resistance and CHF.

  • CHF, congestive heart failure
  • ECG, electrocardiography
  • HOMA, homoeostasis model assessment
  • IDF, International Diabetes Federation
  • LVH, left ventricular hypertrophy
  • MetS, metabolic syndrome
  • NCEP ATP III, National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
  • NHANES III, Third National Health and Nutrition Examination Survey

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  • Competing interests: None.

  • The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

    Contributors: CL had full access to all of the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: CL, ESF. Acquisition of data: CL, ESF. Analysis and interpretation of data: CL, ESF, LCMcG, AHM. Drafting of the manuscript: CL. Critical revision of the manuscript for important intellectual content: CL, ESF, LCMcG, AHM. Statistical analysis: CL, ESF. Administrative, technical, or material support: CL, ESF, AHM. Study supervision: ESF, AHM.

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