Lipoprotein Insulin Resistance Score and Mortality Risk Stratification in Heart Failure

BACKGROUND: Higher total serum cholesterol is associated with lower mortality in heart failure. Evaluating associations between lipoprotein subfractions and mortality among people with heart failure may provide insights into this observation. METHODS: We prospectively enrolled a community cohort of people with heart failure from 2003 to 2012 and assessed vital status through 2021. Plasma collected at enrollment was used to measure lipoprotein subfractions via nuclear magnetic resonance spectroscopy. A composite score of 6 lipoprotein subfractions was generated using the lipoprotein insulin resistance index (LP -IR) algorithm. Using covariate-adjusted proportional hazards regression models, we evaluated associations between LP -IR score and all -cause mortality. RESULTS: Among 1382 patients with heart failure (median follow-up 13.9 years), a one-standard-deviation (SD) increment in LP -IR score was associated with lower mortality (hazard ratio [HR] 0.93; 95% confidence interval [CI], 0.97-0.99). Among LP -IR parameters, mean high-density lipoprotein (HDL) particle size was significantly associated with lower mortality (HR per 1 -SD decrement in mean HDL particle size = 0.83; 95% CI, 0.78-0.89), suggesting that the inverse association between LP -IR score and mortality may be driven by smaller mean HDL particle size. CONCLUSIONS: LP -IR score was inversely associated with mortality among patients with heart failure and may be driven by smaller HDL particle size. Published by Elsevier Inc. This is an open access article under the CC BY -NC -ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/) center dot The American Journal of Medicine (2024) 137:640 - 648