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 six 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 1,382 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% 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 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.