All ETDs from UAB

Advisory Committee Chair

Virginia Howard

Advisory Committee Members

George Howard

Emily B Levitan

Document Type


Date of Award


Degree Name by School

Master of Public Health (MPH) School of Public Health; Master of Science (MS) School of Public Health


Background: Insulin resistance is linked to the development of heart failure (HF). However, there is limited understanding of the racial differences in the association of insulin resistance with the risk of incident HF among individuals without diabetes. Objectives: In a US national cohort of Black and White participants, we sought to evaluate: 1) the relationship between insulin resistance with incident HF participants, and 2) whether there are racial differences in the association of insulin resistance with HF. Methods: We examined >16,000 participants without HF and diabetes at baseline from the REGARDS cohort. Cox regression modeling was used to assess the relationship of insulin resistance (defined using the homeostatic model assessment (HOMA-IR) equation ≥2.5) with incident HF overall participants as well as by racial groups. Incremental adjustment including demographic such as age, sex, race and multivariable-adjusted (i.e., demographic + traditional risk factors) was used in Cox regression modeling. We performed multiplicative interaction in the relationship between insulin resistance and incident HF by race. Results: Among 16,542 participants, there were a total of 654 incident HF events. The risk of HF was higher among individuals with HOMA-IR ≥2.5 in a demographic-adjusted model (Hazard ratio (HR): 1.28 (95% CI: 1.09-1.49); p=0.002), but it was attenuated by iii adjustment for multiple risk factors (HR:0.99 (95% CI: 0.83-1.17); p=0.88). We observed a significant interaction in the risk of HF and insulin resistance by race (p=0.10) in the multivariable model. In the demographic-adjusted model, we observed a higher risk of incident HF with HOMA-IR ≥2.5 (HR: 1.41 (95% CI: 1.18-1.71); p

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