Journal of Hypertension · Oct 20, 2026

Insulin resistance in the adipose tissue is associated with cardiac mortality: the Hiroshima study on glucose metabolism and cardiovascular diseases

By Sasaki N, Ueno Y, Ozono R et al.

OBJECTIVE: Insulin resistance is a fundamental pathophysiology of cardiovascular disease. This study aimed to investigate the association of adipose tissue insulin resistance with cardiac and cerebrovascular mortality in comparison with hepatic and skeletal muscle insulin resistance. METHODS: This retrospective cohort study enrolled 12 306 participants (mean age, 64.5 years; female, 49.9%) who underwent a general health checkup in Hiroshima City between January 1982 and March 2003. Based on the median values of adipose insulin resistance index (Adipo-IR), homeostasis model assessment of insulin resistance (HOMA-IR), and Matsuda index, participants were divided into high and low insulin resistance groups in adipose tissue, liver, and skeletal muscle, respectively. RESULTS: Over a median 15.6-year follow-up period, 1001 cardiac and 629 cerebrovascular deaths occurred. Multivariate Cox proportional hazards regression analysis revealed that the hazard ratio (HR) for cardiac mortality was higher in the high Adipo-IR group than in the low Adipo-IR group (1.20 [95% confidence interval, 1.05-1.38]), whereas the HR for cerebrovascular mortality did not differ. In the stratified analyses, a significantly increased HR for cardiac mortality was observed in participants without antihypertensive or antihyperlipidemic medications in the high Adipo-IR group. HOMA-IR and the Matsuda index were also associated with cardiac mortality; however, these associations were not significant after adjusting for glycemic status. CONCLUSION: The association between insulin resistance in various tissues and cardiac mortality has been clarified. An increased risk of cardiac mortality was associated with insulin resistance in adipose tissue, independent of glycemic status.

doi.org/10.1097/hjh.0000000000004466 PubMed 42937097 Populations