Dr. Bhupinder Singh, Professor and Head, Dept. of Cardiology, All India Institute of Medical Sciences, Bathinda, Punjab; and Dr Sanjay Kalra, DM (AIIMS), Treasurer, International Society of Endocrinology; Bharti Hospital, Karnal, Haryana
Persistently high blood glucose and insulin resistance may raise the risk of heart damage as adolescents transition into young adulthood, suggests a study published on April 29, 2025 in the journal Diabetes Care.1 These effects occurred more rapidly in women than in men.
Scientists from UK, Finland, Australia, US and Switzerland collaborated to investigate if alterations in metabolic health from adolescence to young adulthood are linked to progressive cardiac remodeling. They also explored possible underlying mechanisms driving this association. For this, they enrolled 1595 adolescents, mean age 17.7 years, from the Avon Longitudinal Study of Parents and Children (ALSPAC), UK cohort. They were followed up to age 24 years. Data on fasting plasma glucose and insulin levels, and echocardiography left ventricular (LV) mass indexed for height raised to the power of 2.7 (LVMI2.7) for the selected participants was collated. Hyperglycemia was defined as blood glucose level of ≥5.6 mmol/L (100.8 mg/dL) and ≥6.1 mmol/L (109.8 mg/dL), and LV hypertrophy was defined as LVMI2.7 ≥51g/m2.7. Insulin resistance (HOMA-IR) was calculated from fasting glucose and insulin.
At age 17, 6.2% of adolescents had fasting blood glucose levels ≥5.6 mmol/L, which rose nearly fivefold to 26.9% by age 24. Over the same period, the prevalence of levels ≥6.1 mmol/L increased from 1.1% to 5.6%.
Analysis further showed that the prevalence of LV hypertrophy rose threefold from 2.4% at baseline to 7.1% at 24 years. The prevalence of heart dysfunction increased from 9.2% to 15.8% within the same time period. Over the 7-year period, each unit increase in glucose was independently associated with a 0.37 g/m2.7 rise in LVMI2.7, while each unit increase in HOMA-IR was associated with a 1.10 g/m2.7 increase in LVMI2.7.
Persistent hyperglycemia of ≥5.6 mmol/L (100.8 mg/dL) was linked to 46% increased risk of worsening left ventricular hypertrophy over 7 years, with odds ratio of 1.46. Persistent hyperglycemia of ≥6.1 mmol/L (109.8 mg/dL) tripled the risk of worsening LV hypertrophy with OR of 3.10.
Increased fat mass significantly mediated the relationship between higher HOMA-IR and elevated LVMI2.7, accounting for 62% of the association. Persistent insulin resistance was associated with a 10% increase in the risk of premature and worsening heart damage. Over the 7-year period, rising glucose levels were associated with a greater increase in cardiac mass in females (0.57 g/m2.7) compared to males (0.11 g/m2.7).
This study therefore establishes that worsening cardiometabolic health during the transition period from adolescence to early adulthood may contribute to significant adverse changes in heart structure and function, potentially increasing long-term cardiovascular risk. Hence, there is a pressing need to monitor glucose metabolism and insulin resistance during adolescence, even in those who are mostly normal weight. Early detection of dysglycemia or elevated insulin resistance could help identify youth at risk of future cardiac remodeling.
Furthermore, the increase in prevalence of hyperglycemia during the course of the study underscores the crucial role of healthy lifestyle habits during this period to mitigate insulin resistance and reduce the likelihood of cardiac remodeling in early adulthood.
Reference
1. Andrew O Agbaje, et al. Persistent hyperglycemia and insulin resistance with the risk of worsening cardiac damage in adolescents: a 7-year longitudinal study of the ALSPAC Birth Cohort. Diabetes Care. 2025 Apr 29:dc242459. doi: 10.2337/dc24-2459.