Insulin Resistance, Metabolic Syndrome, and Subclinical Atherosclerosis
- 1 November 2007
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 30 (11), 2951-2956
- https://doi.org/10.2337/dc07-1042
Abstract
OBJECTIVE—To investigate the association of insulin resistance and clinically defined metabolic syndrome (MetS) with subclinical atherosclerosis and examine whether these relationships vary by race/ethnicity or sex. RESEARCH DESIGN AND METHODS—Subclinical atherosclerosis was assessed by coronary artery calcium (CAC) and carotid intima-medial thickness (IMT) in 5,810 participants without diabetes in the Multi-Ethnic Study of Atherosclerosis, a cohort of adults aged 45–84 years without prior cardiovascular disease (CVD). Fasting insulin and glucose were utilized to estimate insulin resistance by the homeostasis model assessment of insulin resistance (HOMA-IR) index, and the revised National Cholesterol Education Program definition of MetS was utilized. Multivariable linear or relative risk regression was used to analyze the association between HOMA-IR and subclinical atherosclerosis and assess its independence from MetS components. RESULTS—HOMA-IR was associated with increased IMT after adjustment for demographics (age, site, and education), smoking, education, and LDL cholesterol in each ethnic group, except Hispanic subjects, and in both men and women. After further adjusting for nonglucose MetS components, HOMA-IR was not associated with increased IMT. Subjects in the highest quintile of HOMA-IR had an elevated prevalence of CAC in each ethnic group and both sexes, after adjustment for demographics, smoking, and LDL but not after further adjustment for nonglucose MetS components. Among those with detectable CAC, there was no significant relationship between HOMA-IR and the amount of CAC. CONCLUSIONS—Although HOMA-IR was associated with increased subclinical atherosclerosis, the association was not independent of the risk factors that comprise MetS. Determination of HOMA-IR is unlikely to contribute to improved determination of risk of subclinical CVD.Keywords
This publication has 23 references indexed in Scilit:
- A comparison of the NCEP-ATPIII, IDF and AHA/NHLBI metabolic syndrome definitions with relation to early carotid atherosclerosis in subjects with hypercholesterolemia or at risk of CVD: Evidence for sex-specific differencesAtherosclerosis, 2007
- Diagnosis and Management of the Metabolic SyndromeCirculation, 2005
- Relation of the Metabolic Syndrome to Calcified Atherosclerotic Plaque in the Coronary Arteries and AortaThe American Journal of Cardiology, 2005
- Association between metabolic syndrome and subclinical coronary atherosclerosis in asymptomatic adultsThe American Journal of Cardiology, 2004
- Prevalence of coronary heart disease and carotid arterial thickening in patients with the metabolic syndrome (The ARIC Study)The American Journal of Cardiology, 2004
- Measures of Insulin Resistance Add Incremental Value to the Clinical Diagnosis of Metabolic Syndrome in Association With Coronary AtherosclerosisCirculation, 2004
- Impaired insulin sensitivity is an independent predictor of common carotid intima-media thickness in a population sample of elderly menAtherosclerosis, 2003
- The metabolic syndrome, diabetes, and subclinicalatherosclerosis assessed by coronary calciumJournal of the American College of Cardiology, 2003
- Use of sonography to evaluate carotid atherosclerosis in the elderly. The Cardiovascular Health Study. CHS Collaborative Research Group.Stroke, 1991
- Banting lecture 1988. Role of insulin resistance in human diseaseDiabetes, 1988