Insulin Resistance, Metabolic Syndrome, and Subclinical Atherosclerosis

The Multi-Ethnic Study of Atherosclerosis (MESA)

  1. Alain G. Bertoni, MD, MPH1,
  2. Nathan D. Wong, PHD2,
  3. Steven Shea, MD3,
  4. Shuangge Ma, PHD4,
  5. Kiang Liu, PHD5,
  6. Srikanthan Preethi, MBBS6,
  7. David R. Jacobs, Jr, PHD7,
  8. Colin Wu, PHD8,
  9. Mohammed F. Saad, MD, MRCP9 and
  10. Moyses Szklo, MD10
  1. 1Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, North Carolina
  2. 2Division of Cardiology, University of California, Irvine, California
  3. 3Departments of Medicine and Epidemiology, Columbia University, New York, New York
  4. 4Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
  5. 5Department of Preventive Medicine, Northwestern University, Evanston, Illinois
  6. 6Division of Epidemiology and Preventative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
  7. 7Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota
  8. 8National Heart, Lung, and Blood Institute, Bethesda, Maryland
  9. 9Graduate Program in Public Health, State University of New York at Stonybrook, Stonybrook, New York
  10. 10Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  1. Address correspondence and reprint requests to Dr. Bertoni, Public Health Sciences, Medical Center Blvd., Winston-Salem, NC 27157. E-mail: abertoni{at}wfubmc.edu

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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 17 August 2007. DOI: 10.2337/dc07-1042.

    N.D.W. has received honoraria from Takeda and Sanofi-Aventis.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted August 9, 2007.
    • Received June 1, 2007.
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  1. Published online before print August 17, 2007, doi: 10.2337/dc07-1042 Diabetes Care November 2007 vol. 30 no. 11 2951-2956
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