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(Circulation. 1999;100:123-128.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Insulin Resistance Syndrome Predicts Coronary Heart Disease Events in Elderly Nondiabetic Men
From the Department of Medicine, University of Kuopio, Finland (P.L., L.M., K.P., M.L., J.K.), and the University of Texas Health Science Center at San Antonio (L.M.).
Correspondence to Markku Laakso, MD, Professor and Chair, Department of Medicine, University of Kuopio, PO Box 1777, FIN-70211 Kuopio, Finland. E-mail markku.laakso{at}uku.fi
Background—The role of a cluster of risk factors characteristic for the insulin resistance syndrome as a predictor for coronary heart disease (CHD) has not been studied previously.
Methods and Results—Clustering of cardiovascular risk factors was analyzed by factor analysis to investigate whether these clusters (factors) predict CHD events (CHD death or nonfatal myocardial infarction) in a nondiabetic population of 1069 subjects 65 to 74 years old from eastern Finland followed up for 7 years. There were 151 CHD events (92 for men, 59 for women) during the follow-up period. In men, factor 1 (the insulin resistance factor, which reflected primarily body mass index, waist-to-hip ratio, triglycerides, fasting plasma glucose, and insulin) (hazards ratio [HR] with 95% CI, 1.33, CI 1.08, 1.65, P=0.008), factor 2 (alcohol consumption, high HDL cholesterol, low triglycerides) (HR 0.78, CI 0.63, 0.96, P=0.020), factor 3 (age, systolic blood pressure, urinary albumin/creatinine ratio, left ventricular hypertrophy) (HR 1.52, CI 1.26, 1.83, P<0.001), and factor 4 (high total cholesterol and triglycerides) (HR 1.42, CI 1.15, 1.77, P=0.002) predicted CHD events in multivariate Cox regression analysis. In women, the insulin resistance factor did not predict CHD events (HR 1.06, CI 0.82, 1.36), but factor 2 (previous stroke, low HDL cholesterol and high triglycerides) (HR 1.34, CI 1.06, 1.69, P=0.014) and factor 3 (age, systolic blood pressure, urinary albumin/creatinine ratio, left ventricular hypertrophy) (HR 1.44, CI 1.15, 1.82, P=0.002) predicted CHD events.
Conclusions—Our study supports the notion that the insulin resistance syndrome is a risk factor for CHD in elderly men.
Key Words: insulin • coronary disease
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