(Circulation. 2000;101:975.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Insulin-Resistant Prediabetic Subjects Have More Atherogenic Risk Factors Than Insulin-Sensitive Prediabetic Subjects
Implications for Preventing Coronary Heart Disease During the Prediabetic State
From the Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio.
Background—Subjects who convert to type 2 diabetes mellitus have increased cardiovascular risk factors relative to nonconverters. However, it is not known whether these atherogenic changes in the prediabetic state are predominantly due to insulin resistance, decreased insulin secretion, or both.
Methods and Results—We examined this issue in the 7-year
follow-up of the San Antonio Heart Study, in which 195 of 1734 subjects
converted to type 2 diabetes. At baseline, converters had significantly
higher body mass index, waist circumference, triglyceride
concentration, and blood pressure and lower HDL cholesterol
than nonconverters. Atherogenic changes in converters were markedly
attenuated (and no longer significant) after adjustment for the
homeostasis model assessment of insulin resistance (HOMA IR, a
surrogate for insulin resistance); in contrast, the differences in risk
factors between converters and nonconverters increased after adjustment
for the ratio of early insulin increment to early glucose increment
(
I30-0/G30-0) during an oral glucose
tolerance test (a surrogate for insulin secretion). We also compared
converters who had a predominant insulin resistance (high HOMA IR and
high I30-0/G30-0) (n=56) and converters
who had a predominant decrease in insulin secretion (low HOMA IR and
low I30-0/G30-0) (n=31) with
nonconverters (n=1539). Only the converters who were insulin
resistant had higher blood pressure and
triglyceride levels and lower HDL cholesterol
levels than nonconverters.
Conclusions—Our data suggest that atherogenic changes in the prediabetic state are mainly seen in insulin-resistant subjects and that strategies to prevent type 2 diabetes might focus on insulin-sensitizing interventions rather than interventions that increase insulin secretion because of potential effects on cardiovascular risk.
Key Words: insulin • diabetes mellitus • lipids • cholesterol • blood pressure
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