Insulin Sensitivity, Insulinemia, and Coronary Artery Disease

Rewers, Marian; Zaccaro, Daniel; D'agostino Jr., Ralph; Haffner, Steven; Saad, Mohammed F.; Selby, Joe V.; Bergman, Richard; Savage, Peter
March 2004
Diabetes Care;Mar2004, Vol. 27 Issue 3, p781
Academic Journal
The aim of this study was to evaluate whether low insulin sensitivity (S1) measured using a modified frequently sampled intravenous glucose tolerance test with minimal model analysis is associated with coronary artery disease (CAD) independent of other cardiovascular risk factors. The odds ratio (OR) for CAD was greatest among individuals in the two lowest quintiles of S1 (2.4, 95% CI 1.0–5.6 and 4.7, 2.1–10.7) compared with the highest S1 quintile. After adjusting for demographic and cardiovascular risk factors, a decrement from the 75th to 25th percentile in S1, was associated with a 56% increase in CAD (P = 0.028). Similar increments in fasting or 2-h insulin levels were associated with, respectively, only 15 (NS) and 3% (NS) increases in CAD. The association between S1, and CAD was partially mediated by insulin, HDL cholesterol and triglyceride levels, hypertension, diabetes, and obesity, but not LDL cholesterol or cigarette smoking. Low S1 is associated with CAD independently of and stronger than plasma insulin levels. Part of the association is accounted for by dyslipidemia, hypertension, diabetes, and obesity.


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