Insulin
Resistance Is a Predictor of CVD in Type 2 Diabetic Subjects
Prospective
data from the Verona Diabetes Complications Study
The
object of the study was to evaluate whether homeostasis model
assessment-estimated insulin resistance (HOMA-IR) is an
independent predictor of cardiovascular disease (CVD) in
type 2 diabetes.
Conventional
CVD risk factors (sex, age, smoking, plasma lipids, blood
pressure, and metabolic control) and insulin resistance
(estimated by HOMA) were evaluated at baseline in 1,326
patients with type 2 diabetes examined within the Verona
Diabetes Complications Study. At baseline and after a mean
follow-up of 4.5 years, CVD was assessed by medical
history, physical examination, electrocardiography, and
echo-Doppler of carotid and lower limb arteries. Death certificates
and medical records of subjects who died during the follow-up
were carefully scrutinized to identify cardiovascular deaths.
In statistical analyses, CVD was an aggregate end point
including both fatal and nonfatal coronary, cerebrovascular,
and peripheral vascular disease as well as ischemic
electrocardiographic abnormalities and vascular lesions
identified by echo-Doppler.
The
results showed that at baseline, 441 subjects were coded positive
for CVD (prevalent cases). Incident cases numbered 126. Multiple
logistic regression analyses showed that, along with sex, age,
smoking, HDL/total cholesterol ratio, and hypertension, HOMA-IR
was an independent predictor of both prevalent and incident
CVD. A 1-unit increase in (log)HOMA-IR value was associated
with an odds ratio for prevalent CVD at baseline of 1.31 (95%
CI 1.10–1.56, P = 0.002) and for incident CVD during
follow-up of 1.56 (95% CI 1.14–2.12, P <
0.001).
From
the results of the study it was concluded that HOMA-IR is an
independent predictor of CVD in type 2 diabetes. The
improvement of insulin resistance might have beneficial
effects not only on glucose control but also on CVD in
patients with type 2 diabetes.
From
the Endocrinology and Metabolic Diseases, University of Verona Medical
School, Verona, Italy Diabetes Care 25:1135-1141, 2002
