American Journal of Epidemiology Vol. 146, No. 4: 315-321
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
Low Insulin Sensitivity is Associated with Clustering of Cardiovascular Disease Risk Factors
1Department of Medicine, University of Kuopio Kuopio, Finland
2Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio San Antonio, TX
3Research and Development Center of the Social Insurance Institution Turku, Finland
4Department of Medicine, University of Turku Turku, Finland
5Department of Physiology and Biophysics, University of Southern California Los Angeles, CA
Reprint requests to Dr. Leena Mykkänen, Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7873
Hyperinsulinemia is associated with multiple metabolic disorders including high triglyceride level, low high density lipoprotein (HDL) cholesterol level, hypertension, and impaired glucose tolerance (IGT). This metabolic constellation is also called the insulin resistance syndrome. All previous data on clustering of these risk factors are, however, based on insulin levels. Therefore, the authors examined the association of insulin sensitivity estimated by means of a frequently sampled intravenous glucose tolerance test and the minimal model with the number of metabolic disorders (dyslipidemia [high triglyceride level or low HDL cholesterol level or both], hypertension, and IGT according to the World Health Organization criteria). Of 153 nondiabetic subjects aged 53–61 years who had participated in a previous population-based study, 79 had no disorders, 55 had one disorder, 16 had two disorders, and 3 had three disorders. Insulin sensitivity index (S1) decreased with the increasing number of disorders (4.1, 3.5, 1.8, and 1.4x10–4 min–1 µU–1 mL–1, in subjects with 0, 1, 2, and 3 disorders, respectively; p<0.001 for trend). Similarly, fasting (7.5, 7.8, 15.3, and 22.0 µU/mL; p<0.001) and 2-hour insulin levels (39.9, 49.0, 98.7, and 149.6 µU/mL; p<0.001) increased by the increasing number of disorders. The relations of S1 and fasting and 2-hour insulin levels with multiple metabolic disorders were independent of sex, obesity, and body fat distribution. Furthermore, these associations were similar in men and women and in lean and obese subjects. The authors conclude that a clustering of cardiovascular disease risk factors in nondiabetic subjects is not only associated with hyperinsulinemia but also with insulin resistance. Am J Epidemiol 1997;146:315-21.
blood glucose; glucose intolerance; glucose tolerance test; hypertension; insulin resistance; lipoproteins, HDL cholesterol; triglycerides
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