American Journal of Epidemiology Vol. 148, No. 9: 869-878
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
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Risk Factor Clustering in the Insulin Resistance Syndrome
The Strong Heart Study
1Medlantic Research Institute Washington, DC
2National Heart, Lung, and Blood Institute Bethesda, MD
3Department of Biostatistics and Epidemiology, University of Oklahoma Oklahoma City, OK
Reprint requests to Dr. Barbara V. Howard, Medlantic Research Institute, 108 Irving Street, N.W., Washington, DC 20010-2933.
The objective of this study was to examine how the major components of the insulin resistance syndrome relate to each other and to macrovascular disease in American Indians in the Strong Heart Study. The study cohort (4, 228 resident tribal members 45–74 years old) underwent a personal interview and a physical examination between July 1989 and January 1992 at three centers: Arizona, Oklahoma, and North and South Dakota; blood samples were drawn and a 75-g oral glucose tolerance test was performed. Factor analysis was used to assess the clustering and interdependence of groups of insulin resistance syndrome variables. Within both diabetic and nondiabetic groups, three factors emerged. In nondiabetic participants, a cluster of glucose, body mass index, and insulin accounted for 35% (male) and 32% (female) of the total variance in all variables considered, and a cluster of systolic blood pressure and diastolic blood pressure accounted for 25% and 22% in men and women, respectively. Both clusters were positively associated with coronary heart disease but not peripheral vascular disease. In diabetic participants, the combination of systolic and diastolic blood pressures was the most important factor, but the cluster was not associated with coronary heart disease or peripheral vascular disease. A component containing high density lipoprotein cholesterol, triglycerides, and glucose had a positive association with coronary heart disease in diabetic women and with peripheral vascular disease in both sexes. The association of clusters of risk factors and their relations with coronary heart disease provide important clues that may be used in understanding the metabolic disorders associated with insulin resistance and diabetes. Am J Epidemiol 1998; 148: 869–78.
coronary disease; factor analysis; statistical; Indians; North American; insulin resistance
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