Key result
Among individuals without hypertension, the highest quartile of HOMA-IR was associated with a significantly increased risk of incident cardiovascular disease (HR 2.34; 95% CI 1.15-4.75).
Why the study?
Does insulin resistance increase the risk of incident cardiovascular or coronary heart disease in a Middle Eastern population, and is this modified by hypertension?
Cohort (n=3,777)
Does insulin resistance increase the risk of incident cardiovascular or coronary heart disease in a Middle Eastern population, and is this modified by hypertension?
Hazard Ratio: 2.34 (95% CI 1.15–4.75)
Insulin resistance is an independent risk factor for incident cardiovascular and coronary heart disease specifically in individuals without hypertension, suggesting hypertension modifies this risk.
High HOMA-IR may flag CVD risk in normotensives; leaves open hypertension modification and causality in Middle Eastern cohorts.
AIMS: To examine the independent impacts of the homeostasis model assessment of insulin resistance (HOMA-IR) and the updated model (HOMA2-IR) on incident cardiovascular /coronary heart disease in a Middle Eastern population with a high prevalence of cardiovascular disease risk factors. METHODS: We examined 3777 Iranian people, aged ≥ 30 years, without history of cardiovascular disease and without use of antidiabetic medication at baseline. Both HOMA-IR and HOMA2-IR were log-transformed and categorized into quartiles. The multivariable Cox proportional hazard regression model, adjusted for traditional cardiovascular disease risk factors, was applied to examine the association between HOMA-IR/HOMA2-IR with incident cardiovascular/coronary heart disease, considering the lowest quartile as reference. RESULTS: During a median follow-up of > 10 years, 197 cardiovascular disease and 181 coronary heart disease events occurred. Among the covariates, we found a significant interaction between hypertension and HOMA-IR/HOMA2-IR for incident coronary heart/cardiovascular disease (all P ≤ 0.01). Among the population without hypertension, the risk of cardiovascular disease significantly increased in the second [hazard ratio 1.96 (95% CI 1.04-3.68)], third [hazard ratio 1.93 (95% CI 1.00-3.75)] and fourth [hazard ratio 2.34 (95% CI 1.15-4.75)] quartiles of HOMA-IR, and the risk of coronary heart disease increased significantly in the fourth quartile of HOMA-IR [hazard ratio 2.30 (95% CI 1.12-4.73)], but no significant association was detected between HOMA-IR and cardiovascular/coronary heart disease in the population with hypertension. Among the populations both with and without hypertension, no risk was found to be associated with HOMA2-IR quartiles however, a 1-unit increase in HOMA2-IR was associated with a significant risk of cardiovascular disease among the non-hypertensive group [hazard ratio 1.60 (95% CI 1.03-2.48); P = 0.03]. CONCLUSIONS: The presence of hypertension modified the impact of HOMA-IR/HOMA2-IR on incident cardiovascular/coronary heart disease. The presence of insulin resistance highlighted a significant and independent risk for cardiovascular disease/coronary heart disease only in the population without hypertension.
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Ghoreishian et al. (2015) conducted a cohort in Cardiovascular disease (n=3,777). Insulin resistance (HOMA-IR and HOMA2-IR) vs. Lowest quartile of HOMA-IR/HOMA2-IR was evaluated on Incident cardiovascular disease (HR 2.34, 95% CI 1.15-4.75). Among individuals without hypertension, the highest quartile of HOMA-IR was associated with a significantly increased risk of incident cardiovascular disease (HR 2.34; 95% CI 1.15-4.75).
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