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 Presentation

"Diabetes and CHD : Inflammation in Insulin Resistance (Academic and community specialists)"

Prof. Steven M. Haffner (biography)
English - 2002-04-11 - 47 minutes
(40 slides)

Summary :
Studies have shown a positive relationship between HbA1c and CHD. The pre-diabetic state may hold some clues as to how this correlation manifests itself. Some population subsets have a higher predisposition to insulin resistance. These people have worse cardiovascular risk factors than people who become diabetic due to low insulin secretion. Different diabetic medications also have different effects on the progression of CHD: for example, insulin sensitizers may have superior effects in the prevention of CVD than do insulin secretagogues. Inflammatory markers such as CRP and PAI-1 have not only been found to be predictors of CHD, but they also correlate with some type 2 diabetes parameters, which are outlined here.

More information is available about C-Reactive Protein.

Learning objectives :
Upon this presentation, the participant should:
- learn the magnitude of the relationship of diabetes to coronary heart disease
- review the relationship of glycemia and insulin resistance to coronary heart disease
- review blood pressure and lipid lowering in diabetes

Bibliographic references :
Homeostasis model assessment of insulin resistance in relation to the incidence of cardiovascular disease: the san antonio heart study.

Hanley AJ, Williams K, Stern MP, Haffner SM.

Division of Clinical Epidemiology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas. Division of Epidemiology and Biostatistics, Samuel Lunenfeld Research Institute, Mt. Sinai Hospital, Toronto, Ontario.

OBJECTIVE-The prospective association between insulin levels and risk of cardiovascular disease (CVD) is controversial. The objective of the present study was to investigate the relationship of the homeostasis model assessment of insulin resistance (HOMA-IR), as well as insulin levels, with risk of nonfatal and fatal CVD over the 8-year follow-up of the San Antonio Heart Study. RESEARCH DESIGN AND METHODS-Between 1984 and 1988, randomly selected Mexican-American and non-Hispanic white residents of San Antonio participated in baseline examinations that included fasting blood samples for glucose, insulin, and lipids, a glucose tolerance test, anthropometric measurements, and a lifestyle questionnaire. Between 1991 and 1996, 2,569 subjects who were free of diabetes at baseline were reexamined using the same protocol.
RESULTS-Over the follow-up period, 187 subjects experienced an incident cardiovascular event (heart attack, stroke, heart surgery, angina, or CVD death). Logistic regression analysis indicated that risk of a CVD event increased across quintiles of HOMA-IR after adjustment for age, sex, and ethnicity (P for trend <0.0001; quintile 5 vs. quintile 1, odds ratio [OR] 2.52, 95% CI 1.46-4.36). Additional adjustment for LDL, triglyceride, HDL, systolic blood pressure, smoking, alcohol consumption, exercise, and waist circumference only modestly reduced the magnitude of these associations (P for trend 0.02; quintile 5 vs. quintile 1, OR 1.94, 95% CI 1.05-3.59). Furthermore, there were no significant interactions between HOMA-IR and ethnicity, sex, hypertension, dyslipidemia, glucose tolerance (impaired glucose tolerance versus normal glucose tolerance), or obesity. The magnitude and direction of the relationship between insulin concentration and incident CVD were similar.
CONCLUSIONS-We found a significant association between HOMA-IR and risk of CVD after adjustment for multiple covariates. The topic remains controversial, however, and additional studies are required, particularly among women and minority populations.

Diabetes Care 2002 Jul;25(7):1177-84


   


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