TY - JOUR
T1 - Sex differences in the association between insulin resistance and incident coronary heart disease and stroke among blacks without diabetes mellitus
T2 - The Jackson Heart Study
AU - Effoe, Valery S.
AU - Wagenknecht, Lynne E.
AU - Tcheugui, Justin B.Echouffo
AU - Chen, Haiying
AU - Joseph, Joshua J.
AU - Kalyani, Rita R.
AU - Bell, Ronny A.
AU - Wu, Wen Chih H.
AU - Casanova, Ramon
AU - Bertoni, Alain G.
N1 - Funding Information:
The authors thank the participants and data collection staffof the Jackson Heart Study for their important contributions. JHS Diabetes and Obesity Working Group supported by 1 R01 HL117285-01 from National Heart, Lung, and Blood Institute. The Jackson Heart Study is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268 201300048C, HHSN268201300049C, HHSN2682013000 50C from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.
Publisher Copyright:
© 2017 The Authors.
PY - 2017
Y1 - 2017
N2 - Background-Studies exploring the association between insulin resistance (IR) and cardiovascular disease in blacks have not been conclusive, especially for coronary heart disease (CHD). The McAuley index and homeostasis model assessment of IR (HOMA-IR) perform differently in predicting cardiovascular disease. We investigated this association in the Jackson Heart Study, a large longitudinal cohort of blacks. Methods and Results-IR was estimated for 3565 participants without diabetes mellitus and cardiovascular disease at baseline using the McAuley index and HOMA-IR, and their associations with incident CHD and stroke (composite outcome) were compared. A lower McAuley index and higher HOMA-IR are indicative of IR. Cox regression analysis was used to estimate adjusted hazard ratios for incident CHD and/or stroke. There were 158 events (89 CHD-only, 58 stroke-only, and 11 CHD/stroke) over a median follow-up of 8.4 years. After adjustment for demographic factors, the risk of the composite outcome decreased with each SD increase in the McAuley index (hazard ratio 0.80; 95% CI: 0.67-0.96), with no attenuation after further accounting for CHD and stroke risk factors. When considered individually, McAuley index and HOMA-IR were associated with CHD (hazard ratio 0.71, 95% CI: 0.55-0.92 and hazard ratio 1.33, 95% CI: 1.03-1.72, respectively), but not stroke risk. The logHOMA-IR and CHD association was present in men, but not in women (Pinteraction=0.01). Conclusions-Both HOMA-IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA-IR and CHD association was present in men, but not in women.
AB - Background-Studies exploring the association between insulin resistance (IR) and cardiovascular disease in blacks have not been conclusive, especially for coronary heart disease (CHD). The McAuley index and homeostasis model assessment of IR (HOMA-IR) perform differently in predicting cardiovascular disease. We investigated this association in the Jackson Heart Study, a large longitudinal cohort of blacks. Methods and Results-IR was estimated for 3565 participants without diabetes mellitus and cardiovascular disease at baseline using the McAuley index and HOMA-IR, and their associations with incident CHD and stroke (composite outcome) were compared. A lower McAuley index and higher HOMA-IR are indicative of IR. Cox regression analysis was used to estimate adjusted hazard ratios for incident CHD and/or stroke. There were 158 events (89 CHD-only, 58 stroke-only, and 11 CHD/stroke) over a median follow-up of 8.4 years. After adjustment for demographic factors, the risk of the composite outcome decreased with each SD increase in the McAuley index (hazard ratio 0.80; 95% CI: 0.67-0.96), with no attenuation after further accounting for CHD and stroke risk factors. When considered individually, McAuley index and HOMA-IR were associated with CHD (hazard ratio 0.71, 95% CI: 0.55-0.92 and hazard ratio 1.33, 95% CI: 1.03-1.72, respectively), but not stroke risk. The logHOMA-IR and CHD association was present in men, but not in women (Pinteraction=0.01). Conclusions-Both HOMA-IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA-IR and CHD association was present in men, but not in women.
KW - Blacks
KW - Cardiovascular disease risk factors
KW - Cerebrovascular disease/stroke
KW - Coronary heart disease
KW - Epidemiology
KW - Insulin resistance
KW - Myocardial infarction
KW - Stroke
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U2 - 10.1161/JAHA.116.004229
DO - 10.1161/JAHA.116.004229
M3 - Article
C2 - 28154164
AN - SCOPUS:85016032738
SN - 2047-9980
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - e004229
ER -