Insulin resistance and risk of incident cardiovascular events in adults without diabetes: meta-analysis

• Published in: PloS one Vol. 7; no. 12; p. e52036
• Main Authors: Gast, Karin B, Tjeerdema, Nathanja, Stijnen, Theo, Smit, Johannes W A, Dekkers, Olaf M
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28-12-2012; Public Library of Science (PLoS)
• Subjects: Adult; Adults; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - etiology; Case-Control Studies; Controlled vocabularies; Coronary artery disease; Coronary heart disease; Diabetes mellitus; Diabetes Mellitus, Type 2; Diabetes therapy; Fasting; Glucose; Health risk assessment; Health risks; Heart; Heart diseases; Homeostasis; Humans; Hypoglycemic agents; Infrared radiation; Insulin; Insulin Resistance; Laboratory testing; Lists; Low concentrations; Mathematical models; Medicine; Meta-analysis; Risk analysis; Risk assessment; Risk Factors; Standard deviation; Stroke; Systematic review; Type 2 diabetes; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0052036

Glucose, insulin and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) are markers of insulin resistance. The objective of this study is to compare fasting glucose, fasting insulin concentrations and HOMA-IR in strength of association with incident cardiovascular disease.
We searched the PubMed, MEDLINE, EMBASE, Web of Science, ScienceDirect and Cochrane Library databases from inception to March, 2011, and screened reference lists. Cohort studies or nested case-control studies that investigated the association between fasting glucose, fasting insulin or HOMA-IR and incident cardiovascular disease, were eligible. Two investigators independently performed the article selection, data extraction and risk of bias assessment. Cardiovascular endpoints were coronary heart disease (CHD), stroke or combined cardiovascular disease. We used fixed and random-effect meta-analyses to calculate the pooled relative risk for CHD, stroke and combined cardiovascular disease, comparing high to low concentrations of glucose, insulin or HOMA-IR. Study heterogeneity was calculated with the I(2) statistic. To enable a comparison between cardiovascular disease risks for glucose, insulin and HOMA-IR, we calculated pooled relative risks per increase of one standard deviation.
We included 65 studies (involving 516,325 participants) in this meta-analysis. In a random-effect meta-analysis the pooled relative risk of CHD (95% CI; I(2)) comparing high to low concentrations was 1.52 (1.31, 1.76; 62.4%) for glucose, 1.12 (0.92, 1.37; 41.0%) for insulin and 1.64 (1.35, 2.00; 0%) for HOMA-IR. The pooled relative risk of CHD per one standard deviation increase was 1.21 (1.13, 1.30; 64.9%) for glucose, 1.04 (0.96, 1.12; 43.0%) for insulin and 1.46 (1.26, 1.69; 0.0%) for HOMA-IR.
The relative risk of cardiovascular disease was higher for an increase of one standard deviation in HOMA-IR compared to an increase of one standard deviation in fasting glucose or fasting insulin concentration. It may be useful to add HOMA-IR to a cardiovascular risk prediction model.