Lower insulin sensitivity as an independent risk factor for carotid wall thickening in normotensive, non-diabetic, non-smoking normal weight and obese premenopausal women (original) (raw)
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Arteriosclerosis, Thrombosis, and Vascular Biology, 2013
Objective— Despite a wealth of experimental data in animal models, the independent association of insulin resistance with early carotid atherosclerosis in man has not been demonstrated. Approach and Results— We studied a European cohort of 525 men and 655 women (mean age, 44±8 years) free of conditions known to affect carotid wall (diabetes mellitus, hypertension, and dyslipidemia). All subjects received an oral glucose tolerance test, a euglycemic hyperinsulinemic clamp (M/I as a measure of insulin sensitivity), and B-mode carotid ultrasound. In 833 participants (380 men), the carotid ultrasound was repeated after 3 years. In men, baseline intima-media thickness in the common carotid artery (CCA-IMT) was significantly higher ( P <0.05) in the lowest M/I tertile, whereas in women CCA-IMT was higher ( P <0.0005) in the highest fasting plasma glucose tertile (after adjustment for established risk factors). In multiple regression models, with CCA-IMT as the dependent variable and...
Journal of Internal Medicine, 2001
Bokemark L, Wikstrand J, Attvall S, Hulthe J, Wedel H, Fagerberg B (Sahlgrenska University Hospital, and the Nordic School of Public Health, Go Èteborg, Sweden). Insulin resistance and intima± media thickness in the carotid and femoral arteries of clinically healthy 58-year-old men. The Atherosclerosis and Insulin Resistance Study (AIR). J Intern Med 2001; 249: 59±67. P , 0.05), log triglycerides (r = 0.28, P , 0.01), apoA 1 (r = 2 0.20, P , 0.05), apoB (r = 0.21, P , 0.05), LDL particle size (r = 2 0.22, P , 0.05) and plasma insulin (r = 0.20, P , 0.05). In a multiple regression, common carotid IMT was independently associated with log triglycerides (b = 0.25, P = 0.012) and pulse pressure (b = 0.21, P = 0.031) (R 2 = 8.7%, P = 0.005) Conclusions. Insulin sensitivity, measured with the gold standard euglycaemic hyperinsulinaemic clamp method, showed similar associations with ultrasound-assessed measures of atherosclerosis in the carotid arteries as established cardiovascular risk factors, but only triglycerides and pulse pressure contributed independently to the variability in the common carotid intima±media thickness.
Diabetes/Metabolism Research and Reviews, 2001
Objective Atherosclerosis is associated with insulin resistance (IR) and dyslipidaemia. Impaired glucose tolerance (IGT) is characterised by IR and is associated with a higher risk of atherosclerosis. The objective of the present study was to test whether early atherosclerosis indicated by intimal medial thickness (IMT) of common carotid artery (CCA) and internal carotid artery (ICA) is higher in IGT than in normoglycaemic subjects (NGT) and to look for an association of IMT with IR and dyslipidaemia.
1997
The aim of this study was 1) to compare intimal-medial thickness (IMT) of the carotid artery in nondiabetic and NIDDM patients and 2) to evaluate the association of this early marker of atherosclerosis with several cardiovascular risk factors, including plasma insulin and insulin resistance. RESEARCH DESIGN A N D METHODS-A total of 58 nondiabetic and 56 NIDDM patients, randomly selected among those attending the outpatient Diabetes Clinic or the Clinic for Internal Medicine were examined. BM1, waist-to-hip ratio (WHR), blood pressure, glycohemoglobin (HbA lc), and fasting concentrations of plasma glucose, serum lipids (total and HDL cholesterol, triglycerides), and serum insulin were measured. Insulin resistance was assessed by computing glucose disappearance rate from plasma after intravenous insulin injection (K Ut). IMT of the carotid artery was measured by ultrasonography. RESULTS-IMT was significantly higher in diabetic patients, and the difference remained highly significant after adjusting for sex, age, BMI, WHR, presence of hypertension and dyslipidemia, and smoking status (1.39 vs. 1.24 mm, common SD 0.12, P < 0.001). Univariate regression analyses showed that IMT was negatively correlated with K itt in either nondiabetic (r =-0.348, P < 0.01) or diabetic patients (r =-0.492, P < 0.001). However, multiple regression analyses showed that IMT was independently associated with age and WHR in nondiabetic subjects, whereas in diabetic patients, IMT was independently predicted by K itt and hypertension. These two variables explained-62% and ~35% of the variability of IMT in nondiabetic and diabetic patients, respectively. Plasma insulin was not independently associated with IMT in either groups. CONCLUSIONS-These results indicate that I) diabetes is characterized by a greater thickness of the carotid artery independently of other established risk factor of atherosclerosis, 2) early atherosclerosis is independently associated with insulin resistance in diabetic but not in nondiabetic patients, 3) central adiposity is an independent predictor of IMT in nondiabetic individuals. A bout 15 years ago epidemiological prospective studies (Paris Prospective Study, Busselton Study, and Helsinki Policemen Study) reported that hyperinsulinemia can predict coronary heart disease, independently of the presence of diabetes, dyslipidemia, and hypertension (1-3). Despite several inconsistencies within and between these studies, especially in extended follow-up examinations (4-7), From the Division of Metabolic Diseases (E.
Insulin Sensitivity and Carotid Intima-Media Thickness
Arteriosclerosis, Thrombosis, and Vascular Biology, 2013
Objective— Despite a wealth of experimental data in animal models, the independent association of insulin resistance with early carotid atherosclerosis in man has not been demonstrated. Approach and Results— We studied a European cohort of 525 men and 655 women (mean age, 44±8 years) free of conditions known to affect carotid wall (diabetes mellitus, hypertension, and dyslipidemia). All subjects received an oral glucose tolerance test, a euglycemic hyperinsulinemic clamp (M/I as a measure of insulin sensitivity), and B-mode carotid ultrasound. In 833 participants (380 men), the carotid ultrasound was repeated after 3 years. In men, baseline intima-media thickness in the common carotid artery (CCA-IMT) was significantly higher ( P <0.05) in the lowest M/I tertile, whereas in women CCA-IMT was higher ( P <0.0005) in the highest fasting plasma glucose tertile (after adjustment for established risk factors). In multiple regression models, with CCA-IMT as the dependent variable and...
Atherosclerosis, 2003
Most previous studies of associations between insulin sensitivity and common carotid artery (CCA) atherosclerosis have been conducted in small samples, have not used direct measurement of insulin sensitivity, and have yielded inconclusive results. We investigated associations of CCA intima-media thickness (IMT) and diameter (CCA-D) measured by B-mode ultrasound and insulin sensitivity measured by the euglycemic hyperinsulinemic clamp test together with risk factors of the insulin resistance syndrome in a community-based sample of 493 elderly men. The clamp glucose disposal rate was an independent predictor of CCA-IMT in multivariate models adjusting for blood pressure, smoking, serum cholesterol, and body mass index (1% decrease in CCA-IMT for a 1 unit increase in glucose disposal rate, P0/0.009). Glucose disposal rate was significantly related to CCA-D in univariate (r 0/(/0.11, P 0/0.02) but not in multivariate models. In conclusion, this study is the first to establish impaired insulin sensitivity, measured by the euglycemic hyperinsulinemic clamp test, as an independent predictor of CCA-IMT in a population-based sample of elderly men. #
Diabetes and Progression of Carotid Atherosclerosis: The Insulin Resistance Atherosclerosis Study
Arteriosclerosis, Thrombosis, and Vascular Biology, 2003
Objective-We sought to determine the rate of progression of carotid atherosclerosis in persons with normal glucose tolerance, impaired glucose tolerance, and undiagnosed and diagnosed type 2 diabetes. Methods and Results-The Insulin Resistance Atherosclerosis Study (IRAS) is an observational cohort study in which 1192 men and women were examined at a 5-year interval. Participants of 3 ethnic groups (non-Hispanic white, African American, and Hispanic) were selected from the general population to represent a range of glucose tolerance. Baseline and follow-up ultrasound studies were obtained to estimate progression of common carotid artery (CCA) and internal carotid artery (ICA) intimal-medial thickness (IMT). Baseline glucose tolerance status was defined by an oral glucose tolerance test and World Health Organization criteria. In persons with normal glucose tolerance, progression of CCA IMT was 3.8 m/y, and ICA IMT, 17.7 m/y. In both CCA and ICA, progression of IMT, unadjusted for cardiovascular disease (CVD) risk factors, was approximately twice the rate in persons with diabetes than in those with normal or impaired glucose tolerance. Adjustment for CVD risk factors attenuated these differences somewhat in both sites of the carotid artery. Persons with undiagnosed diabetes had a greater ICA IMT progression rate than did persons with diagnosed diabetes (33.9 m/y vs 26.6 m/y, PϭNS). Progression rates did not differ between persons with normal and impaired glucose tolerance.
The Insulin Resistance Atherosclerosis Study (IRAS)
Annals of Epidemiology, 1995
The brsulin Resistance Achero&rosis Study (IRS) is the first epidemiologic study designed to assess the relationships between insulin resistance, insulinemia, glycemia, other components of the insulin resistance syndrome, and prevalent cardiwascular disease (CVD) in a large multiethnic cohort. Over I 600 men and women were recruited from four geographic areas to represent a range of glucose tolerance (normal, impaired, and diabetic) and ethnic@ (hispanic, non-Hispanic white, and African-American). Insulin resistance was assessed directly using the frequently sampled intravenous glucose tolerance test with minimal model analysis. lntimal-medial carotid artery wall thickness, an indicator ofathero sclerosis, was measured using &mode ultrasonography. Prevalent CVD was assessed by questionnaire and resting electrocardiography. This report describes the design of the study and provides the recruitment results. Forthcoming cross-sectional analyses will help to disentangle the association between insulin resistance and CVD, apart from the concomitant hyperinsulinemia and related CVD risk factors. Ann Epidemiol 1995;5:464-472.