Insulin Resistance, Metabolic Syndrome, and Subclinical Atherosclerosis: The MultiEthnic Study of Atherosclerosis (MESA) (original) (raw)
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Multi-Ethnic Study of Atherosclerosis: Objectives and Design Downloaded from
The Multi-Ethnic Study of Atherosclerosis was initiated in July 2000 to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease (CVD) in a population-based sample of 6,500 men and women aged 45-84 years. The cohort will be selected from six US field centers. Approximately 38% of the cohort will be White, 28% African-American, 23% Hispanic, and 11% Asian (of Chinese descent). Baseline measurements will include measurement of coronary calcium using computed tomography; measurement of ventricular mass and function using cardiac magnetic resonance imaging; measurement of flow-mediated brachial artery endothelial vasodilation, carotid intimal-medial wall thickness, and distensibility of the carotid arteries using ultrasonography; measurement of peripheral vascular disease using ankle and brachial blood pressures; electrocardiography; and assessments of microalbuminuria, standard CVD risk factors, sociodemographic factors, life habits, and psychosocial factors. Blood samples will be assayed for putative biochemical risk factors and stored for use in nested case-control studies. DNA will be extracted and lymphocytes will be immortalized for genetic studies. Measurement of selected subclinical disease indicators and risk factors will be repeated for the study of progression over 7 years. Participants will be followed through 2008 for identification and characterization of CVD events, including acute myocardial infarction and other coronary heart disease, stroke, peripheral vascular disease, and congestive heart failure; therapeutic interventions for CVD; and mortality. cardiovascular diseases; cardiovascular system; cohort studies; coronary disease; epidemiologic methods; prospective studies Abbreviations: CVD, cardiovascular disease; MESA, Multi-Ethnic Study of Atherosclerosis.
Frontiers in Cardiovascular Medicine, 2014
The study aimed to provide new evidence of health disparities in cardiovascular disease (CVD) and diabetes mellitus (DM), and to examine their associations with lifestyle-related risk factors across the U.S. multi-racial and ethnic groups. Methods: The analysis included a randomized population sample of 68,321 subjects aged ≥18 years old who participated in the U.S. 2012 and 2013 National Health Interview Surveys. Hypertension, coronary heart disease (CHD), stroke, and DM were classified according to participants' self-report of physician diagnosis. Assessments of risk factors were measured using standard survey instruments. Associations of risk factors with hypertension, CHD, stroke, and DM were analyzed using univariable and multivariable analysis methods. Results: Non-Hispanic (NH)-Blacks had significantly higher odds of hypertension, while Hispanics had significantly lower odds of hypertension, and NH-Asians and Hispanics had significantly lower odds of stroke than NH-Whites (p < 0.001). All minority groups, NH-Blacks, NH-Asians, and Hispanics had significantly higher odds of DM, but they had significantly lower odds of CHD than NH-Whites (p < 0.001). Increased body weight, cigarette smoking, and physical inactivity were significantly associated with increased odds of hypertension, CHD, stroke, and DM (p < 0.001). However, the strengths of associations between lifestyle-related factors and the study outcomes were different across racial and ethnic groups. NH-Asians with BMI ≥30 kg/m 2 had the highest odds ratios (OR, 95% CI) for hypertension (5.37, 4.01-7.18), CHD (2.93, 1.90-4.52), and stroke (2.23, 1.08-4.61), and had the second highest odd ratios for DM (3.78, 2.68-5.35) than NH-Whites, NH-Blacks, and Hispanics. Conclusion: CVD and DM disproportionately affect the U.S. multi-racial and ethnic population. Although lifestyle-related risk factors are significantly associated with increased odds of CVD and DM, the magnitudes of these associations are different by race and ethnicity.
The metabolic syndrome, diabetes, and subclinicalatherosclerosis assessed by coronary calcium
Journal of the American College of Cardiology, 2003
Carotid intima-media thickness (IMT) is a useful surrogate marker of cardiovascular disease and is associated with cardiac events. We investigated cross-sectionally the association between carotid intima-media thickness (IMT), confounding risk factors, and metabolic syndrome (MetS) using the modified Japanese criteria. Methods: Carotid IMT was evaluated on B-mode ultrasonography in 918 patients (394 men aged 66 15 years and 524 women aged 72 13 years). Results: Among our 918 patients, 74 (8.1%) had no metabolic abnormalities, 478 (52.1%) had a metabolic abnormality with neither type 2 diabetes or MetS, and 127 had MetS without diabetes. Of the patients with type 2 diabetes, 132 (14.4%) did not have MetS and 107 (11.7%) had both type 2 diabetes and MetS. The carotid IMT values in the four groups with any metabolic abnormalities were significantly greater than the IMT of the group with neither condition (p 0.001), respectively. In syndrome model, type 2 diabetes was significantly associated with carotid atherosclerosis (p 0.006), but MetS was borderline significant. In the component model of MetS, there was a significant association with hypertension (p 0.001) and dyslipidemia (p 0.006). Multiple logistic regression analysis for carotid atherosclerosis compared to neither condition demonstrated that subjects with both MetS and diabetes (OR, 5.58; 95% CI, 2.64-11.8), those with type 2 diabetes without MetS (OR, 3.00; 95% CI, 1.45-6.22), and those with MetS without type 2 diabetes (OR, 2.58; 75% CI, 1.24-5.39) showed a higher odds ratio after adjustment for covariates. Conclusion: Even after taking into account each individual component of MetS, the clustering of visceral obesity with at least 2 of the 3 components, and diabetes are independently associated with increased carotid IMT. This suggests that the components of MetS and type 2 diabetes interact to affect vascular thickness synergistically.
Diabetes Care, 2007
OBJECTIVE-The purpose of this study was to evaluate whether insulin resistance is associated to cardiovascular disease (CVD) and to understand whether this association can be explained by traditional and novel CVD risk factors associated with this metabolic disorder. RESEARCH DESIGN AND METHODS-We examined a sample representative of the population of Bruneck, Italy (n ϭ 919; aged 40-79 years). Insulin-resistant subjects were those with a score in the top quartile of the homeostasis model assessment (HOMA) for insulin resistance (HOMA-IR). Risk factors correlated with insulin resistance included BMI, A1C, HDL cholesterol, triglycerides, blood pressure, high-sensitivity C-reactive protein (hsCRP), fibrinogen, oxidized LDL, vascular cell adhesion molecule-1 (VCAM-1), and adiponectin. Subjects without CVD at baseline were followed up for 15 years for incident CVD, a composite end point including fatal and nonfatal myocardial infarction and stroke, transient ischemic attack, and any revascularization procedure. RESULTS-During follow-up, 118 subjects experienced a first symptomatic CVD event. Levels of HOMA-IR were higher at baseline among subjects who developed CVD (2.8) compared with those remaining free of CVD (2.5) (P Ͻ 0.05). Levels of HOMA-IR also were significantly correlated (P Ͻ 0.05) with most CVD risk factors we evaluated. In Cox proportional hazard models, insulin-resistant subjects had an age-, sex-, and smoking-adjusted 2.1-fold increased risk (95% CI 1.3-3.1) of incident symptomatic CVD relative to non-insulin-resistant subjects. After sequential adjustment for physical activity and classic risk factors (A1C, LDL cholesterol, and hypertension) as well as BMI, HDL cholesterol, triglycerides, and novel risk factors, including fibrinogen, oxidized LDL, hsCRP, VCAM-1, and adiponectin, the association between HOMA-IR and incident CVD remained significant and virtually unchanged (hazard ratio 2.2 [95% CI 1.4-3.6], P Ͻ 0.001). CONCLUSIONS-HOMA-estimated insulin resistance is associated with subsequent symptomatic CVD in the general population independently of all classic and several nontradi-tional risk factors. These data suggest that insulin resistance may be an important target to reduce CVD risk.
Journal of the American Heart Association, 2017
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. 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...
American Journal of Roentgenology, 2006
OBJECTIVE. MRI provides accurate and high-resolution measurements of cardiac anatomy and function. The purpose of this study was to describe the imaging protocol and normal values of left ventricular (LV) function and mass in the Multi-Ethnic Study of Atherosclerosis (MESA). SUBJECTS AND METHODS. Eight hundred participants (400 men, 400 women) in four age strata (45-54, 55-64, 65-74, 75-84 years) were chosen at random. Participants with the following known cardiovascular risk factors were excluded: current smoker, systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, fasting glucose > 110 mg/dL, total cholesterol > 240 mg/dL, and high-density lipoprotein (HDL) cholesterol < 40 mg/dL. Cardiac MR images were analyzed using MASS software (version 4.2). Mean values, SDs, and correlation coefficients in relationship to patient age were calculated. RESULTS. There were significant differences in LV volumes and mass between men and women. LV volumes were inversely associated with age (p < 0.05) for both sexes except for the LV end-systolic volume index. For men, LV mass was inversely associated with age (slope = − 0.72 g/year, p = 0.0021), but LV mass index was not associated with age (slope = −0.179 g/m 2 /year, p = 0.075). For women, LV mass (slope = −0.15 g/year, p = 0.30) and LV mass index (slope = 0.0044 g/m 2 /year, p = 0.95) were not associated with age. LV mass was the largest in the African-American group (men, 181.6 ± 35.8 [SD] g; women, 128.8 ± 28.1 g) and was smallest in the Asian-American group (men, 129.1 ± 20.0 g; women, 89.4 ± 13.3 g). CONCLUSION. The normal LV differs in volume and mass between sexes and among certain ethnic groups. When indexed by body surface area, LV mass was independent of age for both sexes. Studies that assess cardiovascular risk factors in relationship to cardiac function and structure need to account for these normal variations in the population.