Contrasting associations of insulin resistance with diabetes, cardiovascular disease and all-cause mortality in the elderly: PROSPER long-term follow-up

Welsh, P. et al. (2014) Contrasting associations of insulin resistance with diabetes, cardiovascular disease and all-cause mortality in the elderly: PROSPER long-term follow-up. Diabetologia, 57(12), pp. 2513-2520. (doi:10.1007/s00125-014-3383-9) (PMID:25264116)

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Abstract

<i>Aims/hypothesis</i> Insulin resistance is commonly proposed as a precursor to both type 2 diabetes and cardiovascular disease (CVD), yet few studies have directly compared insulin resistance with both outcomes simultaneously and determined whether associations with each outcome differ in strength or are comparable. We assessed the association of fasting insulin and HOMA-IR with incident CVD and diabetes in older people.<p></p> <i>Methods</i> In the long-term follow-up of the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) cohort, HOMA-IR measurement was available in 4,742 older people (70–82 years) without diabetes at baseline. Of these, 283 developed diabetes during the 3.2 year within-trial follow-up, while 1,943 all-cause deaths, 470 CHD deaths (identified from death records) and 590 fatal/non-fatal CVD events (identified from medical record linkage in the Scottish participants) occurred during an extended 8.6 years of total follow-up. Cause-specific Cox proportional-hazards models were fitted using multivariable models.<p></p> <i>Results</i> Higher HOMA-IR was associated with incident diabetes: HR 4.80 (95% CI 3.14, 7.33) comparing extreme thirds after adjustment for confounders. However, HOMA-IR in the top third was not associated with all-cause mortality, CHD mortality or fatal/non-fatal CVD: HR 1.02 (95% CI 0.90, 1.17), 1.03 (0.79, 1.36) and 0.94 (0.74, 1.20), respectively. Results were similar when fasting insulin was considered as an exposure.<p></p> <i>Conclusions/interpretation</i> Our data support insulin resistance as a predictor of diabetes in later life but, perhaps surprisingly, suggest this pathway is of negligible importance to CVD outcomes in the elderly.<p></p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Preiss, Dr David and Welsh, Dr Paul and Briggs, Professor Andrew and Stott, Professor David J and Sattar, Professor Naveed and Ford, Professor Ian and Lloyd, Miss Suzanne
Authors: Welsh, P., Preiss, D., Lloyd, S. M., de Craen, A. J., Jukema, J. W., Westendorp, R. G., Buckley, B. M., Kearney, P. M., Briggs, A., Stott, D. J., Ford, I., and Sattar, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Diabetologia
Publisher:Springer-Verlag
ISSN:0012-186X
ISSN (Online):1432-0428

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
525471Biological, demographic, cognitive and social determinants of health outcomes in older people: results from within-study and extended follow-up of the PROSPER trial.Ian FordScottish Executive Health Department (SEHHD-CSO)CZH/4/637IHW - ROBERTSON CENTRE
612031Cardiac biomarkers and CVD risk screening: a cost-effective public health measure?Paul WelshBritish Heart Foundation (BHF)FS/12/62/29889RI CARDIOVASCULAR & MEDICAL SCIENCES