Fasting glucose, fasting insulin, and insulin resistance in the prediction of myocardial infarction and mortality at long-term follow-up

M. L. Nielsen, M. Pareek, M. Leosdottir, P. M. Nilsson, M. H. Olsen

Research output: Contribution to journalConference abstract in journalResearchpeer-review

Abstract

Objective: To assess the additional prognostic value of fasting blood glucose (FBG), fasting plasma insulin (FPI), and homeostasis model assessment derived insulin resistance (HOMA-IR) for predicting incident myocardial infarction (MI) and all-cause mortality, independently of traditional cardiovascular (CV) risk factors Methods: As part of a population-based cohort study aiming to screen for CV risk factors, 6024 men and 1013 women without known diabetes mellitus (DM) or overt CV disease (CVD defined as previous MI, stroke, or transient ischemic attack), recruited 1974-1992, had both FBG and FPI measured at baseline. Subsequently, HOMA-IR was derived using the computerized HOMA calculator and ranked into quartiles due to the non-normal distribution and presumably non-linear biological effect of insulin resistance. Prognostic values of FBG, FPI, HOMA-IR, and traditional risk factors were tested using Cox proportional hazards regression analysis and likelihood-ratio testing. Follow-up time from inclusion until event (first MI or death) or censoring (emigration or last follow-up date (<20 years)) comprised the underlying time scale Results: Median [IQR] age at inclusion was 47.7 [47.1-48.3] years, whereas median [IQR] HOMA-IR was 0.9 [0.4-1.4]. Over a median follow-up time of 20 years, 1448 events occurred (11.3 per 1000 person-years). The simple prediction model, i.e. the model with traditional CV risk factors only, included age, gender, body mass index, systolic blood pressure, total cholesterol, and smoking status. Addition of FBG, but not FPI or HOMA-IR resulted in significant model improvement (FBG: chi2 = 5.82, p = 0.02; FPI: chi2 = 0.29, p = 0.59; HOMA-IR: chi2 = 0.08, p = 0.78). Moreover, we detected significant interactions between both FBG and FPI (chi2 = 12.52, p <0.001), FBG and HOMA-IR (chi2 = 6.07, p = 0.01), and FPI and HOMA-IR (chi2 = 13.15, p <0.001) Conclusion: Addition of FBG, but not FPI or HOMA-IR provided additional significant prognostic value on top of traditional CV risk factors in the prediction of MI or death at long-term follow-up in subjects without CVD and/or DM at baseline. Furthermore, interaction analyses revealed that the prognostic values of both FBG and FPI were significantly greater among subjects in the highest HOMA-IR quartile.
Original languageEnglish
Article numberA19319
JournalCirculation
Volume132
Number of pages1
ISSN0009-7322
Publication statusPublished - 2015
EventAmerican Heart Association Congress - Orlando, United States
Duration: 7. Nov 201511. Nov 2015

Conference

ConferenceAmerican Heart Association Congress
CountryUnited States
CityOrlando
Period07/11/201511/11/2015

Cite this

@article{2846c7c835664052b40d03251aaf5363,
title = "Fasting glucose, fasting insulin, and insulin resistance in the prediction of myocardial infarction and mortality at long-term follow-up",
abstract = "Objective: To assess the additional prognostic value of fasting blood glucose (FBG), fasting plasma insulin (FPI), and homeostasis model assessment derived insulin resistance (HOMA-IR) for predicting incident myocardial infarction (MI) and all-cause mortality, independently of traditional cardiovascular (CV) risk factors Methods: As part of a population-based cohort study aiming to screen for CV risk factors, 6024 men and 1013 women without known diabetes mellitus (DM) or overt CV disease (CVD defined as previous MI, stroke, or transient ischemic attack), recruited 1974-1992, had both FBG and FPI measured at baseline. Subsequently, HOMA-IR was derived using the computerized HOMA calculator and ranked into quartiles due to the non-normal distribution and presumably non-linear biological effect of insulin resistance. Prognostic values of FBG, FPI, HOMA-IR, and traditional risk factors were tested using Cox proportional hazards regression analysis and likelihood-ratio testing. Follow-up time from inclusion until event (first MI or death) or censoring (emigration or last follow-up date (<20 years)) comprised the underlying time scale Results: Median [IQR] age at inclusion was 47.7 [47.1-48.3] years, whereas median [IQR] HOMA-IR was 0.9 [0.4-1.4]. Over a median follow-up time of 20 years, 1448 events occurred (11.3 per 1000 person-years). The simple prediction model, i.e. the model with traditional CV risk factors only, included age, gender, body mass index, systolic blood pressure, total cholesterol, and smoking status. Addition of FBG, but not FPI or HOMA-IR resulted in significant model improvement (FBG: chi2 = 5.82, p = 0.02; FPI: chi2 = 0.29, p = 0.59; HOMA-IR: chi2 = 0.08, p = 0.78). Moreover, we detected significant interactions between both FBG and FPI (chi2 = 12.52, p <0.001), FBG and HOMA-IR (chi2 = 6.07, p = 0.01), and FPI and HOMA-IR (chi2 = 13.15, p <0.001) Conclusion: Addition of FBG, but not FPI or HOMA-IR provided additional significant prognostic value on top of traditional CV risk factors in the prediction of MI or death at long-term follow-up in subjects without CVD and/or DM at baseline. Furthermore, interaction analyses revealed that the prognostic values of both FBG and FPI were significantly greater among subjects in the highest HOMA-IR quartile.",
keywords = "*heart infarction *diet restriction *insulin resistance *resuscitation *medical society *follow up *mortality *prediction *diabetes mellitus risk factor model human death proportional hazards model homeostasis insulin blood level biological activity normal distribution transient ischemic attack cerebrovascular accident glucose blood level female male cohort analysis smoking population systolic blood pressure body mass gender cholesterol blood level cardiovascular risk *insulin *glucose",
author = "Nielsen, {M. L.} and M. Pareek and M. Leosdottir and Nilsson, {P. M.} and Olsen, {M. H.}",
year = "2015",
language = "English",
volume = "132",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams & Wilkins",

}

Fasting glucose, fasting insulin, and insulin resistance in the prediction of myocardial infarction and mortality at long-term follow-up. / Nielsen, M. L.; Pareek, M.; Leosdottir, M.; Nilsson, P. M.; Olsen, M. H.

In: Circulation, Vol. 132, A19319 , 2015.

Research output: Contribution to journalConference abstract in journalResearchpeer-review

TY - ABST

T1 - Fasting glucose, fasting insulin, and insulin resistance in the prediction of myocardial infarction and mortality at long-term follow-up

AU - Nielsen, M. L.

AU - Pareek, M.

AU - Leosdottir, M.

AU - Nilsson, P. M.

AU - Olsen, M. H.

PY - 2015

Y1 - 2015

N2 - Objective: To assess the additional prognostic value of fasting blood glucose (FBG), fasting plasma insulin (FPI), and homeostasis model assessment derived insulin resistance (HOMA-IR) for predicting incident myocardial infarction (MI) and all-cause mortality, independently of traditional cardiovascular (CV) risk factors Methods: As part of a population-based cohort study aiming to screen for CV risk factors, 6024 men and 1013 women without known diabetes mellitus (DM) or overt CV disease (CVD defined as previous MI, stroke, or transient ischemic attack), recruited 1974-1992, had both FBG and FPI measured at baseline. Subsequently, HOMA-IR was derived using the computerized HOMA calculator and ranked into quartiles due to the non-normal distribution and presumably non-linear biological effect of insulin resistance. Prognostic values of FBG, FPI, HOMA-IR, and traditional risk factors were tested using Cox proportional hazards regression analysis and likelihood-ratio testing. Follow-up time from inclusion until event (first MI or death) or censoring (emigration or last follow-up date (<20 years)) comprised the underlying time scale Results: Median [IQR] age at inclusion was 47.7 [47.1-48.3] years, whereas median [IQR] HOMA-IR was 0.9 [0.4-1.4]. Over a median follow-up time of 20 years, 1448 events occurred (11.3 per 1000 person-years). The simple prediction model, i.e. the model with traditional CV risk factors only, included age, gender, body mass index, systolic blood pressure, total cholesterol, and smoking status. Addition of FBG, but not FPI or HOMA-IR resulted in significant model improvement (FBG: chi2 = 5.82, p = 0.02; FPI: chi2 = 0.29, p = 0.59; HOMA-IR: chi2 = 0.08, p = 0.78). Moreover, we detected significant interactions between both FBG and FPI (chi2 = 12.52, p <0.001), FBG and HOMA-IR (chi2 = 6.07, p = 0.01), and FPI and HOMA-IR (chi2 = 13.15, p <0.001) Conclusion: Addition of FBG, but not FPI or HOMA-IR provided additional significant prognostic value on top of traditional CV risk factors in the prediction of MI or death at long-term follow-up in subjects without CVD and/or DM at baseline. Furthermore, interaction analyses revealed that the prognostic values of both FBG and FPI were significantly greater among subjects in the highest HOMA-IR quartile.

AB - Objective: To assess the additional prognostic value of fasting blood glucose (FBG), fasting plasma insulin (FPI), and homeostasis model assessment derived insulin resistance (HOMA-IR) for predicting incident myocardial infarction (MI) and all-cause mortality, independently of traditional cardiovascular (CV) risk factors Methods: As part of a population-based cohort study aiming to screen for CV risk factors, 6024 men and 1013 women without known diabetes mellitus (DM) or overt CV disease (CVD defined as previous MI, stroke, or transient ischemic attack), recruited 1974-1992, had both FBG and FPI measured at baseline. Subsequently, HOMA-IR was derived using the computerized HOMA calculator and ranked into quartiles due to the non-normal distribution and presumably non-linear biological effect of insulin resistance. Prognostic values of FBG, FPI, HOMA-IR, and traditional risk factors were tested using Cox proportional hazards regression analysis and likelihood-ratio testing. Follow-up time from inclusion until event (first MI or death) or censoring (emigration or last follow-up date (<20 years)) comprised the underlying time scale Results: Median [IQR] age at inclusion was 47.7 [47.1-48.3] years, whereas median [IQR] HOMA-IR was 0.9 [0.4-1.4]. Over a median follow-up time of 20 years, 1448 events occurred (11.3 per 1000 person-years). The simple prediction model, i.e. the model with traditional CV risk factors only, included age, gender, body mass index, systolic blood pressure, total cholesterol, and smoking status. Addition of FBG, but not FPI or HOMA-IR resulted in significant model improvement (FBG: chi2 = 5.82, p = 0.02; FPI: chi2 = 0.29, p = 0.59; HOMA-IR: chi2 = 0.08, p = 0.78). Moreover, we detected significant interactions between both FBG and FPI (chi2 = 12.52, p <0.001), FBG and HOMA-IR (chi2 = 6.07, p = 0.01), and FPI and HOMA-IR (chi2 = 13.15, p <0.001) Conclusion: Addition of FBG, but not FPI or HOMA-IR provided additional significant prognostic value on top of traditional CV risk factors in the prediction of MI or death at long-term follow-up in subjects without CVD and/or DM at baseline. Furthermore, interaction analyses revealed that the prognostic values of both FBG and FPI were significantly greater among subjects in the highest HOMA-IR quartile.

KW - heart infarction diet restriction insulin resistance resuscitation medical society follow up mortality prediction diabetes mellitus risk factor model human death proportional hazards model homeostasis insulin blood level biological activity normal distrib

M3 - Conference abstract in journal

VL - 132

JO - Circulation

JF - Circulation

SN - 0009-7322

M1 - A19319

ER -