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Presence of hypertension modifies the impact of insulin resistance on incident cardiovascular disease in a Middle Eastern population: the Tehran Lipid and Glucose Study
Author(s) -
Ghoreishian H.,
Tohidi M.,
Derakhshan A.,
Hajsheikholeslami F.,
Azizi F.,
KazempourArdebili S.,
Hadaegh F.
Publication year - 2015
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12733
Subject(s) - medicine , hazard ratio , quartile , insulin resistance , proportional hazards model , population , cardiology , diabetes mellitus , homeostatic model assessment , endocrinology , insulin , confidence interval , environmental health
Aims To examine the independent impacts of the homeostasis model assessment of insulin resistance ( HOMA ‐ IR ) and the updated model ( HOMA 2‐ IR ) on incident cardiovascular /coronary heart disease in a Middle Eastern population with a high prevalence of cardiovascular disease risk factors. Methods We examined 3777 Iranian people, aged ≥ 30 years, without history of cardiovascular disease and without use of antidiabetic medication at baseline. Both HOMA ‐ IR and HOMA 2‐ IR were log‐transformed and categorized into quartiles. The multivariable Cox proportional hazard regression model, adjusted for traditional cardiovascular disease risk factors, was applied to examine the association between HOMA ‐ IR / HOMA 2‐ IR with incident cardiovascular/coronary heart disease, considering the lowest quartile as reference. Results During a median follow‐up of > 10 years, 197 cardiovascular disease and 181 coronary heart disease events occurred. Among the covariates, we found a significant interaction between hypertension and HOMA ‐ IR / HOMA 2‐ IR for incident coronary heart/cardiovascular disease (all P ≤ 0.01). Among the population without hypertension, the risk of cardiovascular disease significantly increased in the second [hazard ratio 1.96 (95% CI 1.04–3.68)], third [hazard ratio 1.93 (95% CI 1.00–3.75)] and fourth [hazard ratio 2.34 (95% CI 1.15–4.75)] quartiles of HOMA ‐ IR , and the risk of coronary heart disease increased significantly in the fourth quartile of HOMA ‐ IR [hazard ratio 2.30 (95% CI 1.12–4.73)], but no significant association was detected between HOMA ‐ IR and cardiovascular/coronary heart disease in the population with hypertension. Among the populations both with and without hypertension, no risk was found to be associated with HOMA2‐IR quartiles however, a 1‐unit increase in HOMA 2‐ IR was associated with a significant risk of cardiovascular disease among the non‐hypertensive group [hazard ratio 1.60 (95% CI 1.03–2.48); P = 0.03]. Conclusions The presence of hypertension modified the impact of HOMA ‐ IR / HOMA 2‐ IR on incident cardiovascular/coronary heart disease. The presence of insulin resistance highlighted a significant and independent risk for cardiovascular disease/coronary heart disease only in the population without hypertension.