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Background  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.    Methods and Results   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  increase in the McAuley index (hazard ratio 0.80; 95%  CI : 0.67–0.96), with no attenuation after further accounting for  CHD  and stroke risk factors. When considered individually, McAuley index and  HOMA ‐ IR  were associated with  CHD  (hazard ratio 0.71, 95%  CI : 0.55–0.92 and hazard ratio 1.33, 95%  CI : 1.03–1.72, respectively), but not stroke risk. The log HOMA ‐ IR  and  CHD  association was present in men, but not in women ( P  interaction =0.01).    Conclusions  Both HOMA‐IR and the McAuley index demonstrate strong associations with  CHD  but not stroke risk in blacks. The log HOMA ‐ IR  and  CHD  association was present in men, but not in women.

journal of the american heart association

Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study