Insulin Resistance Syndrome Predicts Coronary Heart Disease Events in Elderly Type 2 Diabetic Men

Insulin Resistance Syndrome Predicts Coronary Heart Disease Events in Elderly Type 2 Diabetic Men Johanna Kuusisto , MD 1 , Päivi Lempiäinen , MD 1 2 , Leena Mykkänen , MD 1 and Markku Laakso , MD 1 1 Department of Medicine, University of Kuopio, Kuopio, Finland, and the 2 Department of Medicine, University of Oulu, Oulu, Finland Abstract OBJECTIVE —To investigate whether cardiovascular risk factors cluster with hyperinsulinemia in elderly type 2 diabetic subjects and, if so, whether this clustering predicts coronary heart disease (CHD) events during a 7-year follow-up. RESEARCH DESIGN AND METHODS —Clustering of cardiovascular risk factors was analyzed by factor analysis. Cox regression models were used to investigate whether these clusters (factors) predict CHD events (CHD death or nonfatal myocardial infarction) during a 7-year follow-up in 229 type 2 diabetic subjects aged 65–74 years. RESULTS —There were 70 CHD events (21 in men and 49 in women) during the follow-up period. In diabetic men, components of the insulin resistance syndrome (IRS) loaded on Factor 1 (the insulin resistance factor), which reflected high fasting insulin, obesity (high BMI), central obesity (high waist-to-hip ratio), high total triglycerides, and a short duration of diabetes. Only this IRS factor predicted CHD events in multivariate Cox regression analysis (hazard ratio [HR] 1.71, 95% CI 1.08–2.71, P = 0.022). In diabetic women, components of IRS loaded on two factors, none of which predicted CHD events. In women, only Factor 4, characterized by advanced age, left ventricular hypertrophy on electrocardiogram, high alcohol consumption, high systolic blood pressure, and albuminuria, predicted CHD events in multivariate Cox regression analysis (1.34, 1.03–1.74, P = 0.03). CONCLUSIONS —IRS is a risk factor for CHD in elderly type 2 diabetic men. ACR, albumin-to-creatinine ratio CHD, coronary heart disease ECG, electrocardiogram HR, hazard ratio IRS, insulin resistance syndrome LVH, left ventricular hypertrophy MI, myocardial infarction WHO, World Health Organization WHR, waist-to-hip ratio Footnotes Address correspondence and reprint requests to Markku Laakso, MD, Department of Medicine, University of Kuopio, P.O. Box 1777, FIN-70211 Kuopio, Finland. E-mail: markku.laakso{at}kuh.fi . Received for publication 22 February 2001 and accepted in revised form 31 May 2001. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for ma