Insulin resistance is acardiovascular risk factor in hypertensive adults without type2 diabetes mellitus.

Abstract

Metabolic syndrome refers to the association among several cardiovascular risk factors: obesity, dyslipidemia, hyperglycemia, and hypertension. It is associated with increased cardiovascular risk and the development of type2 diabetes mellitus. Insulin resistance is the underlying mechanism of metabolic syndrome, although its role in increased cardiovascular risk has not been directly identified. We investigated the association between insulin resistance and increased cardiovascular risk in hypertensive adults without diabetes mellitus. We enrolled participants without diabetes from an outpatient setting in aretrospective, longitudinal study. Several demographic, clinical, and laboratory parameters were recorded during the observation period. Plasma insulin and homeostatic model assessment for insulin resistance (HOMA-IR) were used to determine insulin resistance and four cardiovascular events (acute coronary disease, acute cerebrovascular disease, incident heart failure, and cardiovascular mortality) were combined into asingle outcome. Logistic regression and Cox proportional hazards models were fitted to evaluate the association between covariates and outcomes. We included 1899 hypertensive adults without diabetes with an average age of 53years (51.3% women, 23% had prediabetes, and 64.2% had metabolic syndrome). In alogistic regression analysis, male sex (odds ratio, OR = 1.66) having high levels of low-density lipoprotein (LDL, OR = 1.01), kidney function (OR = 0.97), and HOMA-IR (OR = 1.06) were associated with the incidence of cardiovascular events; however, in asurvival multivariate analysis, only HOMA-IR (hazard ratio, HR1.4, 95% confidence interval, CI: 1.05-1.87, p = 0.02) and body mass index (HR 1.05, 95% CI: 1.02-1.08, p = 0.002) were considered independent prognostic variables for the development of incident cardiovascular events. Insulin resistance and obesity are useful for assessing cardiovascular risk in hypertensive people without diabetes but with preserved kidney function. This work demonstrates the predictive value of the measurement of insulin, and therefore of insulin resistance, in an outpatient setting and attending to high-risk patients.