The Risk for Coronary Heart Disease According to Insulin Resistance with and without Type 2 Diabetes

Abstract

Objective. To examine the role of insulin resistance versus hyperglycemia in the risk for coronary heart disease (CHD) and to explore the interaction of insulin resistance with hyperglycemia. Methods. This is a cross-sectional study based on the National Health and Nutrition Examination Survey III (NHANES). 4,825 subjects were selected from 9,737 adults aged 340 years excluding those with fasting <8 hours, type 1 diabetes, pregnancy, or missing data. Insulin resistance was calculated using the HOMA II and then log-transformed (log IR). Odds ratios (OR) of CHD was obtained with multiple logistic regression with reference to non-diabetics with log IR > 1. Results. CHD and type 2 diabetes were present in 9.1 % and 10.5%. Elevated insulin resistance was common; diabetics and non-diabetics with log IR > 1 constituted 6.3% and 12.1% of the population, respectively. ORs for CHD increased as insulin resistance increased in both non-diabetic and diabetics. When log IR > 1, the risk for CHD was not different between diabetics and non-diabetics (OR 1.12, 95% CI; 0.76–1.65). Furthermore, the risk for CHD was higher in non-diabetics with log IR > 1 than in diabetics with log IR1 (OR 0.55, 95% CI; 0.36–0.85). Conclusions. Insulin resistance was a greater risk for CHD than type 2 diabetes. Non-diabetics can have a higher risk for CHD than diabetics when insulin resistance is elevated. More research is warranted to develop strategies to identify and treat insulin resistance.