This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager patientINFORMation Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Saely, C. H. Articles by Drexel, H. Search for Related Content PubMed PubMed Citation Articles by Saely, C. H. Articles by Drexel, H. Related Collections Cardiovascular Endocrinology Diabetes and Insulin Metabolism

The Metabolic Syndrome, Insulin Resistance, and Cardiovascular Risk in Diabetic and Nondiabetic Patients

Vorarlberg Institute for Vascular Investigation and Treatment (C.H.S., S.A., T.M., P.L., H.D.), Feldkirch 6800, Austria; and Department of Medicine, Academic Teaching Hospital Feldkirch (C.H.S., S.A., T.M., G.H., H.D.), Feldkirch 6800, Austria

Address all correspondence and requests for reprints to: Dr. Heinz Drexel, Carinagasse 47, A-6800 Feldkirch, Austria. E-mail: vivit{at}lkhf.at.

Context: The contribution of insulin resistance per se to the vascular risk conferred by the metabolic syndrome (MetS) is not known; conversely, it is uncertain whether insulin resistance confers vascular risk beyond the entity of the MetS.

Objective: The objective of this study was to investigate the impact of the MetS (Adult Treatment Panel III criteria) and insulin resistance (as estimated by the homeostasis model assessment index) on the incidence of vascular events.

Design and Patients: This was a prospective cohort study enrolling 750 consecutive patients undergoing coronary angiography for the evaluation of coronary artery disease.

Setting: The study was performed at a tertiary care clinical research center.

Main Outcome Measure: The main outcome measure was the incidence of vascular events over 2.3 yr.

Results: Both the MetS and insulin resistance predicted vascular events after controlling for non-MetS risk factors [hazard ratio (HR), 2.74 (95% confidence interval, 1.71–4.39; P < 0.001) and 1.51 (1.24–1.84; P < 0.001), respectively]. After additional adjustment for insulin resistance, the MetS remained significantly predictive of vascular events [HR, 2.69 (1.57–4.64); P < 0.001], and conversely, insulin resistance remained significantly predictive of vascular events despite adjustment for the MetS [standardized HR, 1.41 (1.14–1.75); P = 0.002]. Additional adjustment for the presence of type 2 diabetes revealed that both the MetS [adjusted HR, 2.57 (1.47–4.51); P = 0.001] and homeostasis model assessment of insulin resistance [standardized adjusted HR, 1.37 (1.09–1.73); P = 0.007] significantly predicted vascular events independent from diabetes status.

Conclusions: Both the MetS and insulin resistance are strong and mutually independent predictors of vascular risk among angiographed coronary patients.

Find additional patient-related information at:

Metabolic Syndrome and Its Link to Heart and Blood Vessel Disease

This article has been cited by other articles:

				B. B Yeap, S A P. Chubb, Z. Hyde, K. Jamrozik, G. J Hankey, L. Flicker, and P. E Norman Lower serum testosterone is independently associated with insulin resistance in non-diabetic older men: the Health In Men Study Eur. J. Endocrinol., October 1, 2009; 161(4): 591 - 598. [Abstract] [Full Text] [PDF]

				E. Xu, M.-J. Dubois, N. Leung, A. Charbonneau, C. Turbide, R. K. Avramoglu, L. DeMarte, M. Elchebly, T. Streichert, E. Levy, et al. Targeted Disruption of Carcinoembryonic Antigen-Related Cell Adhesion Molecule 1 Promotes Diet-Induced Hepatic Steatosis and Insulin Resistance Endocrinology, August 1, 2009; 150(8): 3503 - 3512. [Abstract] [Full Text] [PDF]

				L. W. Cho, V Jayagopal, E S Kilpatrick, and S L Atkin The mean and the biological variation of insulin resistance does not differ between polycystic ovary syndrome and type 2 diabetes Ann Clin Biochem, May 1, 2009; 46(3): 218 - 221. [Abstract] [Full Text] [PDF]

				L. F. Lien, A. J. Brown, J. D. Ard, C. Loria, T. P. Erlinger, A. C. Feldstein, P.-H. Lin, C. M. Champagne, A. C. King, H. L. McGuire, et al. Effects of PREMIER Lifestyle Modifications on Participants With and Without the Metabolic Syndrome Hypertension, October 1, 2007; 50(4): 609 - 616. [Abstract] [Full Text] [PDF]

				L. Persegol, B. Verges, P. Gambert, and L. Duvillard Inability of HDL from abdominally obese subjects to counteract the inhibitory effect of oxidized LDL on vasorelaxation J. Lipid Res., June 1, 2007; 48(6): 1396 - 1401. [Abstract] [Full Text] [PDF]

				H. Shimizu, K. Inoue, and M. Mori The leptin-dependent and -independent melanocortin signaling system: regulation of feeding and energy expenditure J. Endocrinol., April 1, 2007; 193(1): 1 - 9. [Abstract] [Full Text] [PDF]

				E. S. Kilpatrick, A. S. Rigby, and S. L. Atkin Insulin Resistance, the Metabolic Syndrome, and Complication Risk in Type 1 Diabetes: "Double diabetes" in the Diabetes Control and Complications Trial Diabetes Care, March 1, 2007; 30(3): 707 - 712. [Abstract] [Full Text] [PDF]

				C. H. Saely, L. Koch, F. Schmid, T. Marte, S. Aczel, P. Langer, G. Hoefle, and H. Drexel Adult Treatment Panel III 2001 but Not International Diabetes Federation 2005 Criteria of the Metabolic Syndrome Predict Clinical Cardiovascular Events in Subjects Who Underwent Coronary Angiography Diabetes Care, April 1, 2006; 29(4): 901 - 907. [Abstract] [Full Text] [PDF]