Sex differences in the association between insulin resistance and incident coronary heart disease and stroke among blacks without diabetes mellitus: The Jackson Heart Study

Valery S. Effoe, Lynne E. Wagenknecht, Justin Echouffo Tcheugui, Haiying Chen, Joshua J. Joseph, Rita R. Kalyani, Ronny A. Bell, Wen Chih H Wu, Ramon Casanova, Alain G. Bertoni

Research output: Contribution to journalArticle

Abstract

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 logHOMA-IR and CHD association was present in men, but not in women (Pinteraction=0.01). Conclusions-Both HOMA-IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA-IR and CHD association was present in men, but not in women.

Original languageEnglish (US)
Article numbere004229
JournalJournal of the American Heart Association
Volume6
Issue number2
DOIs
StatePublished - 2017

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Sex Characteristics
Coronary Disease
Insulin Resistance
Diabetes Mellitus
Stroke
Homeostasis
Cardiovascular Diseases
Regression Analysis
Demography

Keywords

  • Blacks
  • Cardiovascular disease risk factors
  • Cerebrovascular disease/stroke
  • Coronary heart disease
  • Epidemiology
  • Insulin resistance
  • Myocardial infarction
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sex differences in the association between insulin resistance and incident coronary heart disease and stroke among blacks without diabetes mellitus : The Jackson Heart Study. / Effoe, Valery S.; Wagenknecht, Lynne E.; Echouffo Tcheugui, Justin; Chen, Haiying; Joseph, Joshua J.; Kalyani, Rita R.; Bell, Ronny A.; Wu, Wen Chih H; Casanova, Ramon; Bertoni, Alain G.

In: Journal of the American Heart Association, Vol. 6, No. 2, e004229, 2017.

Research output: Contribution to journalArticle

Effoe, Valery S. ; Wagenknecht, Lynne E. ; Echouffo Tcheugui, Justin ; Chen, Haiying ; Joseph, Joshua J. ; Kalyani, Rita R. ; Bell, Ronny A. ; Wu, Wen Chih H ; Casanova, Ramon ; Bertoni, Alain G. / Sex differences in the association between insulin resistance and incident coronary heart disease and stroke among blacks without diabetes mellitus : The Jackson Heart Study. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 2.
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abstract = "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 logHOMA-IR and CHD association was present in men, but not in women (Pinteraction=0.01). Conclusions-Both HOMA-IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA-IR and CHD association was present in men, but not in women.",
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T1 - Sex differences in the association between insulin resistance and incident coronary heart disease and stroke among blacks without diabetes mellitus

T2 - The Jackson Heart Study

AU - Effoe, Valery S.

AU - Wagenknecht, Lynne E.

AU - Echouffo Tcheugui, Justin

AU - Chen, Haiying

AU - Joseph, Joshua J.

AU - Kalyani, Rita R.

AU - Bell, Ronny A.

AU - Wu, Wen Chih H

AU - Casanova, Ramon

AU - Bertoni, Alain G.

PY - 2017

Y1 - 2017

N2 - 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 logHOMA-IR and CHD association was present in men, but not in women (Pinteraction=0.01). Conclusions-Both HOMA-IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA-IR and CHD association was present in men, but not in women.

AB - 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 logHOMA-IR and CHD association was present in men, but not in women (Pinteraction=0.01). Conclusions-Both HOMA-IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA-IR and CHD association was present in men, but not in women.

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KW - Cardiovascular disease risk factors

KW - Cerebrovascular disease/stroke

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KW - Epidemiology

KW - Insulin resistance

KW - Myocardial infarction

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