title: HOMA-estimated insulin resistance is an independent predictor of cardiovascular disease in type 2 diabetic subjects: prospective data from the Verona Diabetes Complications Study.
abstract: OBJECTIVE
  To evaluate whether homeostasis model assessment-estimated insulin resistance (HOMA-IR) is an independent predictor of cardiovascular disease (CVD) in type 2 diabetes.
  
  
  METHODS
  Conventional CVD risk factors (sex, age, smoking, plasma lipids, blood pressure, and metabolic control) and insulin resistance (estimated by HOMA) were evaluated at baseline in 1,326 patients with type 2 diabetes examined within the Verona Diabetes Complications Study. At baseline and after a mean follow-up of 4.5 years, CVD was assessed by medical history, physical examination, electrocardiography, and echo-Doppler of carotid and lower limb arteries. Death certificates and medical records of subjects who died during the follow-up were carefully scrutinized to identify cardiovascular deaths. In statistical analyses, CVD was an aggregate end point including both fatal and nonfatal coronary, cerebrovascular, and peripheral vascular disease as well as ischemic electrocardiographic abnormalities and vascular lesions identified by echo-Doppler.
  
  
  RESULTS
  At baseline, 441 subjects were coded positive for CVD (prevalent cases). Incident cases numbered 126. Multiple logistic regression analyses showed that, along with sex, age, smoking, HDL/total cholesterol ratio, and hypertension, HOMA-IR was an independent predictor of both prevalent and incident CVD. A 1-unit increase in (log)HOMA-IR value was associated with an odds ratio for prevalent CVD at baseline of 1.31 (95% CI 1.10-1.56, P = 0.002) and for incident CVD during follow-up of 1.56 (95% CI 1.14-2.12, P < 0.001).
  
  
  CONCLUSIONS
  HOMA-IR is an independent predictor of CVD in type 2 diabetes. The improvement of insulin resistance might have beneficial effects not only on glucose control but also on CVD in patients with type 2 diabetes.
authors.affiliation: Endocrinology and Metabolic Diseases, University of Verona Medical School, Verona, Italy. enbonor@tin.it
authors.forename: Enzo
authors.initials: E
authors.lastname: Bonora
authors.forename: Gianni
authors.initials: G
authors.lastname: Formentini
authors.forename: Francesco
authors.initials: F
authors.lastname: Calcaterra
authors.forename: Simonetta
authors.initials: S
authors.lastname: Lombardi
authors.forename: Franco
authors.initials: F
authors.lastname: Marini
authors.forename: Luciano
authors.initials: L
authors.lastname: Zenari
authors.forename: Francesca
authors.initials: F
authors.lastname: Saggiani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Poli
authors.forename: Sandro
authors.initials: S
authors.lastname: Perbellini
authors.forename: Andrea
authors.initials: A
authors.lastname: Raffaelli
authors.forename: Vittorio
authors.initials: V
authors.lastname: Cacciatori
authors.forename: Lorenza
authors.initials: L
authors.lastname: Santi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bonadonna
authors.forename: Michele
authors.initials: M
authors.lastname: Muggeo
mesh_terms: D017668:Age of Onset; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D005260:Female; D006706:Homeostasis; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012907:Smoking; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D008055:Lipids; D008074:Lipoproteins; D014280:Triglycerides; D002784:Cholesterol