Fasting insulin has a stronger association with an adverse cardiometabolic risk profile than insulin resistance: the RISC study.
OBJECTIVE
Fasting insulin concentrations are often used as a surrogate measure of insulin resistance. We investigated the relative contributions of fasting insulin and insulin resistance to cardiometabolic risk and preclinical atherosclerosis.


METHODS
The Relationship between Insulin Sensitivity and Cardiovascular disease (RISC) cohort consists of 1326 European non-diabetic, overall healthy men and women aged 30-60 years. We performed standard oral glucose tolerance tests and hyperinsulinemic euglycemic clamps. As a general measure of cardiovascular risk, we assessed the prevalence of the metabolic syndrome in 1177 participants. Carotid artery intima media thickness (IMT) was measured by ultrasound to assess preclinical atherosclerosis.


RESULTS
Fasting insulin was correlated with all elements of the metabolic syndrome. Insulin sensitivity (M/I) was correlated with most elements. The odds ratio for the metabolic syndrome of those in the highest quartile of fasting insulin compared with those in the lower quartiles was 5.4 (95% confidence interval (CI) 2.8-10.3, adjusted for insulin sensitivity) in men and 5.1 (2.6-9.9) in women. The odds ratio for metabolic syndrome of those with insulin sensitivity in the lowest quartile of the cohort compared with those in the higher quartiles was 2.4 (95% CI 1.3-4.7, adjusted for fasting insulin) in men and 1.6 (0.8-3.1) in women. Carotid IMT was only statistically significantly associated with fasting insulin in both men and women.


CONCLUSIONS
Fasting insulin, a simple and practical measure, may be a stronger and independent contributor to cardiometabolic risk and atherosclerosis in a healthy population than hyperinsulinemic euglycemic clamp-derived insulin sensitivity.
de Rooij
Susanne R
SR
Department of Clinical Epidemiology and Biostatistics, Institute for Research in Extramural Medicine, VU University Medical Center, 1081 BT, Amsterdam, The Netherlands. s.r.derooij@amc.uva.nl
Dekker
Jacqueline M
JM
Kozakova
Michaela
M
Mitrakou
Asimina
A
Melander
Olle
O
Gabriel
Rafael
R
Guidone
Caterina
C
Højlund
Kurt
K
Murphy
Matthew S
MS
Nijpels
Giel
G
D000328:Adult; D002318:Cardiovascular Diseases / Q000097:blood*; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005215:Fasting; D005260:Female; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000378:metabolism; D014463:Ultrasonography
D007328:Insulin