title: Homeostasis model assessment of insulin resistance and the risk of cardiovascular events in middle-aged non-diabetic Japanese men.
abstract: OBJECTIVE
  Little is known about the relationship between the HOMA of insulin resistance (HOMA-IR) and the risk of cardiovascular events in Asian populations, which have lower levels of HOMA-IR than Western populations. Accordingly, we determined the predictive value of HOMA-IR for cardiovascular risk in a Japanese population that was apparently free of diabetes, addressing whether insulin resistance itself increases cardiovascular risk independently of other relevant metabolic disorders.
  
  
  METHODS
  We followed 2,548 non-diabetic men aged 35 to 59 years for 11 years. The hazard ratios for the incidence of cardiovascular events due to increased HOMA-IR were estimated using a Cox proportional hazards model that was adjusted for potential confounding factors.
  
  
  RESULTS
  The multivariate-adjusted hazard ratio for cardiovascular events compared with the first quartile of HOMA-IR (<or=0.66) was 1.07 (95% CI 0.44-2.64) for the second (HOMA-IR 0.67-1.01), 1.36 (0.56-3.28) for the third (HOMA-IR 1.02-1.51) and 2.50 (1.02-6.10) for the fourth quartile (HOMA-IR >or=1.52). The hazard ratio associated with a one SD (0.61) increment in log-transformed HOMA-IR was 1.51 (1.13-2.02). A similar positive relationship was observed for coronary events and stroke. In addition, the relationship between HOMA-IR and cardiovascular risk was broadly similar in participants with and without hypertension, dyslipidaemia (elevated triacylglycerol and/or reduced HDL-cholesterol), abdominal obesity and current smoking.
  
  
  CONCLUSIONS
  Increased HOMA-IR predicted subsequent cardiovascular events in non-diabetic Japanese men. The association was independent of traditional cardiovascular risk factors and other relevant metabolic disorders.
authors.affiliation: Department of Epidemiology and Public Health, Kanazawa Medical University, Uchinada, Ishikawa, Japan. knaka@kanazawa-med.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Nakamura
authors.forename: M
authors.initials: M
authors.lastname: Sakurai
authors.forename: K
authors.initials: K
authors.lastname: Miura
authors.forename: Y
authors.initials: Y
authors.lastname: Morikawa
authors.forename: M
authors.initials: M
authors.lastname: Ishizaki
authors.forename: K
authors.initials: K
authors.lastname: Yoshita
authors.forename: T
authors.initials: T
authors.lastname: Kido
authors.forename: Y
authors.initials: Y
authors.lastname: Naruse
authors.forename: H
authors.initials: H
authors.lastname: Nakagawa
mesh_terms: D000328:Adult; D044466:Asian People; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D020521:Stroke / Q000453:epidemiology