title: Insulin resistance, incident cardiovascular diseases, and decreased kidney function among nondiabetic American Indians: the Strong Heart Study.
abstract: OBJECTIVE
  Prevalence of insulin resistance is high in the American Indian population, likely as a result of the high prevalence of obesity. This condition may be influential for clinical outcomes such as cardiovascular disease (CVD) and decreased kidney function.
  
  
  METHODS
  Normal glucose tolerant (NGT) participants free of hypertension and CVD at the baseline examination (1989-1992) (N=964) of the Strong Heart Study were selected to explore the cross-sectional association between insulin resistance quantified by homeostasis model assessment (HOMA-IR) and demographic, behavioral, and cardiometabolic variables. The longitudinal association between baseline HOMA-IR and the development of CVD was also explored. The longitudinal association between baseline HOMA-IR and the development of high urinary albumin-to-creatinine ratio was explored among nondiabetic participants (N=1,401).
  
  
  RESULTS
  Cross-sectionally, HOMA-IR was associated with sex, residence location, smoking, and high-risk cardiometabolic profile. Prospectively, insulin resistance is associated with the development of CVD and decreased kidney function in this population.
  
  
  CONCLUSIONS
  Insulin resistance may have an important role in the pathogenesis of CVD and chronic kidney disease. Since obesity contributes to the development of insulin resistance, intervention focusing on modifiable factors such as physical activity and weight control may reduce the development of these diseases.
authors.affiliation: Corresponding author: Ying Zhang, ying-zhang4@ouhsc.edu.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Lyle G
authors.initials: LG
authors.lastname: Best
authors.forename: Jason G
authors.initials: JG
authors.lastname: Umans
authors.forename: Jeunliang
authors.initials: J
authors.lastname: Yeh
authors.forename: Wenyu
authors.initials: W
authors.lastname: Wang
authors.forename: Fawn
authors.initials: F
authors.lastname: Yeh
authors.forename: Tauqeer
authors.initials: T
authors.lastname: Ali
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007198:Indians, North American; D007333:Insulin Resistance / Q000502:physiology*; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models