title: Insulin resistance predicts early cardiovascular morbidity in men without diabetes mellitus, with effect modification by physical activity.
abstract: OBJECTIVE
  to assess how well insulin resistance predicts cardiovascular disease (CVD) in non-diabetic men and women and to explore the influence of physical activity.
  
  
  METHODS
  in this prospective study 2563 men and women without diabetes were examined with an oral glucose tolerance test, anthropometric measurements and blood pressure assessment. Questionnaires about lifestyle and physical activity were completed. Insulin resistance was estimated by fasting concentrations of plasma insulin and by HOMA index for insulin resistance. Participants were followed up for cardiovascular morbidity and mortality during an 8-year period, using information from the National Swedish Inpatient and Mortality registers.
  
  
  RESULTS
  at follow-up, HOMAir predicted CVD morbidity in males (50 events) and females (28 events) combined (HRage/sex-adj 1.4, 95% CI 1.1-1.7); however, when stratified by gender HOMAir was predictive solely in men (HRage-adj 1.8, 95% CI 1.3-2.4), whereas no association was found in women (HRage-adj 1.1, 95% CI 0.8-1.5). When stratifying the data for high and low physical activity, the predictive value of insulin resistance became stronger in sedentary men (HRage-adj 2.3, 95% CI 1.5-3.4) but was abolished in men performing moderate to vigorous physical activity (HRage-adj 1.0, 95% CI 0.6-1.6). The results remained when step-wise adjusted also for BMI, ApoB/ApoA1 and hypertension, as well as for smoking, alcohol consumption and education. Outcome for fasting plasma insulin was similar to HOMAir.
  
  
  CONCLUSIONS
  insulin resistance predicts CVD in the general population; however, men may be more vulnerable to increased insulin resistance than women, and physically inactive men seem to be at high risk.
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care, the Sahlgrenska Academy at the University of Gothenburg, Sweden margareta.leonardsson-hellgren@vgregion.se.
authors.forename: Margareta I
authors.initials: MI
authors.lastname: Hellgren
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care, the Sahlgrenska Academy at the University of Gothenburg, Sweden.
authors.forename: Bledar
authors.initials: B
authors.lastname: Daka
authors.affiliation: The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, the Sahlgrenska Academy at the University of Gothenburg, Sweden.
authors.forename: Per-Anders
authors.initials: PA
authors.lastname: Jansson
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care, the Sahlgrenska Academy at the University of Gothenburg, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Lindblad
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care, the Sahlgrenska Academy at the University of Gothenburg, Sweden Social Medicine and Global Health, Department of Clinical Science, Malmö, Lund University, Sweden.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Larsson
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D057185:Sedentary Behavior; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D007328:Insulin
keywords: Insulin resistance; cardiovascular disease; physical activity; prospective cohort study