title: The relationship between insulin resistance and vascular calcification in coronary arteries, and the thoracic and abdominal aorta: the Multi-Ethnic Study of Atherosclerosis.
abstract: OBJECTIVE
  Insulin resistance may be related to vascular calcification as both are associated with abdominal obesity. We investigated the association of insulin resistance with abdominal aortic calcium (AAC), coronary artery calcium (CAC) and thoracic aortic calcium (TAC), and whether it differs according to different levels of subcutaneous fat area (SFA) and visceral fat area (VFA) in a cross-sectional study design.
  
  
  METHODS
  We investigated 1632 participants without diabetes from the Multi-Ethnic Study of Atherosclerosis with valid data on homeostasis model assessment index (HOMA-IR), AAC, CAC, and TAC. Adipocytokines, SFA, and VFA were also determined.
  
  
  RESULTS
  HOMA-IR was associated with the presence of CAC, but not AAC and TAC, and the association remained significant after adjusting for traditional risk factors, adipocytokines, abdominal muscle mass, SFA, and VFA (prevalence ratio = 1.04 per one interquartile range [IQR] increase, P = 0.01). As the strength of the association of HOMA-IR with vascular calcification may differ by abdominal fat composition, subgroup analysis was performed among participants with different tertiles of SFA and VFA. Significant interactions between HOMA-IR with SFA and VFA separately were observed for the presence of TAC, but not AAC and CAC, even after adjusting for confounding factors. The association of HOMA-IR with TAC tended to be stronger in participants with more SFA and VFA.
  
  
  CONCLUSIONS
  Atherosclerotic calcification, especially in the coronary arteries, is related to insulin resistance. Further studies are needed to delineate the mechanisms by which visceral obesity can lead to vascular calcification.
authors.affiliation: Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. Electronic address: kwokleung.ong@unsw.edu.au.
authors.forename: Kwok-Leung
authors.initials: KL
authors.lastname: Ong
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, United States.
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.affiliation: Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
authors.forename: Kerry-Anne
authors.initials: KA
authors.lastname: Rye
authors.affiliation: Department of Medicine, University of Hong Kong, Hong Kong, China.
authors.forename: Bernard M Y
authors.initials: BM
authors.lastname: Cheung
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Dhananjay
authors.initials: D
authors.lastname: Vaidya
authors.affiliation: Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.affiliation: Departments of Medicine and Pathology, University of Vermont, Burlington, VT, United States.
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.affiliation: Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Barter
authors.affiliation: Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States. Electronic address: mallison@ucsd.edu.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
mesh_terms: D054392:Adipokines / Q000097:blood; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000737:chemistry; D001013:Aorta, Thoracic / Q000737:chemistry; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging; D002118:Calcium / Q000032:analysis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000033:anatomy & histology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D050151:Subcutaneous Fat / Q000033:anatomy & histology
chemical_list: D054392:Adipokines; D016207:Cytokines; D002118:Calcium
keywords: Adipocytokines; Body composition; Calcium; Insulin resistance; Vascular calcification
references.citation: Am J Cardiol. 2001 Jul 19;88(2A):16E-19E
references.pmid: 11473739
references.citation: Diabetes Care. 2009 Nov;32 Suppl 2:S168-73
references.pmid: 19875546
references.citation: Diabetes Care. 2002 Aug;25(8):1313-9
references.pmid: 12145227
references.citation: Am J Prev Med. 2012 Jan;42(1):8-13
references.pmid: 22176840
references.citation: Circulation. 2004 Aug 17;110(7):803-9
references.pmid: 15289378
references.citation: Arterioscler Thromb Vasc Biol. 2001 Dec;21(12):2051-8
references.pmid: 11742884
references.citation: Am J Epidemiol. 2002 Nov 1;156(9):871-81
references.pmid: 12397006
references.citation: Diabetes Care. 2004 Jun;27(6):1487-95
references.pmid: 15161807
references.citation: Vasc Med. 2014 Jun 6;19(4):264-271
references.pmid: 24907349
references.citation: Int J Cardiol. 2013 Nov 5;169(3):166-76
references.pmid: 24063931
references.citation: Circulation. 2005 Apr 19;111(15):1877-82
references.pmid: 15837939
references.citation: Am J Cardiol. 2009 Sep 15;104(6):812-7
references.pmid: 19733716
references.citation: Arterioscler Thromb Vasc Biol. 2010 Nov;30(11):2289-96
references.pmid: 20814018
references.citation: Metabolism. 2013 Nov;62(11):1562-9
references.pmid: 23916063
references.citation: J Am Coll Cardiol. 2008 Jul 15;52(3):231-6
references.pmid: 18617073
references.citation: Circulation. 2007 May 29;115(21):2722-30
references.pmid: 17502571
references.citation: Eur J Prev Cardiol. 2014 Oct;21(10):1233-41
references.pmid: 23689526
references.citation: Nature. 2006 Dec 14;444(7121):881-7
references.pmid: 17167477
references.citation: Clin Chim Acta. 2013 Apr 18;419:87-94
references.pmid: 23422739
references.citation: J Am Coll Cardiol. 1990 Mar 15;15(4):827-32
references.pmid: 2407762
references.citation: Obesity (Silver Spring). 2011 Dec;19(12):2418-24
references.pmid: 21475146
references.citation: Circulation. 2005 Mar 15;111(10):1313-20
references.pmid: 15769774
references.citation: Circulation. 2008 Feb 5;117(5):605-13
references.pmid: 18212276
references.citation: Atherosclerosis. 2011 Oct;218(2):507-10
references.pmid: 21798541
references.citation: Am J Epidemiol. 2009 Feb 15;169(4):444-54
references.pmid: 19075250
references.citation: Diabetes Care. 2007 Nov;30(11):2951-6
references.pmid: 17704348
references.citation: Diabetes. 2010 Dec;59(12):3008-16
references.pmid: 20841607
references.citation: Arterioscler Thromb Vasc Biol. 2012 Jan;32(1):140-6
references.pmid: 22034514
references.citation: Int J Cardiol. 2010 Jan 7;138(1):3-8
references.pmid: 19398137
references.citation: Arterioscler Thromb Vasc Biol. 2004 Feb;24(2):331-6
references.pmid: 14656730
references.citation: Circulation. 1995 Sep 1;92(5):1355-74
references.pmid: 7648691
references.citation: Diabetes. 1988 Dec;37(12):1595-607
references.pmid: 3056758
references.citation: Diabetologia. 1985 Jul;28(7):412-9
references.pmid: 3899825