Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study.
Studies exploring the association between insulin resistance (IR) and cardiovascular disease in blacks have not been conclusive, especially for coronary heart disease (CHD). The McAuley index and homeostasis model assessment of IR (HOMA-IR) perform differently in predicting cardiovascular disease. We investigated this association in the Jackson Heart Study, a large longitudinal cohort of blacks.



IR was estimated for 3565 participants without diabetes mellitus and cardiovascular disease at baseline using the McAuley index and HOMA-IR, and their associations with incident CHD and stroke (composite outcome) were compared. A lower McAuley index and higher HOMA-IR are indicative of IR. Cox regression analysis was used to estimate adjusted hazard ratios for incident CHD and/or stroke. There were 158 events (89 CHD-only, 58 stroke-only, and 11 CHD/stroke) over a median follow-up of 8.4 years. After adjustment for demographic factors, the risk of the composite outcome decreased with each SD increase in the McAuley index (hazard ratio 0.80; 95% CI: 0.67-0.96), with no attenuation after further accounting for CHD and stroke risk factors. When considered individually, McAuley index and HOMA-IR were associated with CHD (hazard ratio 0.71, 95% CI: 0.55-0.92 and hazard ratio 1.33, 95% CI: 1.03-1.72, respectively), but not stroke risk. The logHOMA-IR and CHD association was present in men, but not in women (Pinteraction=0.01).



Both HOMA-IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA-IR and CHD association was present in men, but not in women.
Division of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA veffoe@msm.edu valeffoe@gmail.com.|Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC.
Valery S
VS
Effoe
Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC.
Lynne E
LE
Wagenknecht
Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Justin B
JB
Echouffo Tcheugui
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, NC.
Haiying
H
Chen
Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD.
Joshua J
JJ
Joseph
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
Rita R
RR
Kalyani
Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC.|Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, NC.
Ronny A
RA
Bell
Department of Medicine, Alpert Medical School of Brown University, Providence, RI.
Wen-Chih H
WH
Wu
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, NC.
Ramon
R
Casanova
Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC.|Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, NC.
Alain G
AG
Bertoni
D000328:Adult; D001741:Black or African American / Q000208:ethnology*; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000097:blood / Q000208:ethnology*; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D020521:Stroke / Q000097:blood / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
blacks; cardiovascular disease risk factors; cerebrovascular disease/stroke; coronary heart disease; epidemiology; insulin resistance; myocardial infarction; stroke