Fasting insulin concentrations and incidence of hypertension, stroke, and coronary heart disease: a meta-analysis of prospective cohort studies

Published on Dec 1, 2013in The American Journal of Clinical Nutrition6.568
· DOI :10.3945/ajcn.113.065565
Pengcheng Xun23
Estimated H-index: 23
Ying Wu1
Estimated H-index: 1
+ 1 AuthorsKa He36
Estimated H-index: 36
Background: Insulin resistance is a precursor of numerous chronic diseases, including cardiovascular disease (CVD). The fasting insulin concentration is considered a reasonable surrogate of insulin resistance, especially among nondiabetic individuals. Objective: We aimed to quantitatively summarize the literature on the association of fasting insulin concentrations with risk of hypertension, stroke, and coronary heart disease (CHD) by conducting a meta-analysis of prospective cohort studies. Design: Eligible studies were identified by searching PubMed and EMBASE through January 2013. Additional information was retrieved through Google Scholar or a hand review of the reference lists from relevant articles. Prospective cohort studies that reported RRs and corresponding 95% CIs for the association of interest were identified. Data were extracted independently by 2 investigators, and the weighted RRs and 95% CIs for the associations were obtained by using a random-effects model. Results: Of the 22 identified studies, 10 reported results on hypertension (36,617 individuals and 4491 cases), 7 on stroke (27,887 individuals and 1550 cases), and 9 on CHD (22,379 individuals and 1986 cases). Comparison of the highest with the lowest quantile of fasting insulin concentrations showed a pooled RR (95% CI) of 1.63 (1.35, 1.97) for hypertension, 1.18 (0.87, 1.60) for stroke, and 1.50 (1.28, 1.77) for CHD. Each 50-pmol/L increment in fasting insulin was associated with a 25% increase in risk of hypertension [RR: 1.25 (1.14, 1.36)] and a 16% increase in risk of CHD [RR: 1.16 (1.10, 1.22)] but was not associated with risk of stroke [RR: 0.999 (0.99, 1.01)]. Conclusions: A higher fasting insulin concentration or hyperinsulinemia was significantly associated with an increased risk of hypertension and CHD but not stroke. This meta-analysis suggests that early fasting insulin ascertainment in the general population may help clinicians identify those who are potentially at high risk of CVD.
  • References (57)
  • Citations (29)
📖 Papers frequently viewed together
52 Citations
21.8k Citations
7 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Se Eun Park (SKKU: Sungkyunkwan University)H-Index: 22
#2Eun-Jung Rhee (SKKU: Sungkyunkwan University)H-Index: 36
Last. Won-Young Lee (SKKU: Sungkyunkwan University)H-Index: 41
view all 7 authors...
Abstracts Background and Aims This study aimed to investigate the association between baseline fasting insulin levels, changes in fasting insulin levels, and future development of hypertension in normotensive, non-diabetic, healthy adults. Methods We analyzed data from 11,123 adults, aged 20–65 years, who had no history of hypertension or diabetes mellitus at a 2004 medical examination in a health promotion program and had attended a repeat examination in 2008. Subjects were divided into four gr...
14 CitationsSource
#1Karin B. Gast (LUMC: Leiden University Medical Center)H-Index: 8
#2Nathanja Tjeerdema (LUMC: Leiden University Medical Center)H-Index: 5
Last. Olaf M. Dekkers (LUMC: Leiden University Medical Center)H-Index: 55
view all 5 authors...
Background Glucose, insulin and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) are markers of insulin resistance. The objective of this study is to compare fasting glucose, fasting insulin concentrations and HOMA-IR in strength of association with incident cardiovascular disease. Methods We searched the PubMed, MEDLINE, EMBASE, Web of Science, ScienceDirect and Cochrane Library databases from inception to March, 2011, and screened reference lists. Cohort studies or nested case-control...
89 CitationsSource
textabstractInsulin resistance, which plays a key role in the development of diabetes mellitus, is a putative modifiable risk factor for stroke. The aim of this study was to investigate if markers of insulin resistance were associated with risk of stroke in the general elderly population. This study was part of the large population-based Rotterdam Study and included 5,234 participants who were aged 55 years or older and stroke free and diabetes free at baseline (1997-2001). Fasting insulin level...
11 CitationsSource
Epidemiological research into insulin resistance has focused on excess body weight, type 2 diabetes mellitus (DM), physical activity, and coffee consumption. These common modifiable factors have also been suggested to play a role in the process of carcinogenesis via associations with insulin resistance. Findings of systematic literature reviews and meta-analyses have generally supported an association between excess body weight and DM with an increased risk of colon cancer in males, and of liver...
68 CitationsSource
#1Kerry L. Hildreth (Anschutz Medical Campus)H-Index: 8
#2Rachael E. Van Pelt (Anschutz Medical Campus)H-Index: 22
Last. Robert S. Schwartz (Anschutz Medical Campus)H-Index: 114
view all 3 authors...
Obesity has reached epidemic proportions in our society, affecting over one-third of US adults, with two-thirds overweight or obese (1). Trends toward overweight and obesity among younger age groups are alarming; 27.5% of men and 34.0% of women ages 20–39 are obese (1), and 11.3% of children 2–19 years of age are at or above the 97th percentile for 2000 BMI-for-age growth charts (2). The majority of overweight or obese individuals are also insulin resistant (3). The adverse health consequences o...
41 CitationsSource
#1Pengcheng Xun (UNC: University of North Carolina at Chapel Hill)H-Index: 23
#2Kiang Liu (NU: Northwestern University)H-Index: 60
Last. Ka He (UNC: University of North Carolina at Chapel Hill)H-Index: 36
view all 6 authors...
OBJECTIVE Although hyperinsulinemia, a surrogate of insulin resistance, may play a role in the pathogenesis of hypertension (HTN), the longitudinal association between fasting insulin level and HTN development is still controversial. We examined the relation between fasting insulin and incidence of HTN in a large prospective cohort. RESEARCH DESIGN AND METHODS A prospective cohort of 3,413 Americans, aged 18–30 years, without HTN in 1985 (baseline) were enrolled. Six follow-ups were conducted in...
12 CitationsSource
#1Evan L. Thacker (UW: University of Washington)H-Index: 18
#2Bruce M. Psaty (Group Health Cooperative)H-Index: 153
Last. David S. Siscovick (UW: University of Washington)H-Index: 125
view all 14 authors...
Background and Purpose—Few studies have assessed post-glucose load measures of insulin resistance and ischemic stroke risk, and data are sparse for older adults. We investigated whether fasting and post-glucose load measures of insulin resistance were related to incident ischemic stroke in nondiabetic, older adults. Methods—Participants were men and women in the Cardiovascular Health Study, age 65+ years and without prevalent diabetes or stroke at baseline, followed for 17 years for incident isc...
27 CitationsSource
#1Ki Chul Sung (SKKU: Sungkyunkwan University)H-Index: 30
#2Soo Lim (Seoul National University Bundang Hospital)H-Index: 42
Last. Robert S. Rosenson (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 59
view all 3 authors...
18 CitationsSource
#1Gregory P. Levin (UW: University of Washington)H-Index: 9
#2Bryan Kestenbaum (UW: University of Washington)H-Index: 61
Last. de Boer Ih (UW: University of Washington)H-Index: 57
view all 8 authors...
Diabetes mellitus and hypertension commonly coexist, but the nature of this link is not well understood. The authors tested whether diabetes and higher concentrations of fasting serum glucose and insulin are associated with increased risk of developing incident hypertension in the community-based Multi-Ethnic Study of Atherosclerosis. At baseline, 3,513 participants were free of hypertension, defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihyperte...
28 CitationsSource
#1Tatjana Rundek (UM: University of Miami)H-Index: 62
#2Hannah Gardener (UM: University of Miami)H-Index: 26
Last. Ralph L. Sacco (UM: University of Miami)H-Index: 126
view all 10 authors...
Background Whether insulin resistance predicts ischemic stroke (IS) is still a matter of debate. Objective To determine the association between insulin resistance (IR) and risk of first ischemic stroke in a large, multiethnic, stroke-free cohort without diabetes. Design Prospective, population-based cohort study. Setting Longitudinal epidemiologic study. Participants A cohort of 1509 nondiabetic participants from the Northern Manhattan Study (mean [SD] age, 11 [10] years; 64.2% women; 58.9% Hisp...
71 CitationsSource
Cited By29
Abstract Epidemiologic studies have reported conflicting results on the association between insulin resistance and risk of stroke. This meta-analysis sought to evaluate the association between homeostasis model assessment-insulin resistance (HOMA-IR) and risk of stroke. Eligible studies were identified by searching PubMed and Emabse databases up to December 2018. Prospective observational studies investigating the association between HOMA-IR and incident stroke were included. Seven studies invol...
(1) Background: The variation in the concentration of different components found in milk depends on mammalian species, genetic, physiological, nutritional factors, and environmental conditions. Here, we analyse, for the first time, the content of different components (cholesterol concentration and fatty acids composition as well as the overall fat and mineral content determined using the same analytical methods) in milk of different mammal species. (2) Methods: The samples (n = 52) of human, cow...
#1He Wang (Sichuan University)
#2Xiaomeng Li (Sichuan University)
Last. Lishi Zhang (Sichuan University)H-Index: 4
view all 7 authors...
Metal exposure has recently been related to the risk of hypertension. However, the association remains unclear and relevant epidemiologic studies are limited. The present study aimed to assess the associations between exposure to metals and the odds of hypertension, as well as blood pressure (BP) levels. A total of 816 participants were enrolled in southwestern China. Hypertension was defined as a systolic BP (SBP) of >/=140 mmHg or diastolic BP (DBP) of >/=90 mmHg, a self-reported physician dia...
#1Kimon Stamatelopoulos (UoA: National and Kapodistrian University of Athens)H-Index: 32
#2Michael Apostolakis (UoA: National and Kapodistrian University of Athens)H-Index: 1
Last. Irene Lambrinoudaki (UoA: National and Kapodistrian University of Athens)H-Index: 29
view all 11 authors...
AbstractIntroduction: We aimed to investigate the incidence of hypertension and to identify potential risk factors in healthy, non-diabetic recently postmenopausal Greek women with normal renal fun...
#1Aidin Baghbani-Oskouei (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 1
#2Maryam Tohidi (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 21
Last. Farzad Hadaegh (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 30
view all 5 authors...
Background To examine the association between changes in fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and insulin-glucose ratio (IGR) levels, over approximately 3 years with incident hypertension.
#1Shao-wei Chen (CDC: Centers for Disease Control and Prevention)H-Index: 1
#2Zi-hui Chen (CDC: Centers for Disease Control and Prevention)H-Index: 1
Last. Jie-wen Peng (CDC: Centers for Disease Control and Prevention)H-Index: 1
view all 5 authors...
Summary Background & aims The association between dietary acid load and hypertension risk is inconclusive. We conducted a systematic review and meta-analysis to summarize effect of dietary acid load on blood pressure. Methods A comprehensively search was performed in electronic databases including EMBASE, PubMed, Web of Science and Chinese National Knowledge Infrastructure. Summary ORs and their corresponding 95% CIs were computed assuming a randomized model or fixed model. Results Ten publicati...
#1Rolanda Johnson (Vandy: Vanderbilt University)H-Index: 5
#2Tom Cook (Vandy: Vanderbilt University)H-Index: 1
ABSTRACTAccess to medications is a critical determinant of health which often mediates the effects of diseases and leads to healthier lifestyles. With limited access to pharmacies, neighborhoods become pharmacy deserts. The purpose of this study was to explore the medication needs and perceptions of low-income community residents. A purposive sample of 40 low-income community residents participated in focus groups. Content analysis revealed four themes: transitioning to the present, stereotyping...
#1Katharina Nimptsch (MDC: Max Delbrück Center for Molecular Medicine)H-Index: 22
#2Stefan Konigorski (HPI: Hasso Plattner Institute)H-Index: 3
Last. Tobias PischonH-Index: 68
view all 3 authors...
Abstract The global epidemic of obesity is a major public health problem today. Obesity increases the risk of many chronic diseases, such as type 2 diabetes, coronary heart disease, and certain types of cancer, and is associated with lower life expectancy. The body mass index (BMI), which is currently used to classify obesity, is only an imperfect measure of abnormal or excessive body fat accumulation. Studies have shown that waist circumference as a measure of fat distribution may improve disea...
5 CitationsSource
#1Hilary A. Tindle (VUMC: Vanderbilt University Medical Center)H-Index: 29
#2Meredith S. Duncan (VUMC: Vanderbilt University Medical Center)H-Index: 7
Last. Matthew S. Freiberg (VUMC: Vanderbilt University Medical Center)H-Index: 30
view all 15 authors...
Background Psychological attitudes reflecting expectations about the future (optimism, pessimism) and people (cynical hostility) independently predict incident cardiovascular disease and possibly diabetes, but underlying biologic pathways are incompletely understood. We examined the cross-sectional relationship between optimism, pessimism, and cynicism and biomarkers of metabolic function in the Women's Health Initiative. Methods Among 3443 postmenopausal women, biomarkers of metabolic function ...
3 CitationsSource