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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
Abstract
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)
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References57
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#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
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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...
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#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
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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...
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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...
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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...
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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...
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Last. Ka He (UNC: University of North Carolina at Chapel Hill)H-Index: 36
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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...
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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...
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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...
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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...
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