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Insulin resistance, cystatin C, and mortality among older adults.
Tuesday,2012-11-06 12:26 America/Los_Angeles — eenright
| Title | Insulin resistance, cystatin C, and mortality among older adults. |
| Publication Type | Journal Article |
| Year of Publication | 2012 |
| Authors | de Boer, IH, Katz, R, Chonchol, MB, Fried, LF, Ix, JH, Kestenbaum, B, Mukamal, KJ, Peralta, CA, Siscovick, DS |
| Journal | Diabetes Care |
| Volume | 35 |
| Issue | 6 |
| Pagination | 1355-60 |
| Date Published | 2012 Jun |
| ISSN | 1935-5548 |
| Keywords | Aged, Aged, 80 and over, Blood Glucose, Blood Pressure, C-Reactive Protein, Cardiovascular Diseases, Cholesterol, HDL, Cholesterol, LDL, Cohort Studies, Cystatin C, Fasting, Female, Glomerular Filtration Rate, Humans, Insulin Resistance, Life Style, Male, Mortality, Predictive Value of Tests, Proportional Hazards Models, Renal Insufficiency, Risk Factors, Triglycerides, Waist Circumference |
| Abstract | <p><b>OBJECTIVE: </b>Insulin resistance is a risk factor for cardiovascular and noncardiovascular diseases. Impaired kidney function is linked with insulin resistance and may affect relationships of insulin resistance with health outcomes.</p><p><b>RESEARCH DESIGN AND METHODS: </b>We performed a cohort study of 3,138 Cardiovascular Health Study participants (age ≥ 65 years) without diabetes. Insulin sensitivity index (ISI) was calculated from fasting and 2-h postload insulin and glucose concentrations. Associations of ISI and fasting insulin concentration with all-cause mortality were tested using Cox proportional hazards models, adjusting for demographic variables, prevalent cardiovascular disease, lifestyle variables, waist circumference, and LDL cholesterol. Subsequent models were additionally adjusted for or stratified by glomerular filtration rate estimated using serum cystatin C (eGFR).</p><p><b>RESULTS: </b>A total of 1,810 participants died during the 14.7-year median follow-up. Compared with the highest quartile of ISI, the lowest quartile (most insulin resistant) was associated with 21% (95% CI 6-41) and 11% (-3 to 29) higher risks of death without and with adjustment for eGFR, respectively. Compared with the lowest quartile of fasting insulin concentration, the highest quartile was associated with 22% (4-43) and 4% (-12 to 22) higher risks of death without and with adjustment for eGFR, respectively. Similar attenuation by eGFR was observed when blood pressure, triglycerides, HDL cholesterol, and C-reactive protein were included in models.</p><p><b>CONCLUSIONS: </b>Insulin resistance measured as ISI or fasting insulin concentration is associated with increased risk of death among older adults, adjusting for conventional confounding characteristics. Impaired kidney function may mediate or confound this relationship.</p> |
| DOI | 10.2337/dc11-1657 |
| Alternate Journal | Diabetes Care |
| PubMed ID | 22432118 |
| PubMed Central ID | PMC3357240 |
| Grant List | R01 DK087726 / DK / NIDDK NIH HHS / United States R01-AG-027002 / AG / NIA NIH HHS / United States R01 DK088762 / DK / NIDDK NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States U01-HL-080295 / HL / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States N01-HC-55222 / HC / NHLBI NIH HHS / United States N01-HC-75150 / HC / NHLBI NIH HHS / United States R01 AG027002 / AG / NIA NIH HHS / United States N01HC75150 / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01 HC045133 / HC / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States R01-DK-087726 / DK / NIDDK NIH HHS / United States |