Insulin resistance probability score and incident cardiovascular disease.
Level 3 - non-randomized controlled study
Prospective cohort study with long-term follow-up
PubMed 37424183 · doi:10.1111/joim.13687
What was done
A prospective cohort of 3,645 elderly individuals without baseline cardiovascular disease (CVD) or diabetes (median age 68 years) was sampled from the population-based Malmö Preventive Project and followed for 13.3 years. Insulin resistance probability, p(IR), was calculated using mass-spectrometry measurements of insulin and C-peptide. Multivariable Cox models evaluated the association between high p(IR) (>80%, n = 152) versus p(IR) <= 80% and incident CVD as well as combined CVD or all-cause mortality, adjusting for age, sex, hypertension, smoking, HDL-cholesterol, total cholesterol, triglycerides, BMI, and prediabetes.
What was found
During 13.3 years of follow-up, 794 incident CVD events occurred. High p(IR) (>80%) was associated with an increased risk of incident CVD (HR = 1.51, 95% CI 1.12-2.05, p = 0.007) and an increased risk of combined CVD or all-cause mortality (HR = 1.43, 95% CI 1.16-1.77, p = 0.0009) after full adjustment.
Why it matters
A mass-spectrometry-derived score for insulin resistance independently predicts incident cardiovascular disease and mortality in older adults without baseline diabetes, demonstrating the prognostic utility of insulin resistance assessment in the elderly.
Limits
The observational design cannot establish causality. The high-risk group comprised only 152 participants, limiting power for granular subgroup analyses. Findings may not generalize beyond the specific elderly cohort studied.
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- context A mass spectrometry blood test developed by Quest measuring the ratio of C-peptide to insulin is as specific and predictive of insulin resistance as the euglycemic clamp test.