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The predictive relationship between baseline insulin and glucose with subclinical carotid atherosclerosis after 5 years in a multi-ethnic cohort

      Highlights

      • Ethnicity sometimes modifies the relationship between insulin and glucose with subclinical atherosclerosis.
      • Ethnic minorities showed lower progression of atherosclerosis with increasing insulin or glucose compared with Europeans.
      • South Asians showed evidence of insulin resistance after five years of follow up.

      Abstract

      Background and aims

      We aimed at exploring the relationship between baseline insulin and glucose and the progression of carotid atherosclerosis in a multi-ethnic cohort.

      Methods

      Males and females (n = 797) of European, Chinese, South Asian and Aboriginal origin were assessed as part of the Multicultural Community Health Assessment Trial (MCHAT) study for socio-demographics, smoking status, fasting insulin and glucose at baseline. IMT, plaque area and total area were assessed after 5 years.

      Results

      A total of 545 participants returned after 5 years for a follow-up assessment. Average age of the study participants was 47.5 (SD 8.9) years. At baseline, the median and interquartile range for insulin was 62.0 (49.5) pmol/L, and glucose was 5.2 (0.60) mmol/L.
      Baseline glucose and insulin predicted the 5-year progression of atherosclerosis in our models, after adjusting for covariates. We found significant insulin-ethnicity interactions in the IMT model (p = 0.044) with the slope of the relationship showing that for every percentage change in insulin the Europeans experienced 7.3% more increase in IMT at 5 years than the Aboriginals. In the plaque area and total area models, there were significant glucose-ethnicity interactions (p = 0.009 and p=0.016 respectively), with the slope showing a 101% and 121% increase for plaque area and total area, respectively, in Europeans, at 5 years per percent change in glucose at baseline. Logistic regression found a significant glucose-ethnicity interaction with the presence of plaques (OR = 0.31, p = 0.03) such that compared to the Europeans, the South Asians had a lower odds of developing plaque presence. Similarly, we found glucose-ethnicity interactions in the logistic regression when comparing the Chinese to the Europeans (OR = 0.2, p=0.005), with the Chinese being less likely to develop plaque presence.

      Conclusions

      Ethnicity modifies the predictive relationship between insulin and glucose with sub-clinical indicators of carotid atherosclerosis but not consistently so.

      Keywords

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      References

        • Lozano R.
        • Naghavi M.
        • Foreman K.
        • Lim S.
        • Shibuya K.
        • et al.
        Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2013; 380: 2095-2128
        • Levi F.
        • Chatenoud L.
        • Bertuccio P.
        • Lucchini F.
        • Negri E.
        • et al.
        Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update.
        Eur. J. Cardiovasc. Prev. Rehabilitation. 2009; 16: 333-350
        • Allender S.
        • Scarborough P.
        • Peto V.
        • Rayner M.
        • Leal J.
        • et al.
        European Cardiovascular Disease Statistics.
        European Heart Network, Brussels, England2008
        • Finegold J.A.
        • Asaria P.
        • Francis D.P.
        Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations.
        Int. J. Cardiol. 2013; 168: 934-945
        • Yusuf S.
        • Reddy S.
        • Ôunpuu S.
        • Anand S.
        Global burden of cardiovascular diseases part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies.
        Circulation. 2001; 104: 2855-2864
        • Anand S.S.
        • Yusuf S.
        • Jacobs R.
        • Davis A.D.
        • Yi Q.
        • et al.
        Risk factors, atherosclerosis, and cardiovascular disease among aboriginal people in Canada: the study of health assessment and risk evaluation in aboriginal peoples (SHARE-AP).
        Lancet. 2001; 358: 1147-1153
        • Kahn S.E.
        • Hull R.L.
        • Utzschneider K.M.
        Mechanisms linking obesity to insulin resistance and type 2 diabetes.
        Nature. 2006; 444: 840-846
        • Lear S.A.
        • Humphries K.H.
        • Kohli S.
        • Chockalingam A.
        • Frohlich J.J.
        • et al.
        Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT).
        Am. J. Clin. Nutr. 2007; 86: 353-359
        • Misra A.
        • Vikram N.K.
        Insulin resistance syndrome (metabolic syndrome) and obesity in Asian Indians: evidence and implications.
        Nutrition. 2004; 20: 482-491
        • Tsai C.F.
        • Thomas B.
        • Sudlow C.L.
        Epidemiology of stroke and its subtypes in Chinese vs white populations A systematic review.
        Neurology. 2013; 81: 264-272
        • Keaney J.F.
        Atherosclerosis: from lesion formation to plaque activation and endothelial dysfunction.
        Mol. aspects Med. 2000; 21: 99-166
        • Salonen J.T.
        • Salonen R.
        Ultrasound B-mode imaging in observational studies of atherosclerotic progression.
        Circulation. 1993; 87: II56-65
        • Lorenz M.W.
        • Markus H.S.
        • Bots M.L.
        • Rosvall M.
        • Sitzer M.
        Prediction of clinical cardiovascular events with carotid intima-media thickness a systematic review and meta-analysis.
        Circulation. 2007; 115: 459-467
        • Einarson T.R.
        • Hunchuck J.
        • Hemels M.
        Relationship between blood glucose and carotid intima media thickness: a meta-analysis.
        Cardiovasc. Diabetol. 2010; 9: 37
        • Stout R.W.
        Overview of the association between insulin and atherosclerosis.
        Metabolism. 1985; 34: 7-12
        • Lear S.A.
        • Birmingham C.
        • Chockalingam A.
        • Humphries K.H.
        Study design of the Multicultural Community Health Assessment Trial (M-CHAT): a comparison of body fat distribution in four distinct populations.
        Ethn. Dis. 2006; 16: 96-100
        • Aminbakhsh A.
        • Frohlich J.
        • Mancini G.J.
        Detection of early atherosclerosis with B mode carotid utrasonography: assessment of a new quantitative approach.
        Clin. investigative Med. 1999; 22: 265
        • Chan S.Y.
        • Mancini G.J.
        • Kuramoto L.
        • Schulzer M.
        • Frohlich J.
        • et al.
        The prognostic importance of endothelial dysfunction and carotid atheromaburden in patients with coronary artery disease.
        J. Am. Coll. Cardiol. 2003; 42: 1037-1043
        • Brohall G.
        • Oden A.
        • Fagerberg B.
        Carotid artery intima-media thickness in patients with Type 2 diabetes mellitus and impaired glucose tolerance: a systematic review.
        Diabet. Med. 2006; 23: 609-616
        • Marini M.A.
        • Frontoni S.
        • Succurro E.
        • Arturi F.
        • Fiorentino T.V.
        • et al.
        Insulin clearance is associated with carotid artery intima–media thickness.
        Atherosclerosis. 2013; 229: 453-458
        • Pataky Z.
        • Golay A.
        • Laville M.
        • Disse E.
        • Mitrakou A.
        • et al.
        Fasting insulin at baseline influences the number of cardiometabolic risk factors and RR interval at 3years in a healthy population: the RISC Study.
        Diabetes & metabolism. 2013; 39: 330-336
        • Kowall B.
        • Ebert N.
        • Then C.
        • Thiery J.
        • Koenig W.
        • et al.
        Associations between blood glucose and carotid intima-media thickness disappear after adjustment for shared risk factors: the KORA F4 study.
        PLoS One. 2012; 7: e52590
        • Faeh D.
        • William J.
        • Yerly P.
        • Paccaud F.
        • Bovet P.
        Diabetes and pre-diabetes are associated with cardiovascular risk factors and carotid/femoral intima-media thickness independently of markers of insulin resistance and adiposity.
        Cardiovasc. Diabetol. 2007; 6: 32
        • Anand S.S.
        • Yusuf S.
        • Vuksan V.
        • Devanesen S.
        • Teo K.K.
        • et al.
        Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE).
        lancet. 2000; 356: 279-284
        • Carnethon M.R.
        • Bertoni A.G.
        • Shea S.
        • Greenland P.
        • Ni H.
        • et al.
        Racial/ethnic differences in subclinical atherosclerosis among adults with diabetes the multiethnic study of atherosclerosis.
        Diabetes Care. 2005; 28: 2768-2770
        • Fuster V.
        • Badimon L.
        • Badimon J.J.
        • Chesebro J.H.
        The pathogenesis of coronary artery disease and the acute coronary syndromes.
        N. Engl. J. Med. 1992; 326: 242-250