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Insulin resistance is a cardiovascular risk factor in hypertensive adults without type 2 diabetes mellitus

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Summary

Background

Metabolic syndrome refers to the association among several cardiovascular risk factors: obesity, dyslipidemia, hyperglycemia, and hypertension. It is associated with increased cardiovascular risk and the development of type 2 diabetes mellitus. Insulin resistance is the underlying mechanism of metabolic syndrome, although its role in increased cardiovascular risk has not been directly identified.

Objective

We investigated the association between insulin resistance and increased cardiovascular risk in hypertensive adults without diabetes mellitus.

Design and participants

We enrolled participants without diabetes from an outpatient setting in a retrospective, longitudinal study. Several demographic, clinical, and laboratory parameters were recorded during the observation period. Plasma insulin and homeostatic model assessment for insulin resistance (HOMA-IR) were used to determine insulin resistance and four cardiovascular events (acute coronary disease, acute cerebrovascular disease, incident heart failure, and cardiovascular mortality) were combined into a single outcome. Logistic regression and Cox proportional hazards models were fitted to evaluate the association between covariates and outcomes.

Results

We included 1899 hypertensive adults without diabetes with an average age of 53 years (51.3% women, 23% had prediabetes, and 64.2% had metabolic syndrome). In a logistic regression analysis, male sex (odds ratio, OR = 1.66) having high levels of low-density lipoprotein (LDL, OR = 1.01), kidney function (OR = 0.97), and HOMA-IR (OR = 1.06) were associated with the incidence of cardiovascular events; however, in a survival multivariate analysis, only HOMA-IR (hazard ratio, HR 1.4, 95% confidence interval, CI: 1.05–1.87, p = 0.02) and body mass index (HR 1.05, 95% CI: 1.02–1.08, p = 0.002) were considered independent prognostic variables for the development of incident cardiovascular events.

Conclusion

Insulin resistance and obesity are useful for assessing cardiovascular risk in hypertensive people without diabetes but with preserved kidney function. This work demonstrates the predictive value of the measurement of insulin, and therefore of insulin resistance, in an outpatient setting and attending to high-risk patients.

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Funding

The authors received no financial support for this research or the authorship or publication of this article.

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Authors and Affiliations

  1. Department of Internal Medicine, Mostoles University Hospital, Rey Juan Carlos University (Madrid), Calle Rio Jucar, s/n, 28935, Mostoles (Madrid), Spain

    Rafael Garcia-Carretero & Oscar Vazquez-Gomez

  2. Department of Preventive Medicine and Public Health, Rey Juan Carlos University (Madrid), Madrid, Spain

    Ruth Gil-Prieto & Angel Gil-de-Miguel

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  1. Rafael Garcia-Carretero
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  2. Oscar Vazquez-Gomez
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  3. Ruth Gil-Prieto
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  4. Angel Gil-de-Miguel
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Contributions

Dr. Garcia-Carretero designed and conceived the study, preprocessed the data, analyzed and interpreted the data, and wrote the first draft of the article. Dr. Vazquez-Gomez made substantial contributions to the interpretation of the results, critically reviewed the first draft of the manuscript, and made valuable suggestions. Drs. Gil-Prieto and Gil-de-Miguel supervised the project and critically reviewed and edited the final draft of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rafael Garcia-Carretero.

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Conflict of interest

R. Garcia-Carretero, O. Vazquez-Gomez, R. Gil-Prieto and A. Gil-de-Miguel declare that they have no competing interests.

Ethical standards

This retrospective study was approved by the Research and Ethics Committee of Mostoles University Hospital. All procedures involving human participants were conducted in accordance with the ethical standards of the responsible institutional and/or National Research Committee and with the tenets of the 1964 Helsinki Declaration and its later amendments and comparable ethical standards. The authors obtained consent for publication from their institution and its Research and Ethics Committee.

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Data availability

According to the terms of a contract signed with Mostoles University Hospital, the authors cannot provide the dataset to any other researcher. Furthermore, it was destroyed at the conclusion of the research.

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Garcia-Carretero, R., Vazquez-Gomez, O., Gil-Prieto, R. et al. Insulin resistance is a cardiovascular risk factor in hypertensive adults without type 2 diabetes mellitus. Wien Klin Wochenschr 136, 101–109 (2024). https://doi.org/10.1007/s00508-023-02278-1

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