Risk Factors for Progression to Incident Hyperinsulinemia: The Atherosclerosis Risk in Communities Study, 1987–1998

• Published in: American journal of epidemiology Vol. 158; no. 11; pp. 1058 - 1067
• Main Authors: Carnethon, Mercedes R., Fortmann, Stephen P., Palaniappan, Latha, Duncan, Bruce B., Schmidt, Maria I., Chambless, Lloyd E.
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 01.12.2003; Oxford Publishing Limited (England)
• Subjects: ARIC; Arteriosclerosis - complications; Atherosclerosis (general aspects, experimental research); Atherosclerosis Risk in Communities; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure; BMI; Body Mass Index; Cardiology. Vascular system; Cholesterol - blood; diabetes; Educational Status; Female; HDL; Health Behavior; high density lipoprotein; Humans; hyperinsulinemia; Hyperinsulinism - etiology; insulin resistance; LDL; Life Style; Longitudinal Studies; low density lipoprotein; Male; Medical sciences; Metabolic Syndrome - blood; metabolic syndrome X; Middle Aged; non-insulin-dependent; Population Surveillance; Risk Factors; United States - epidemiology; Vascular disease; Human; Hyperinsulinemia; Atherosclerosis; Risk factor; Race; Sex; Cardiovascular disease; Metabolic diseases; non-insulin-dependent; hyperinsulinemia; insulin resistance; longitudinal studies; metabolic syndrome X; risk factors; Epidemiology; diabetes
• ISSN: 0002-9262; 1476-6256; 0002-9262
• DOI: 10.1093/aje/kwg260

Hyperinsulinemia is a marker of insulin resistance, a correlate of the metabolic syndrome, and an established precursor of type 2 diabetes. This US study investigated the role of risk factors associated with hyperinsulinemia in cross-sectional studies in progression to incident hyperinsulinemia. Nondiabetic participants from the Atherosclerosis Risk in Communities Study (n = 9,020) were followed from 1987 to 1998 for the development of hyperinsulinemia (fasting serum insulin ≥90th percentile, 19.1 µU/ml). After adjustment for demographic characteristics, all risk factors simultaneously, and baseline insulin value, the risk of progressing to hyperinsulinemia increased per standard deviation increase in baseline uric acid (odds ratio (OR) = 1.3, 95% confidence interval (CI): 1.2, 1.4; per 1.4 mg/dl) and waist/hip ratio (OR = 1.4, 95% CI: 1.2, 1.5; per 0.08) and was inversely associated with high density lipoprotein cholesterol (OR = 0.8, 95% CI: 0.7, 0.9; per 0.4 mmol/liter). Starting to smoke (OR = 1.5, 95% CI: 1.2, 2.0) and becoming obese (OR = 2.4, 95% CI: 1.8, 3.1) during the study were also associated with increased risk. The associations were similar across race and gender groups. These data suggest that, in addition to weight gain, hyperuricemia, dyslipidemia, and smoking can be detected prior to development of hyperinsulinemia.