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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1997;17:2413-2417.)
© 1997 American Heart Association, Inc.

Articles

Does Insulin Resistance Unite the Separate Components of the Insulin Resistance Syndrome?

Evidence From the Miami Community Health Study

Richard P. Donahue; Judy A. Bean; Rosemary DeCarlo Donahue; Ronald B. Goldberg; ; Ronald J. Prineas

From the University of Miami School of Medicine, Department of Epidemiology and Public Health (R.P.D., J.A.B., R.J.P.); the University of Miami School of Nursing (R.D.D.); and the University of Miami School of Medicine, Department of Medicine R.B.G.), Miami, Fla.

Correspondence to Richard P Donahue PhD, MPH, SUNY Buffalo, Department of Social and Preventative Medicine, 270 Farber Hall, Buffalo, NY 14218 E-mail rdonahue{at}ubmed.buffalo.edu

Abstract A number of coronary heart disease risk factors have been identified that often cluster together to increase the risk of macrovascular disease. This cluster is referred to as the insulin resistance syndrome, and the risk factors commonly include dyslipidemia, elevated blood pressure, an android pattern of body fat distribution, and glucose intolerance. Whether hyperinsulinemia or insulin resistance per se provides a common pathway for these metabolic abnormalities is unclear. The authors studied 50 nondiabetic persons who had completed a euglycemic hyperinsulinemic clamp protocol in addition to a 75-g oral glucose tolerance test and other measures of the coronary risk profile. Using principal-component analysis, we reduced nine coronary risk factors to two uncorrelated factors that explained 54.5% of the variance. Factor 1 consisted of positive loadings for uric acid, systolic and diastolic blood pressure, triglyceride concentration, and waist girth and negative loadings for HDL cholesterol and the rate of insulin-mediated glucose disposal (M, in milligrams per kilogram of body weight per minute). M also loaded on factor 2, along with fasting insulin and glucose concentrations, diastolic blood pressure, and waist girth. The observation that M loaded on both factors suggests that a resistance to insulin action may provide the mechanism uniting the features of the insulin resistance syndrome. Hyperinsulinemia with concomitant insulin resistance may be necessary to produce this metabolic derangement, as well as the increased risk of macrovascular complications.

Key Words: insulin • atherosclerosis • coronary risk factors

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