Published online before print March 6, 2003, doi: 10.1161/01.ATV.0000065636.15310.9C
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© 2003 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
C-Reactive Protein Is Independently Associated With Fasting Insulin in Nondiabetic Women
From the Center for Cardiovascular Disease Prevention (A.D.P., J.E.B., J.E.M., P.M.R.), the Leducq Center for Molecular and Genetic Epidemiology of Cardiovascular Disorders (P.M.R.), the Divisions of Cardiology (A.D.P., P.M.R.) and Preventive Medicine (A.D.P., N.R.C., J.E.B., J.E.M., P.M.R.), Brigham and Women’s Hospital and Harvard Medical School; and the Department of Ambulatory Care and Prevention (J.E.B.), Harvard Medical School, Boston, Mass.
Correspondence to Dr Paul M. Ridker, Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, 900 Commonwealth Ave E, Boston, MA 02215-1204. E-mail pridker{at}partners.org
Objective— Insulin resistance is associated with chronic subclinical inflammation, and both conditions are linked with increased risk for type 2 diabetes mellitus and atherothrombotic cardiovascular disease.
Methods and Results— In a cross-sectional study conducted among participants in the Women’s Health Study, an ongoing US primary prevention trial of cardiovascular disease and cancer, we evaluated the correlates of elevated fasting insulin, a marker of insulin resistance, among 349 healthy, nondiabetic women who remained free from clinically diagnosed type 2 diabetes mellitus during a 4-year period from biomarker assessment. Fasting insulin was strongly associated with body mass index (BMI) (r=0.53, P<0.001), C-reactive protein (CRP) (r=0.38, P<0.001), and interleukin-6 (r=0.33, P<0.001). Physical activity level, alcohol consumption, and use of hormone replacement therapy were also related to fasting insulin. However, in multivariable linear regression analysis, BMI and CRP were the only independent correlates of log-normalized fasting insulin. Overall, the final model explained 32% of the variance in log insulin level. In multivariable logistic regression, the fully adjusted odds ratio (OR) for elevated fasting insulin (
51.6 pmol/L) increased with tertile of BMI, CRP, and IL-6, such that the ORs in the highest versus lowest tertile of each parameter were 9.0 (95% confidence interval [CI], 4.4 to 18.7), 4.4 (95% CI, 1.9 to 10.1), and 2.0 (95% CI, 0.9 to 4.2), respectively. Furthermore, increasing levels of CRP were associated with a stepwise gradient in odds for elevated fasting insulin among both lean and overweight women.
Conclusions— CRP is independently associated with fasting hyperinsulinemia in nondiabetic women. These data provide additional support for previously reported associations between subclinical inflammation and the risk of type 2 diabetes and cardiovascular disease.
Key Words: fasting insulin • C-reactive protein • women
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