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Insulin Resistance and Triglycerides
  1. Charles J. Glueck, MD*,
  2. Naseer A. Khan, MD*,
  3. Muhammad Umar, MD*,
  4. Muhammad S. Uppal, MD*,
  5. Waqas Ahmed, MD*,
  6. John A. Morrison, PhD,
  7. Naila Goldenberg, MD*,
  8. Ping Wang, PhD*
  1. From the *Cholesterol Center, Jewish Hospital of Cincinnati; †Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
  1. Received December 14, 2008, and in revised form August 12, 2009.
  2. Accepted for publication August 14, 2009.
  3. Reprints: Charles J. Glueck, MD, Cholesterol Center, ABC Bldg, 3200 Burnet Ave, Cincinnati, OH 45229. E-mail: glueckch{at}healthall.com.
  4. Supported in part by the Lipoprotein Research Fund and the Medical Research Funds of the Jewish Hospital of Cincinnati.

Abstract

In 1385 adults with primary untreated hyperlipidemia and in a population study of 339 adults (Princeton Follow-up Study [PFS]), we hypothesized that homeostasis model assessment (HOMA) insulin resistance (IR) was a significant explanatory variable for triglycerides (TG) and that IR rose in a stepwise fashion, independent of age, race, sex, and body mass index (BMI), whereas TG categories rose from less than 150 to 150 to 200, to 200 to 500, and to more than 500 mg/dL. A third hypothesis was that TG, BMI, and the ratio of TG to high-density lipoprotein cholesterol (TG/HDL-C) were significant explanatory variables for IR and that IR was inversely associated with HDL-C quintiles and positively associated with non-HDL-C quintiles. By stepwise multiple regression with age, race, sex, BMI, and IR as explanatory variables, in the 1385 patients, positive explanatory variables for TG included BMI (partial R2 = 1.3%, P < 0.0001), sex (men higher, partial R 2 = 1.1%, P = 0.0001), and IR (partial R 2 = 0.4%, P = 0.012). In the 339 PFS subjects, positive explanatory variables for TG were IR (partial R 2 = 11.4%, P < 0.0001), race (whites higher, partial R 2 = 2.1%, P = 0.005), and sex (men higher, partial R 2 = 1.4%, P = 0.019). After adjusting for age, race, sex, and BMI, in 1385 patients, HOMA IR rose while TG categories rose, with least square means of 2.64 for the TG category less than 150 mg/dL, 3.27 for 150 to 200 mg/dL, 3.85 for 200 to 500 mg/dL, and 4.12 for more than 500 mg/dL. Similarly, in the PFS, while TG categories rose, the least square means of HOMA IR rose, with 1.68 for the TG category less than 150 mg/dL, 2.34 for 150 to 200 mg/dL, and 3.03 for 200 to 500 mg/dL. Body mass index, TG, and TG/HDL-C were significant explanatory variables for IR. Homeostasis model assessment IR is a significant, potentially reversible explanatory variable for TG in patients referred because of hyperlipidemia and in population subjects.

Key Words
  • insulin
  • insulin resistance
  • triglycerides
  • HDL cholesterol
  • cardiovascular disease

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