Insulin resistance and cardiovascular events with low HDL cholesterol

The veterans affairs HDL intervention trial (VA-HIT)

Sander J. Robins, Hanna Bloomfield Rubins, Fred H. Faas, Ernst J. Schaefer, Marshall Elam, James W. Anderson, Dorothea Collins

Research output: Contribution to journalArticle

245 Citations (Scopus)

Abstract

OBJECTIVE - To assess the effect of insulin resistance and the benefit of the fibrate, gemfibrozil, on the incidence of major cardiovascular events in subjects with low HDL cholesterol and a broad range of triglyceride values who participated in the Veterans Affairs High Density Lipoprotein Intervention Trial (VA-HIT). RESEARCH DESIGN AND METHODS - This intention-to-treat analysis, specified as a secondary objective in VA-HIT, determined using Cox proportional hazards models the 5-year combined incidence of nonfatal myocardial infarction, coronary heart disease (CHD) death, or stroke in relation to the presence or absence of insulin resistance (defined by the highest tertile of the homeostasis model assessment of insulin resistance, HOMA-IR) in conjunction with lower and higher levels of HDL cholesterol and triglycerides. The study population consisted of 2,283 men with known coronary heart disease (CHD), treated with either placebo of gemfibrozil, who could be subdivided into groups with diabetes with or without insulin resistance, with no diabetes but insulin resistance, and with neither diabetes nor insulin resistance. RESULTS - With insulin resistance there was a significantly higher relative risk (RR) of a cardiovascular event both with diabetes (RR of 1.62 with 95% CI of 1.28-2.06) and without diabetes (RR of 1.43 with 95% CI of 1.03-1.98) than without insulin resistance. Throughout both lower and higher ranges of HDL cholesterol and triglycerides, the rate of new cardiovascular events and the reduction o f events with gemfibrozil was greater in subjects with insulin resistance than without, despite the finding that an increase in HDL cholesterol and a decrease in triglycerides with gemfibrozil was less with insulin resistance than without insulin resistance. CONCLUSIONS - Results show that in VA-HIT the occurrence of a new cardiovascular event and the benefit of fibrate therapy was much less dependent on levels of HDL cholesterol or triglycerides than on the presence or absence of insulin resistance.

Original languageEnglish (US)
Pages (from-to)1513-1517
Number of pages5
JournalDiabetes Care
Volume26
Issue number5
DOIs
StatePublished - May 1 2003
Externally publishedYes

Fingerprint

Veterans
HDL Cholesterol
Insulin Resistance
Gemfibrozil
Triglycerides
Fibric Acids
Coronary Disease
Intention to Treat Analysis
Incidence
HDL Lipoproteins
Proportional Hazards Models
Homeostasis
Research Design
Stroke
Myocardial Infarction
Placebos

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Insulin resistance and cardiovascular events with low HDL cholesterol : The veterans affairs HDL intervention trial (VA-HIT). / Robins, Sander J.; Rubins, Hanna Bloomfield; Faas, Fred H.; Schaefer, Ernst J.; Elam, Marshall; Anderson, James W.; Collins, Dorothea.

In: Diabetes Care, Vol. 26, No. 5, 01.05.2003, p. 1513-1517.

Research output: Contribution to journalArticle

Robins, Sander J. ; Rubins, Hanna Bloomfield ; Faas, Fred H. ; Schaefer, Ernst J. ; Elam, Marshall ; Anderson, James W. ; Collins, Dorothea. / Insulin resistance and cardiovascular events with low HDL cholesterol : The veterans affairs HDL intervention trial (VA-HIT). In: Diabetes Care. 2003 ; Vol. 26, No. 5. pp. 1513-1517.
@article{6a1da0bee2d6486aa67860188feb77ac,
title = "Insulin resistance and cardiovascular events with low HDL cholesterol: The veterans affairs HDL intervention trial (VA-HIT)",
abstract = "OBJECTIVE - To assess the effect of insulin resistance and the benefit of the fibrate, gemfibrozil, on the incidence of major cardiovascular events in subjects with low HDL cholesterol and a broad range of triglyceride values who participated in the Veterans Affairs High Density Lipoprotein Intervention Trial (VA-HIT). RESEARCH DESIGN AND METHODS - This intention-to-treat analysis, specified as a secondary objective in VA-HIT, determined using Cox proportional hazards models the 5-year combined incidence of nonfatal myocardial infarction, coronary heart disease (CHD) death, or stroke in relation to the presence or absence of insulin resistance (defined by the highest tertile of the homeostasis model assessment of insulin resistance, HOMA-IR) in conjunction with lower and higher levels of HDL cholesterol and triglycerides. The study population consisted of 2,283 men with known coronary heart disease (CHD), treated with either placebo of gemfibrozil, who could be subdivided into groups with diabetes with or without insulin resistance, with no diabetes but insulin resistance, and with neither diabetes nor insulin resistance. RESULTS - With insulin resistance there was a significantly higher relative risk (RR) of a cardiovascular event both with diabetes (RR of 1.62 with 95{\%} CI of 1.28-2.06) and without diabetes (RR of 1.43 with 95{\%} CI of 1.03-1.98) than without insulin resistance. Throughout both lower and higher ranges of HDL cholesterol and triglycerides, the rate of new cardiovascular events and the reduction o f events with gemfibrozil was greater in subjects with insulin resistance than without, despite the finding that an increase in HDL cholesterol and a decrease in triglycerides with gemfibrozil was less with insulin resistance than without insulin resistance. CONCLUSIONS - Results show that in VA-HIT the occurrence of a new cardiovascular event and the benefit of fibrate therapy was much less dependent on levels of HDL cholesterol or triglycerides than on the presence or absence of insulin resistance.",
author = "Robins, {Sander J.} and Rubins, {Hanna Bloomfield} and Faas, {Fred H.} and Schaefer, {Ernst J.} and Marshall Elam and Anderson, {James W.} and Dorothea Collins",
year = "2003",
month = "5",
day = "1",
doi = "10.2337/diacare.26.5.1513",
language = "English (US)",
volume = "26",
pages = "1513--1517",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "5",

}

TY - JOUR

T1 - Insulin resistance and cardiovascular events with low HDL cholesterol

T2 - The veterans affairs HDL intervention trial (VA-HIT)

AU - Robins, Sander J.

AU - Rubins, Hanna Bloomfield

AU - Faas, Fred H.

AU - Schaefer, Ernst J.

AU - Elam, Marshall

AU - Anderson, James W.

AU - Collins, Dorothea

PY - 2003/5/1

Y1 - 2003/5/1

N2 - OBJECTIVE - To assess the effect of insulin resistance and the benefit of the fibrate, gemfibrozil, on the incidence of major cardiovascular events in subjects with low HDL cholesterol and a broad range of triglyceride values who participated in the Veterans Affairs High Density Lipoprotein Intervention Trial (VA-HIT). RESEARCH DESIGN AND METHODS - This intention-to-treat analysis, specified as a secondary objective in VA-HIT, determined using Cox proportional hazards models the 5-year combined incidence of nonfatal myocardial infarction, coronary heart disease (CHD) death, or stroke in relation to the presence or absence of insulin resistance (defined by the highest tertile of the homeostasis model assessment of insulin resistance, HOMA-IR) in conjunction with lower and higher levels of HDL cholesterol and triglycerides. The study population consisted of 2,283 men with known coronary heart disease (CHD), treated with either placebo of gemfibrozil, who could be subdivided into groups with diabetes with or without insulin resistance, with no diabetes but insulin resistance, and with neither diabetes nor insulin resistance. RESULTS - With insulin resistance there was a significantly higher relative risk (RR) of a cardiovascular event both with diabetes (RR of 1.62 with 95% CI of 1.28-2.06) and without diabetes (RR of 1.43 with 95% CI of 1.03-1.98) than without insulin resistance. Throughout both lower and higher ranges of HDL cholesterol and triglycerides, the rate of new cardiovascular events and the reduction o f events with gemfibrozil was greater in subjects with insulin resistance than without, despite the finding that an increase in HDL cholesterol and a decrease in triglycerides with gemfibrozil was less with insulin resistance than without insulin resistance. CONCLUSIONS - Results show that in VA-HIT the occurrence of a new cardiovascular event and the benefit of fibrate therapy was much less dependent on levels of HDL cholesterol or triglycerides than on the presence or absence of insulin resistance.

AB - OBJECTIVE - To assess the effect of insulin resistance and the benefit of the fibrate, gemfibrozil, on the incidence of major cardiovascular events in subjects with low HDL cholesterol and a broad range of triglyceride values who participated in the Veterans Affairs High Density Lipoprotein Intervention Trial (VA-HIT). RESEARCH DESIGN AND METHODS - This intention-to-treat analysis, specified as a secondary objective in VA-HIT, determined using Cox proportional hazards models the 5-year combined incidence of nonfatal myocardial infarction, coronary heart disease (CHD) death, or stroke in relation to the presence or absence of insulin resistance (defined by the highest tertile of the homeostasis model assessment of insulin resistance, HOMA-IR) in conjunction with lower and higher levels of HDL cholesterol and triglycerides. The study population consisted of 2,283 men with known coronary heart disease (CHD), treated with either placebo of gemfibrozil, who could be subdivided into groups with diabetes with or without insulin resistance, with no diabetes but insulin resistance, and with neither diabetes nor insulin resistance. RESULTS - With insulin resistance there was a significantly higher relative risk (RR) of a cardiovascular event both with diabetes (RR of 1.62 with 95% CI of 1.28-2.06) and without diabetes (RR of 1.43 with 95% CI of 1.03-1.98) than without insulin resistance. Throughout both lower and higher ranges of HDL cholesterol and triglycerides, the rate of new cardiovascular events and the reduction o f events with gemfibrozil was greater in subjects with insulin resistance than without, despite the finding that an increase in HDL cholesterol and a decrease in triglycerides with gemfibrozil was less with insulin resistance than without insulin resistance. CONCLUSIONS - Results show that in VA-HIT the occurrence of a new cardiovascular event and the benefit of fibrate therapy was much less dependent on levels of HDL cholesterol or triglycerides than on the presence or absence of insulin resistance.

UR - http://www.scopus.com/inward/record.url?scp=0042669791&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0042669791&partnerID=8YFLogxK

U2 - 10.2337/diacare.26.5.1513

DO - 10.2337/diacare.26.5.1513

M3 - Article

VL - 26

SP - 1513

EP - 1517

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 5

ER -