Fasting hyperinsulinaemia as a stronger cardiovascular risk factor in women than men
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Fasting insulinaemia in normoglycaemic subjects is a surrogate for insulin resistance, as reciprocal fasting insulin reflects insulin sensitivity. As it is not yet known whether there is a gender difference in the association between hyperinsulinaemia and cardiovascular disease (CVD), fasting insulin was assessed in 6916 fasting, nondiabetic subjects, without prior history of CVD, participating to the PREVEND study. Major Adverse Cardiovascular Events (MACE) were prospectively recorded after baseline survey over a 7.5-year follow-up period. During this period, 98 cardiovascular events were recorded in 3626 women and 242 events in 3290 men. Cox-regression model analysis revealed that there was a significant interaction between gender and fasting insulinaemia for MACE, with the strongest association found in women. Further adjustment for components of the insulin resistance syndrome weakened the association, to a further degree in men than in women. Similar results were obtained when using HOMA-modelled insulin resistance instead of insulinaemia. In conclusion, fasting hyperinsulinaemia as a reflection of insulin resistance in nondiabetic subjects appears to be associated with an increased risk for cardiovascular disease, the association being more pronounced in women than in men.
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