Long-term High Level of Insulin Resistance Increase the Prevalence of Coronary Artery Calcification: the CARDIA study

Abstract

Abstract Background: Coronary artery calcification is a key marker of subclinical atherosclerotic cardiovascular disease. Understanding its related risk factors is conducive to prevention in youths. Seldom studies revealed the relationship between long-term insulin resistance (IR) trajectory and CAC. We aimed to study whether the long-term IR time series of young adults are associated with incident CAC in mid-age. Methods: In a cohort study of 2777 individuals from the Coronary Artery Risk Development in Young Adults (CARDIA), we calculated the homeostasis model assessment for IR (HOMA-IR) as the index of the IR level of each individual and used group-based trajectory modeling to fit three 25-year HOMA-IR trajectories (low, moderate, and high level). CAC was scored by the Agatston method and CAC score >0 was defined as a CAC event. The relationship between three HOMA-IR trajectories and CAC events at year 25 was evaluated by logistic regression after full adjustment. Results: Among 2777 participants (mean age: 50.10 ± 3.58, 56.2% were women, and 46.4% were black), there were 780 incident CAC events after a 25-year follow-up. After full adjustment, the prevalence of CAC was higher in the moderate [OR (95% CI): 1.38 (1.08-1.75), P =0.010] and the high level HOMA-IR trajectories [OR (95% CI): 1.79 (1.17-2.73), P =0.007] than in the low level trajectory. And this association is not modified by obesity status. Conclusions: Young adults with a higher level of IR were associated with an increased prevalence of CAC in middle age. This association was independent of obesity status, but it was more significant in the obese. Indicating that it was valuable to identify subclinical cardiovascular risk factors and primary prevention.