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. 2005 May 10;172(10):1301-5.
doi: 10.1503/cmaj.1040834.

Insulin resistance syndrome, body mass index and the risk of ischemic heart disease

Annie C St-Pierre  1 , Bernard Cantin, Pascale Mauriège, Jean Bergeron, Gilles R Dagenais, Jean-Pierre Després, Benoît Lamarche
Affiliations

Insulin resistance syndrome, body mass index and the risk of ischemic heart disease

Annie C St-Pierre et al. CMAJ. .

Abstract

Background: Many people who are not obese according to standard height and weight criteria may still display features of insulin resistance syndrome and thus be at high risk of ischemic heart disease. We sought to investigate the effect of cumulative features of insulin resistance syndrome on the risk of ischemic heart disease associated with variations in body mass index (BMI) among men who participated in the Quebec Cardiovascular Study.

Methods: A cohort of 1824 nondiabetic men free of ischemic heart disease was evaluated at the 1985 baseline evaluation and followed for a period of 13 years, during which 284 first ischemic heart disease events were recorded. Relative hazards (RHs) of ischemic heart disease in 3 BMI groups (normal weight, overweight and obese) were estimated using Cox proportional hazards regression.

Results: Although obese men (BMI > or = 30 kg/m2) were the most likely to accumulate features of insulin resistance syndrome, the univariate risk of ischemic heart disease in this group was not significantly increased compared with normal-weight men (BMI < 25 kg/m2) (RH 1.26, 95% confidence interval [CI] 0.88-1.80). However, obese men who accumulated more than 4 features of insulin resistance syndrome were at increased risk of ischemic heart disease (RH 1.81, 95% CI 1.02-3.19) compared with normal-weight men who had fewer than 3 features of the syndrome. Conversely, having more than 4 features of insulin resistance syndrome was associated with a 3-fold increase in the risk of ischemic heart disease among normal-weight men (RH 3.01, 95% CI 1.70-5.32).

Interpretation: Although obesity is an important risk factor for ischemic heart disease, variations in BMI alone poorly reflect the risk of ischemic heart disease associated with features of insulin resistance syndrome.

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Figures

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Fig. 1: Determination of the study population. The study population was originally screened from 7 towns in the Québec City metropolitan area in 1974 for the Québec Cardiovascular Study. Data collected in 1985 were used as the baseline characteristics for the present prospective study. Volunteers were men who asked to be part of the original study but were not selected among the randomly identified participants. ECG = electrocardiogram, IHD = ischemic heart disease.
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