The relationship of insulin resistance measured by reliable indexes to coronary artery disease risk factors and outcomes - a systematic review

OBJECTIVES: To provide a qualitative and quantitative review of the publish ed literature that examines the relationship between reliable markers of in sulin resistance and coronary artery disease risk factors (plasma glucose, triglycerides, high density lipoprotein cholesterol, hypertension, obesity, low density lipoprotein size) and outcomes las related to ischemic heart d isease) in populations with and without type 2 diabetes. METHODS: The MEDLINE database was searched (January 1966 to April 2000). Ad ditional references were identified from bibliographies of retrieved articl es. The quantitative relationship between insulin resistance and coronary a rtery disease outcomes was estimated in individual studies by derivation of 2x2 tables. RESULTS: Of 780 publications reviewed, 28 met the inclusion criteria. Twent y publications investigated the, relationship of insulin resistance markers with coronary artery disease risk factor profiles only, while eight public ations primarily evaluated coronary artery disease outcomes. CONCLUSIONS: The present review suggests that populations with lower insuli n resistance measured by reliable indexes are consistently associated with better overall cardiovascular risk profiles (including reduced clustering o f risk factors), and improved coronary artery disease outcomes than populat ions with elevated insulin resistance.