Estimated coronary heart disease attributable to insulin resistance in populations with and without type 2 diabetes mellitus

Objective: To estimate the annual number and costs of coronary heart diseas e (CHD) events in the United States attributable to insulin resistance amon g individuals with and without type 2 diabetes. Research Design and Methods: Medline-indexed articles and government statis tical reports were screened for data on the prevalence of insulin resistanc e, the relative risk of. CHD by insulin resistance status, and number of CH D events per year among individuals with and without type 2 diabetes. These data were used to estimate the number of CHD events per year by insulin re sistance and type 2 diabetes status, the proportion of CHD events attributa ble to insulin resistance, and the annual cost of these events. Results: Of the 171,000 annual CHD events in the type 2 diabetes population , 164,000 (96%) occurred in those with insulin resistance, 80,000 of which were attributable to insulin resistance. Of the 929,000 annual CHD events i n the non-type 2 diabetes population, 162,000 (17%) occurred in patients wi th insulin resistance, 58,000 of which were attributable to insulin resista nce. Thus, insulin resistance is responsible for 46.8%, 6.2%, and 12.5% of the annual CHD events in the type 2 diabetes, non-type 2 diabetes, and tota l US population, respectively. The estimated annual total cost of these ins ulin resistance-attributable events was $12.5 billion in the United States in 1999, of which $6.6 billion were direct medical costs. Conclusion: Preventing or modifying insulin resistance may reduce the morbi dity, mortality, and costs associated with CHD.