Published Online
on February 28, 2008

A more recent version of this article appeared on April 1, 2008

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Submitted on August 23, 2007
Accepted on September 19, 2007

Insulin Resistance as a Risk Factor for Carotid Atherosclerosis. A Comparison of the Homeostasis Model Assessment and the Short Insulin Tolerance Test

Harald Sourij MD^*; Isabella Schmoelzer MD; Peter Dittrich PhD; Bernhard Paulweber MD; Bernhard Iglseder MD; and Thomas C. Wascher MD

From the Department of Internal Medicine (H.S., I.S., T.C.W.), Metabolism and Vascular Biology Research Unit, Medical University of Graz, Graz, Austria; the Department of Internal Medicine (B.P.), Christian Doppler Klinik, Landeskliniken and Paracelsus Private Medical University Salzburg, Salzburg, Austria; the Department of Pharmacology and Toxicology (P.D.), University of Graz, Graz, Austria; and the Department of Geriatrics (B.I.), Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria.

^* To whom correspondence should be addressed. E-mail: ha.sourij{at}meduni-graz.at.

Background and Purpose—The independent contribution of insulin resistance to atherosclerosis is still under debate. We compared associations of 2 different indices of insulin resistance, the Homeostasis Model Assessment (HOMA) index and kITT from a short insulin tolerance test with carotid atherosclerosis.

Methods—A total of 1771 middle-aged white patients were investigated. Intima media thickness (IMT) and extent of carotid atherosclerosis were quantified by ultrasound. HOMA was calculated and an insulin tolerance test was performed.

Results—HOMA and kITT were significant predictors for average carotid IMT (P<0.001). After adjustment for age and the components of the metabolic syndrome, HOMA still remained an independent predictor for IMT_avg (P=0.02), whereas kITT failed to do so. HOMA and kITT were also predictive (P=0.004 and P=0.024) for carotid plaques and extent of carotid atherosclerosis (P<0.001). After adjustment for age and the components of the metabolic syndrome, neither HOMA nor kITT were independently predictive any more.

Conclusions—Our results provide evidence that HOMA rather than kITT is associated with carotid atherosclerosis and that the association is largely explained by the clustered expression of the components of the metabolic syndrome.

Key words: atherosclerosis • intima media thickness • metabolic syndrome

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