Impact of systemic inflammation on the relationship between insulin resistance and all-cause and cancer-related mortality |
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| Institution: | 1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea;3. Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;4. Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;5. Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea;6. Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;7. Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;1. Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany;2. German Center for Diabetes Research (DZD), München-Neuherberg, Germany;3. Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany;1. Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine University, Düsseldorf, Germany;2. Division of Endocrinology and Diabetology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany;3. German Center for Diabetes Research, München-Neuherberg, Germany;4. Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf, Germany;5. IUF - Leibniz Research Institute for Environmental Medicine, Institute for Occupational, Social and Environmental Medicine, Heinrich-Heine University, Düsseldorf, Germany;6. Metabolic Unit, Institute of Neuroscience, CNR, Padova, Italy |
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| Abstract: | BackgroundInsulin resistance and inflammation play an important role in a variety of chronic diseases.ObjectiveWe investigated the influence of systemic inflammation on the relationship between insulin resistance and mortality risk in apparently healthy adults.MethodsThis study examined the mortality outcomes for 165,849 Koreans enrolled in a health-screening program. The subjects were divided into four groups according to their homeostatic model assessment of insulin resistance (HOMA-IR) and high-sensitivity C-reactive protein (hs-CRP) levels: group 0, HOMA-IR < 75% and hs-CRP < 2.0 mg/L; group 1, HOMA-IR ≥ 75% and hs-CRP < 2.0 mg/L; group 2, HOMA-IR < 75% and hs-CRP ≥ 2.0 mg/L; and group 3, HOMA-IR ≥ 75% and hs-CRP ≥ 2.0 mg/L. The Cox proportional hazard models were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cardiovascular disease, and cancer-related mortality.ResultsDuring the follow-up period of 1,417,325.6 person-years, a total of 1316 deaths (182 from cardiovascular disease) occurred. The multivariate-adjusted HRs for all-cause mortality were significantly higher in groups 2 (HR 1.40; 95% CI: 1.19–1.64) and group 3 (HR 1.68; 95% CI: 1.34–2.10) than that in group 0. For cardiovascular mortality, the sex-adjusted hazards were also significantly higher in groups 2 and 3 than that in group 0; however, this increased risk disappeared during multivariate analysis. Groups 2 and 3 had significantly higher risk for cancer-related mortality than group 0, with multivariate-adjusted hazard ratios of 1.48 (95% CI: 1.18–1.86) and 1.84 (95% CI: 1.35–2.51), respectively.ConclusionsSystemic inflammation can be used to stratify the subjects according to the all-cause and cancer-related mortality risks, irrespective of the insulin-resistance status. And this tendency is most pronounced in cancer-related mortality. |
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