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 published literature that examines the relationship between reliable markers of insulin resistance and coronary artery disease risk factors (plasma glucose, triglycerides, high density lipoprotein cholesterol, hypertension, obesity, low density lipoprotein size) and outcomes (as related to ischemic heart disease) in populations with and without type 2 diabetes.

Methods: The MEDLINE database was searched (January 1966 to April 2000). Additional references were identified from bibliographies of retrieved articles. The quantitative relationship between insulin resistance and coronary artery disease outcomes was estimated in individual studies by derivation of 2x2 tables.

Results: Of 780 publications reviewed, 28 met the inclusion criteria. Twenty publications investigated the relationship of insulin resistance markers with coronary artery disease risk factor profiles only, while eight publications primarily evaluated coronary artery disease outcomes.

Conclusions: The present review suggests that populations with lower insulin resistance measured by reliable indexes are consistently associated with better overall cardiovascular risk profiles (including reduced clustering of risk factors), and improved coronary artery disease outcomes than populations with elevated insulin resistance.