@article {999, title = {Pancreatic beta-cell function as a predictor of cardiovascular outcomes and costs: findings from the Cardiovascular Health Study.}, journal = {Curr Med Res Opin}, volume = {24}, year = {2008}, month = {2008 Jan}, pages = {41-50}, abstract = {

OBJECTIVE: To explore relationships between beta-cell function and incident cardiovascular events, death, and medical costs among elderly individuals.

RESEARCH DESIGN AND METHODS: In a prospective, population-based cohort of 4555 elderly individuals, we examined the effect of beta-cell function on incident cardiovascular events and mortality. We also examined costs for 3715 of these individuals. We used the computer-based homeostasis model assessment (HOMA) to calculate indices of beta-cell function (HOMA-\%B) and insulin sensitivity (HOMA-\%S) using baseline fasting glucose and insulin levels. All subjects were followed from 1992/1993 for 6 years or until death.

MAIN OUTCOME MEASURES: Discrete-time survival model of the effects of beta-cell function on incident cardiovascular events and all-cause mortality; and semiparametric estimators for calculations of mean 6-year costs.

RESULTS: Controlling for HOMA-\%S, a 20\% decrease in HOMA-\%B was associated with increased odds of incident cardiovascular events (odds ratio [OR], 1.09; 95\% confidence interval [CI], 1.05-1.14) and death (OR, 1.10; 95\% CI, 1.07-1.14). The relationships persisted after controlling for clinical and sociodemographic confounders. A 20\% decrease in HOMA-\%B was also associated with increased costs (cost ratio, 1.03; 95\% CI, 1.01-1.05). The significant association did not persist after controlling for confounders.

LIMITATIONS: The sample comprises relatively healthy elderly individuals and is based on data from 1992 through 1999, which may not reflect current experience. The measure of beta-cell function is an estimate generated from single measures of glucose and insulin.

CONCLUSIONS: Beta-cell function as measured by HOMA-\%B is a significant predictor of incident cardiovascular events and mortality but not of costs, controlling for HOMA-\%S and sociodemographic and clinical confounders.

}, keywords = {Aged, Aged, 80 and over, Cardiovascular Diseases, Cohort Studies, Coronary Disease, Female, Follow-Up Studies, Health Care Costs, Heart Failure, Humans, Insulin-Secreting Cells, Male, Myocardial Infarction, Outcome Assessment, Health Care, Prognosis, Prospective Studies, Stroke}, issn = {1473-4877}, doi = {10.1185/030079908x253573}, author = {Curtis, Lesley H and Hammill, Bradley G and Bethel, M Angelyn and Anstrom, Kevin J and Liao, Lawrence and Gottdiener, John S and Schulman, Kevin A} }