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Pancreatic beta-cell function as a predictor of cardiovascular outcomes and costs: findings from the Cardiovascular Health Study.
Tuesday,2012-11-06 12:09 America/Los_Angeles — eenright
| Title | Pancreatic beta-cell function as a predictor of cardiovascular outcomes and costs: findings from the Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2008 |
| Authors | Curtis, LH, Hammill, BG, M Bethel, A, Anstrom, KJ, Liao, L, Gottdiener, JS, Schulman, KA |
| Journal | Curr Med Res Opin |
| Volume | 24 |
| Issue | 1 |
| Pagination | 41-50 |
| Date Published | 2008 Jan |
| ISSN | 1473-4877 |
| 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 |
| Abstract | <p><b>OBJECTIVE: </b>To explore relationships between beta-cell function and incident cardiovascular events, death, and medical costs among elderly individuals.</p><p><b>RESEARCH DESIGN AND METHODS: </b>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.</p><p><b>MAIN OUTCOME MEASURES: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>LIMITATIONS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p> |
| DOI | 10.1185/030079908x253573 |
| Alternate Journal | Curr Med Res Opin |
| PubMed ID | 18021490 |
| PubMed Central ID | PMC: N/A |
| Grant List | N01HC15103 / HC / NHLBI NIH HHS / United States N01HC35129 / HC / NHLBI NIH HHS / United States N01HC55222 / HC / NHLBI NIH HHS / United States N01HC85086 / HC / NHLBI NIH HHS / United States U01HL080295 / HL / NHLBI NIH HHS / United States |