Early insulin resistance in low-risk subjects with normal glycemia is associated with subclinical atherosclerosis
Bibliographic record
Abstract
Abstract Background Higher glycated hemoglobin (HbA1c) levels are directly associated with subclinical atherosclerosis burden. However, the association between earlier insulin resistance markers and the development of subclinical atherosclerosis is poorly understood. Purpose To assess the association between the Homeostatic Model Assessment of Insulin Resistance Index (HOMA-IR) and subclinical atherosclerosis, on top of cardiovascular risk factors in individuals with normal HbA1c. Methods A cohort of 3,741 middle-aged individuals from the PESA study, with basal HbA1c <6.0% and without known CV disease, underwent extensive imaging (multi-territorial vascular ultrasound and coronary artery calcium score, CACS) to assess for the presence, burden, and extent of subclinical atherosclerosis. Results Individuals with higher HOMA-IR values had a higher prevalence of both traditional and non-traditional CV risk factors. Higher HOMA-IR values showed a positive association with the multi-territorial extent of subclinical atherosclerosis and CACS (p<0.001), Figure 1, and an increased global plaque volume by 3DVUS (p<0.001), Figure 2. The association was observed in both individuals with HbA1c levels below and above the median value of 5.4% (p < 0.001). This trend held for three individual territories (carotid, femoral, and coronary artery). Overall, after adjusting for key CV risk factors and HbA1c levels, HOMA-IR values ≥3 were associated with both the multi-territorial extent of subclinical atherosclerosis and CACS>0: odds ratio of 1.41 (95CI: 1.01 to 1.95, p=0.041), and 1.74 (95CI: 1.20 to 2.54, p=0.004) respectively, as compared to HOMA-IR <2 (reference). In a stratified analysis, this association remained significant in low-to-moderate SCORE2 risk individuals (75.6% of the cohort) but not in high-risk adults. Conclusions The use of HOMA-IR identified low-risk individuals with a higher burden of subclinical atherosclerosis on top of traditional CV risk factors and HbA1c. HOMA-IR is a simple measure in clinical practice that could facilitate earlier implementation of CV primary prevention strategies. HOMA-IR and subclinical atherosclerosis. HOMA-IR and 3D vascular ultrasound.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".