BACKGROUND: Compared to whites, insulin-resistant African Americans have worse outcomes. Screening programs that could identify insulin resistance early enough for intervention to affect outcome often rely on triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels. Racial differences in TG and HDL-C may compromise the efficacy of these programs in African Americans. A recommendation currently exists to use the TG/HDL-C ratio ≥2.0 to predict insulin resistance in African Americans. The validity of this recommendation needs examination. Therefore, our aim was to determine the ability of TG/HDL-C ratio to predict insulin resistance in African Americans. METHODS: In 1,903 African Americans [895 men, 1,008 women, age 55 ± 12 years, mean ± standard deviation (SD), range 35-80 years, body mass index (BMI) 31.0 ± 6.4 kg/m(2), range 18.5-55 kg/m(2)] participating in the Jackson Heart Study, a population-based study of African Americans, Jackson, Mississippi tricounty region, insulin resistance was defined by the upper quartile (≥4.43) of homeostasis model assessment of insulin resistance (HOMA-IR). An area under the receiver operating characteristic curve (AUC-ROC) of >0.70 was required for prediction of insulin resistance by TG/HDL-C. The optimal test cutoff was determined by the Youden index. RESULTS: HOMA-IR was similar in men and women (3.40 ± 2.03 vs. 3.80 ± 2.46, P = 0.60). Women had lower TG (94 ± 49 vs. 109 ± 65 mg/dL P < 0.001) and TG/HDL-C (1.9 ± 1.4 vs. 2.7 ± 2.1, P < 0.001). For men, AUC-ROC for prediction of insulin resistance by TG/HDL-C was: 0.77 ± 0.01, mean ± standard error (SE), with an optimal cutoff of ≥2.5. For women, the AUC-ROC was 0.66 ± 0.01, rendering an optimal cutoff indefinable. When women were divided in two groups according to age, 35-50 years and 51-80 years, the results did not change. CONCLUSIONS: In African-American men, the recommended TG/HDL-C threshold of 2.0 should be adjusted upward to 2.5. In African-American women, TG/HDL-C cannot identify insulin resistance. The Jackson Heart Study can help determine the efficacy of screening programs in African-Americans.
BACKGROUND: Compared to whites, insulin-resistant African Americans have worse outcomes. Screening programs that could identify insulin resistance early enough for intervention to affect outcome often rely on triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels. Racial differences in TG and HDL-C may compromise the efficacy of these programs in African Americans. A recommendation currently exists to use the TG/HDL-C ratio ≥2.0 to predict insulin resistance in African Americans. The validity of this recommendation needs examination. Therefore, our aim was to determine the ability of TG/HDL-C ratio to predict insulin resistance in African Americans. METHODS: In 1,903 African Americans [895 men, 1,008 women, age 55 ± 12 years, mean ± standard deviation (SD), range 35-80 years, body mass index (BMI) 31.0 ± 6.4 kg/m(2), range 18.5-55 kg/m(2)] participating in the Jackson Heart Study, a population-based study of African Americans, Jackson, Mississippi tricounty region, insulin resistance was defined by the upper quartile (≥4.43) of homeostasis model assessment of insulin resistance (HOMA-IR). An area under the receiver operating characteristic curve (AUC-ROC) of >0.70 was required for prediction of insulin resistance by TG/HDL-C. The optimal test cutoff was determined by the Youden index. RESULTS: HOMA-IR was similar in men and women (3.40 ± 2.03 vs. 3.80 ± 2.46, P = 0.60). Women had lower TG (94 ± 49 vs. 109 ± 65 mg/dL P < 0.001) and TG/HDL-C (1.9 ± 1.4 vs. 2.7 ± 2.1, P < 0.001). For men, AUC-ROC for prediction of insulin resistance by TG/HDL-C was: 0.77 ± 0.01, mean ± standard error (SE), with an optimal cutoff of ≥2.5. For women, the AUC-ROC was 0.66 ± 0.01, rendering an optimal cutoff indefinable. When women were divided in two groups according to age, 35-50 years and 51-80 years, the results did not change. CONCLUSIONS: In African-American men, the recommended TG/HDL-C threshold of 2.0 should be adjusted upward to 2.5. In African-American women, TG/HDL-C cannot identify insulin resistance. The Jackson Heart Study can help determine the efficacy of screening programs in African-Americans.
Authors: Sonja R Fuqua; Sharon B Wyatt; Michael E Andrew; Daniel F Sarpong; Frances R Henderson; Margie F Cunningham; Herman A Taylor Journal: Ethn Dis Date: 2005 Impact factor: 1.847
Authors: Catherine C Cowie; Keith F Rust; Danita D Byrd-Holt; Mark S Eberhardt; Katherine M Flegal; Michael M Engelgau; Sharon H Saydah; Desmond E Williams; Linda S Geiss; Edward W Gregg Journal: Diabetes Care Date: 2006-06 Impact factor: 19.112
Authors: K G M M Alberti; Robert H Eckel; Scott M Grundy; Paul Z Zimmet; James I Cleeman; Karen A Donato; Jean-Charles Fruchart; W Philip T James; Catherine M Loria; Sidney C Smith Journal: Circulation Date: 2009-10-05 Impact factor: 29.690
Authors: DeMarc A Hickson; Ana V Diez Roux; Samson Y Gebreab; Sharon B Wyatt; Patricia M Dubbert; Daniel F Sarpong; Mario Sims; Herman A Taylor Journal: Am J Public Health Date: 2012-05-17 Impact factor: 9.308
Authors: Martin R Salazar; Horacio A Carbajal; Walter G Espeche; Carlos E Leiva Sisnieguez; Carlos E March; Eduardo Balbín; Carlos A Dulbecco; Marcelo Aizpurúa; Alberto G Marillet; Gerald M Reaven Journal: Diab Vasc Dis Res Date: 2013-04-26 Impact factor: 3.291
Authors: Kendra A Young; Amita Maturu; Carlos Lorenzo; Carl D Langefeld; Lynne E Wagenknecht; Yii-Der I Chen; Kent D Taylor; Jerome I Rotter; Jill M Norris; Neda Rasouli Journal: J Diabetes Complications Date: 2018-11-03 Impact factor: 2.852
Authors: Sophia S K Yu; Natalie L M Ramsey; Darleen C Castillo; Madia Ricks; Anne E Sumner Journal: Metab Syndr Relat Disord Date: 2012-12-05 Impact factor: 1.894
Authors: Miguel Murguía-Romero; J Rafael Jiménez-Flores; Santiago C Sigrist-Flores; Miguel A Espinoza-Camacho; Mayra Jiménez-Morales; Enrique Piña; A René Méndez-Cruz; Rafael Villalobos-Molina; Gerald M Reaven Journal: J Lipid Res Date: 2013-07-17 Impact factor: 5.922