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(Circulation. 2008;118:e156.)
© 2008 American Heart Association, Inc.

Correspondence

Letter by Bell and O’Keefe Regarding Article, "Use of Alternative Thresholds Defining Insulin Resistance to Predict Incident Type 2 Diabetes Mellitus and Cardiovascular Disease"

David S.H. Bell, MB

Clinical Professor of Medicine, University of Alabama at Birmingham, Birmingham, Ala

James H. O'Keefe, MD

Director of Preventive Cardiology, Mid American Heart Institute, Kansas City, Mo

To the Editor:

Rutter et al¹ reported that 3 surrogate markers of insulin resistance only modestly predicted the development of diabetes and cardiovascular events. In clinical practice, the clearest indicator of the presence of insulin resistance is a triglyceride to high-density lipoprotein ratio >3.5. This ratio has been shown to correlate well with the insulin suppression test and to be comparable with the clinical criteria of the National Cholesterol Education Panel Adult Treatment Panel III.^2,3 Would the use of the triglyceride:high-density lipoprotein ratio have predicted the development of diabetes and/or cardiovascular events more accurately than the fasting insulin level, homeostasis model assessment of insulin resistance, and the reciprocal of the Guft insulin sensitivity index in this study?¹ If the triglyceride:high-density lipoprotein ratio was equally or more predictive, in clinical practice there would be no reason to measure the highly variable fasting insulin level.

	Acknowledgments

 
Disclosures

None.

	References

Top References

 
1. Rutter MK, Wilson PWF, Sullivan LM, Fox CS, D'Agostino RB Sr, Meigs JB. Use of alternative thresholds defining insulin resistance to predict incident type 2 diabetes mellitus and cardiovascular disease. Circulation. 2008; 117: 1003–1009.[Abstract/Free Full Text]

2. McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003; 139: 802–809.[Abstract/Free Full Text]

3. McLaughlin T, Reaven G, Abbasi F, Lamendola C, Saad M, Waters D, Simon J, Krauss RM. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol. 2005; 96: 399–404.[CrossRef][Medline] [Order article via Infotrieve]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bell, D. S.H. Articles by O'Keefe, J. H. Search for Related Content PubMed PubMed Citation Articles by Bell, D. S.H. Articles by O'Keefe, J. H. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Diabetes Related Collections Type 2 diabetes Chronic ischemic heart disease