The relationship between insulin-sensitive obesity and cardiovascular diseases in a Chinese population: results of the REACTION study

Int J Cardiol. 2014 Mar 15;172(2):388-94. doi: 10.1016/j.ijcard.2014.01.073. Epub 2014 Jan 25.


Objective: Obesity and insulin resistance are risk factors for cardiovascular diseases. Whether insulin-sensitive obese individuals are at higher risk for cardiovascular diseases is still debated. We aim to investigate whether insulin-sensitive obesity associates with prevalent cardiovascular diseases and 10-year coronary heart disease (CHD) risk.

Research design and methods: At the baseline of the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study, 211,641 participants aged 40 years or older were recruited from 25 communities across the China mainland, in 2011 to 2012. Participants were categorized by insulin-sensitive/resistant and general/abdominal obese status. Cardiovascular diseases included CHD, stroke, and myocardial infarction. Framingham risk score (FRS) was calculated according to National Cholesterol Education Program-Adult Treatment Panel III and FRS greater than 20% or cardiovascular diseases were identified as high risk for 10-year CHD.

Results: Controlling for potential confounders, compared with insulin-sensitive normal weight individuals, insulin-sensitive general obese individuals had increased risks for prevalent cardiovascular diseases (men: OR, 2.55, 95% CI, 2.04-3.18; women: 1.73, 1.45-2.06) and 10-year Framingham risk for CHD (men: 2.26, 1.86-2.76; women: 1.73, 1.46-2.06). Compared with insulin-sensitive normal waist subgroup, insulin-sensitive abdominal obesity was associated with higher risks for prevalent cardiovascular diseases (men: 1.32, 1.20-1.46; women: 1.36, 1.27-1.47) and 10-year Framingham risk for CHD (men, 1.34, 1.23-1.45; women, 1.37, 1.27-1.47).

Conclusion: Both general and abdominal obesity were associated with elevated prevalent cardiovascular diseases and 10-year CHD risk, regardless of the presence or absence of insulin resistance.

Keywords: Cardiovascular diseases; Epidemiology; Insulin resistance; Obesity.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology*
  • China / epidemiology
  • Female
  • Humans
  • Insulin Resistance*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Obesity / complications*
  • Prevalence
  • Prospective Studies
  • Risk Factors