Does insulin resistance, measured by fasting insulin and HOMA-IR, predict incident cardiovascular disease (CVD) and diabetes in older people, and do these associations differ in strength?
Fasting Insulin / HOMA-IR Kit, studied in 4,742 older individuals (Diabetologia 2014, PMID 25264116) — higher HOMA-IR was associated with incident diabetes, with a hazard ratio (HR) of 4.80 (95% CI 3.14, 7.33) when comparing extreme thirds after adjustment. In older adults, insulin resistance predicts diabetes but does not significantly predict cardiovascular disease or mortality.
Source: Diabetologia 2014, PMID 25264116 ↗ · Research map · How Magellan grades evidence · evidence confidence: high
Diabetologia · 2014 · PMID 25264116 · DOI 10.1007/s00125-014-3383-9
In older adults, insulin resistance predicts diabetes but does not significantly predict cardiovascular disease or mortality.
The question
Does insulin resistance, measured by fasting insulin and HOMA-IR, predict incident cardiovascular disease (CVD) and diabetes in older people, and do these associations differ in strength?
What they tested
Insulin resistance is commonly proposed as a precursor to both type 2 diabetes and cardiovascular disease.
How they did it
The study used data from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) cohort, specifically 4,742 older individuals (70-82 years) without diabetes at baseline who had HOMA-IR measurements. Participants were followed for 3.2 years for incident diabetes and 8.6 years for all-cause mortality, CHD deaths, and fatal/non-fatal CVD events. Cause-specific Cox proportional-hazards models were fitted using multivariable models to assess associations.
What they found
Higher HOMA-IR was associated with incident diabetes, with a hazard ratio (HR) of 4.80 (95% CI 3.14, 7.33) when comparing extreme thirds after adjustment. However, HOMA-IR in the top third was not associated with all-cause mortality (HR 1.02, 95% CI 0.90, 1.17), CHD mortality (HR 1.03, 95% CI 0.79, 1.36), or fatal/non-fatal CVD (HR 0.94, 95% CI 0.74, 1.20). Similar results were observed when fasting insulin was used as the exposure.
| Incident Diabetes | 4.8 | |
|---|---|---|
| All-cause Mortality | 1.02 | |
| CHD Mortality | 1.03 | |
| Fatal/Non-fatal CVD | 0.94 |
Hazard ratios for incident diabetes, all-cause mortality, CHD mortality, and fatal/non-fatal CVD when comparing the top third of HOMA-IR to lower thirds, adjusted for confounders.
What it means
The data support insulin resistance as a predictor of diabetes in later life. However, this pathway appears to be of negligible importance to cardiovascular disease outcomes in the elderly.
Limitations
The abstract does not explicitly state limitations beyond the scope of the study, but it implies that the findings regarding CVD in the elderly might be surprising given common proposals.
Where the published abstract does not list limitations, we say so rather than inventing them. Read the full paper on PubMed before drawing conclusions.
The paper at a glance
| Title | Contrasting associations of insulin resistance with diabetes, cardiovascular disease and all-cause mortality in the elderly: PROSPER |
|---|---|
| Journal | Diabetologia |
| Year | 2014 |
| PMID | 25264116 ↗ |
| DOI | 10.1007/s00125-014-3383-9 ↗ |
| Topic | Metabolic health, glucose & body composition |
Read the source: PubMed record (authors, abstract, full citation) ↗ · Publisher via doi.org ↗
Where Magellan uses this paper
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Fasting Insulin / HOMA-IR Kit
Higher fasting insulin and HOMA-IR reflect greater insulin resistance, a central feature of metabolic syndrome that precedes and predicts type 2 diabetes and, in large cohorts and meta-analyses, is associated with increased risk of cardiovascular disease, all-cause and cardiovascular mortality, certain cancers, and…
The homeostatic model assessment of insulin resistance (HOMA-IR) is a simple index derived from a…
Research describes the compound or intervention studied. It is not a claim about any specific product.
Cite this page
These citations point at this summary. To cite the original paper with its full author list, use the PubMed record or doi.org.
Magellan Longevity. (2026). Does insulin resistance, measured by fasting insulin and HOMA-IR, predict incident cardiovascular disease (CVD) and diabetes in older people, and do these associations differ in strength? [Plain-English summary of Diabetologia 2014, PMID 25264116, DOI 10.1007/s00125-014-3383-9]. Magellan Longevity. https://magellanlongevity.com/study/d25264116.html@misc{magellan_d25264116,
title = {Does insulin resistance, measured by fasting insulin and HOMA-IR, predict incident cardiovascular disease (CVD) and diabetes in older people, and do these associations differ in strength?},
author = {{Magellan Longevity}},
year = {2026},
howpublished = {\url{https://magellanlongevity.com/study/d25264116.html}},
note = {Plain-English summary of PubMed PMID 25264116; DOI 10.1007/s00125-014-3383-9; Diabetologia 2014. Reviewed by Gabriel Radu, DO},
urldate = {2026-08-11}
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