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Hostility and Urine Norepinephrine Interact to Predict Insulin Resistance: The VA Normative Aging Study

From the Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana (J.Z., J.R.D.); The Butler Hospital and Brown Medical School, Providence, Rhode Island (R.N.); the Department of Psychology, University of Miami, Miami, Florida (B.-J.S.); Centers for Behavioral & Preventive Medicine, The Miriam Hospital and Brown Medical School, Providence, Rhode Island (J.F.T., J.M.M.); Boston University School of Public Health and Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts (A.S.); and the Department of Health & Sport Sciences, and Center for Community Health, University of Memphis, Memphis, Tennessee (K.D.W.).

Address correspondence and reprint requests to Jianping Zhang, MD, PhD, Department of Psychiatry and Psychology, Cleveland Clinic Foundation, 9500 Euclid Ave, P57, Cleveland, OH 44195. E-mail: jpzhang2005{at}gmail.com.

Objective: Previous research has produced mixed results pertaining to the association between hostility and insulin resistance. These inconsistent findings may be the result of a lack of studies examining potential moderators of this relationship and inconsistent measures of insulin resistance and/or hostility. We hypothesized that hostility may interact with circulating norepinephrine (NEPI) levels, indexed by 24-hour urine concentrations, to affect insulin resistance.

Methods: Six hundred forty-three men (mean age = 63.1 years) free of diabetic medications completed the Minnesota Multiphasic Personality Inventory and participated in a laboratory assessment. The Cook-Medley Hostility (Ho) and 24-hour urine NEPI were used to predict insulin resistance defined by the homeostatic model assessment (HOMA) index, 2-hour postchallenge glucose (PCGL), and insulin levels (PCIL) after controlling for nine common covariates.

Results: Multiple regression showed that the two-way interaction between Ho and NEPI significantly predicted HOMA and PCIL, but not PCGL, after controlling for covariates. Simple regression slopes of Ho on HOMA and PCIL were explored and indicated that, at higher levels of NEPI, higher Ho was associated with higher HOMA (ß = 0.14, p < .05). Ho was not a significant predictor of HOMA at mean and lower levels of NEPI. Similar results were obtained for PCIL, but not PCGL. Cynicism, but not other subscales of Ho, was similarly related to insulin resistance and NEPI.

Conclusion: Individuals with high stress and high hostility were more likely to have insulin resistance. It is important to study moderators in the relationship between hostility and insulin resistance.

Key Words: hostility • norepinephrine • insulin resistance • HOMA • metabolic syndrome

Abbreviations: CVD = cardiovascular disease; CHD = coronary heart disease; NIDDM = noninsulin-dependent diabetes mellitus; HTN = hypertension; HOMA = homeostatic model assessment approach; OGTT = oral glucose tolerance test; CMHOST = Cook-Medley hostility scale; Ho = full scale score of CMHOST; QUICKI = quantitative insulin-sensitivity check index; NEPI = norepinephrine; NAS = Normative Aging Study; MMPI = Minnesota Multiphasic Personality Inventory; BMI = body mass index; WHR = waist-to-hip ratio; FFQ = food frequency questionnaire; SD = standard deviation.

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