Joint effect of insulin signaling genes on all-cause mortality

Objective: We have previously reported the combined effect of SNPs perturbing insulin signaling (ENPP1 K121Q, rs1044498; IRS1 G972R, rs1801278; TRIB3 Q84R, rs2295490) on insulin resistance (IR), type 2 diabetes (T2D) and cardiovascular events. We here investigated whether such a combined effect affects also all-cause mortality in a sample of 1851 Whites of European ancestry. Methods: We investigated a first sample of 721 patients, 232 deaths, 3389 person-years (py). Replication was assessed in two samples of patients with T2D: the Gargano Mortality Study (GMS) of 714 patients, 127 deaths, 5426 py and the Joslin Kidney Study (JKS) comprising 416 patients, 214 deaths, 5325 py. Results: In the first sample, individuals carrying 1 or 2 risk alleles had 33% (p ¼ 0.06) and 51% (p ¼ 0.02) increased risk of mortality, as compared with individuals with no risk alleles. A similar, though not significant, trend was obtained in the two replication samples only for subject carrying 2 risk alleles. In a pooled analysis, individuals carrying 2 risk alleles had higher mortality rate as compared to those carrying 0 risk alleles (HR ¼ 1.34, 95%CI ¼ 1.08e1.67; p ¼ 0.008), and as compared to those carrying only one risk allele (HR ¼ 1.41, 95% CI ¼ 1.13e1.75; p ¼ 0.002). This association was independent from several possible confounders including sex, age, BMI, hypertension and diabetes status. Conclusion: Our data suggest that variants affecting insulin signaling exert a joint effect on all-cause mortality and is consistent with a role of abnormal insulin signaling on mortality risk