As identified in the literature, the prevalence of cardiovascular disease risk in AAW may be underestimated based on the sole use of the NCEP criteria. Further, because there is some evidence that insulin resistance develops before many other indicators, the addition of a marker of insulin resistance may assist in earlier identification of AAW at high risk for cardiovascular disease.

Objective-To determine the associations of the Homeostatic Model of Assessment-insulin resistance (HOMA -ir ), acanthosis nigricans, high sensitivity C-reactive protein ( hs-CRP), and plasminogen activator inhibitor-1 (PAI-1) with two of the commonly used definitions of the metabolic syndrome (Adult Treatment Panel III {ATP III} and International Diabetes Federation {IDF}) among reproductive age healthy free living African-American women.Methods-A pilot study with a cross-sectional design examined 33 African-American women aged 20 to 46 (mean 31.24, +/-7.25), for the presence of metabolic syndrome determined by ATP III and IDF criteria, insulin resistance (HOMA -ir and/or acanthosis nigricans), degree of inflammation ( hs-CRP) and presence of dysfibrinolysis (PAI-1).Results-HOMA-ir identified insulin resistance in 27 (81.8%) of the women, whereas the presence of acanthosis nigricans indicated that 16 (48 %) of these women manifested insulin resistance. Metabolic syndrome was found in 7 women (21.2 %) by ATP III or 9 (27.3 %) by IDF criteria. Bivariate correlations showed associations between HOMA-ir and waist circumference, body mass index (BMI), acanthosis nigricans, the ATP III and IDF definitions for metabolic syndrome. PAI-1 was significantly correlated with waist circumference, BMI, fasting glucose, HOMA-ir , and ATP III. Both HOMA-ir and PAI-1 were significantly and negatively correlated with HDL-C. hs-CRP was significantly correlated with BMI and 2-hour post glucose.Conclusion-Both dysfibrinolysis (PAI-1 levels) and insulin resistance (HOMA-ir ) when individually regressed on the ATP III definition of metabolic syndrome explained 32 % and 29% of the respective variance. The addition of HOMA-ir measurement may significantly improve early recognition of cardiometabolic risk among reproductive age African-American women who have not yet met the criteria for the ATP III or IDF definitions of the metabolic syndrome. Likewise, acanthosis nigricans is potentially a clinically significant screening tool when used to determine early recognition of insulin resistance and/or cardiometabolic risk among this population.African-American women's risk for CVD is likely underestimated based on the sole use of ATP III criteria for diagnosis of metabolic syndrome. Clinicians should consider a broader definition of risk than that is contained within ATP III. Inclusion of biomarkers of inflammation and dysfibrinolysis along with measures of insulin resistance may add to early detection of NIH Public Access Recommendations from Healthy People 2010 1 emphasize the need to eradicate racial disparities in cardiovascular health. African-American women experience higher age adjusted prevalence rates for obesity, hypertension, coronary heart disease, stroke and type 2 diabetes than compared with any other group of U.S. women. 2-6 However, these disparities are not fully explained by conventional risk factors. Obesity and hyperinsulinemia have been strongly associated with an inflammatory state leading to release of substance...